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Home My WebLink About10447-z ~FOI~M NO. 2 TOWN OF $OUTHOLD 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? 10447 Z Permission is hereby granted to~ ~ . ...... '.~. ~/~ ...~.c..~. ~.~,~i~ ....... ...... ,j~....~,//~.~....~,,~ .......... ...... ........ ~o ..... F,j~./~,.~.~...~.~.o.c~.....~,u.~.,,,~.O. o,,~,~.. ..,q~ ~......4~....~'',,~e'~... ............................... at premises located at Z~.....~:~" '~' +~'-Y~'"~'~ ...... ~...-~Z.~-~t~. ~...~.~. pursuant to application dated (~7'~'~..,~. ...... .-~.~. ................ , ]97..?.., and approved by the Building Inspector. Inspector TOWN OF $OUTHOLD Building Department Town Hall $outhold, 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 requirementswhere 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. Cate of any housing code or safety inspecti/on 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 $5.00 Date ..... New Building ............. Old or Pre-existing Building(X} .. ........ ~/Vacant Land ............ Location of Property .,,2000 Gillette Drive . East Marion, New York House No. Street Ham/et Owner or Owners of Property ...:E~oger Sch±z~e~Ii~er..an~l.p. ame:L¢..S.(;~_~.e.$~¢Z. ........... County Tax Map No. 1000 Section .... ¢ .......... Block ............... Lot ............... Subdivision ...~.~9. ~9~ ................ Filed Map No. 2038 .Lot No. 14 Perm.t No...~.~,. Pate of Permit .......... ~ ................ ~ .... pplicant10/1?/? RoCe= Sc~i~e Ze= ............. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ................. Fee Submitted $..5,: .0.0 ..................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E om,ned .............. ,J...q... ............ .............. , ,,m. ..... o,,op~o~,~ ,~, :'"'"2~ ....................... ~:'"~ ....................... t ..................... ............................................... ............. 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 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, 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 ir~ buildings for nece~ry inspections. /'/ ......... ......... (Address of applicant) State whether applicant~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Lic~se No Plumber's License No .............. .~/~/~ .............. .,~ .... Electrician's License No .... ~~,....V~ Other Trade's License No ............................................... Location of land on which proposed wo~ will begone. ~p~o.: ....................................... Lot No ......................... O0 0 ~ ,'1~ ~ b~ f~,~ Street and Number ............................ ~..~ ................. ~.......,..,.¢. ................................... Municipoli~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ..... ~........~] ...................................................................................................... b. Intended use and occupa nc y ....~~... ~.]'Z~~...~(~~ .~ / / 3 Nature of work (check which ~pplicable): New Building.. ................. Addition ...~ ....... .,.... Alteration ............ Repo,r .................. Removal ' ................. Demolitior ........~ ....... OIher Work .~..~..O.L....~,......?...'~...~.,..~....,~'~~ ~ -~"=~ (Description) 4 Estimated Cost ....... ...~......~....d.....~....~ ................ Fee .../~..Z.~..'..~ ............................................................ I (to be paid on filing this application) 5 If dwelling, number of dwelling unHs ..........................Number of dw~elhng umts on each floor .......................... if garage, number of cars ...... i ............................................................................................................................. 6. If basiness, commercial or ~ixed oceupanes'C ~peclfy nature end extent of eoch~type of use ........................ 7. Dime~ns,ans of existing structures, if eny: Front ~.. Rear ~ ......... Depth~ Hei0ht ........................ Number of Stories ............................................................................................................. D~mensions of same strueturelwith alterations or additions: Front ....................................Rear ........................ Depth ................................ H~ight ............................ Number of Stories ................................ 8 Dimensions of entire new construction: Front ..... : ........ : ..................... Rear ............................ Depth ..................... Height .................... Number !of Stories ................................................ ~ .......................................................... 9. ze ~f lot' F ro~, . Rear .0.. ~ .....................Depth ...1 ~ ~ 10. Date of Purchase ...........'.....:.~ .,~. ..... ~/.......l.. ................ Name of Former Owner ........................................................ 1. Zone or use district in which premises are situated ..................................................... .,~-..j....~;,~ ........................ Does proposed construction vi$1ate any zoning Iow, ordinance or regulation'. ....... /...~.~......¥,~': .............................. 12 13 W, II lot be regraded ..... ~.~.~z ,ri-- ......... Will e,xcess fill be removed from,.../,~premises: (~ Yes ( ) No Name of Arch,tect ......................... ..~....~..~.:~/...~..!.!.~. ~.... Address ................................ Phone No ....................... Nome of Contractor ............... ........................................... Address ................................ Phone No ....................... PLOT DIAGRAM L.ocote clearly and distinctly all buildings, whether ex=sting or proposed, and indicate ell set-back dimensions from property hnes Give street and blo~k number or description according to deed, and show street names and indicate whether interior or coiner Io~ ~ /~ 0 j '"'--,-~ STATE OF NEW If~Rl~, / ~, / /"S S COUNTY ' , ~"'~V~~4~. .. 2.. be,ag duly sworn, deposes and says thor he is the applicard ................ i ' 7'' , , above named, , ,-- "~/~ (Contractor, agent, corporate officer, etc.) of °aid owner or owners anti is duly authorized to perform or have performed the said work and to make end file this application; that al/ stotement~ contained in this application are true to the best of ~is knowledge and be ieF; o,~d that the work will be performed.in the mbnher set forth in the application filed therewith. Sworn to b~fore me this ~i ' // ........ ).~..~1... day of ................. '~'~,.,Z~"'"" 19'~7" ,~x'~.,4..~~'~/~ '4~ ~ ELIZAB~H AH NOTARY pLIBL C, State o! Hew Yof / No, 52 ~125850, Suflo k Co~.~ Term Expires M~'c , ~ ~