HomeMy WebLinkAbout9778-z FOltl~I NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. ¥.
BUILDING PERMIT
(THIS PERMIT ,MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Ne 9778 Z
Date June 14 19 78
Permission is hereby granted to:
Joseph F. Schoenstein
build a Private One Family Dwellin
at premises located at 165 The Short Lane
East Marion N.Y.
Pebble Beach Farms---Map # 6266 Lot-2
pursuant to application dated June 1/~ ' 19 ?'8, and approved by the
Building Inspector.
Building Inspector
1000-30-2-3
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 unusua~ 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 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 $5.00
3. Copy of certificate of occupancy $1,00
/9??.
Date., .~..Q-..~:.'~... ,/ .........
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property . .~. ~..~.~...'T'./~./-~..,~'J~.q ~-.'~....~.../~)?~f.~..... ~,~./~...~'.~,...,/~../~)../~../io.../~',. .....
House No, Street Hamlet
Owner or Owners of Property
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision. ,~. ~,J~.~.l.c~..~).F_. ~.~. ~..~ ~ ¢-, .f~.% ..... Map No, ' Lot No...?-. ..........
Permit No. ~.~.~.~)~?~. Date of Permit ~.]!~./.~.~..Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $..~7..~ .....................
Construction on above described building and ~ermit meets ali a~ble code~_s a~d regulations.
Rev. le-lo-Ta
I I
0 0
70.27
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/Yl:~~-~ d:)(:: :_:?': :': ,, ' ~ water supply and Sewage dis
o~4 ~em for this residence will con-~
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~OWN O/~" ::~ :t40~ O~ /"Y.~ '; ,
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TErn. '7~5-c'660
TOWN OF 13OUTHO/D
OF'FlOE OF BUILDING INc:IPEOTOR
TOWN rl-LEI~K'S OFFICE
SOUTHOLD, N. Y. 119'71
TO~N OF $OUTHOLD
BUILDIN~ DKP~RTMENT
TO~N ~LERK°$ OFFI¢~
~OUTHOLD~ N. Y.
Approved .......... ~'l~'J~' ....... I/f ........ , 19.,~8.. Permit No. '"9~8~ ....................
Disapproved a/c ................ ;;.-;.==:.~.¥.,~ ..........................................................
/
..................... ........
Application No
APPLICATION FOR BUILDING PERMIT
Date .......... "/' / 19.
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 lot and of buildings on premises, relationship to adjoining premises or ptJbJic 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 perm,i
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 pursuat~t 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.
(Si'gnature of applicant, or name, if a corporation)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber o, buiJderr
......... . . . - ....................................................................................................
Name of owner of premises ........... ~.~::.~.;~....~.~.......'.~.......:~)..C:Nt.~...~-.~..~..~.~,.4~:~,~ ......................................................
If applicant is o corporate, signature of duly authorized officer.
..................
.......... ...... ............. ................................
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 occupancy ......... ~..~...~~ .......
3. Nature of work (check which applicable): New Building' .... Addition .................. Alteration .................
Repair .................. Removal .................. Demolitior ..................... Other Work ....................................................
(Description)
4. Estimated Cost ............ ~,~..~..~.~. ......................... Fee ..........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units .......... / ............... Numbcr 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 .........~....~.,...~...C.~. Rear ................................ Depth ....................
Height ........................ Number of Stories .................................................................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ............................
Depth ............................... .. Height ............................ Numl~er o(fStories ............ '~"F"'"~" .......
8, DimensiOns of entire new construction: Front ......... .~..,?.,...~../....._... Rear ......~...?.....~.. .......... Depth ..,~.....'./. ...........
, t /f
Height ¢~..~....~.. ....... Number of Stories ...... ~:fkcC_~:...~b<lz..~; ....... ~ .............................. .~...i ...........
9. Size of lot: Front ............. "~1 ---/,7~'~'~'''~*''-z,,~, ............................... Rear .......... ~..~.......................! "-'.... Depth ...~o~...~ ................
10. Date of Purchase ..... ~../~../..~.,~.// ................... 'c'' 'c''~ ';~'Name/p'f For_~e? ~.~ ...................................................
1~ Zone or use district in v/hich premises are situated ~. .................................................................
~2. Does proposed construction violate any zoning law, ordinance or regulation: ............... ~..~. ................................
13. Will lot be regroded . ....... ...~,.,,~. .......... Will excess fill be removed from premises: ( ) Yes
14. Name of Owner of premises ..~.~q'.~..?...r~.~f..~Address .~,.'.,.. Phone No.
Nome of Architect .......... ..~?.¢....'~...:.'./.~'. .................... ~ .......... Address ................................ Phone No .......................
Nome of Contractor .,(~....~..~...(~.......~.~....¢..c::~ .~...~7~.<..'~. Address ~..~..~. ......... Phone No.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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 Io~ q,~ ~¥'~ .
/
-.~.% | ~ ~5-~
STATE OF NEW 'ilO.RI/,,/ ~ /~ /~q ~ .
~~ ............. being
~of individual signing contract)
duly sworn, deposes and soys that he is the applicant
above named.
Fie is the ........ ~ ...............
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove 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 forth in the 9pplication filed therewith.
Sw~.n to,~re me this ~ ~
...........................