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Home My WebLink About10463-zTOWN OF SOUTHOLD BUILDING DEPARTMEN'E 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? 10463 Z Permission is hereby granted to: ..... ./..~.~/,~/~.~..,,~'.c~/:~.~....../.~.C ............. ~'~/'J'z'"~ ~''~'~'''~ .... ~ ...... Z/~ ~z~.o......~ *.~ .............. , ~o ....... ~ ~.~.~.~.c.z....~ ...... ~.~.~ ...... ~.1~ ........................ at premises Iocat~ ct ~.~ ..... ~;~.~-~.. ~ ....... &'/'--~%~ "~7 ...... ...................................... ~ ........................................ ~ .......................... ~. ............... ~ ....................... Building Inspector. Fee .... ,~ ..... FORM NO. 6 TOWN OF SOUTHOLD Building 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: 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 disposat-(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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date . ,H,~. ,~'. ,[.7, ~ . ,~,9,8.3 .......... X New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .2.O..O..~.a:.~..~.~.1;o.~ .A.v.e?.~.e, Cutch. ogue~ Ne,~ ¥o~ck House No. Street Ham/et Owner or Owners of Property .... ~.qt3..~.~p, .l~e.e.~a ......................................... County Tax Map No. 1000 Section ]-:]LO ............... Block .......... .~.... Lot...P/.O...]-.2 ....... Subdivision ................................. Filed Map No ........... Lot No .............. Perm;t No...........:1'O4'03Z Date of Permit ?LO/31/7~Applicant ][:NJ,AND HOHiES, TNCo Health Dept. Approval . .3./;~.4./.80 .............. Labor Dept. Approval ........................ Underwriters Approval N4838].2 ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .-~ tO.O. ....................... Construction on above described building an~d-cer-m~meet,~~ pplicable c~i'des and regulations. Applicant '~ ~'~'E'.' ' Rev, 10-10-78 ~ ~I_~D I~SPECTION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FKAME& PLUMBING INSULATION P~ N.Y. STATE ENERGY CODE FINAL [TIONAL COMMENT~,: FOBM NO, TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y, Exam,nod ................ proved ............... . .... ............ ......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date Octobe~ 26 l~..g. ......... a. This application must be completely filled in by typewriter or, in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee accord!ng to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ 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 commenc.ed before issuance of Building Permit. d. Upon approval of ;~hi~ application, the Building Inspector wdl issueCa 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. INLA..~D HOMES. INC. (Signature of appJJcant, or nome, if a corporation) Box 117, Mat~l~uck~ N,y, 11952 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder General Con~ractoz Name of owner of p emlses .................~.k~];fJbQ...[~.~.~%~.~ ..................................................................................................... If applicant is a corporate, signature of duly authorized officer. Robert E. Hiltz - P~es. (Name and title of corporate officer) Builder's License No .......... Z .......................................... Plumber's License No .... ~..........~.~.¢~ ~-~ El t' ' ' L' 2148-~ ec r~clan s ~cense No ............. .~.. ............................ Other Trade's License No ............................................... Location of land on which prgposed work will be done. Map No.: ...................................... Lot . Street and Number ~!~?..m.:'~.~.~.~..~.~``~`.?~.e.!.~?.~.~..C.~...t~h~q~t~ .................................................................. Municipality State existing use and occupancy of premises and intended use and 'oc~upancy of proposed construction: a. Exisiting use and occupancy Vacant b Intended use and occupancy 1 -Farailv 3. Nature of work (check which [applicable): New Building ......3~...x.. ....... Addition .................. Alteration ............... Repair .................. Removal ~'. ................. Demolition .............. r:*.. Other Work ' ..~ ~ /(.~, (Description) · $30 ooo.o0 ----- 4. Estlmoted Cost ...... ~. .................................................... Fee .......... ..~r,. .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwel[ihg units], ........................... Number of dwelling units on each floor ............................ [f garage, number of cars 6. tf business, commercial or rmxed occupancy, specify nature and extent of each type of use ............................ 7. Dimensmns of existing structuj'es, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure] with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8 Dimensmns of enttre new coqstruction: Front ............. ~.~..7. .......... Rear ..,.~..,~,..~... ......... Depth ...~....~....~.. ....... Height _.3:.8. .............. Numberj of Stories ..........3:... ....1. /. .2: .............................................................................................. 9. Size of lot: Front ........... .3:..O.,.0. ...................................... Rear ............ ~-.Qg ....................... Depth ....1..5g ..................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 h Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction vi,olate any zoning law, ordinance or regulation: ..x.t..g .................................................. 13. Will lot be regraded' =s · .......... .Y.~ ............. Wdl excess fill be removed from premises: ( ) Yes (x) No 14. Nam~ of Owner of premises ,.H..%t..~...~..%..°...R..e..~[.e. ...................... Address ................................ Phone No ....................... Name of Architect ............... ' .............................................. Address ................................ ,Phone No ....................... Name of Contractor ~..N.~,.D...~.O.~.~.s....-.[.~.C...*.~.°.~...~.$.?.~ddress .H..a..~..~..l;~.c,~...~.e.~..*Phone No..~...~..-.0...~.9.,(' .... PLOT DIAGRAM Locate clearly and distinctly a!l buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner tot STATE OF NE',,5/ Y,D.P,I~,, lc ¢ COUNTY OF .~..U.~.Z:,,gzK. .. .~obert E~ Hilt.~ .... ~ ..... bein dub (Name of indivi~Jual signing col~tr~cf) above named. ~worn, depo: and says that he is the applicam ~CoDCrac¢or , , , He is the .................................. , ....................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the'best of his knowledge and belief; and that the work will be performed in ithe manner set forth in the application filed therewith. Sworn to before me this i ........................ day of ................. ...... ~ ~ ~ .n~r~-~ 8~nt) Inland Home~ s Inc.