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Home My WebLink About9774-z FO~M NO. ~ TOWN OF $OUTHOLD 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) N? 9774 Z Date Jgr~e 'l 2 19 78 Permission is hereby granted to: .~//\ W'illiam Ao Midgley Jr. ................... ....... ot premises Iocoted at .1.,~.~ ;.~:~L;k.~--^..,,W~.~,,;, ....................................... Peco~ic~ Near York pursuant to application dated ..... ~[1,1~f~ .......... .~ .............................. , 19...,.=.,~/~ and approved by the Building Inspector. Fee $... J .~. ~..QQ ......... 1000-98-4-17 .......... /--r'~:~ ...... ...... ~uilding inspector ' TO REMOVE EX, C[-~:, FROM ABOVE PRb,',;:~ ~ ~qRADING LOT r - -/'-:WAy C©;~qSTRLJCTh?z, - (' POOL COFJSTRUCT;7, FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 approva~ of Health Dept. of water supply and sewerage disposel-(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 topographic 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. 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 Date 11/2/'79 New Building ............. Old or Pre-existing Building ...,~- ........ Vacant Land ............. Location of Property .. 163.5. ~S~'~.~}~. ~p~.0, ........................... ~P.e.c. qz)~(; ............. House No. Street Ham/et Owner or Owners of Property .... ]~a..z'~0~'.e.-.E..a. 9 .e. ~D.~.f,.~.e..~ .................................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision.. ~z.d~l.e.[1 .~'~C~..~.e,~'~ ............. Filed Map No...~.~1. ..... Lot No..~.o?.~. Permit No... ~)?.?./~7~.. Date of Permit . .~.l.2./'.?.~.Applicant ~/i3.].~.Am A. t41~gle~', Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Z Fee Submitted $..~.,.0.0. ....................... Construction on above described building an~rm,,~t///~//me/ez~all~ap,~ble codes and regu,ations. ..,..., ....... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo Examined ........... ~.~1~.. _..J.~. ......... , 19._~.~. Approved ........... ~,.t~e......12. ......... , 19...~.~. Permit No ........ ~C//4.2. ................. Disapproved a/c ............................................. .~ ............................................. APPROVED AS NOTED ~ /~' ~ / ~" ~' DATE: ~, r~ ~ ~ I...~ .................... t...~L:~;.%...~ ~...C..,,.=...: ~L: .L~,..~=. ....... (Building Inspector) Application No ...... 9.~.7.~. ................. NOTIFY BUILDINGDEPARTMENT PPLICATION FOR BUILDING PERMIT 765-2660 9AM to 4PM FOR REQUIR. ED INSPECTIO,NS. Date ............................................... 19...~.. ~c~ 1. BEFORE BACKFILL N~ ~'O'.!NDA. i~..~(//r,~ ~, , ......... T~ON OR STAFYI' :'~,~,. .......: ~t.~ INSTRUCTIONS 2. FRAMIF~G IN,' ~'3' Fj~i[ EBEFO[ ~T,~',m~stC ,r:F~ ,,,~ ':,'2~"~e ~bYe~l~ed ....m by typewnter o~ in mk and submitted in triplicate to the Building Ins~e~t~', ~i~';3'~et~)~ ~l~B~;'~dc~ate p at plan to ~ale Fee according to schedule b. ~o~{g5p' ~g[~,~ ~' 'Cm,loeat,~ ........ and of buildings on'premises,' relahonsh,p' ' to adlommg"' premises or public streets ~. A~g,~ ~ ~-~q~[~d~C~ion,, ~ -, , . of. layout ofproperty must be drawn on. the d agram which is part of this app cation. W~ c~¥~[~y~HEra~at~on may not be commenced before msuance of Bud ng Perm t. )~val of tH ~'.a~ti~e Bui d ng Inspector will issue Building Permit to the applicant. Such permit shatl~'~ ~t omthe,p'remi~e~ ~i~l~F~spectlon 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 Buildinfl Permit oursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appliqable Law~, 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 admit authorized inspectors on premises and in buildings for n~essa~ inspections. .4, q~' ~..~.,~.~..~...~ ............................. (S[~noture of opplic~ o~o~, i{ o corporot[on) Store whether opplicont is owner, les~ee~ a~ent, ~rchitect, eng~neer~ Oenerol controctor, eloctricion, plumber or .......... ..................................................................................................................................................... ~ome o~ owner o* promise~).~.L.~.~X2.....~.....~L~Z~ ................................................................................. ~.~ I~ opplicont is o corporote, si~noture o{ duly ~uthorized officer. (Name and title of corporate officer) ~/~ ~~' I Plumber's License No ................................................. ~ "-~'~ ~ '~'~ ~ C~._ ,, F~ I~. 1~o~._~_ ~w7 E~,i~.'~ L~.~ No ............................................. ~.~. ~,~ ~" Other Trade s License No ............................................ oc ,o. o, o. wh,¢, work w'" ........................ .......... Street and Number ..~.~...,.~.~r ........................ ~',~..~ ...................................... ~.f'~/~4.~ ............. Municipali~ 2. 5tare existing use and occupancy of premises and in~ended use and occupancy of proposed construction: a. Exisifing use and occupancy ~ ~c. ........................ b. Intended use and occupancy .~.~.~4 ................................................................................................................. PERMIT INCLUDES ~J TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT DRIVEWAY CONSTRUCTION CESSPOOL CONS YRUCTION CE'LLAR CONSTRUCTION , (~TNFR 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ...~,{.~..~..&.(/:../.~* ............................ (Description) 4. Fstimated Cost ........................................................... tee .......................................................................................... (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, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front .......... ~'.~..'. .......... Rear ¢ d ~ Depth ;z ~" Height ........ ./....F...~ ....... Number of Stories ./. ..................................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Kear ............................................ , .................................. 10. Date of Purchase ../t-4.~...~.~..X....../..&.7.,~. ......................... Name of Former Owner ~...~/~'~...~..~,,,~ ............ 1 1. Zone or use district in which premises ere situated ...Z~..~T.~.~¢ ..................................................................................... ]2, Does proposed construction violate any zoning law, ordinance or regulation: .d~...O.. ............................................... 13. Will lot be regreded ..,~-...~.. .............. Will excess fill be removed from premises: (~>'~Yes ( ) No 14. Name of Owner of premises .i~/~..(?/.J{~....~.~./.,ZZ./~.Z/4/.~.... Address .ff?~.~..~../Y. ff..~=.. ......... Phone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .J44?~/.&/.¢,.~..~.(P.,~.~ff.~..,...zT~ ........... Address .d.~.7..G.~.~...~.~...~--. ...... Phone No. PLOT DIAGRAM Locate clearly and distinctly ail 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. /OJ-r STATE OF NEW YORK, OF ..... ............................ ~ ........... h ................ /.v.~(,~.....~L.:.being duly sworn, deposes and says that he is the applicanl (Name of individual signing contrc/cf) / /~ ] ' 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 ali statements contained in this application are true to the best of his knowledge and belief; and t?',ar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................ day of ............................................ , 19 ........ " Notary Pu~ e, ................................................. Co,,nty .... ~.t./ ........ ~ ......... ~,-....J..';...~-.,~.....~?,~:... ..............................