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Home My WebLink About10009-z F01~[ ~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 100(19 Z Permission is hereby granted to: ..C.~.:~2,:..~.:L~(.~ ........... ~.~,~..~. ............ Cc/.~-~:!~ .... ~...a.~..o,.,~.:..c. ....... ~.....~..~.~.~x.. ...... ..C~ ~ / Building Inspector. lc~ ,~ ~ .... Fee $. /. .. .~.~: ................ Building Inspector TOWN OF $OUTHOLD , Building Depar~ment Town Clerks Office $o.thold~ N. Y. 11971 APPLICATION FOI~ CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE 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 disposol--(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 ]957), 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 $5.00 3. Copy of certificate of occupancy $1.00 Date August 22, 1979 New Building ~.~ ........... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property N/S Glen Court Owner Or Owners Of Property Antonio Vangi Subdivision .... ~i,s,~,~_D,l~t~f_~p,, ,5,.Q.G,,0. .............. Lot No.....l ...... Block No ............. House No.~.5, ..... Permit No..&.00~0.9...Z Date Of Permit .%~/8./.2.~..'.Applicant~ ~G~(,.~/~,e.. Co~.s~rtzc~,io~..C,~r~ ...... Health Depto Approva! ............................................ Labor Dept. Approval ................................................ Underwriters Approval ..... J~,~.~.7..~ ........................ Planning Board Approval ........................................ Request For Temporary Certificate ....................................... Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations t~/nne~/~ZQ~$tr~c~zon CorD. , pphcont · - · ............................... Sworn to before me this ..... .... Pub c Notary ~4~J~ ........... County Everett J. Fuchs,Vice President - , NOT~,Ry PUBLIC, $~e .f N~I~ ~ ., TOWN OF' SOUTHDLD nFFIOE r-IF BUILDING IN~PEm-TOR Ti3WN P-LERK'=S FIFFICE SI3LITHOLD, N. Y. 119'71 TEL. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Examined ........................................ / [. >'(' , ,19~/, ....... Approved ........................................ , 19 ........ Permit/r /x-~ Disapproved a/c ............................................................................................ ...~ ~ ~, ., ? -~.:'.. . . ................................... ~,~,~ .......... . ......... /.,...-...,~ .......................... -(J~(zi ding nspe~tor) Application ~o/, X'"f'"'~ ..................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter ot~ 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 location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of BuiJdlng Permit. d. Upon approval of this.application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been grented 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~WYNN~ CONSTS.UCTION C~f2 (Signature of ap~icanf, or nome, if a corporation) 163A liont~auk ~.~.~.~ton....~..y.,s (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. BUll,DEll Nome of owner ~);bmises ...... .~J~J]J~J..~JD...~...V~J'~J[ ........................................................... ~ .......................... If applicant isa corporate, signature of duly authorized officer. ~ ~/: ~.~ ~- (Nome ond title of co~orote office~) 10~0 -- ~ -- I ~ ~. Builder's License No ..................................................... :~.:, ~ ~ ~0~- / , f Plumber's License No ..... .~.~.~ ................................ Electrician's License No. ~.~.~. ............................... Other Trade's License No ............................................... ~ ~ 1. Location of land on which propose~work will be done. Map No.: ...~ ........................... ~ULot No. ~ ...................... St reet o nd~ N b m bet ............... ~ ~...~.~ ~.~.~...~.~.~.~.~.~ ..................................................... Municipali~ 2.Store existing use and occupancy of premises and intended use and occuponcy of proposed construction: a. Exisiting use and occupancy ~ ~ ec . .nc ................... .............................................................. 3. Nature of work (check which applicable): New Building.....X; ........... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other War. k" ................................................ .... ~,~c) (Description) 4. Estimated Cost~ --.~.......~.~.?.~:/./~ ..................... ............ Fee ............... .' "~ .~M/,-'.... ...... ....... .......................................... .............. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars '??!!:~:~::'2~...~..~.':~.?.:~ ............. ' ........................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height .................... ~r.~r~.Number of Stories ........:':F~ .................. 8. Dimensions of entire new construction: Front ..r~J'.~', .......................... Rear ,..~ .................. Depth ..ag ................. Height .................... Number of Stories ........ 2 ........................................................................................................... 9. Size of lot: Front ~00! Rear 1001 ...... Depth ~100t , 10. Dote of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use'district in which premises are situated ................................................................ .~..: ...... ; .......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ...l~,.. ........................................... emises: ( ) No 13. Will [at be regraded . ........................... Will excess fill be removed~.~, ~-~im~plro~'~,~*.~") Yes · Anl~onio V, 14. Narr, e of Owner of prem,ses ...................... ~ ....................... AddressG~B~..[q~lt~.~ ......... Phone No...2.~1~1.'~t~.~.. .... Name of Architect ]~.~.~.~.:~.~.~.~.~ ...................................... Address~.~ll~X"~A~lll~ ..........Phone No..~.~..~.~.~... GW-~ne Con~tt. uct~lon ~. l&3~ml:m~.lt~ ~2,8,..-,9~.~1, Name of Contractor ............................................................ Address .,,,,l~l~,~ll..~,X.~..'Phone No .............. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. G!ve street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, I.S.S COUNTY OF ...~1~.~'1~,~;. ........... ................ ~'~l~,..~'~...~r~C~t, II ...................... Z ................. being duly sworn, deposes and says that he is the applicom (Name of individual signing contrac~ above nome& He is the ~..~.~d~ ............................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that' the work will be performed in the manner set fo~h in the application filed therewith. ...... ~ .............. day of .....~&Ve~ ................... , 19'78" Nota~ Public, . .......... ~.~ ............. ~n~ BUILDER'S JOB NO. TITLE NO. SUFFO~COUNTYTAXMA~ ~IST.--/~S[CT.--~B~.-/ ~OT--7 Ii BURTON & HAND .~..o.~ ~*~:~./~.1 CONSULTING ENGINEERS TOWN O F~: ..,.~.~L/7~.4-..~D/__. Z=~, SURVEYED: ~ CERTIFIED TO: ~/~ ~~ ~/ AND LAND SURVEYORS 144 MEDFORD AVE. PATCHOGUE, N. Y. .~ .~ 11772 · , /l~'' SUFFOLK COUNTY TAX MAP DIST.--/~SECT.--~ =~.-/ ~OT-~ BURTON & HAND DATE:~./~ ~. CONSULTING ENGINEERS LOTS / BLOCK 'AND : LAND SURVEYORS 144 MEDFORD AVB. LOCATION:~U~~~ " : PATOHOGUE, N. Y. TOWN O p: ¢¢TH~L ~URVEYED: CERTIFIED TO: ~/~