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Home My WebLink About9985-z FORM NO. 2 TOWN OF SOUTHO~D ~' BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTi~OLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9985 Z Permission is hereby granted to: TOWN OF $OUTHOLD Building Depor~ment Town Clerk~ Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY J nstructions ~-~ A. This application must be filled in typewriter OR ink, and submitted in t~te 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 dlsposal--(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 approvaJ 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 aT 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 dwelJing or land use $5.00 3, Copy of certificate of occupancy $1.00 Date ................................................ New Building ....... ?.. .......... Old or Pre-existing Building ............................ Vacant Land ............................ · ' .04' S O S uare Ri er Lane Southold $ Brl antzne Dr. 926 / .q ~ :, Location Of Property ...W.~ ........... a ................................................................................................ Riverside Homes; Inc. Owner Or Owners Of Property ..................................................... Harbor Lights Estates, Sec 3 ! . 60 Subdivision ................................................................. or No ............. Block No ............. House No ............. Permit No...9..9.~.,~. .......... Date Of Permit ...~..Q,/.~.~./.7..8...Applicant .l~i.~.e-.~-~,i,.d...~..Iti~t~..e..s.e..l.t!..c..' ....................... 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 pencil applicabl~ codes and regulations. Applicant ...~~ ...................... ;7. ...................... ~chard Wandoloski~ Vice President of Sworn to before me 1ibis Riverside Homes~ Inc, ...L.~..~.... day of ...,~.../..~.Zf (stamp or seol) Notary Public .................................... County TOWN I-IF -qOUTHDLD DFFICE OF BUILDIN[-~ IN~PE~CTOR SOUTHOLD, N. Y. 11971 TEL, ~65-~66Q TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examihed ............... '~......~.~ ......... ~.~1~.19 ........ "7~ ' Application No ...~...?~>~Z~- ............................... . Approved ................ C//~.......(Z ,gZ~Permit No. c/~(~...~..,~f- '~'c' - Disapproved a/c .............. ~"..~.~ ........ ~ ......... ~.~,. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ...........: ......... . ,~,...~i~., 19Z.,,~. 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, accu~ate~plot plan to scale. F. ee acq-ording to schedule. b. Plot plan showing location of lot anchor buildings on premises, relatiooship to adjoining premises or public streets oF areas, and giv!ng o detailed description crt layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commen~:ed'beforeqssuanc&~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 part 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 in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. builder Name of owner of premises ......~..i.y..e.~..s,~..d.~,....i~..~.e.p.~....[.9.c.... ..................................................................................................... If applic~gg,t,.,j§, a_~orporate, ~gnature of duly authorized officer. (Name and title of corporate officer) Richard Wandoloski~ Vice President Builder's License No ..................................................... Plumber's License No .... ..4.l~.-.E .................................. Electrician's License No ...... ..4.~.{~.~.~ ............................ Other Trade's License No ............................................... v 1. Location of land on which proposed work will be done. Map No.: .......... .5. [ .4:. .7. ...................... Lot N0; .......... .5..0. .......... Street and Number ~W~/~S~`~g~.$~V~e~;~S~.~quar~.~gg~L~ne .............. Sou.~:bol.d. ............. Municipality 2. State existing use and occupancy of premises add intended use and occfipancy of-proposed construction: a. Exisiting use and occupancy .......... ¥.~.g..a..t)_.~...~,.~g,.d. ................................................................................................ b. Intended use and occupancy ........... z~n~..£~m~[y..~[1.~ ............................................................................ .. 3 Nature at work (check which applicable): New Building' ...,.x ............ Addition .................. Alteration .... x; ....... Repa,r . ................. Removal .................. Demolition .................... Other y~ork ........................................... t..,, '7 ~ ~ (Description) 4. Estimated Cost ....... ~2..~ ............................................. Fee .......................................................................................... (to be paid on filing this application) 5. If dweHing~ number of dwelling units ...... } ..................... Number of dwelHng units on each floor .~...~...?...