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Home My WebLink About11489-z No. Z PermissiOn is hereby granted to: (THIs PERMIT MUST BE KEPT ON T~,E pI?,E~I~ES UNTIL~FULL COMPLETION OF THE WORK AUTHORIZED)[ ...... ~ ........ ..... .......... : ....... ,~,...~....~.;,,., ..... ~.....~.y. ............... ~ ~ ' ~ ~ ' O: Co~n~ ~ox Map No. 1000 Sechon .., 'r.;?.;Blo~k ?.t .,.., ........... ~~ ~ ... and~approv~ by the pursuant a~4ca4on dated .. r Building nspector. : 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 surYey 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, 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 unusua! 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. 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 '¢?~b) ~'~'t~ .... Old or Pre-existing Building(X) .. ...... ~Vacant Land ............ ..... t,. . l, / Location of Property .. ........ . ,~ ,~ ~ ¢ . Hou~ No. ' Street Ham/et GounW Tax ~ap ~o. 1000 Sectio, ..... ~g.~ ...... Block ...... g .~ .... Lot ..... ~ ...... Subdivision ..... ~ ~.5 F.s .....Filed Ma0 ~o ........... kot ~o. Health Dept. Approval ............ .~ .......... Labor Dept. Approval ........ Unde~riters Approval ~ .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ...... Fee Submitted $ ......... Construction on above described building and permi~meets all appl~cabte~codes and regulations. FIELD gNSPECTION FOUNDATION (~st) FOUNDATION (2nd) COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C DE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 .... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.././..~..~. ........ 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 promises or public streets or areas, and giving a detailed description of layout of property must be drown 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 in buildings for necessary inspections. .Deorge. AbAers. Bldr,..Inc ................. (Signatu~ of applicant, or name, if a corporation) 855 Eugenes Road, Cutchouge, N.Y. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General C o~'~rac-tor Nmne of owner of premises ... S~.a. nl ~.y..Dcm.hr o sky. ~. O~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 ......................... Electrician's License No... ~'~/o. .~.'~ .?.~. ....... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ........ Lo~:. q¢29 ........ kligh:~anO, l~r~ve ....................... Cu.%ohoguo .................. House Number Street Hamlet County Tax Map No. 1000 Section ...102 ............ Block ...... 8 ........... Lot.. 26 .............. Subdivision Highland Estates Filed Map No, Lot .2.9 .... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .dwe.lling .......................................................... s~Orage buildin~ b. Intended use and occupancy ............................................................. 3. Nature of work (check which applicable): New Building X Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... : e~.~/r.''Jf''~. ~ (Description) 4. Estimated Cost.. $7000,00 . Fe (to be paid on filing this application) 5. If dwellihg, number of dwelling uhits ............... Number of dwelling units on each floor ................ If garage, number of cars .... o~e ................................................................. 6. If business, commercial or mixed bccupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures; if any: Front ............. Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure witl~ alterations or additions: Front ................. Rear .................. Depth ..................... :. Height ...................... Nmnber of Stories ...................... 8. Dimensions of entire new constru:chon: Front . 2t3' ........... Rear . .20 ! .......... Depth ..... 20 ! ....... Height . .... 17! ....... Number of Stories ........................................................ 9. Size of lot: Front . .21./+..7.Q...i .......... Rear .. 23./~,7./4 ............. Depth .... 2k88,52. .......... 10. Date of Purchase ............ ! ................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated .... A 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... n. 9 ......................... 13. Will lot be regraded ...... no..: .................. Will excess fill be removed from premises: no Yes No 14. Name of Owner of premises ,$tanl. oy. Dembrosk/g~ktt~s · · Cutclaougus.,.N.Yl~hone No ................ Name of Architect Address Phone No 7~./k-~5 3./*5 Name of Contractor .Go. Ahler. a .Bldg.,,. ;trio, Address . .C. LVCCh.og~e~. ~I,¥,Phone No..?~.14.-.50~D. .... PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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. See attached STATE OF NE~yX)R[,/ , ~,~ iS S COUNTY .... i ' ............... .G.~.q~.g .o f.A.h. 1..e.r.s. ............ being duly sworn, deposes and says that he is the applicant (Name of individual sighting contract) above named. He is the ........... .C.Q~;F.a. qtbr. ................................................................. (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 are true to the best of his knowledge and belief; and that the work will b'e performed in the mann}r set forth in the application filed therewith. Sworn to before me this ............ day of ....... ,19 . ~- ~/ ELIZABETH ~,NN NEV[LLE .................... , NOTARY PUBLIC, 3taro of New York (Signature of applicant) II0. 52-8i25850, Suffolk C0u~lj~O~ l'~ ExOircs March 30, 19..~.'~ TEL NOTE: SMBD~VISION MAP FILED IN T~bE' OFF/CE OF ~ C~.~I~K OFSUFFOLK ~OUNTY ON APR ~, 197Y,~S FI££NO. 655i' FJ : MUNUMENT SURVEY FOR STANLEY DEMBRO~,KY, JR. LOT IVO. 2.9, .' HIGHLAND. ESTATES I~T~' CUTCHOGUE ~N,. OF SOUTHO~D SUFFOLK ~UNTY, NEW YORK DATE: AUG. ,~8 , I,,~1 SCALE. I " -" 50' NO. $1 - 506' ,4 GUARANTEED TO ~ ~IDER AVENUE YOUNG a YOUNG . RIVERHEAD, NEW YORK ALDEN w YpUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR N YS. UCEN$E NO. 12845 HOWARD W. YOUNG~ LAND SURVEYOR NYS LICENSE NO 45893