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Home My WebLink About10011-z FOKI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 10O11 Z Date ........................................................ , 19 ........ Permission is herebygrante~ t~o'/, z K L- 7~F /~ ~ {~'/~/~/? ~ ['0 ........................................................................................... cz ........................ ~ ...................................... at premises located at ............................. ~-',2~' ......... ~'~"~;7i~",~~' ................................................ · '"'z'~"~ ....... ~;'; ........ ~z-'~',~z"~: ......... :":~Z";~'~'Ti .......... ~:x";:;:f:'~' ...... '~,~">'":~"~':'~"~, ..... pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. Fee $ ........................ I~,~'c) ~. 2,0-~ ..... : ::: ........... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink. and submitted in duplicate to the Building Inspec- tor 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 installa- tions, 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. For existing buildings (prior to April 1957). Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph ic featu res. 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 informa- tion required to prepare a certificate. C. Fees: ,/1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use /~. Copy of certificate of occupancy $1.00 $5.O0 New Building *'" Old or Pre-existing Building Vacant Land .......... ................ Location of Property ./.~ ..... /.../~. ~....5,~/...~. Z~.~'' ~..~ ~ ~T~ /~.~.~'.Z~/~.~ . .~..~.. House No. .Street Ham/et Owner or Owners of Property . .z~:~. ~.~./~.././........ ./~.~.~.~/~...~.../.~. ... ~. ~..~..,~.. ~-. County Tax Map No. 1000 Section .... ~ ~ ....... Block ... ~ ......... Lot "~ Subdivision. ~.~/~.~..~..~:.~..~j~..~..~,~..~..~..Map No .... ,~.~. ~. ~.'.~... Lot No....~'. .......... Permit No. Z .~.P.f./.'.~T. Date of Permit.././..~.~. ~7~pplicant..~..~.~..../~.. M~/'.-...~'~-~?.~.~..-~-. ~-- Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...~.~ .................. Fee Submitted $ ...... .~. ~. ~.~.. .............. Construction on above described building and .p~e~erm~r~ts all~li~t~..c~s, and regulations. TOWN OF SOUTHOLD Building Inspector's Office Town Clerk Building Southold, N.Y. 765-2660 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN r-LERK'S OFFICE SOUTHOLD, N, Y, 119'7'1 FOILM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined ~[/'~//'- 6~'~-10~ ~w~ ....................................... , ~,..~ ~ ~ ..................................... ....... ................................. .................................................... ............... ................. App,catlon APPLICATION FOR BUILDING PERMIT ............ Date ............ ~ ............................ , 19 7~;~ 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 location, of tot and of buildings on premises, relationship to adjoining premises or public streets or 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 Building 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 port for 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 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 ir~ buildings for necessary inspections. ~~ame, if a corporatien, (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map Ho.: ........................................ LOt No ......................... Street and Number ..................~.~.'~......~tZ~.~..........~.....~..~ ................ ~.~...~.~...~."~,<~w~...~.~r~'~'~.'.~ ....... Municipality State existing use and occupancy of premises ~nd intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............... b~....~...~....~.~./~...'.~."......./~...~.?...'~.../?. ..................................................................... b. Intended use and occupancy ........................................................................