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Home My WebLink About12958-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEFAI~TMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12958 Z Dote .....~/.~. ............................... , Permission is hereby granted to: ...... .................. .~...~..~ .............................. .~.~.....~....~.:~..~......!.~..~.~e... ,~_.~...¢......~.. ~.~....~.~~.~.~...~ ....... ~ ............. -~~...~.. ~.~.....~....~~...~.~ ......................................................... at premises located at .....~...~...~...i~.....c~.~.~b....~.~-~~ ........................... County Tax Mop No. 1000 Section ..... ..~i.~.....~. ........ Block ......... .~. ......... Lot No .......~!. ............... pursuant to application dated .... .~...~..~...~..~ ...................... , 19..~..~., and approved by the Building Inspector. Fee $ ........................ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~outhold, 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 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: I, Certificate of occupancy. $5,00 2, Certificate of occupancy on pre-existing dwelling 3, Copy of certificate of occupancy $1.00 landuse--Pre-Existing C.O. $15o00 Vacant land C.O. $ 5.00 Date .... I~larch. 1_6, .L984 ........ Deck Addition New Building / ............ Old or Pre-existing Building ............ Vacant Land ............. Location of Property 4.90. Ba¥¥Jew Road, Southo]d, New York .. House No. Street Hamlet Owner or Owners of Property ...Hez:b~r.t. ~F,. OA1].agher. ~.c1 .~atrJ¢[& .&~ ,Gallagher ............. County Tax Map No. 1000 Section ...?.8 ........... Block ....... 6, ....... Lot..11 ............ Subdivision ................................. Filed Map No ........... Lot No .............. Permit Uo./.~..~ .~?..~... Date of Permit .&Ji~'..17~[..Applicant ................................ Health Dept. Approval ........................ Labor Dept. Approval ..................... Underwriters Approval ........................ Planning Board Approval ,. .................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .5:0.0..: ....................... Construction on above described building and permitfT~tsj~all ~lica~3.~d. es and regulati°ns- Applicant ......... ~:::jL~. '~'~...'T'T:~-... ............. R~v.,0-,o-,~ ~O ~ HERBERT F. GALLAGH~ HERBERT F. GALLAOHER (6 16) 74~-0046 March 20, 1984 Building Department Town of Southold Town Hall Southold, New York 11971 Gentlemen: Enclosed are applications for a building permit and C.G. in connection with a deck added to my house. Please be advised that the work is now com- plete and I would appreciate an immediate inspection. Also enclosed are two checks payable to the Town of Southold, one in the amount of $5.00 for the C.G. and the other for $25.00 for the building permit. If you have any questions, please call. Very truly yours, tlFG:kh Herbert F. Gallagher () Enclosures FIEL~ iNSPECTION COMMENTS '~ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C~ODE FINAL Examined...~.~..%.°.. Approved ...~ .c¢4-. ~.x...7~. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-180:3 ., t9 Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT C ..... ,19... a. This application must be completely filled in by typewriter or in ink and submitted 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 issued 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 cod?, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspectiott~} (Signature of applicant, or name, if[h corporation) · .~?...~..¢.~ .x.~.u,..~.9.~:%..¢.~.¢. ~z.~.~. ?.-.-~. ~. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... O..~.~¢.~ ................................................................................. Name of owner of premises ...~.6.R. [5.~ .R.T.... ~ . .~.A.L..L.h.C?.bl.~l~....~.ki..D...?~. '.~.~. I.~. I..~...~..,...~..~.L. '.L.~..~..g.~ ~. (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 ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ... 9.o. ..... ....................... ...... House Number Street Hamlet County Tax Map No. 1000 Section 7~.. Block .... ~.. Lot... ! ] Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~ ~.~ I ~.~ gt T.I ~..~... !7[.°. ~.~. ..................................... b. Intended use and occupancy ........................................ : ........................... 3. Nature of work (check which appli :able): New Building ..... ' ..... Addition ........ Alteration ...- ........ Repair .............. Removhl .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ........................................ ' ............................. ~', (to be paid on filing this application) 5. If dwelling, number of dwelling u~its · · .%"Z. .......... Number of dwelling units on each floor. · · ............. If garage, number of cars w; 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ... 7: ................ ' Rear Depth 7. Dimensions of existing structures,lif any: Fr°nt ............................................ Height ............... Number of Stories ....................................................... Dhnensions of same structure with alterations or additions: Front ................. Rear ................. Depth ..................... !. Height ...................... Number of Stories ..................... 8. Dhnansions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ....................................................... 9. Size oflot: Front .... !00~. .... i ...... R .(0.0. I .............. Depth ..l~.Q ............ 10. DateofPurchase .0.q.~.~,.I.l~.l.q.g.i . "i -ear i i ~ame of Former Owner ~NTHO~Y L6 ~,o, sA .... 11. Zone or use district in which premises are situated. ~* Si b.~ u'U A ............. 12. Does proposed construction violale any zoning law, ordinance or regulation: }Jo 13. Will lot be regraded .......... i .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises l~,.~.:.Ggt-,)-.h~'B~.~, Address %-/ 6R)~Tg~ ROAD Phone No.~.~.q'7.-~clZ~o.. Nme of Architect ...-777.. ...... ! ............... Address ................... t'none ~o ................ Name of Contractor J'.-,..~,..~..15 ~.~..AI~.I~ .......... Address .~ .q .~ .t)~.~.~?.~.X · .t?.,. Phone No.. ,~..q.-.0%2~ ... MASTic B~ACl41 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 numbe~' or descnptmn according to deed, and show street names and indicate whether interior or corner lot. .-qouT HO el>., STATE OF NEW YORK, ,~ o ......... :~.g.k.T.. ?.: . .~..~.~0,qJ~f. ............. being &fly sworn, deposes and says that he is the applicant (Name of individual sig~i~contract) above named. He~....~.~ ~ ........ T. ~..~ ................. ~~'~ ........................... ,, ~orporate_officer, etc.) of said owner or owners, ~d is ~[~ ~ )~e[~med the said work and to m~e ~d file this application; that ~,~'~niained m this application are true to the best of his knowledge and behef; and that the wor~~6~ed in the m~ner set forth in the application filed therewith. Sworn ~re ~fis' ~ ................. day .... 19 Nota Public, ........ .... .... ~ffgnty Quzl?/ied it~ bJass~u County ~