$ 2nd ~1 - 2 If 9orage, number of cots ............. ~ ......................................................................................................................... d. ~f business, commercJQt or m~xed OccupQncy~ specify me,ore ond extent of each type of use ........................... 7. D~mensioms of exisfin~ structures, ff any: Front ............................ Rear ................................Depth .................... Height ........................ Number of 5tortes ................................................................................................................. Dimensions of sm~e structure w~th ~[terotions or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of 5todes ................................ 8~ Dh~ensions of entire ~ew construction: Front ........... ~ ..................... Reor .......4.~ .................. Depth ...... ~.~. .............. Height ........ ~2 ........Number of Stories ..... ~ ............................................................................................................... 9. Size of ~ot: Front ....... 100 ........................................... Rear ...........~00 ......................... Depth ........ ~.0 ................... voto ......... !P/ /2g ................................. ...................... 11. Zone or use d~strict Jm which premises ore s~i~mted ..................................................................................................... ~2. Does proposed construction violate o~y zorn{rog ~aw, ord~momce or regulation: ....... ~ ............................................. ]3. ~ViH lot be regmded .......... ym~ ............WHI excess fill be removed from premises: ( ) Yes (~ No ] 4. Nome of Owner of premises ..... R~r~..gp~.~I.R~ ...... Address .P~E~ead~.~ ..... Phone No. 72~3395 Name of Amhitect Richard Wandoloski S ~ unt y Rd 727-3395 .............................................................. Address .~s~r.~ ............... Phone No ....................... Nome of Contractor Riverside Homes~ Inc. Address Riverhead Phone No. 727-3395 PLOT D~AGRAM LocQte c~e~rly &md d~stimct~y ~[~ buS'dings, whether ex~st~m9 or proposed, ~md ind~cote ~H set-b~ck dimensions pmpcrty ~nes. Give street ~md b~ock number or description ~ccording to deed, ~nd show street names ~md ~ndic~te ~hether interior or corner STATE OF NEW YORK, ~ S S COUNTY OF ....S..U.F.F.~. .............. f" RICHARD WANDOL OSKI ................................................................................................ being duly sworn, deposes and says thor' he is the opplicanl (~Name of individual signing controcf) above named. hie is the ...................,V,£ce,,,P,~a,~J.r~en~:..~£,,bu.iJ..d,er,/,~,p,~-£~a~ ...................................................................................... (Contractor, agent, corporate officer, otc.) 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 Ihis applicction are true to the best of his knowledge and belie~; ~k,o~ the work will be performed in the manner set forth in the application,flied therewith. Sworn to before me %b~ ~ ~ ~ ~,~-'~ ......... .z.. .......... . Notary Public~..~:~....~ .......... /7~ %, ~tur, e.of applicant) / ~tlZ~B~ '. ~~ Richard Wan~,loskt ' ¥ pUBLg State o THE WAFER SUPPLY & SEWAGE DISPO.%AL FOR THiS RESIDENCE WiLt. CONFORM TO THE STAND ARDS Of-' THE SUFFOLK COtJNTY DEPT OF HEALTH SERVICE JOB NO. LOT NO 60 SITUAFED A-: .COOT//OLD TOWN O~ .$O~6Z/) - ,~SZ/tcA~gL/.~ CCUA~7"~ A~ ¢ GUARANTEED ..NJ f EbOOK'NO HAROLP, F' TRAf!CHON .IR PC ' CR *"0 WI~.LIAM G. MEIER SU CL. E.~S ~ M~ROLD F TRANCHON JR N.Y' LIC. NO. O~Bgg2 73:3~6 . uPENN. LIC. NO. 21115-E 16>929~469,~ AU'I, ~ FREDERICK ~ I-/AROLI~ RE£$£~ A4/7°0/ · I /00.00' O0 I00.00' SUFFOLK COUNTY HEALTH SERVICES DEPT OF THE WATER SUPPLY 6, SEWAGE FOR DISPOSAL FOR THIS RESIDENCE APPROVAL OF CONST. ONLY DATE l0- It'''~OO GUARANTEEO ONLY TO WILL CONFORM TO THE STAND ARDS OF T.HE SUFFOLK COUNTY ~,URYEY ED FOR '. LOT NO, ~O NAME ADDRE~.C3. J305~'~ 2,S'4 EJ37~,'.¥1'i.~xgl:~D l',I.Y'. 11902, NY. LIC. NO. 048992 4 TRANCHON JR. PENN. LIC. NO. 211 15- E tELePHONE FILE NO. /"IARSOR ZI¢//T$ £$T$. TOWN O~ ~OU~OZ~ - ~F~OZ/~ SCALE 1' : ~o' DATE /O-~- FILED MAP NO. 5/47 OATE BOOK NO, L.L. PAGE HAROLD IE TRANCHON JR.I~C. LANO SURVEYOR SUCCESSOR TO WlLLtAM G. METER NORTH COUNTRY ROAD-WADING RIVER NEW YORK 11792 (517)~29- 469.,5 ALT. 473-3626 "yACANT" LOT' AREA 2o, ooo .-~;L FT. TA)< {v)A~ D~sT. Jooo SEC, 7~ ~L~ 4 C~ ~I The ~wase ~i~posa! ~nd ~t. er supD]y fao~]itJes. ~or t.~:l~ ~o<'atton haYe b~en tO be Satis~acto,~Z"~ / ~ O~ief of ~e~era! Englnee~jn~ .... ~--- SUFFOLK COUNTY OEPT OF-; I THE WATER SUPPLY' ~ ~,~A~£ I NkM[ HEALTH SERVICES FOR DISPOSAL FOR THIS ~E~iO~NCE AP~OVAL OF CONST. ONLY WILL CONFORM TO THE S~NO ~DDRES5 SUFFOLK c~UNTy DATE , , AROS OF THE ~ ...... H.S. REE HO.. DEPT. Of HEALTH SERVICES. A~ROVEO ~Y ,,, ~LEPHDN E -- E%PEESSWAY FEDE~ ~VINS3 .J LoAN A~N :; :r~ ~[ rFt~ GUA~MT~ COmP~]N~ ~ LANb' SgRVEYOR SUCCESSOR ~O W~LL{AM G. ~EIER T ANC ON