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HomeMy WebLinkAbout9794-z FOE~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~? 979~ Z Permission is hereby granted to: Jack Thllberg to .~1~ .~ ~.~.~.s..p.g.p.g..o.1 ..a~....d. fence at premises located at 175 ~!t Road & 55 8~ ~e ... ~o~o1~ .~ 7~r~ ................................ pursuant to application dated ~e 1 ........ ........................................................ , 19 ~8, and approved by the Buildin~ Inspector. Fee $....I...~...0. O. ......... 1000-78-9-9 Building Inspector FORM NO. 6 TOWN OF $O~THOLD , Building Department Town Clerks Office 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 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 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 installations, 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of 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 dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 · ×o, Date New Building ......~... ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ./~...'.?...~.i..~.~'~t~:~./..~'.~'~/-....~.......~.~......~..~.~..~.~T~ ...... ~.~..¢~.~.z~..; ................... Owner Or Owners Of Property .....-~...~.~./.C......~../.: ....... , .~.~..//~.~-'~../~ ........................................................ S d v Ion "~' ub i is' · ............................................................... Lot No ............. Block No ............. House No ............. Permit No../?.~...~. '.~.. ~.... Date Of Permit .~...~.~../.:] .~...~..Applicant .... .-~./~.~/~...~..~/z/..~/~..6~..z~-~....~.. ..... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ~;~.,...~.~,~..~.~;~,./. ........... Planning Board Approvol ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate .......................................... Fee Submitted $ ...~,...~....~. ................... Construction on above described building and permit meets all applicable codes and reguJations. Sworn to before me this Applicant ..~.'.~......~.......~.,,__,j.. ................ day of ............................................ Notary Public .................................... County o (stamp or seal) n FORM NO, 5 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION (owner or authorized agent of owner) ..... .~..~..~.~.?:.~.....})~y. ....... ~ ..... .?:~:z :-.g.~ "(address of owner or authorized agent '~"~wne~')" PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance ......................................... 7 Other Applicable Laws, Ordinances'or Regulations ............................................ at premises hereinafter described in that*~'?...~...f./.¢/,/...( ....... .~..~.'.%.~......~.'.s:...~.~.z::.....:,....~ ......... (state character of violation) ~,.~:~,~., .......... ~¢~.~.L ....... .~&..~¢ ........... ~ ............ ~:::c5...:~ ....... z~:.~ .... ...:~.~ ......... .~.~ .......... ~Z ....... ~ ....... :z......~ ...................... · ..................................... (~gt~ ~e~gg"g~'"~g~?'~gg"~T'~?~i~6'i~"i~'~: T~gg g~"~T ~e~di~ig~ ...................... YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the Iow and to remedy the conditions above mentioned forthwith on or before the .............. ..~z.:,.:.=.,: ..................... .~.~... ....... ................................ ,~,, .............. t9...2.O day of .-..~l The premises to which this ORDER TO REMEDY VIOLATION refers are situated at ,...~,~,~.~..../.~,~....,~'...;.~r~,~,.,~,~f,~.,...C;~'.~..;~AT.. of Suffolk, New York. Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. Building Inspector Approved ........tl'tllte ....... ~'~ .......... , 19..~. Permit No .......... ¢~ ............... Disopproved a/c ............................... ~ ............................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application INSTRUCTIONS a. This application must be completely filled in by typewriter 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 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 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 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 na~n/~ if a corporation) State whether applicant is owner, lessee,~'a~ect, engineer, general contractor, electrician, plumber If applicant is a corporate, signature of du y authorized off'ce. __ (Name and title of corporate officer) t'75 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 b~ dona. Map No.: ........... Lot No ................ Street and Number ..... ................................................................................................ Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~ a. Exisiting use and occupancy cJ~'~"" / ~ / ~" b Intended use and occupancy .................................. ..................... ~ ....... .......... ~ ................. ~. ........... ,:.tit' ............. ~ 3. Nature of work (check which applicable): New Building...: ............... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work .~..~¢./..Z', .~./.~..~. ........ ~ (l~scriptidn) 4. Fstimated Cost .... ~..9~ .............................. lee .......................................................................................... (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 car's ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Fro~,t ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Namber 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 ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. N a m e o f Own e r o f p r e mi ses ... · ~'../-~.~.z'~.. · .~.- ~...~..~../..~-~6~-;~7¢ Add tess --~Z¢'. ,~PZ-.'~. 4..~... f~.. Phono No...~.~X.~ J/ Name of Architect ........................................................ (/...Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No. ...................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner ST^T OF s S . COUN'E'Y OF ~~..'".~.~" .......~-'- ' ............................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perforrn 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 thor the work will be performed Jn the manner set forth in the application filed therewith. Sworn to ~ me this ~ _ ~ ........ /_~. day~f ..,t~.,~..~. ............. , 19~ ¢ , . ~/ /// ,o, ...... ...........................