The URL can be used to link to this page

Home My WebLink About10764-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? J0764 Z Dote .................................. , ........................... . .......................... ~o ...... ~x~.~.~.~/.~.~,.c.:.......~.,~2~...:::.~,.~,~..: ..'~:,,~,~.../.~:~:?..~)~ ...... :..,-.'~.,':~ ................. ........... ~-~.-,~. ~ ,~. ~,, . ~, . . . . . ~. ,5 ~. ........ ~ . ~. . ,~. . .h. .z~. ~ 7. ~.- ~. .). .................................................. at premises located at ..~./:'..~'.'.~.~.'..~. .......... ...~...~.....~'...¢~..,~...--.'~.~ .~.'-~...~.:£~. ................ pursuon~ to appllcotion dated ........... Buildlng Inspector, Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.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 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 Buildii~g .....~... ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~//.o.~, .~../.~. .... ..?.~.';27 .o.,, ,~..~?..z~... :.,~,~-/)., .~. ;,~.,: ...................... House No, Street Hamlet Owner or Owners of Property . . ,~.~..~z././.~../.~ .~.~ ...... /.o. ~.z~;'. ............................ County Tax Map No. 1000 Section .... ~./.~'. ....... Block :..~./. .......... Lot...: .'/~. ·/..~. · .~. · . Subdwision .... ~.~..~..~.~.....~..~.~..~'.~. .......... Filed Map No.~..~, ./~.. .... Lot No ..... ./..~'. ..... Permit No. ~'.0.7.~ .. Date of Permit 2/.//~.q. ,Applicant .................................. .~2~/~[/. ~..~/~"Dept Approval Health Dept. Approval . ~'~'.~.¢..~¢~ ........................... Underwriters Approval/~ ~,/'~.,,~.//. ~ .......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ............... Fee Submitted $...~,3.: ....................... Construction on above described building and p'~r,~ rrreets all applicable codes and regulations. Applicant ~ "'~' ' '~' ~~ ' ' ' '~' ' '~' ' '~' "'~'~'"(~ NEW. YORK BOARD OF UNDERWRITERS ~ j r 85 JOHN STREET, NEW YORK, NEW Y,OR[~ 1,0038 ~'-- ' ~ .... . ~ ~:e, ~/s ~o:th Sea ~ , o2p.. ~e~ay ~es~, O:~t, ~.~. ,n the follow,ng l~at~on; ~ Basement ~ Ist FI ~ 2nd Fl , , -~ :'., - ~ , Section Bl~,k ,v~ examined on ~b~ 5~ 198~ , ~ :;~' andfoundtbbelncompliancdwlthther~uiren*entsofthisBoard. :'25 COMMENTS FOUNDATION FOUNDATION (2nd) ROUGH FPJ~ME & PLUMBING INSULATION PER N.Y. STATE ENERGY C0~E FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD, BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ TEL.: 765-180;3 Exam,ned y ........ ,19 2 - Application ./ ....... APPLICATION FOR BUILDING PERI~IT' Date Ju&y.. 1o ........... 19.8.0 INSTRUCTIONS c a. This application must be cOmlJle, tel~ filled in by typewriter or'in inch and ~ubmRted in triplicate to the Building Inspector, With 3 sets of plans, acc~urat& plo~t 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 m 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 Regulationa, for the construction of buildings, additiona 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 in buildings for necessary inspections. .1',1!,..~$¢g.~ .n.b.a.c.h .......................... -)' ,- .~~ y ?, / (Signature of applicant, or name, if a corporation) .Box .412,..Cutctl~gue.,..l~lew..~orl~..11935. .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Agent Name of owner of premises ...l)o~t.e.P,i~C9. Lo..R.~ ................................................ (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 License No .... ~"'./~7 .... /.~-.~ .~' ./~:-~d~"'~X Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ... Lo.e ,#18. ~.,~..o.... ~o.r th. ~iea. 1)r.~ve ................ 0r~enl; ............................. House Number Street Hamlet County Tax Map No. 1000 Section ..... 0J-~5, ......... Block ...1. .............. Lot..'.1.8..P.a.r. 9.e.1' . .2 .... Subdivision.. lff~p. O.f .Gte.afl Act, eS ............. Filed Map No .............. Lot ............... (Nmne) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... Va.aarll:.-...Ur~ilalprgy.~.d. ........................................... b. Intended use and occupancy .... ~.tlm~.e.r..R¢~.id. eh.c.c. .... .~/~ ../-f~. ........................ 3. Nature of work (check which app Repair I ...... ' Remov ~1 4. Estimated Cost .. $40 ~ 000, · .? · 5. If dwelling, number of dwelling u~its icable): New Building . .~'.. ...... Addition .......... Alteration .......... ............ Demolition .............. Other Work ............... ~'/_~/ 7~ (Description) .................... Fee..,. ~ac.,.. .............................. (to be paid on filing this application) .. O~te ........ Number of dwelling units on each floor ................ If garage, number of cars ........ None .............. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structuresi if any: Front ............... Rear .............. Depth ............... Height ............... Numl0er of Stories ........................................................ Dimensions of same structure witt~ alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front ..... 52 ........ Rear .... 52 ......... Depth . '....2.9 ........ Height ...... 20 ....... Numl~er of Stories ........ 2. .............................................. Size of lot: Front ...... .1,10..~ .......... Rear ........ 1 J..0. .......... Depth ....... 250 ............ Date of Purchase ........... Flay.,. 1.97.9 ....... Name of Former Owner ............................. Zone or use district in whichprero~ses' ' are situated .................................... .... Residential Does PrOPosed construclhon violate any zoning law, ordinance or regulation: ....... ]No ....................... Will lot be regraded ...... No..i .................. Will excess fill be removed from premises: Yes x No Name of Owner of premises Dora~Jtlco. hQ. Re .... Address ;~J-, .q"O{~.t.~t%U. ~,,,,,Phone No. ~16.5.07.? 0.4.40. Name of Architect .Gagl.iardo..~sso~iate~ Address ~.~?~roA~a~ ..... PhoneNo. 516.5.4 ~11. 9. Nmne ofContractorR. &. ~ .E~:~3. s ........... Address ~lassape(3ua~ ,.N~.ll~he No 51~ 698-125~ SW~ z~ro~ Rd,' ............. Middle Island,NY 11953 PLOT DIAGRAM Locate c!early and distinctly all )uildings, whether existing or proposed, and, indicate all set-back dimensions from umber or description according to deed, and show street names and indicate whether 10. 11. t2. 13. 14. property lines. Give street and block r interior or corner lot. STATE OF NEW Y.~RI~, /., /Z ,, o COUNTY OF&;~.. (Name of individual sig~ing contract) above named. - (Contractor, agent, corporate 6lifter, 6tc~) of said owner or owners, ~d is dujy authorized to perform or have perfo~ed the said work and to m~e ~d file this application; that ~1 statements cont~ned ~ this application are ~ue to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set fo~h ~ the application filed therewith. Sworn to before me this . ' - ............. ......... day or ......... ..... ~mmisslon Expires March 30, ~9 ~. /