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HomeMy WebLinkAbout10394-z FOR~I ~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1039~ Z Permission is hereby granted to: / ..zf~.(....~..~;.; ......... at premises located at ..... .~.:...~.~.~.~. ........... .~..~r..'~.-~..- ~..~ .~r.~-~,....~r..-~r.-~..~...~.-.~.'~..'~.~...-..r..,r.. ~~...:...~....6..~~~..~....:, ' - (~-.~ ............... ~. ........ ,: ....................... pursuanf to application~dated ............. ~~ ~ ....... , 19..~./~.., and approved by the Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD B~i~ding 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: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-ex~sting dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date New Building . .. ~'.~.~ ..... Old or Pre-existing Building ............ Vacant Land ............. · ocat on of Property .... ...... :. House No. Street Hamlet Owner or Owners of Property ...~)~ .~, .~.~....~....~'~./[~.~../?. · ~., .... .~.O .~. ......... County Tax Map No. 1000 Section .... .c~ .~. ....... Block...o~.. .......... Lot... · .~/.~. ........ Subdivision . . ~..~/'~ .~./~Z/~... ~,~.~-~ ....... Filed Map N o...~'~,/..Lot No.. {~. ......... Permit No. /'~.~, .~.. Date of Permit ~.'~/o..-2~.Applicant .... ~~z...~.~.. ~.~'O~..'.... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... .~.~--~.~. ............. Fee Submitted $ .... ~..O~_o. ................... Construction on above described building and permit meets all ap~11~able codes and regulations. Rev. 10-10-78 ~, ~, 7-/~//~ i,:Q " Z~-Pe '5 Ai~) DITIOI~JAL C LOT SOUTHERN BOULEVA RD N.79e 14' O0"E' ITl LOT ~ o IDATE~B P. NOT~F¥ ~U~'~ ~ ~,T ~T 765-]802 9 AM TO 4 PM THE FOLLOWING INSPECTIONS' ,1. FOUNDATION - TWO IIRED FOR POURED C ~ 2. ROUGH - FRA~ING & I~ING 3, INSULATION ~, FINAL - CONST~ ~UST ~ BE COmpLETE FOR C O ~CON STR UCTION sHAL ~-~T~T~ ~ONSTRUCTION & ~ DESIGN OR CONSTRUCTION ERRORS. ; 1~2.91 ' DZENKOWSI~i (D FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined19 Z. ? Application ...... Approved~4v. ' · . ~ © ./(.'../..q..., 19/.~:Permit No../.1.~..~?...~..~. ~/ Disapproved a/c ..... }~-~' .~ 7.'~i ............ ~2~ ........ (Builaing Inspector) APPLICATION FOR BUILDING PERMIT Date . .Se. p.t.,....6 ....... , INSTRUCTIONS a. Th~s 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 bmldings on premises, relationshxp to adjoining premises or public streets or areas, and giving a detailed descriptmn of layout of property must be drawn on the diagram which is part of this appli- cation. 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 w~ll issue a Bmlding 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 Budding 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 m buildings for necessary inspecbons. (Sigrfffture of aptfflicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contrac~tor, electrician, plumber or builder. 0521e r Name of owner of premises ...S..t.oJ2.h.e..ri..J.*...S.o.h. ot..t..a.~.d...B.a.r.b.a..r.a..A.?..~.o.h.o..t.t. ........................ (as on the tax roll or latest deed) Jf applicant is a corporahon, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... .~.~.~.~..~. ............ Plumber's License No ...................... Electrician's License No ....................... Other Trade's License No t. Location of land on which proposed work w~ll be done .................................................. 1235 Cedar Drive East Marion House Number Street Hamlet County Tax Map No. 1000 Section . . .2.2 .............. Block . . .2 ............. Lot..4.4. ............... Subdivision.. A~uavlew Park Filed Map No. 5621 Lot ll (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~..i.n.g.l.e...F.a.m.i..1.y...D~..w.l.l.i.~ ........................................ b. Intended use and occupancy . .G.a..r.a.~e... ~z~.~?~.~..~C).2..r_~.~.. ...................................... 3. Natur~ of work (check which a >plicable): New Building . .~ ....... Addition .......... Alteration Repal~ .............. Rem oval .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ... $~1~000. ! .......................... Fee .~/O. OD [ (to be paid on filing this application) 5. If dwelling, number o~ dwelling~ units ............... Number of dwelling units on each floor ............. " If garage, number of ars ..... J,~' Oal) ........................................................ 6. [f business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Danensions of existing structures, if any: Front./&81,27 ........ Rear Height 1.~*. Number of Stories ). ..... Dimensions of same structure with alterations or additions: Front ................. Rear ......... ' ......... pth Height Number of Stories ............ 8. Dimensions of entire new construction: Front .. ~L6~. ......... Rear ...],6Y ......... Depth . I~ ............ mber of St ries l, ' Height .. l.~l*. ......... Nu o .................................................. 9. Size of lot: Front . .i~l?~,O0~ ,'. ........... Rear ... ~[Ol; ,~9.*. .......... Depth .~,~I~.,.~)17 ............. 10. Date of Purchase . .~/I~.~/.~.~] ................... Name of Former Owner A~IIIIt'~ ~.&~llO~ ~t,. . ..... 11. Zone or use district in which p~emises are situated .l$.~l~.tO~,.~OWrt, 12. Does proposed construction violate any zoning law, ordinance or regulation: .. ~10 ........................... 13. Will lot be regraded .,. I~O · · ! .................... Will excess fill be removed from premises: Yes X No 14. Name'of Owner of premisesltl(~)llll~)l. ,1'.o..& ...... Address . tt0~$):. ])lO~pI~al~l/. Phone No...~F.~.'.~..~?.~. .... a ~ ' . .1i[~1'1~t)~. A~ . ~101tO~...... Address ................... Phorie No ................ Name of Contractor Ot*)lOl' Add .................... tess ................... 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. 'j STARE OF NE~ RI)4 COUNTY 0 · -. · ~ · ,,n~,,, ~~i..~, '~"~,,,a,,, being duly sworn, deposes and says that he is the applicant above nm'ed. He is the.' .................. ~,~ ......................................................... (Contractor, agent, corporate officer, etc.) of s~d owner or owners, ~d is d¢ly authorized to perform or have perfomed the said work and to m~e and file this application; that ~1 statements cont~ned work will be perfo~ed in the m~er set forth in ~e application filed therewith. Sworn to before me this ........... ....... ~RY ~LIC, State of N~ ~ , ' , ~ 92-8125~50, Suffot~ ~e~ Expires March ~, 19~