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Home My WebLink About10872-z TOWN OF BUILDING, D~PARTM~N' TOWN HALL SOUTHOLD, BUILDING (THIS PER~IT MUST BE KEPT ON ~H,E PRE~IS COMPLETION OF THE WORK AUTHORIZED) N? 10872 Z Vote .... .~?.., Permission is hereby gradted to: UNTIL EULL ........... : .......................... ."4: ...... '*Y$'", .......................................... ~ ....... ~""U~'" BUnD A PRIVATE 0~ F~LY to 80~0~, C~n~ T~x ~ep No. 1000 Section ..................... Bilk pursuent, to opplicetion doted ............................. , ~ ........... , ~ -;. ........ , Building Inspector. Fee $.,~.~'~ ~' .......... , 'il. ........ iLo, No ........... 2..:.~ ....... , ond opproved by the 'Bud ng!~ihsPector FORM NO. ~ TOWN OF $OUTHOLD Building Department Town Hall Southold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and subr~itted 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 tines, 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 naturat 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.. '~ e ull ~n ~/ orP ~ i N wB 'd' g .... ..~ ........ Old re-exist'ng Build'ng(X)., ........ ~ Vacant Land ............ House No, Street Hamlet Owner or Owners of Property .../-p.b! . '~'d~(?~_., ..................................... County Tax Map No. 1000 Section ,O.~-~c/ ......... Block .. _~..~ .......... Lot.. ~. ?.; ......... Subdivisio :/. ........... Permit No. !.0.~.~.~.~~-. .~, Date o, PermJt .?~/?.l .c~., .AppJicant .... ~.%~."~'.2...~..~?././.~..~.%.,~,~ ......... Health Dept. Approval... l .0.~; .~'.C!..~.J .......... Labor Dept. Approval ...................... Underwriters Approval .~ ~'~. ~.--! .~: ~.i,~ .......... Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate . Fee ~ubmitted $..%.~.~..~r~.~. ................... Construction on above described building a~d~p~it'me~t~ all aP/~cable~co,des and regulations. Applicant ..... : ........................ Rev. 10-10-78 THE NEW YORK BOARD OF FilRE UNDERWRITERS BUREAU OF ELECTRIdlTY( ~. 85 JOHN STREET, NEW YORK, NE~v ~ORK 10038 O, te ~ '~ ,~.. L::;'!. ~pplleatlon~Vo.o,~/ile ~ 01~5545/80 m ~ ~ ~ e ~ ~ THIS CERTIFIES THAT only the e[ectrlcal equipment ~ described belo~ and introduced ~y the applicant ~m~d on ~he able application nu tuber in the premises in ~he foltowing location; ~ Base,nent ~ 1st FI. ~ 2nd Fl. Section Block Lot was examined on ~ ~ and /ound ~o be in com~hance with the requ retnents of this Board FIXTURE FIXTURES RANGES OVENS OUTLETS SWITCHES FLUORESCENT VAPOR EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDER~ UNIT HEATERS MULTI-OUTLET SYSTEMS NO OF FEET DIMMERS SERVICE DISCONNECT S E R OTHER APPARATUS, NO OF NEUTRALS Th~s cert;ficate must not be altered in any manner, return to the off,ce of the Board if r EOR ILDING M.c. Inspec, t%rs may be identified by Is. IN ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 (Building Inspector) APPLICATION FOR BUILDING PERI'IT Application No .................. INSTRUCTIONS a. This application must be completely tilled 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 wall issue a Building Permit to the applicant· Such permit shall be kept on the promises 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, h/e~sing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inSpectiolas./~//~ ~,~ff~ ....... ................ (Signature of applicant, or Fr~ime, if a ~rporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or bmmm~ (as on the tax roll or latest deed) If apltlicantp~ a corp, oration, signature of duly authorized officer· (Name an~'itle of corporate officer) Builder's L~cense No .......................... Plumbers License No. C~.:..~..~?T! ~(~,1~.. (.~... Electrician's License No.~r., O.... ~/~.~'~...~.~.. Other Trade's License No. :'. ................... i / 1. Location ofland on which proposed worl~will be done. . ..~..0.~..~(~r~.... 0.~_ · - -- 5; ......... ................ .......... House Number Street Hamlet County TaxMap No. 1000 Section..~...~ .......... Block ..¢ .............. Lot ~'.