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Home My WebLink About11029-z FOB, I~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPART/v~ENT TOWN HALL SOUTHOLD, N.. Y. BUILDING F,ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 11029 Z Permission is hereby granted to: ...... ....... ................................... :~.~/... ~.~...:~~.....~-.~ ........ ~.: :.:.~. ~--~- -~....~, ........ /~5-~ ~o ............................ ~ ............................................. T ......... ~ ........................................................... County Tax Map No. 1000 Section /'~"~ ~ Block ~-P~' Lot No. "~-~ pursuant to application doted .......................... .~...~..T....../. .............. , 19. .., and approved by the Building Inspector. /~ Fee $ ....................... Building Inspector Rev. 6/30/80 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 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 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 3. Copy of certificate of occupancv $1.00 $5.00 Date... ~./~.~../~ ./. ....... New Building .... .../~...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property..~ ~ ~...~ .... ~'~.~':77~ ,¢0.. ~J ~,2/~, 4/./~7~.., ./~, ..... ~..~. ~.._//~L~. ~ C~./1~... House No, Street Hamlet Owner or Owners of Property .... ~..~.-~'2 .~.~... ~.~--*,~. ................................. County Tax Map No. 1000 Section . ./, .';~.. 3 ........ Block .... 51 ......... Lot ...... ~'. ........ Subdivision ........... ..~. .................... Filed Map No ........... Lot No .............. Permit,o..~,0~,.~,~, Date of Permit ~)~/~/~/~/.Applicant .... ~"~,:0~..~ .... l~J~, ~-~,t. ...... Health Dept Approval Labor Dept Approval '- Underwriters Approval ...... -. ................. Planning Board Approval ....................... Request for Temporary Certificate ..................... Final Certificate ...... ~ ........ Fee Submitted $. ~,~.'x ~ Construction on above described building and permit meets ~11 applicable codes and re,~[~lations. Applicant ....... ~ C:;l~ )'~-C4i...//f.,,/~..~. ............... Rev, 10-10-78 FORH NO. 5 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION TO ~/~.~:~...~{~......~..~-Z:/. ............................ (owner or authorized agent of owner) ~da~,,, PLEASE TAKE NOTICE there exists a violation of: ..... ........... Other Applicable Laws, Ordinances'or Regulations ............................................ at premises hereinafter described in that ~....~Z~.~.../~.LL.Zd~,~...,~/~I.~ ........... (state character of violation) ~ ~ .................................. :~ ........ ?~ ................................ ., ~j~.~(~ ., ~ ..................................................................... ~n vlo~atJon of ........................................................................................................................................ (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned forthwith on or before the ............. ~,~.~ ........................................ day of .... ~;~, ................. , 1~. The premises to which this ORDER TO REMEDY VIOLATION refers ore situated at Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute on offense punishable by fine or imprisonment or both. ...~i~~....4ff.~ ......... Building Inspector FORM NO. 5 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION (~)wner or authorized agent of owned, r) / , (address of owner 6r authorized agent at owner; PLEASE TAKE NOTICE there exists o violation of: Zoning Ordinance .... ~.Z.. ,~...., .~'T~ ............ Other Applicable Laws, Ordinances'or Regulations ............................................ at premises hereinafter described in that .~...C..~.~-..~.~.....~?:..../.~.~.~.~.~'~'.~z.~..~....~'K~,~(~.,'2,~ L~ '(state character of violation) ,..(.. ~.~¢~¢.~.Z. ....................................................................................................................................... in violation of ....... -~,~.~'~C~.....~..~:)....O..;.:..¢'....~. .................................................................................. (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned forthwith on or before the .................... ~= ~-~-~ ~ ~. c 19~.. day of ...... ~.,.'~ ~[~.~..~ ............ , The premises to which this ORDER TO REMEDY VIOLATION refers are situated at ,, ~.County of Suffolk, New York. Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprisonment or both. .......... ~i,~ .............. (...:.~.~ ............................ :..' ............. Building Inspector FOI~M NO. 5 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION Date ..................................................... , · (awner ar autharized agent af awner) "'~:~':~:~ o'f'~wner ~ buthorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Other Applicable Laws, Ordinances'or Regulations ............................................ (state character of violation) The premises to which this ORDER TO REMEDY VIOLATION refers are situated at ~.~,~,' ~/~.~ Suffolk, York. .,.~.~ ........... ~ & ~2, ~'~v'~...County of .............. r/ . ...~ ~0 New Failure to remedy the conditions oforesoid and to comply with the opplicoble provisions of Iow moy constitute an offense punishable by fine or imprisonment or both. Builaing Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;3 Examined ................ ,19... Approved ................. 19... Permit No ............ Disapproved a/c ..................................... Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT 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, Ordiminces 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 ad m it au th oriz ed in spec to rs on premises and in bu il din gs fornecessary...3~inspecti°ns"'~ ///'~..~.k. ...... !- ~) '.r2~. ~.~. ,.d. ................... (Sij[~ture of applicant, or name, if a corporation) .... (Mailing add, reds of applicant) / State whether applicant is owner, lessee, agent, architect, engmeer~ general contractor, electrician, plumber or builder. ..... ......... 7 .................................................. Name of owner of premises .... ~.c~T'2).e 3.. ~.~.,~.. <~/.C .................................................. (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 ..................... '.r~.... Plumber's LicenseNo .................... .3C-.... Electrician's License No .................. ~.... Other Trade's License No ................. 3v'.:.. 1. Location of land on which proposed work will be done ..... .. ...................... .......... ........... 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 ]~e~.~'. b. Intended use and occupancy ...... '~.. ]~.~ .<. .... ~'~ .... ~?.~.. ............................ 3.Nature 'of work (check which applicable): New Building .......... Addition /~ Alteration Repair .............. Removal .............. Demolition ...... {)O ...... Other Work ............... 4. Estimated Cost .... /.~.~ .................... Fee ..................................... (to be paid on tiling 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 type of use ..................... 7. D~mans~ons of ex~stang structures, ff any: Front ............... Rear .............. Depth ............... Height; ............... Number of Stories ........................................................ Dimensions of same structure wi,th alterations or additions: Front ................. Rear Depth .................... .. Height ...................... Number of Stories ' .. . 8. Dimensions of entire new construction: Front ...... ~. ~ Rear .............. Height ............... Number of Stories ........................................................ 9 Size of lot: Front Rear Depth 10. Date of Purchase ........... ! .................. Name of Former Owner ............................. 11 Zone or use district i whi h p ~mises ar situated · n C re, e .................................................... 12. Does proposed construction violhte any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... : ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. 'i ................. Address ................... Phone No ................ Name of Architect .......... . ................. Address ................... Phone No ................ Name of Contractor ......... i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all lbuildings, 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 ¥C~RK ~ :- S C,OUNTY OF .~...~ being duly ~ (Namer individual signing bontract) above named. sworn, deposes and says that he is the applicant He is the .. ................. S~.et~%~.~r ........................................................... (Contractor, ~tgent, 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 be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... ..... ...... Notary P~bJic,, .......... ~ -.. ~ .~. County ~IZABETH ANN NEV: ~'~ .... ' '~' ' · , // HOTARY PU~)LIO, Stato of New ~ork NO, 62-8125850, Suffblk Countv Term EXpires March i0, 19.,.:~.~ (Signature of applicant)