The URL can be used to link to this page

Home My WebLink About9309-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE,KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) No. 9309 Z Permission is hereby granted to: pu~uant tO apphcahon dated ................... ~: .......................... , 19..[~-~., and approv~ by the ' L TOWN OF $OUTHOLD Building Depo~tment Town Clerkl Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building .................... Old or Pre-ex~q. Building ............................ Vacant Land ............................ Location Of Property ........ ~~..~...~.....~...........~...~....~.~....~..~...~..~ .............................................. Owner Or Owners Of Property ......... .~..~.,~..¢~.,~.'~...~:......~..~.'..~../~.J~..'..x~... .................................................... Subdivision .................................................... ~. .......... Lot No. "~ Block No....'~... ...... House Nc~.~.~.~... Permit No ..................... Date Of Permit .................... Applicant ...~...~../.-~,~...~..~../2~...~:..~.~..~...~.. .......... Health Dept. Approval ...Z-:',~."'-~...:...~....~... ........ Labor Dept. Approval ................................................ Underwriters Approval ...~..~..~.../.~...~.. .............. Planning Board Approval ......... ~ .................. Request For Temporary Certificate ........................................ Final Certificate / Fee Submitted $ .................................... Construction on above described building~dr/_ ~- permit ~e,e~ts ~'~plicabl~.e//~,,/codes and regulations. ...... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp o,r seal) / , THE '- tiovembe: Dote, THIS CERTIFIES THAT NEW YORK BOARD 'OF FIRE ,UNDERWRITERS~? BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 20,].977 ,~p, licotioo ~o. o..r,. 9239/~5 only the ele~trlcgl equipment as dsseribed below ond intro~lueed by tim applicant named on the above appllcotlon number in the premises, of 6er'C~u,de,,ScholLe:. 3060 L£tC].e l~eck Rd. Cutchogue, wu. e~-~l~.d o~q robe -, . ore r 23,].977 Fl. ' Section Block ,' Lot ouC&/.de and found to be in compliance with the requirements of this Board, FIXTURE FIXTURES OUTLETS SWITCHES FLUORESCENt DRYERS 'FURNACE MOTORS FUTURE APPLIANCE FEEDERS ' ' RANGES OVENS DISH WASHERS EXHAUST FANS iTIMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS OF FEET 1.2 ~ SERVICE DISCONNECT S . E R V I C E A W G NO OF HI-LEG PER ,Er O~ CC COND OTHER APPAI~A~'U$:, 1 smoke dececco: 1-6.5k~. hot ~a~eg heaeer '~'~:,,:';,~:~,~ So~hold,"L;I , 11971 ' '~; L":!f t~,, , ;, *' ,t ~': ~,,"~-, ,' '~' :' _',C,:~ ~'~; - Per U ~is cediflcote must not b~ oltered in eny m~nner; return to the o~ice of the Boord ii incorrect. Insp~ors mounted by TOWN OF $OUTHOLD /~-~ ~-~/~ ~/-~-~/~/C~.c~ BUILDING DEPA~T~E"T ~~ ~ ~ TOWNTCLERK'S OFFICE /=/z~v7 ~ ~("'~ D~ ~.~ ~ ~U HOLD~N. Y. ~ ~ ~/ '/ ce~ ~ .~ ~ ~ Ex=mlned ............ ~...L~ ...... 19.....Z ~ __., Applic~tiod No ............... L.. .............. ~ ~, ~ 77 ~ q ~ o 7~~ '~b ~ ................................... ~ ~ ~ ~/~ ~ ................................................. k. ........................ ............................... APPLICATION FOR BUILDING PERMIT ........... .......... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buddings on premises, relahonsh~p to adjoining prem,ses or public streets or areas, and gw~ng a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Budding Inspector will issue a Budding Permit to the applicant Such permit shaJl be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part ~Cor any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulabons, for the construction of buildings, additions or atterahons, or for removal or demolition, as herein described The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if'a corporation) ...................... iA~l~ ~'~ s~ ' ~'~ ~'1:; p fi c ant ) State whether applicant is owner, lesc~.agent, architect, engineer, general contractor, electrician, plumber or budder ............. ~...~..~.~...z.... ~~..,~......z-.z~ ...................................................... Nome of owner of premises ............ ~...~ ./~-..~--~..~.....,~=~. ..... /./.../?...~.. ................................................................ If applicar~--~s a corporate, s~gnature~uly authorized officer. ~ (Name and title of corporate,~fficer) Builder's License No ..................................................... Plumber's License No..~.~..~...~..~.?./.Z~ ............ Electrician's L,cense No. ~~.~.~..'f;.~.. .......... ,/-/Z:> r~ -r*- 7-50 Other Trade's License No ............................................... Ma o Locahon of land on whmh proposed work will be do. De. p N ......................... ~. ..... .Lot; No ......................... Street and Number ........................................ ~.....~'.,f.../~'..~../Z~.f?.~.~. .................... /Municipality State existing use and occupancy of premises~and intended use and occupancy of proposed construction' a Exisiting use and occupancy ............. .~..~....~ff....~....7'../,~.,~...,~. ................................................................................... b Intended use and occupancy ....... ./.....~.;/...~..~'~..~.~.~.~...~.~. ......................................................................... 3. Nature of work (check which applicable) New Building ................. Addition ................. Alteration ......... Repair .................. Removal .................. Demoht~or ............ Other Work ............................................ /--/ C7~ (Description) 4 Estimated Cost ........ ~..?.....~...~..c2..O. .................. Fee ...~)../.. r (to be pa~d on fihng th~s application) 5 If dwelhng, number of dwelhng units ..... ~ .......... Number of dwelling units on each floor .... ../.. ............... If garage, number of cars ..................... ~ .............................................................................................. 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 D~mens~ons of existing structures, if any' Front ..... '"'""- Rear Depth Height ........................ Number of Stor~es ............................................................................................................... D~mensions of same structure with alterations or additions. Front -- "" Rear ................. Depth ............................. Height .......................... Number of Stor~es .......... ~,-.~ 8 D,mensions of ent,re new construct,on Front .......... ~,...~..6~.. ....... Rear .........'~....'~....~..~... ..... Depth'~J/~...~....7.../...~.... / /~ ~ ~ ......... Height .... ~,z~.¢-~. ....... Number of Stories ............. ./f...q .............................................................. 9 S,ze of lot Front .......... .~.~...~..L.../......~.. ..................... Rear ....... .~....~.....~..:.Z~.......~.---~Depth 10 Date of Purchase .............. .~.. ~..~...~> ................ N~e of Former Owner ....... ~./~...~.. ......................... ~1. Zone or use district in which prem,ses are s~tuoted ....r-~...Z'~..~....cz..~...C?.~..~../.~ .............................................. 12 Does proposed construchon violate any zoning law, ordinance or regulation' ....x/~...~..~./.?~.~. ............................ 3 Wdl lot be regroded ..... ..~...c~....,:~.... .......... Will excess f_LUbe removed from practises: ( )~Yes ( I 14 Name of Owner of prem,ses ...~. ~...~...~....~..~...~...~'...~.~.~ A~dress~/'~ ..~..~...~..~....~..~ Phono No. ~.~...~..2:~..,-~...'- Nonce of Contractor .~-~..."~...~....~'~...~'~.../~Address ................................ Phone No.....~..~.~..~..~. PLOT DIAGRAM Locate clearly and d~st~nctly oll buildings, whether ex~st~ng or proposed, and ~nd~cate all set-b~ck dimensions fron property hnes Gtve street and block number or description according to deed, and sho~rstreet names and indicat, whether interior or corner lot ~~ STATE OF NEW YORK, I c c COUNTY OF ~ ...................... ......... ...-~//~,~..~.~~..c~__,¢~..~...,~.~.. ........... be,ng duly sworn, deposes and says that he ,s the opphcar (Name of individual s~gning contract) above named He is the ................................... ~~..~. ........................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d y~6~,~nd to make and fil this apphcation; that all statements contained ~n th~s apphcahon are true to the best of ~s knowledge and behef; an tha~ the work w~ll be performed ~n the manner set forth ~n the apphcat~on file~d therewith Sworn to before me this . ...... Z.g..7.~'~. ...... day of ...... ~........~-~ ................. ,,g.,~/ Notary Pubhc, ~ .................. ~ .......................... County ....... ~~i~f....~.~.¢.~....~...~z~...¥.~...~r~..~:; ............. I~OTARY PUBLIC, State of New Yo~ No. 52-4~43721, Sufl=olk Coun~ty~,, Term Expires March 30, wi£sON Ro4D nov/ or formerly deon S. young VAcANT THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND/OR FROM DATA OBTAINED FROM OTHERS THE WA~:~ SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CC~IFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES APPLICANT ADCRESS TEL -- -- I. nov/or formerly , poul R. Render ~ood dec~ formerly ooVl Or Moeller UNAUTHORfZED ALTERATION OR ADDITION TO THIS SURVEY tS A VIOLATION OF SECTION ?SOgOF THE /~EW YORK~JTATE EDUCATION LAW '1~ COPIES OF THIS SURVEY MAP NOT BEARING REVISIONS ,/ULY~X, 1977 AUG 9~1977 NOV 29, 1977 TEST HOLE TOPSOIL ~OARSE SANO 16. I --'- .... WATER NO TE · = MONUMENT NEAREST WATER MAIN- 4 MILES-+ WATER SUPPLY-PRIVATE WELLS YOUNG & YOUNG ALDEN W. YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK HOWARD W. YOUNG SURVEY FOR: GERTRUDE SCHLOER AT GUARANTEED TO: CUTCHOGU E SECURITY TITLE & GUARANTY CO GERTRUDE SCHLOER SOUTHOLD SAVINGS BANK 'OWN OF SOUTHOLD SUFFOLK CO., N.Y. SCALE: wiLsON now or formerly jean S, young1 ROAD THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND/OR FROM DATA O~TAINED FRO~ OTHERS THE WA'~"ER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF TH.E SUFFgL~K COUNTY SERVICES ., . ~ /)oW or formerly poul R. Render /" OOW SUFFOLK COUNTY DEPARTMENT OF HEALTH FOR APPROVAL OF CONSTRUCTION ONLY .. .s APPROVED . ~ ' ~ 'W. Moeller or f°r~erlY REVISIONS TEST HOLE OO . Zo_P_~gL~.. COARSg SA/VD IG I ........ NOTE' · = MONUMENT NEAREST WATER MAIN- 4 M/LES.-+ . ~IATER SUPPLY-PRIVATE WELLS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: GERTRUDE SCH LOER ,AT CUTCHOGUE I TOWN OF , SOUTHOLD SUFFOLK CO., N.Y.