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HomeMy WebLinkAbout10984-zPermissi°n is horob~ ~ront~d to: ES UNTIL FULL (THIS PERMIT MUST BE KEPT ON THE P~.E~Mli COMPLETION OF THE woRK AUTHOR ZED)} ~, ~.~,,i,,o~o,.~ o~ ~......~,~,~~,i~.~ .................... ' .............. · i' ' i~;,',' -- ~ -....,,© ..... : .................................................................. f Lot No ......................... C0ungt Tox Mop Nol 1000 S~ction ........................ 8loCk ....~.~ .............. pursuant to appli¢otion doted ..,~.~..~.~....~.t/~'-~...~:~..., 19 ~, ond c~ppro¥od by the Building I~spector. Fee ;.. Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 featu res. 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. 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 ......................... New Building ............. O~d or Pre-existing Build}rig ............ Vacant Land ............. Hou~ N~ Street Ham~t County lax Map ~o. 1000 Section/~:~7~?~.~ ~ ~lock .... ~ ......... Cot.. ~ ~ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No .......... Date of Parmit . ,Applicant . ,M. ~ .............. Health Dept. Approval ........................ Labor Dept. Approval .......... Underwriters Approval ........................ Planning Board Approval .............. Request for Temporary Certificate ..................... Final Certificate .. ..¢~..... Fee Submitted $...-,~.. :. ..................... Construction on above described building and permit,m~ets all ap,~licabJ~ ~des and regulations. Applicant .................................. Rev. 10-10-78 FIEL~ IN~-~EC T ION DATE COMMENTS io FOU1VDAT ][ON ( 2nd ) ROUGH F~ & f ' PLYING INS~ATYON P~ N,Y. STATE E~GY FINAL ~ ~ ~DITIONAL CO~ENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~.°¥.°.mb.?.~.C~ ~...., 19..~.0 Application No./~. ~.~.. ........ .......... .......... ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~.o?.m.b.e.r...~.~. .... , 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 diagram 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 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 ii1 buildings for necess~ionst~~ ~igt3a. t.u.r~ of applicant, or name, if a corporation) Bx. h~-O, Rtl~ Cutchogue, N. Yo 11935 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0~ John E. Shirvell & Gloria Shirvell Name of owner of premises .......................................................................... (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 ...... .n.h.. ~ ..... Plumber's License No. na Electrician's License No. na Other Trade's License No. na Location of land on which proposed work will be done ........ . ......................................... 1165 Pine Tree Road Cutchogue , New York 11935 House Number Street Hamlet County Tax Map No. 1000 Section Block ..... ! ............Lot ..... .......... Subdivision .... : ................................ Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... 0.n.e..~ .m~.5.1.7...l~.e.l.l.~n.g. .............................................. b. Intended use and occupancy...S.a.m.o..a.d..a.b.o.7.~.. ?..~....~..~..~/~ ......... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration . ~ ...... Repair .............. Removal .............. Demolition .............. Other Work ............... Enclosure of existing side porch measuring l?'-~" x 10'-2" (No heat } (Description) .,:tooo ' 4. Estimated Cost ..................................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling q2nits 1 family Number of dwelling units on each floor. 1 If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...n.a ................. 7. Dimensions of existing structure's, if any: Front...' ............ Rear .............. Depth ............... Hight ' ' e ............... Number of Stories one Dimensions of same structure with alterations or additions: Front ....s.a~..e .......... Rear .. p.a~. p ............ .................... '.. Height ................. Number of Stories. one Depth same .... ,same ..................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ................ Number of Stories ..................................................... ;... 9. Size of lot: Front ..: .2 .2 .5 ., 9. ~ . '.., ......... Rear....2.6.6:.6.2! ............ Depth V./.s..~79:99! .-..~..s..~9.~,.6~' 10. Date of Purchase . .a.p.r~..1.7~ ~9..~9 ............... Name of Former Owner ~.dg.a.v..W:.&.. pg.r9%13y. ~).a.vip ..... 1 I. Zone or use district in which premises are situated... ~.u.~. 9h. ggu. e. '..M.a.~.~. ~u..ck...89 .h99.~' p.~s. ~..r.~9.~ .............. 12. Does proposed construction violhte any zoning law, ordinance or regulation: . .N..o ............................ 13. Will lot be regraded ........ N..9 .................. Will excess fill be removed from premises: Yes Nox 14. Name of Owner of premises .A. ppl.~qa.n.~. .......... Address ~%6. ~.P~.~O.T~'oO.Rd.. Phone No...7.3.~.-.~.1.J.2 ...... Name of Architect .......... .................. Address ................... Phone No ................ Name of Contractor Address Phone No. PLOT DIAGRAM Locate Clearly and distinctly all: bulldmgs, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description acqording to deed, and show street names and indicate whether interior or corner lot. --,?~. ~; 2 ~ STATE OF NEW YORK, COUNTY OF ................. ,~...~.. .~q .~.~t~ 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 dul~ authorized to perform or have performed the said work and to make and file this application; that all statements contained in this a~plication are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in'~ihe application ~iled therewith. Sworn to before me this ........................ day of ...... .'~./~~ 19... ..~ No. 52-03/JA963 Suf,o)k County,-'~ '~-/. ........ /'~'Y~: ...... : ........ . ' ' Commission Expires Mar!h 30, 19i~,/ '] (Signature of apphcant)