HomeMy WebLinkAbout9756-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
9756 Z
Date IV[a3/' 30 19 78
Permission is hereby granted to:
Curtis Norklun
.......... ~/.~. ...... .~..~,o.~.-..~~ ............
et premises located at ............ ~.'l..~,......~...~..]:.~.~.g.e....~....~....e. .......................................................................
..... .o. ~..e.~.,.. N ..~... ~.o.~ ..............................................
pursuant to application dated ..... .~...~.~. .......... ~ ............................... , 19.?..~...., and approved by the
Building Inspector.
Fee $. ?...0......0..0. ...........
lO00-25-27art of 4
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Buiidin9 Department
Town Hall
Southold, N,Y, 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. Thi; ~23[iaation must be filled in typewriter OR ink, and subr~itted in duplicate to the Buiiding Inspec-
tor ,.'/~m ',ne following; for new buildings or new use:
1. Final sur,'e/ of property w(;h accura;e Iaaa'don of all buildin§s, property lines, streets, and ur~u~al
2. Fma~ a23rcv81 of Heaith Oeot. of water suootv and sewerage disposai--($.9 form or equal).
3, AOnro,,'al Of electrical installation from Boa~:d'of Fire Underwriters.
4. Commercial buildings' Industrial buildines, Multiple ResMences and similar building~ and installa-
tions, a certificate of Code compliance from the Archite'dt 'or Engineer responsible for the building.
5. £ui:mi: Planning Board approval of completed site plan requirements ,,,/here applicable.
8. For existing buildings (prior to April 1957), Nonconforming uses, or buildincs and "pre-ex[sting"
land u.~es:
~. ,Accurate s~Jn/ey of peoperty showlng all prooerty lines, streets, buFldings and unusual natural or
tomoGr~phic fen[utes.
2. Sv.'orn statement of owner or previous owner as to use, occuoancy and condition of buildings.
3. Date of 3ny housing code or safety inspection of buildinos'or premises, or o,ner pertinent informa-
~u~r~ to prepare a certificate. /
C. Fees:
1. C~rtif;calo of occupancy BB.00
2. CarJf;cm~,e of occupancy on pre-existing dwelling or land use $5,00
3. Cas,,, of c~. Jfic.,~ of occupancy 81.00
..... c2 ..........Old or Pr?existing Buildimg(X) ......... =/Vacant Land ...........
............ 6. Eo. ...................
......... o - ' ......
He,Wa] OepL Approval ................... Labor Dept. Approval ......
................... Plannln9 Board Approval ..................
Request for Temporary Cart f cate '
.................... Final Cert~ficaze ......
Fee Subm[(bad S .............................
Cons~,uc"on on above de~crf)=d bu[ldin~nd~it-m ,. ~ -
..... ~ ~,Ulp~[I[~l eats ~p~cabl~odas and reNulations,
//
Memorandum from o,, ,
BUILDING INSPECTOR'S OFFICE
TOWN OF SOUTHOLD
TOWN HALL, SOUTHOLD, N. Y. 11971
765-1802
October 2, 1985
Dear Mr. Jankowski:
The inspection.on your accessory
building was done 9/24/85. B.P. #9756Z
We have your application for C.O.
filled out here in the office but a
check for $5.00 is necessary to cora-
plete ~,
Please send us
will mail the c.o.
your check and we
to you. Thank you
Yours truly
TOV~ZN OF SOU?SOLD
OFF~cE OF BUiLDiNG INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD. N.Y. 11971
TEL. 765-I 802
Perr~zt. No. ~'q~-'~ i~sui' ' ~,~e 3p~b u,.c=r Buzldzng
,.~__te ~hzs file it is necessary
- - · P_-~s_ fill out the
enclosed ~orm(s) ~
~.~c.~ for $5.00 payable to the Town of Southo!d
Ine!cate to whom the Cert~f!cace of OccuDancy is to be mal!e~
and arrange with =' ~ '
~n~s office for an inspecSion date.
Thank you for your prompt attention.
VL:ec
Enclosures
Very truly yours,
Victor Lessard
Adminis ~r~ tot
JOHN WICKHAM, Cbaffman
FRANK S, COYLE
HENRY E. RAYNOR, Jr.
