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Home My WebLink About10196-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHGLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10196 Z Permission is hereby granted to: /,/ _ / / pursuant to application dated ~ ~ ~' .., 1~'., and approved by the Building Inspector. Fee $..~.(... ............ TOWN OP SOUTHOLD , Building Department Town Clerks Office Southold, H. 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 Inspector 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 dlsposal--(S-0 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, 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), Nan-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 in- formation required to prepare o 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 $1.00 Date .A...~.g~...sl; 2:I.~ l~TL? New Bqilding ....A~.... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property S/~ Car, Gull Pond Road & .N..?,r~h Road, Greenpor~. Owner Or Owners Of Property Q'..o.]7~ ..C..o..n...r..~.d.. .............. Subdivision ................................................................ Lot No .....~ ...... Block No......3. ...... House No ............ Permit No.1...0..1.~¥:..Z. ...... Date Of Permit ..5.../..8.../..7.~.....Applicont ,~,~]..a~(~ .~.(~...$..,..I.D...C..t ...................... Health Dept. Approval .9,T..$..~.~.3.:~...-..?.~.'.//..g..~.....Labor Dept. Approval .,...N./...r. .................................... Underwriters Approval ............................................. Planning Board Approval .... y...e.?. ............................. Request For Temporary Certificate ......... ~C§ ........................ Final Certificate ......~..e..s. ............................. · .00 Fee Submitted $5. ................................... Construction on above described building and permit meets all d~olicable codes and regulations. Sworn to before me this Applicant 'Rob-~"~; ]~o H:L:[~"~'~rT~j~'~'~"'Y~'~ .............. ..2..1..9.~ ...... day of ..~.u..gg..9..~_..~.Z.?. ............ (stamp or seal) Notary Public SU;~'o~k County TOWN OF $oUT~OLD BUILDING DEP&RTMEN'r TOWN CLERK'S OFFICE SOUTHOLD, N. Y. am,ned ...... .................... ^pp',cation .......... ~aproved ..... ..c~..:....~.., ...................... , 19Z.~... Permit No...~.I.~.'.,~....~..... D~sapproved a/c ................................... i}~' .............. i~ii:ii ............ :hi: ........ .................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date a. This applicatmn must be completely filled in by typewriter or in ink and subm tted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Icc&hah of lot and of buildings on premises, relationship to adjon ng prem sec 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 Budding 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 Bu ding Permt pursuant to thai' Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances afl 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 necessary inspections. (Signature of applicant, or name, if a corporation) BOX 117, Matt. ituck, N.y. 11953 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.? ....................................................... Dene~;.g;t.....(;..o..n..t.. ,r.~..9.~g..r, ................................................ Name of owner of premises ~el3n Con:tad If applicant is a corporate, signature of duly authorized officer. R,.o..b. ert E. Hiltz (Name and title of corporate officer) Builder's License I~o..-...~.';.:. .......................................... Plumber's License No. 517-p .... 2148-E Electrician s License No ......................................... u, ~ _. , 3~ ~,~ /~7~ / ~{ Other Trodes license No ........ .,~./ ....... ~ ................. Location of land on which prol~se,~.ork will be done, Map No.: ~.o..~...d..~....a~......A..?..~..e..s.. ........ Lot No...5. .................... Street and Number g..~...3r..~..~°..~..~.a.,~.,e..~...~.~...e.~j~.?..~..,t,.~,....~.....~...i ...................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisitlng use and occupancy .¥..~..~..~., ~ b. Intended use and occupancy I F~m£13/ 3. ~atare of work (?he. ck which] applicable): New Building ..~,/,~a ...... Addition,...,..'....:~ ....... Alteration ................ Repair .................. Removall .................. Demolitmn .................... Other Work ................................................ (Description) ' .o. oo4oo 4. Estimated Cost ' Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ~ .................. Number of dwelling units on each floor ............................ if garage, number of cars ....f......~.. ............................................................................................................................... 6. If business, cbmmercial or ,mixed occupancy, specify nature and extent of each ~pe of use ............................ 7. Dimensions of existin~ structgres, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structur~ wit~alterations or odditions: Front .................................... Rear ........................... Depth ................................ ~eight ............................ Number of Stories ................................ B. Dimensions of entire new cohstruction: Front ....... ~,~ ........................ Rear ........ Z~ ............. Depth ....... ~0~ ......... Height [8 Numbe~ of Stories 9. Size of ]or: Front ...............~.~ .................................. Rear ...... ~,~. ............................ Depth ...~.~ ...................... 1~. Date of Purchase .............. ' ........................................ Name of Former Owner ........................................................ 11. Zone or use distnct n which~premises ere situated ................................................... '. 12. Does proposed construction ~olate any zoning~ law, ordinance or regulation: ..... ~D. ............................................. 13. Will lot be regraded' . ...... ~.~ .............. Will excess fill be removed from premises: ( ) Yes (~) No 14. Name of Owner of premmses .., ................................................ Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of ContractorI.~.~..~.~.~....[~.~. .................. Address BOX 117 ~t%t~ No. PLOT DIAGRAM Loc~e c~em~ly and distinctly ql~ buildings, whet~r existing or proposed, and indicate all set-back dimensions from properly lines. Give street and bl,ock number or description according to deed, and show street names and indicate whether idterior or corner tot ........................................................ ~ ......................................... Demg ouly sworn, deposes and s~ys that he is the applicam (Name of individual signing contract) above named. , He is the ................................................................................................................................................................................. (Contractor, agentt corporate officer, etc.) ,of said o~ner or owners, and is d~ly authorized to perform or have performed ~he said work and to mako and file th s appl cation; that oil statements contained in this application are true to the best of his knowledge and belief; and that' the work will be performed in ~the manner set fo~h in the application filed therewith. Sworn to before me this j ~