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Home My WebLink About10192-z FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WARY. AUTHORIZED) No. 10192 Z Permission is hereby granted to://~,~ '~'""'~ "T'"'~/2:~7/;;;7/ .... ~T ::v~;;"~: ..... ..................................................................... , .................. ~. ................... ; ...... : ............. ~ ...... :.~.:;~. / pursuant to oppficotion d,tod ........................................................ , ]9 ........ , ond opproved by the Building Inspector. .ee .... Building Inspector FORM NO. 6 TOWN OF SOUTHOL~D Building Department Town Hal~ 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 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 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 New Building ......... ~/~,~,,, ,Old o~/~:e~x_isting ~ril~7...~ ..... Vacant Land ............. Location of Property ...~-.'~ . . ~.~.' .... ~t ....................................... House No. ~treet Hamlet Owner or Owners of Property .... ~-¢.~ ......... ~ .... ~. ¢...-. ~ ~ ......................... County Tax Map No. 1000 Section ..~ .... V.. Block ..~ ........ Lot..~ ........ Subdivision. Z~¢~/e. ~~~ ........ Filed Ma~.~ ....... Lot No.. ~.~ ....... Permit No. ,Z~./~ ~ate of Permit ~. ~~~.~ ~~,, .Applicant..~F, ~. ..... /. · Health Dept, Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ......., ,,. ,..~/ ...... ,,. ,Planning Board Approval ~.~,, ,- ................ Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .............................. Construction on above described building and permit meets alJ/a,l~pljcable,e~Jes anj;t~-/~ ~' ' regu lat~ons. Applicant ............................... 777o TOWN OF SOUTLIOLD OFFICE OF BUILDINO INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 Peter R. Stoutenberg 310 Ackerly Pond Lane Southold, New York Dear Sir: This is to notify you that Building Permit No. issued____A_pril 27~ 1979 to Stoutenberg, a/c will expire on 10/4/80 '' 1 01 92Z ZO~O, ~ If more time is required to complete the job and obtain a Certificate of Occupancy, you may apply, ~ ~etter, for a six (6) month extension. If the work is not completed and the Certificate of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly yours, GEORGE H. FISHER Sr. Building Inspector TOWN OF SOUTHOLQ BUILDING DE PA RTMEI~I ~""' '.[ ~/ /_ TOWN CLERK'S OFFICE~/~/ ~ / ~ / ~' ~UTHOLD, N. Y. .. Examined ........................................ , 19 ........ ~ Application , ,oved ....... ........... , ........................................... : ............................................... ..... ........ .................... V ~ / Date ~ ~ ............ '~ .......................... INSTRUCTIONS a. Th~s application must be completely filled in by typewriter o¢ 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 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 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 Budding 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, bui(dirJg code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for n~-~"ss'~'~ections. ~, / ...~?...7...5.~.,.~'~.,1¢~:?,...~..~.~?.~.~.~ .................... ~ ~r~[/'(~[:l~(~'~'~ if a ~'poration) .... (Adl;;[/ess of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer,~l~~T~ electrician, plumber or builder.~ Name of owner of premises .... j¢~.~:~.. ~'/~"~/ ......... D' 'O' ............................................................................. If appl'icant is a corporate, signature of, duly auth~ized officer. (Name and title of corporate officer) Builder's License No ................................ ~.,l.~. Plumber's License No ................................................. Electrician's License No. Other Trade's License No ............................................... Location of land on which p~l~s~d work .w~ be done. Map No...,.~'~.........J:..0......~... ................ Lot No..~..; ........ ..~.....~. .... Street and ~....~......]~ .......................... ~ ............. ~~ ....................... ~ ~.~. ~ ~ .~ --' // Municipali~ State existing use and occupancy o~t~s~nded use and occupancy of propos~construction: a Exisiting use and occupancy ....... ~;'.~,.~..~.~ ........ ~.~w.~....~ ......................... b. Intended use and occupancy ......... ~[~.~.~.....~.~,~.~...Z.~....~...~-- -- 3. Nature of work (check whict~ applicable): New Building,. ................. Addition .................. Alteration ................. Repair .................. Removal~ .................. Demolition .................... Other Work ................................................... i (Description) 4. ~'stimoted Cost ............ ~ ............................... Fee ........ ~ ............................................................................. . (to be paid on filing this application) 5. If dwelling, number of dweJ(ing units ........... (. .............. Number of dwelling units on each floor ...,~-,.~',,/-s../......'~..?.~..~/. if garage, number of cars ............................................................................................................................................. 6. If business, commercml or ~m*xed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..........~.9. ........ Rear ....................... Depth ....... i.. Heiaht ~..~ ....... Number of Stories .~......~ ................................................................................................. D~mensions of same structure w~th alterahons or add tons; Front ............ ~'..~. ............... Rear ...... ,..;~J..~. ............ Depth ......... ...~..¢'.~../../. ..... Height ......... ~ ...........Number of Stories ............ 8 ~ Dirffensions of enti~new copstruction Front ............ ~.~ ............... Rear ..... ~..~'/.~ ............. Depth ..... ..~,~;.:..~.....¥ Height ... /.~J,.. Number of Stories ............ / ..................................................................................................... 10. Date of Purchase .... ~ ................................................. Name of F,or~er O,w~ler ..~ ................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~.~.~) .......................................... 13. Will,lot be regraded' ......~1..,1~..,~ .......... Will excess fill be removed from premises: ( ~ ( ) No Name of Architect .............. ............... ~ ............................. Address ........................ ~4,.... Phone No ....................... PLOT DIAGR~kM locate clearly and distinctly dll buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and bi'ack number ar description according to deed, and show street names and indicate ~,hether in,terior or corner lot. : 7' ~ ~ T~' ¢ ~. So ........................................................ ~. ........................................ being duly sworn, deposes and soys that he is the applJcam (Name of individual signing contract) above named. He is the ...................................... ~ .......................................................................................................................................... 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 file this appli~cation; that all stotemeqts contaihed in this application are true to the'best of his knowledge and belief; and tha~ the work will be performed in jthe manner set forth in the application filed therewith. Sworn tobe,~ me this , · -- ~ Uot~r~j Pubfi¢, Stat~ ?[ New York ~. 52-0344963 ouh'olk Coqnty/z,/' ~Wllt~,J0~ Expires March 80, ?~V~