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Home My WebLink About10411-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST DE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? ~0~ Z Date~....../(...~....., 19~..~... Permission is hereby granted to:,, ..~.7o....~z~....~,. .................... ...::~.~~~..~.~ .......... pursuant to application dar ............. , .., and approve the Building Inspector. Fee, ./.~... ............. FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 seweragedisposal-(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 pr 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 unusual natural or topographic featu res. 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-existing dwelling or land use 3, Copy of certificate of occupancy $1.00 $5.00 Date..~/~ .d./. ~..~ ........... New Building ............. Old or Pre-existing Building .. ~. ........ Vacant Land ............. Locat,on of Property ~7/Y/-) >(.~./?./.~. )b/. .~'~).~.~ ...... /.~..£} .~/~. Z-, '../.~,c../.Q.....~... ..... House No. Street inlet Owner or Owners of Property ~0.~. :.~....~..o.~ .(2..~.-... ~.~..A J: .~...~..~../V~. ................... County Tax Map No. 1000 Section ~.~... Block Lot ................ Subdivision ................................. Fried Map No ........... Lot No .............. Permit No/~./,//. ~... Date of Permit ~ ./.~/.Z'..~..Applicant .................................. Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval .. ~ ................. Request for Temporary Certificate ..................... Final Certificate ....~.. ................. Fee Submitted $ " 4,.~',.. Applicant..~.~f'J ~~.~.~...~ ......... c'T o ,.v. ,o-,o-,a .. TOWN OF SOUTHOLD OFFICE OF BUILDING I]NSPECTOP, TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 August 5, 1980 Roy S. Monahan Box 471 Mattituck, N.Y. Dear Mr. Monahan: This is to advise you that the ~ob under Building Permit No, 10411Z issued to R. Monahau on Sept. 19, 1979 for fire~±ace appears to be bompleted as of our last inspection. Before you can legally use or occupy this structure a Certificate of Occupancy must be issued. Please fill out the enclosed form and return same to the above office. There is a fee of $5.00 for a Certificate of Occupancy' Thank you for your prompt attention. Very truly yours, GEORGE H. FISHER Sr. Building Inspector encl. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 August 5, 1980 Roy S. Monahan Box 471 Mattituck, N.Y. 11952 Dear Mr. Monahan: This is to advise you that the job Under Building Permit No. 10411Z issued to R. Monahan on Sept. 19, 1979 for fi~ep±ace appears to be completed as of our la's'~ inspection. Before you can legally use or occupy this structure a Certificate of Occupancy must be issued. Please fill out the enclosed form and return same to the above office. There is a fee of $5.00 for a Certificate of Occupancy' Thank you for your prompt attention, Very truly yours, GEORGE H. FISHER Sr. Building Inspector encl. FORM NO. 1 TOWN 'OF SOUTHOED " BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 p TEL.: 765-1803 Examin~d~'.~.~.~. ~.'.../..~..., ].9 .~.X Application No. ~.~.).~. C./. ........ Approve .f .'../. 197.;. Permit No. Disapproved a/c ..... -:.-77.-7. ............... ~-~ ........ ............... ............. (Bmldin~ Inspector) APPLICATION FOR BUILDING PERMIT Date ...... 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 ~ssue 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 necessary inspections. ~ ,~ - ...... (Sigmt~re of applicant, or name, if a co porat'on) ~ ~. .,!.7./. ~ . .~:). .~. .r. . ~ . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .. o. c~,.b. ¢. !.< ........................................................................... Name of owner of premises [~.)/. ,5.. ?~.') ~.JF.~.J.~.~.).A~..~..Iv..~. ........................................... (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 ................................................ · ..4.?A ............... I:l .o ,?.~x; ....... .~.~!a. ............ /73. ~../7/.-~'. '.:~.~. :~..., ,~' '/ ....... House Number Street Hamlet County Tax Map No. 1000 Section ~./.~. [.. Block . ~..O. ~ .... Lot... ~...~.. ~ ......... Subdivision .................................. Fried Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of propose~ construction' b. Intended use and oc pa ey .... .m~. ~PF-~m,~ .... ~-t~-A~... ~~'/q~'~<, ................ 3. Nature of work (check whmh apphcable): New Bml&ng .......... Ad&tmn .......... Alteration .......... Repair .............. Remgval .............. Demolition .............. Other Work ~./:R~ .'?~...~.~. ~ ~' (Description') 4. Lstnuated Cost. :/./~..0.~.. ~). ~ ......................... Fee ...................................... I (to be paid on filing this application) 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 structuros, ifany: Front ............... Rear .............. Depth . .............. Iteight [ Number of Stories ....................... D~men~ons of same structure with alterahons or addmons: Front ................. Rear .................. ' l~e])th Height Number of Stories ' Depth ...... · Front Rear 8 D~mens~ons of entire new constructton . · · HeightI ............... Number of Stories ........................................................ 9 Size ofilot: Front Rear Depth ........... I0. Date of Purchase ........... . .................. Name of Former Owner ............................. I 1. Zone o¥ use district in which premises are situated .................. , ........................ 12.'Does pioposed construction vioiate any zoning law, ordinance or regulation: .~ ....................... 13.'Will lot be regraded ............................. Will excess fill be r. et;noved from premises:. ~ Yes. No 14. Name of Owner of premises~ .-~,. ~?2.~dress ....~./F'~. · ....... Phone No~. ~'~t'..,-: ~.~ ~. ~.. Name of Architect ........................... Address ................... Phone No ................ Name 6f Contractor Address Phone No ............. PLOT DIAGRAM · ~ Locate ~learly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back .dimensions. from ~~treet and block ;number or description according to deed, and show street names and indicate whether STATE OF NEW Y.ORKr COUNTY OF · ~z~/:~/."~ ....... above name~(.Name ~f individual signing contract) being duly sworn, deposes and says that he is the applicant He is ~he .. l ........................ ~.~..~. ,~..--r~ ~ ................................................ i i (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 fde this appli0tion~that all statements cont)ined in this application are true to the best ofh~s knowledge and belief; and that the work ~vill b~ performed in the manner set forth in the application filed therewith. Sworn to before me this ........ X/....~v~ ..... day o~.....~.. Notary Pub!ic, (Signature of applicant)