FREDERICK E. GORDON
JAMES WALL
T(
,D
Southold, N.Y. 11971
May 18, 1978
TELEPHONE
765- 1938
Mr. George Fisher
Senior Building Inspector
Town Hall
Southold, New York 11971
Dear Mr. Fisher:
The following action was taken by the Southold Town
Planning Board at a regular meeting held May 15, 1978.
RESOLVED to instruct the building inspector that
the purchase by Dr. Jan Moor-Jankowski of laud south and
behind his property on Village Lane, Orient, from Mr.
William Schriever has been approved by the Planning
Board.
Yours truly,
Muriel Brush, Secretary
Southold Town Planning Board
I~OKM ~0. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y,
Examined .........~ ..........~1 ........ , 19....~'B
Approved .......... ~y .......... .~0 ........ , ]9....~ Permit No ..... g.~ ....................
Disapproved a/c ......................... : ..................................................................
(Building Inspector)
APPLICATION FOR BUILDING PERMrT
................................................ , 19 ............
INSTRUCTIONS
a. This application must be completely filled in by typewriter o~ 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 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 part for any purpose whatever uniil 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 ar 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.
/~u~' (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.
........... ............. ..............................................................................................................................................
Na .............. ~ ..........................................................................................................................................................
If applicant is a corporate, signature of duly authorized officer,
(Name and title of corporate officer)
Builder's License No ......... ~.~J. ...................................
Plumber's License No ..... /~.. ..................................
Electrician's License No. L.~....~.. ..................................
Other Trade's License No../.~.~..~.f...'2 ............................
1. Location of land on which proposed work will be done· Map No.: ........................................Lot No .........................
Street and Number ................ ~.~ ..................... ~ .........................................................................................
~1 ~ Municipali~
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ................................................................................................................................
b. Intended use and eccupancy ..... ./...~..~,.. ~......, .~...../?. ~..~.. · ........................................................................................
3. Noture of work (check which applicable): New Build,ng'. ............. Addition .................. Alteration ..............
Repair .................. Removal .................. Demotitior. ................... ~ Other Work (Description)
4. Estimated Cost- fl. ~ l 0~), ¢.~2 Fee /(9 ......
(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 ............................................................................................................................................
6. If business, com~nercial or mixed occupancy specify n,ature and extent of, each type of use ....... '~.'Z') ..............
7. Dimensions of existing structures, if any: Front .......~..~/...~. .......... Rear ..... ~.../. ...................... Depth ..~[...~. ............
Height 7-~- s
........................ Number of Stories ........... J.~.~ ................................................................................................
Dimensions of same structure with alterations or odditions: Front ....................................Rear ...........................
Depth ............................... Height ............................ Number of Stories ................................
· /O/
8. Dimensions of entire new construction: Front ..../.~. ........................... Rear ..... /. ..................... Depth .......................
Height ....... ¢. .......... Number of Stories .................................................................................................... ) ...............
9. Size of lot: Front ............. /..~..~..i ................................ Rear ........ /..~(..¢./. ....................... Depth ...... /.7...~z(. ................
10. Date of Purchose ............................................ 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: ........................................................
13. Will lot be regraded ............/~...¢. ............ Will excess fill be removed from premises: ( ) Yes (/~No
14. Nome of Owner of premises ..c~.¢.~...¢.~'¢...~...C. cZ.¢.~.~.*ff~.,.~..!'.. Address .....~..~.~'/...~ ....... Phone No .......................
Name of Architect .............................................................. Address ................................ Phone No .......................
" 0""
h!omo of Contractor .....~.'..(.t..~..?.(.2.......~...~..~...../.~..!.%9. ........... Address ............................. Phone No.
PLOT DIAGRAM
Locate clearly and d st ncr y a bud ngs, whether existing or proposed and indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and s3ow street names and nd cate
whether interior or corner lot
~TA'F~ OF NEW YORK, / c c
COUN ~ , OF ................................ f
................. ;7'. ....... ::,.' ........ , ........................................................ being duly sworn, deposes and soys that he is the applicon~
u'~ame ..o,f inc~ivic~u~l si, On'ing} contract)
above named.
He is the .................................................................................................................................................................................
(Co~tractor, agent, corporate officer, etc.)
oF soid owner or owners, and is duly authorized to ~erform or have performed the said work and to make and file
d~is opplication; ~hat all statements contained in t~is applicction a~e true to the best of his knowledge and belieF;
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
........................ day of ............................................ , 19 ........
N~6ry I~' "~ ....... ~ ....................................... Coun~ .... ' ......... ' ..........................