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Home My WebLink About10448-z FOES[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10~148 Z Dote ..~.~...,~.~ ...... ../...~ ....... , ~9.Z.~ Permissioh is hereby granted to: ....... /. .~. . ~ /. .,:z. ,~.:. . . . ~ . .. . . . . ~'~. z~. . r.,. /~. Z ~. . . to ...... ¢~.~..~c~.~..-....~:?~ o.~.~_~.[x:.;~-~..m.~...:~....~.,~z~.~..5 ..... ..... .......................................................................... ....... Z ...... ~ ~. / ~... ~ .... ~ ~ee ,.Z~ ............ ~uildin~ In~ector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions This application must be filled in typewriter OR ink, and submitted ~ ~.--.~ 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 Amhitect or 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 property 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-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.Oo $15.00 $15.00 Date .... 7t~:~ 7/O~.~ ............ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property }~7.~.~ ~.~,..~~..~.~....~.' .~.' .~.''..~.,~/... House No.,__¢l ,~ uI Street ~J Hamlet Owner or Owners of Property .l~..~¢J,~.~. .~.(~/.~L].~,'/ .................................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision..t/~. ~.7. ~. ............... Filed Map No ........... Lot No .............. Permit No..1. Q~,.4.8.~... Date of Permit .......... Applicant..~..~ .~..~...~.'....~.. ~;... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Tempo rary Certificate ..................... Final Certificate ...... ~ Fee Submitted $,..~., ,~, .~,,, ,~..~.../.~.C).~2, ..... Construction on above described building and permit~Feets all apl~J~ble codes and regulations. Applicant ................................ Rev 10-10-78 Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OP $OUTHOLD TOWN HALL, $OUTFIOLD, N Y. 11971 765-1802 3/12/86 Dr. Samuels was notified that 3-BP are waiting to be finalized. 10448Z 12208Z 13403Z Greenhouse--Leanto Inground Pool ND--~onvert garage to) C.O. applications were sent. He will be scheduling inspections for all. Or he will be having the builder get in touch with us. George Pontino 765-1802 BUILDING DEPT. INSPE(:TION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: FINAL INSPECTOR _.. ¢ ?LuN~ltQC~ lz-i p,...~' A ! FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:~ Examined Z ,1977 ApplicationNo./ .¢. . ....... Disapproved a/c . . .-i'.~ ................... ~ .......... // APPLICATION FOR BUILDING PERMIT Date 1~ ,/12" /7 q 19 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 &aBram 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 Build~ng 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 taws, 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) , ~.u4. ~- .2:-.~.~.~..~...~.... ~.~ .~.-~? ~, ~ / ,~v.: ~. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . tS~.~d..'.~. · .%~. ~.q.~. ........................................................... (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. (~9~"~cg4~ ' · Plumber's License No ........................ Electrician's License No ....................... Other Trade's License No ..................... 1. Location of land on which proposed work will be done. /- dP 7~ ,r ~... F/.~ ~ .~..m. y~...~. ?. ~ ~ ..... x..~...F.~. ~..~.&.. ~ ?..r~. ~..~? fi:.u. ~x....~. ,. ~ ..... House Number Street Hamlet County Tax Map No. 1000 Section //! / Block ~ ? Lot ~?zO - Subdivision ~.~.'.~'.~./.g/.~. /~?.~:..~. ,~.~.~. .°~. . ./.~../.~d.. Filed Map No..~..~.~. ........ Lot..-.~fi. .......... (Name) 2.State existing use and occupancy of promises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy ............ ,~,~.~,t'~ ,,~..~.~?. . . 10. 11. 12. 13. 14. · · ~7~-~,r,'~o teb;, · Nature of work (check which applicable): New Building .......... Addltlon .......... r~eratlon .......... Repair .............. Removali .............. Demolition ............ Other Work ............... ' ~ (Description) Estimated Cost ; (to be paid on filing this application) If dwelling, number of dwelling unit.s ............... Number of dwelling units on each floor ................ If garage, number of cars ........ ~ .............................................................. If.business. commercial. . or mixed occupancy,. , specify nature, and extent of each. type~ of use ......... ~. · ;, ..... Dnuens~ons of exlstmg structures, ffiany: Front .... 'liar. ........ Rear., .~.,2,- ........ Depth .... ~ ...... Height ............... Number of Stories ...................................................... Dimehsions of same structure with aiterations or additions: Front ................. Rear ................ Depth... ~ .................. I~eight ...................... Number of Stories .................... Dimensions of entire new construction: Front ............. Rear .............. Depth ............. Height .~.~'.~ .......... Number 6f Stories ..... ~ ................................... ., ............ Size of lot: Front .... ~.,-,~... ..... : ....... Rear ..... '.7..~.. ............ De~>th . .?...&.':'~.. · . ~: ......... Date of Purchase .... /~,~,/f~....; .............. Name of Former Owner., .~.A.' .~/~.~, .27, .~_'_'_'~):~, ..... Zone or use district in which premises are situated.....~2. ? ............................................. Does proposed construction violate apy zoning law ordinance or regulation: ./~.O. Will lot be rbgraded ............. I ............... Will excess fill be removed from premises: Yes - No Name of Owner of premises ....... I ............. Address ................... Phone No ................ Name of Architect .............. i ............. 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. Giye street and block numb!r or description according to deed and show street names and indicate whether interior or comer'lot. ,. STATE OF NEW YORK, S.S OONT¥ ..... .... ?J..~...2.~. ~ ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named, He is the ................... ' ............................................................ (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 all Statements contained in t,his application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forti~ in the application filed therewith. Sworn to before me this ..... ............ dayof .... ............ , I;Z¢ ' Not t' o, ....................... ........ ~4_.,,'---''~'--~'~' ' ..... Jqi~. ~s~ - s~{{o~k c~u?v~_4,f Signature ofa vlicant , ~.emml~slorl Explro~ March $0, '19~.~' ( - P- )