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Home My WebLink About10817-z N? 10817 Z Permission is hereby grar~ted to: ~o~t~ ~o. z T~N O~ ..~OU~O~l~, ~ BUILDING D'~p~R~L~ TOWN iHALL ~ SOUTHOLD, N~ Y. ~ ~UILDI~G (THIS PERMIT MUST BE KEPT ON ~H,E PRE~IS~S u~TIL fiULL COMPLETION OF TH~ WORK AUTHORIZED) ~ ~ Rev 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Ha~l Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation 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. 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 3. Copy of certificate of occupancy $1.00 $5.00 Date .(~.~. ...... ! .............. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...................................................... House No. ~ ~ ~,rT Street Hamlet Owner or Owners of Property .W'. ......... '¢~; .( [ X5:-(¢. ¢ ............................... Co, ntyTaxMap No. lO00Section .X¢.¢ ....... Blook ............... Lot..~¢..% ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ................ Fee Submitted $..~....~¢~.. .................... Construction on above described building a~.ermit rr~ll ~ab,/l~codes and regu tations. COMMENTS · FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (2~) INSULATION PER N.Y. STATE ENERGY CO~E FINAL ADDITIONAL COMMENT~: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ c~ TEL.: 765-1802 Examine~gVS' '~'~''' 7 ..... , 19... Approve~ .~,...~....7 ..... ,l .c~..eermitNo.~.~..~../~..~.~i/I Disapproved a/c ..... : . .i!.....~_...~ .................. ~ APPLICATION FOR BUILDING PERMIT Application No..~/~. '.~. ? 7 ........ 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 g~ving a detailed description of layout of property must be drawn ou the diagram which is part of this appli- cation. c. The work covered by this apphcat~on 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 OrdNance 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 coCe, and regulations, and to ad,nit authorized inspectors on premises and in buildings for necessary lOspectiogs~. '//ta~gnature o a e,' p ) . . /. . . . ........ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ~ ~.':~!~ !:5 (7.- ................................................................................. Name of owner of premises...~.. ~.,fx. ? ~- .5:... ~.....~.-/~f..~./.^/Z .......................................... (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....~. ............ Plumber's ~icense No ....... ~ ~. ............... 1. Location of land on which proposed work will be done ................................................. House Number Street Hamlet CountyTa~o.~10~/~z~cti~l~.~....¢~ .... Block ../..~. ......... :.. Lot....d~..._~.~) .......... u, v,s,on ....... ...... ........ 2. State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction: a. Existing use and occupancy... Z;5 27..~./....~.:...~.~.z~.. ~z~..~..~.- .~... .................................. ..... : .................. b. Intended use and occupancy . . ____ f 3. Nature of work (check which applicable): New Building .......... Addition .......... I/ Alteration .......... Repair .............. Remogal .............. Demolition .............. Other Work ............... ..~.~t,, 061i / ~ -- ~Description) 4. Estimated Cost ..................................... Fee .~. ................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number o f dwelling units on each floor ................ If garage, number of cars ...... . .................................................................. 6. If business, commercial or mixed'occupancy, specify nature and extent of each ~¢e of use ........... ~ ......... 7. Dimensions oLexis~ting structuresI if any: Front....~..~ ..~i ..... Rear . .~.. ~ ........ Depth . ~.. ~ .~. ........ " .............. ................................................... sion~ s~ o~d, jt~ons: Front...~u~. i;;i:sRear ),..~..~./..~:/.' ....... p .................... i.. 'g ........ ;.> .......... .. 2s ' · .......... >~./ ....... 8. Dimensions of enti~e new construchon: Front ...... ~. ....... Rear ...... T ........ Depth .... .o. ......... Height ..... ,~. ....... Number of Stories ............... ,..~ ........................ ~ ............. Si e of lot: Front .......... Rear ...... //.0 ..... epth . .............. 10. Date of Purchase .. ~..~.T...~/, t. /?..7.7 .......... Name of Former Owner /~7~i..~t~..~p.' .z.~. ~ ........... 11. Zone or use district in ~hich premises are situated .............. ~.~.. (! .................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... ~.0 ..... r~..,* ......... Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises .J ¢..~. ~..3.,../..~-~..o¢~. Address ................... Phone No ................ Name of Architect .......... ~ ................ Address ................... Phone No ................ Name of Contractor ......... t ................ Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~,YOfl,,K,, COUNTY OF..~..~.~:~-.~ ./.~...... S.S ........... .~..t~.~'..~....,~..../~-P. ~../.~..t~y. .............. being duly sworn, deposes and says that he is the applicant (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 application; that all statements contained in this application am true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... /. ..... Notary Public .... ~v~.s~m,~.~,~,~.~ :~ ~'~ (Signature of applicant) ~ho ~e~,aGe dispOSal and . fao~llties ~'om th' ,~:'ater inSPeCted by Lo! FO Lo/ G8 182 00' 182 00' _ .7 NOTE £] .- STAKF SUBDIWS/ON MAP PILED IN TNE OFFICE OF THE CLERK OF SUFFOLK OOUNTY ON dAN 2B, 1985 AS TILE NO d258 THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREIN ARE FRO?! FIELD OBSERVATIONS AND/OR FRO/f DATA OBTAIi'iED FROl%f OTIIERS YOUNG & YOUNG 400 OSIRANDER AVENUE RIVENHLAD, NEW YORK SI RVEY FOR: BEN MENDOZZA LOT 69 "DEEP HOLE CREEK ESTATES" MATTITUCK ~OWN OF SOUTHOLD AMERICAN TITLE INSURANCE CO SOUTHOLD SAVINGS BANK SUF~ r.)LK CO, NY "Y J~jr~_ ~) J~