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... ~ (Description) 4. Estimated Cost Fee .... ~~''''7'-~'''~''''~''- ......................... ........... ii~"l~'~"~id on filing this application) 5. If dwelling, number of dwelling units ......... .J .................. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use " 7. Dimensions of existing structures, if any: Front ..........-ZT. ............... Rear --' Depth .................... ight ~- Number of Stories Dimensions of same structure with alterations or additions: Front -- Rear .....--T;. ..................... Depth ~ Height ~ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....~...?. .......................... Rear ......~...'~..'.~. ............... Depth ..~.~... ............ Height ....~..~' ........ Number of Stories ........ ~.. .......................................................................................................... 9. Size of lot: Front ..,~,.,~..:..~.'~.~. ..................................... Rear ....~...'~....~....~....~....,~... ............... Depth ..... .~.....~.....~.-~,. ............ 10. Date of Purchase .........'. .............................................. Name of Former Owner ...~..Z~...~..~.......~.~.x:~,~..~... .......... 11. Zone or use district in which premises are situated ....,/-~.~..J..~..~;T.'~.-~.-..,Y~../~....Z~.. ............................................... 12, Does proposed construction violate any zoning Iow, ordinance or regulation: .,Z'..~.,~ .............................................. 13. Will lot be regraded . ............. ~...~...... Will exc,ess fill be removed from premises: ( ),,Yes ( 14. Name of Owner of premises..~.../~...~.,'~. '.,~-..~......~...~.~-~.~..~..'~ddress~f--~,4/~'.-~..~-&.~.~hone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly, all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. s~--~- c~ ~ c ~,~"T, ,~ .~ STATE OF NEW YORK, [ ¢ c COUNTY OF ................................ ........ ..~r..~..__________________~.../~t~..Z'Z~...~.,4¢~,,~-~¢~*~...Z~.. ..................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contrac~ above named. He is the ~-~. (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 tha~ the work will be performed in the manner set foffh in the application filed therewith. Sworn to ~fore me this ....... ~...=~ ..... day of ......... .~.~ ....................... , 19Z~. ........ ......... Cou.W ............................. I..at I~ ,, ,~ ~ ~ 'i ~' ~ L0 ~ ' .~ ~ ,~ '~ ~ ~ Area gURVEY FOR : LOT N~ 6, "PEBBLE BEACH FARMS" MAY I, 1979 ~T EAST MARI~ O~E JULY 14, 1978 TOWN OF SOUTHOLD SCaLe; I" = 40' SUFFOLK COUNTY, NEW YORK ~0 ~ 78-~9 NEW Yoa~ S~e EOUC~O. L~W * coe~Ea o~ T.*s suawY ~oT 8E*m~ ~e L*~O NATIONAL BANKOPNORTH AMERICA SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL :.' NOT BE CONSIDERED TO 8EAVALmO TRUE COPY H~LTH D~PARTMENT- DATA FOR APPROVAL TO CON$TRUGT ~ a YOUNG ~,~.~~o~ ~.' [ :, YOUNG ~oo~~ ~ ~ $UBOIVI$10N MAP Pl~O IN ~NE'OFFICE'OF NE AEDEN ~ YOUNG, PROFESSIONAL ENGINEER CLERK OFSUFFOLKCOUNrYON J~NEI~ 19~ AND LAND SURVEYOR N.~S. LICENSE N0.12845 ~$ P/L~ NO. ~ HOwaRD W. YOUNG, LAND SURVEYOR ~THE EOCAT~N~WELL(W),$E~IC TANK{ST)eC~SP~ES(CP)SHO~ HEREON N.~S. LICENSE NO 45893 L.0t gAVATII}I; suFFoLK COUNIY DEPARTMEN' ~teo ~ Lot 7 TITLE NO. FOR- APPROVAL OF CON~STRUCTION ONLY APPROVED "-- .... HEALTH C ~NSTRUCT ~ NEAREgT WATER MAIN__M L ~ ~ SOUR~k Of WATER, PRWATE__ PUBLIC ~THERE ~E'N~ DWELLINGS WITHIN'IO~ FEET OF ~HIS P~O~TY , , OTHER THAN-~H0$E ~HOWN HEREON, ~ , AppLICANTt C&~K OPEO~F~LK~OUN~ONJ~N~iI~'tg~ . :°5708 VI. '~:~ $oq~'SE''¢/' ,00 56' NEW YOrK ADDITION TO THIS 7:~09 OF THE LAW. BE'ARJNG THE LAND ISSEO SEAL SHALL ~RUE COPY, RUN ONLY TO : USED TO ESTABLISH R~CTfON 0t~ FENCES 8.YOUNG [~Y~UNG,PROFESSIONAL ENGINEER S, LICENSE N0,!2845 LAND SURVEYOR N~ N0,45895 DATE : JULY Id, 1978 SCALE: / ' = 40 ' NO. : 78-409 GUARANTEED TO: CNIC~I;O FITI.£ IIV$t. IltAIttC£ 400 OSTRANDER:NUE' EIVERHEAD, NEW YORK