The URL can be used to link to this page

Home My WebLink About10398-z FOEM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TH~ PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10398 Z pursuant // Building Inspector. b' Fee $.../. ................... FORM NO. 6 TOWN OF SOUTHOLD Buiiding DeparTment Town Hall Southold, N,Y. 11@71 APPLICATION FOR CERTIFICATE OF OCCUPANCY BI.DG DEP'[ TOWN £)~: SOUTF!OLD Instructions A. Th~s apohcat~on must be filled tn typewriter OR ink, and submitted in duplicate to the Building inspec- tor with the following; for new buildings or new use: 1. Final su~zey of property with accurate location of all buildings, property lines, streets, and unusual natural or toDograohic features 2. Final ~proval 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 s~te plan requirements where applicable. B. For existing buildings {prior to April 1957), Non-conforming uses, or buildinas and "pre-existing" land uses ~ 1. Accurate survey of peopert¥ showing all property lines, streets, buildings and unusual natural or topo§raphJc features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Da~e of any housing code or safety inspection of buddings or premises, or other pertinent mforma- tion required to prepare a certificate. / Fees: 1. Certificate of occupancy 85.00 2. Cartd~cate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ............. Old or Pre-existing Buildmg(:~) ...... ~ ZVacant Land ............ Owner or Owners of Properw ~0~ ~ L~-~ County Ta~.Map No, 1000 Section .... /.~ ..... Biock ~ Lot .... · ................. Heahh De~t, Approval ...................... · . Labor Dept, ADDroval ........................ . U~derv~rlters ~proval ........................ Plannio~ Board A~ovovaI .................. ~eq~st for Temporarv C~mfica~e ..................... Final Cerdflcat~ .. ~...- ......... Fee Submitted S .......................... o~tr~t~nonabovedescribedbu[iding~ern~ir~e~s~app~odesandregulat[ons. ., ~.~',.: .~ : . .. TO N OF SOUY OLD O~F]cE O? BUILDING ~NSP£C~OR P O. BOX 728 TOWN HALL $OUTHOLD, N,¥. ] TEL. 76~.1802 llLDC TOWN 0~:' Applicant Perm.it 1~o. /O~q~ i~s,~d t~ ~ . 3~unopr ~Ul!d~n~ o,,,v-ete this file, it is necessary that a Cer%~rica%~ of O~=..cy be lssued. F!ease fill out the · cr.,(s) , resurn same to the above office with a check for $5.00 payable to the Town of Southold Flease n .... ~e to whom the Certiflcate of Occupancy is to be mailed, and arrange wlth this offlce for an inspect'ion date. Thank you for your prompt attention. VL:ec Enclosures Very truly yours, Victor Lessard Adminis tFa tot FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 Examinej~.~ . ./~i f' ..... ,19l..~ TEL.: 765-180:~ Application N°. ~/~2'' 70~' ........ Approved~..~'/~' , 197 .~. Permit No .........//~.) .~. ~. 0C~...,-/?~ Disapproved a/c .................................. ../ (Bfiildlng Inspector) APPLICATION FOR BUILDING PERMIT 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 public streets or areas, and giving a detailed description 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 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, 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 necessaw inspections. .............. (Signature df applicant, or h~me, if a corporation) · .B.x..3-.,s'~..tO ~,.~J..~, .~Y,)/...//..~.~-2~. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... /~x.o.~... fi.. ~'] r.~.o~P. ~..~... Name of owner of premises ·..~.'~. ~..'Q?...~/../-~ .(-~. tTI,c~ .~./. ~.~ ......................................... (as on the tax roll or latest deed) If applicant is a corporation, 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 ..... ~..~? ............. Location of land on which proposed work will be done.. ~ ~ f-)..~-.~. · · ~. ~. · , - ~~.'~"~' · · .. ). .7. ................ ....?! .,...s; ..... .......... 1.,. ........ House Number Street Hamlet / ~ ~/' ~ff/ Map No 1000 Section lC/ Block ~ Lot County Tax . ' .... : ...... ~" ........................ ~' ' ' ' ~_~2 ........ Subdivision.· .~ .~ .~..J.T..~£..~.. ?.h. ?.?... '..:~...07. Filed M~p No....~t~_ ] ........ Lot...~.~.§ ..... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... R.~"-.~.,. ~l..~.1~ .~.~. .......................................... b. Intended use and occupancy ...... ~. ~. ~.~ 4..~..~1..¢'. ~ ........................................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ............. - Removal ............. Demolition .............. O,~er Work ~.~]/~.)C.. L . ~ ~ (Description) 4. Estimated Cost ....... ,~,~dO.: ...................... Fee. ..................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ...5.~ .......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. D~menslonsofex~stmgstructuresilfany: Front .... .:9~O ........ Rear .'.,~,.O. .......... Depth .... Height ............... Number of Stones ............ ~9.t'J ......................................... Dimensions of same structure with alterations or additions: Front ...... ,~!.d../. ...... Rear .....,~...t. ......... Depth .......... ~ ......... ;. Hmght ...................... Number of Stones... ~ ............. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ......... NumBer of Stories ......................................... ~. ............. 9. Size of lot: Front ............. -- ~_:..-5~.~..~ .... Rear .... ~'-~.. f ............. Depth ..././-~...' .............. 10. Dater' of Purchase ...7././.2~/.~. ................ Name of Former Owner ............................. 11. ' Zone on use district in'Z'' --which premises are situated ..................................................... · ' gte ~..d 12. Does proposed constructmn wol any zoning law, ordinance or regulation: ............................ 13. Will lot be regraded ........ ~ ................. Will excess fill be removed from premises: A" Yes No 14. Name of Owner of premises~..~$~/l .-:~ ~.¢/~¢~. t ~'.~Address/~fi.../~/.J/(--.~//., .5. ¢O..~. Phone No2~/~."~. 7'.",~/~,, Name of Architect .......... i ........ :/~. ......Address p).~-.r~ ~.$$.eD/y~./[/.. Phone No ................ Name of Contractor . . . . .(~..(,~.~.0......-7~....t":L. ~..~... Address ................... Phone mo.~.~.. ~..t-lt.~..~...0.. '~ PLOT DIAGRAM ~I, Locate clearly and distinctly all jbuildings, wb,ether 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 ¥ORI(, ....... ~..~..½/.././q' J~...~.[ .~ ~ ~4.~ ........ being duly sworn, deposes and says that he is the applicant (Name ~individual sig~ing cofftract) above named. ~r ~gent e~c He is the . .~ .................................. , , corporate officer, .) of said owner or owners, ~d is du~y authorized to perform or have perfo~ed ~e ~id work ~d to m~e ~d file this application; that all statements eont~ned ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~n~r set forth ~ the application filed therewith. Sworn to before me this ff ' ....... ..... NOTARy ~ ~LIC, NO ', ....... " , -16 ,,8, 5 6cj ° \ pegON~G SURVEY $U$,0 Al AT M~TTITLICK TOWN OF SOUTHOLD SUFFOLK COUNTY, SCALE: I"z $0' ~/ULY 13, 1978 FOR d LEMEFClSE REFERENCE ', i~fATTITUCK PARK PROPERTIES IMO. FILED 1'12-26 AS MAP NO GUARANTEED TO ~ THE TrTLE GOAR/~IVTEE COMPANY SUSAN J, LEMERISE' LAHD :~URVEYOR · qlVERHEADm H.Y,