~. .......... (Name) -- ~ "-~"---'~" ' Subdivision .~-~1~.~[.~7(~.~.[~5~..l~.[... ~..0.(1~.~.¢,~ Filed Map No. ~.~.[.~. ...... .~,~...L~. ........... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy... ~.~..' .~.../~. ........................................... , ............. b. Intended use and occupancy ... [..~ .(.'~..~..~. ..... .~..~..~ ............................................ 3. Nature of work (check which applicable): New Building .......... ~ Addition .......... Alteration .......... Repair .............. Removal ........... ,... Demolition .............. Other Work ............... . (De cription) 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 .]....I .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth .................... :.. Height ......... . ............ Numbertof Stories ........... ~ ......... 8. Dimensions of ~ntire new constrUction: Front ...~'~.~, ......... Rear . ~-'~ .......... DepthoT,~ ............ Height' . . ]7 .......... Number of Stories . . l ......... ~ ............................ r ............... 10. Date of Purchase ........... ' .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ..................... ,., .............................. 12. Does proposed construction vioiate any zoning law, ordinance or regulation: ~/!9. ............................ Will lot be regraded .. ................... Will excess fill be removed from premises: Yes 14. Name of Owner of premis'es ...~.t[E ..~.. ~.o..f~q.~. Address ................... Phone No ................ Name of Architect . .,a ........ ............... i. 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 JPORK, .4 ~ ,, ,, COUNTY (~ ..~~: ,~'~ ........... ~~.~5~/.~. ,~...~... ............... being duly sworn, deposes ~d says that he is the applicant (Nam~ of individual signin~ contract) above named. agent, corporate officer, etc.) of said owner or owners, and is du .y anthogzed to perform or have perfomed the said work and to m~e and file this applicationl that all statements conl ained ~ this application are true to the best of his ~owledge and belief; ~d that the work will be perfomed in the m~n, ,r set forth in the application filed therewith. Sworn to before me this Nota~ Public, ................... ~: County ' /~ ~ i EtIZA~ETH ANN NEVILLE e of applic~t) ,NOTARY PUBLIC,Slate 01 New N0 5~-8125850, Suffolk C0t~ A ~ N6 , nt4 _cF. SU~Y FOR ,,,,~ t~ ~ ~'A~- LOT4,"MAP~GREENFIELDSAT SOUTHOLD"~- dULY I 1981 . DEC. ~3~ 1980 ~'~- ' ~'~ ': ? ~ ~ ' ' ' ,~.o SUFFOLK COUNTY. NEW YORK NO. 80-405 HEALTH DEPARTMENT-DATA FOR APPR~AL TO C~STRUCT ~NO ~ HiS ~HALF m THE TITLE C~P~Y, GOV~N- WIL~ C~FORM TO THE STAN~RDS OF THE SUFF~K COUNTY O[PARTMENT TOEXISTIN~ STRUC~RES ~E FOR A gPECIFIC -~ ~ , OF H~LTH S~ICES PURPOSE AND ARE NOT TO BE USED TO ESTABLISH FENCES YOUNG YOUNG · U~DIVI810~ MAP FILED M T~ OFFIOE ~ ~ CLERK OF 9U~FOLK ALaN W,~NG, PROFE~IONAL ENGINE ER COUNTY ON NOV. I0, 19~8 A8 FILE N~lill. AND LAND SURVEYOR N Y_S UCENSE NO 12845 HOWARD W. YOUNG, LAND SURVEYOR ~ ~ L~ ~ ~L(w),~lc ;A~(s~a c;~t(~) ~N ~;~ N Y. S LICENSE NO 45893 ~ ~ FIELD ~;~s ~ o~ DATA OBTm~E~ F~ O;HE~S TDY POST £0494 Dot ~ LOt 4, o 5. F.* AREA~ 41, ~ cou~rrf o"'~em' De te. At~ ~ ~ov~ o~ ~ HE~L~ DEP~TMENT-D~T~ ~OR IPP~OVIL TO ~STRUCT ' ~ ~F CO, TAX MAP ~T IQ,QQ SECTION 059 BLOCK ~ LOT ~,~4 RTH~ ARE ~ DWELLI~S WITHIN I00 FEET OF TNI~ PROPERTY OTHER THAN THOSE SHOWN HER~ON~ N THE WATER SUP~Y A~ ~EWAGE~OI~AL SYSTEM ~ THI~ WIkLC~FORM TO THE~R~F/THE~FF~K COUNTY DEPARTMENT OF HEALTHA~VIC~5 ~[~ ARE FI?OM FIELD OBSERVATIONS ~ OR ~ATA, OSTAI,NE~ FR~OM OTHER,? SURVEY FOR VlT0 RANDAZZO EOT 4 ~ "MAP OF GREENFtELDS AT SOUTHOLD" AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK iL IN~UTNO~IZED ~LTER~i~TiON OR ADDITION TO URYEy 15 A V OLATON OF SECT ON 7~'O9 OF THE ilCO~IES ~ THIS ~[IURVEY NOT BEARING THE LAND j YOUNG a YOUNG ALDEN W YOUNG** PROFESSIONAL ENGINEER AND LAND SURVEYOR N Y.S UCENSE NO IE845 HOWARD W YOUNG~ LANO SURVEYOR N,Y S. LICENSE NO 45893 OATE AUG. 28, 1980 SCALE, NO. 80-405 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK