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Home My WebLink About9807-zTOWN 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) N? 9807 Z Permission is hereby granted to: /- // // .......... , ...~..~,-~.Z~,~x ........ ~.'.~. .......... ~_..7...~.x ....................................... ......... xx~~.~..7./...~ ........ ./.x ~o ........ .,~..~, ..~x~,Z_....~_...x~.~:.~.......~x~......~~ ................... ../. _~ ~ ' v / / ........... ~'...4.'.1.. . . .~ .................. ~ ................................... .:;:..~ ............ ;, ....................... 'r ......... ..... .--.x..~..~...x/~,~.? ~~...~....~x..,~. .................. p.rsu~nt to opplication doted ......... ].~ ................. , ]9 '., and opproved by the Building Inspector. 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. B. 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 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 3. Copy of certificate of occupancy $1,00 $5.00 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~. ~I. .... ................................................... ; ....... House No, Street ~ ~ ~t~ ~1 ~ ~,Hamlet Owner or Owners of Property ........ ~ ~.~....~ ~ ~.., C~.~ ~: .............. County Tax Map No. 1000 Section ............... Block ............... Eot ................ Subdivision ................................. Map No ............... Lot No ............... Permit No. ?/. :t.O.?.'.~. Date of Permit .~./.~.7.~. ??.Applicant..~..~.LF...~./~, .f~ ~.., .~../~_.~..r~, . . .C,T.O..~?../,~... Health Dept, Approval . ?..-?.o..~.~.'.~ ............ Labor Dept, Approval ........................ Underwriters Approval....~?.~?.. ~ .~'.~' .......... Planning Board Approval. ..................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ..... '.~...~.~. · ................. Construction on above descr bed building and permit meets all applicable codes and regulations. Applicant ........................................... Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 FOlr, M NO. ! ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE //~ SOUTHOLD, N. Y. Examined ..... 2~'~,~, ...?-.Z.. , I'..'7.~'.. ~ Application No. Z~.Z. ........... APPLICATION FOR BUILDING PERMIT '~ ....... ................ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Insj~ector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule~ b. Plot plan showing Iocatior~ of lot and of buildings on premises, relationship to adjoining premises or public streets o~ 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 or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os 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. Name of owner of premises ........ . .~..~..~.?.....[~...I. .......... ..~.....~.....t~.....~.. ........... ~.....~......~...: ................................................ If applicant is a corporate, signature of duly authorized officer. .............. ii~ and title of corporate officer) Builder's License No ..................................................... Plumber's License No ...... .~....~ .................................. Electrician's License No ..... .~'...~...l~..~....,n~'~"~i~fe"' Other Trade's License No ............................................... Locetion of and on which proposed work will be done. Map No.: ................ ~ .................... Lot No ......................... Street and Number ...~..~-....~-....-~.....q~.....~.....W~.....:~....~...-.~.~.t.'~ . --~ __ &, ,,P ...... ed...~.....~..~....~...i.~...~.q~. ~1~..,.....~.....~...' ......................... (I~/~*"T*~'%~'*~I¢'~I~ I I'~J~%d/' Municipality 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 .................. Remover .................. DemotJtior ..................... Other Work .................................................... 4. Estimated Cost ~ p id on filing this application) 5. If dwelling, number of dwelling units J 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 struc?res, if any: Front ............................ Rear ................................ Depth .................... Height ........................ 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 ....~......1~ ........ 9. Size of lot: Front ............. ~ ................................... Rear .......................................... Depth ................................ 10. Date of Purchase .................'------l'~' ...~.~/~ ....................... Name of Former Owner ........ (~.~J~...lm~l~..~ ....................... 11. Zone or use district in which premises are situated .............. i~11~...I.~..~.1.~ ............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................ ...~...~.. ................................ 13. WHI lot be regraded ........~....~...~. ........... WHI excess fill be remo~ved from premises: ( ) Yes ( ~/~1~o b ' Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all 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. STATE OF NEW YORK, [cc COUN FY OF ................................. ' ..... .!..~..,,~,....~....~...~..~.,...~.._~..~...~...~..,...~P.~ ..~.. . .,being duly sworn, deposes and soys that he is the applicam (Name of ~ndividual signing contracf) above named. ............................ .......................................................................................................................... (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 aH statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be perfo~ed in the manner set fo~h in the application filed therewith. Sworn to~ore me this ...... ........... ..................... Notary ...... Co..U ................... ......... NEW APPLICANT. _ __ ADD~ESS TEL ..... now or formerly Chrisfine tq/ng 60.09' NO rE' m -' MONUMENT YOUNG & YOUNG 400 OSFRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W YOUNG HOWARD W, YOUNG SURVEY FOR: ;~DELPHI LAND COt~P. MA TTITUCtq SOU TNOLD ' = 40 NOV. 19, 197~ THE LOCATtON OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FtEL0 THE WATER SUPPLY AND SEWAGE DISPOSA~ SYSTEM~ FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMEN1 SUFFOLK COUNTY DEPARTMENT OF FOR APPROVAL OF CONSTRUCTION ONLY A VENUE YOUNG &'YO z[OQ OSTRANDER ~VENUE, RIV! FOR} ~ MATTITUCK ·: sour~oz~ ',~UFFOLK CO., N. Y, 40 ~ DATE: NOV, GUARANTEED TO: 1014 NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM to 4PM FOR REQUIR- ED INSPECTIONS~ 1. BEFORE BACKFILLING FOUNDA- TION OR START FRAMING 2. FRAMING INSPECTION 3. BEFORE COVERING PIPES OF ANY KIND 4. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTION MUST MEET REQUIREMENTS OF N.Y. STATE CODE AND TOWN HOUSING CODE & ZONING 0 NY~ PI ;/ 42~]7 S T' " ' ' "I S CONSUL]If.LO E bJ Gl N EER