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Home My WebLink About13297-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zd 3596 Date July 5 85 THIS CERTIFIES that the building completion o£ expired permit Location of Property 850 Ha jots Pond Rd. Orient House No. Street Ham/et County Tax Map No. 1000 Section ...... ~.6, .... Block 2 .Lot 39 · 5 Subdivision ............... .x ............... Filed Map No. x .Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated July 9 8¢ ~ 3297Z ...................... 19... pursuant to which Building Permit No ...................... dated July 26 19..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Completion o£ expired permit ff~5738Z £or one- £amily dwelling. The certificate is issued to STUART ~GER (owner~) of the aforesaid building. Suffolk County Department of Health Approval $-SO-f132 N6533~4 UNDERWRITERS CERTIFICATE NO ................................................... Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13297 Z Permission is hereby granted to: ..c.,~..j.~..~?....~..~.~..,:~. ............................. · ..~-~,~-~,....~.:.~k~ ...................................... ,~..~=~__ ....... ~.;~.....~ .................. .~ ....... ~.~ ............ ............................... ............................................................ at premises I~ated at ..~.~.~.,...~...~2~.~.....~'~.~C~...~/. ........ ~,;~:: County Tax Mop No. I000 Section ...... .C.'~5.~a..~4~ ..... Block ........ ~ .......... Lot No .....~.k~..~ ........ pu~uant to a~lication dot~ ............. ~ ~ .......................... , 19.~.~.~, and approv~ by the Building Inspector. Rev. 6/30/80 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall . Southold, N.Y. TEMPORARY Certificate Of Occupancy No T-Z-12704 Date Augus% 15 ................................................... l~?.. THIS CERTIFIES that the building '7 .-.n.e.w. . .d.w.e.l. 1..i.n.g.: seasonal u,se Location of Property 850 Major's Pond Rd. & Rowe Drive Orient: h~ ~io: ...................... 's'tle;i ........... ~,'a'~ ' ~'f .... h~,~iei County Tax Map No. 1000 Section 026 .Block 02 .Lot 039.5 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .J.u.l.y..9 .......... , 19 .8.4. pursuant to which Building Permit No. 13297 Z dated....Jul.%... .....26 .... ............ 19 ...,84 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .. ~. ~.riw.t.e.. 9~.e.~ ~ .a.m.i.%y..d.w.e, .~.Z.i.n.~..w.i.t.h...s.e.a.s..o.n.a.~..u..s.c..o..n.~7..' .............. The certificate is issued to ....... .W.]; .L.LQ.W' . .T.E.R..R,%.C.E..F.A..Rtyl..S.,. INC. (owner, of the aforesaid building. Suffolk County Department of Health Approval . .8.-:$0r.1.}~ ,..8./. 1..3/.8.4.,..S.'q.e.p .h.e.n...A:..C.o..s.ta, P.E. N 653344. UNDERWRITERS CERTIFICATE NO ................................................. Building Inspector Rev, 1/81 : ' ] ~ (THIS PERMIT MUST BE:KEP~r ON T~IE?P~M ~E ~'~I~L i ~ CoMpLETiON OF THE WORK eta' ' · ..... ' Pefm;~ s on is hereby/~granted~t°:~f~ ~p?roved by the: TOV/N OF SOUTHOLI~ OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 ~ugust ~6~ ~984 Robert Douglas a/c Willow Terrace Farms OrSent, NY 11957 Dear Robert Douglas: Enclosed herewith is a temporary seasonal certificate of occupancy. This will permit occupancy of the dwelling from April 15 to October 15. It is understood the present building permit covers only the first floor of the dwelling. The second floor is to be completed, a new permit will have to be obtained before this can be done. Should you wish to con- vert the dwellings present status as a seasonal to a year round home, the heating facility would have to be connected and a physical inspection is required before acceptance and a new certificate of occupancy (permanent) issued. These condi- tions will remain in effect even if the property is sold and the buyer should be made aware of same. Yours truly, Victor Lessard Exec. Admin. VL:smw TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N~Y. 11971 TEL~ 765-1802 July 13,1984 TO Whom It May Concern Researching the files of the Zoning Board of Appeals. I find that a 280A (Road Access) was issued to Mr. Koehler for this piece of property, Appeal 2493 11/30/78. When I asked the Board how the property became a separate piece,"in those days the Building Inspector (Mr. Terry, Okayed this type of action as long as the property met the requirements of that period in time". With this okay they issued a 280A approval and only on that basis. That being the procedure in those days I have no choice but to recognize the property as such. SUFFOLK COUNTY TAX MAP %'S 1000-026-2-P/0 39.2 Yours Truly Victor Lessard Executive Administrator VL/dsm h5 TOWN OF SOUTH0iiD SUILmNG TOWN HALL- SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P'RE/~ISES UNTIL RULL COMPLETION OF THE WORK AUTHORIZED) permissioH is hereby granted to: ButlSing I~spector. ~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPIgCcl'OR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall . Southold, N.Y. TEMPORARY Certificate Of Occupancy Ne.T-Z-12.704 Date August 15 1~.4' THIS CERTIFIES that the building'7?.n.e,w. ..d.w .... .n.g.,. s.easonal, use .e. 1 li ............................ Location of Property .. .8. 5. .0. .M.a. jg.r.'.s..P.o.n.d..R.d... & .R.o. we..D.riv.e Orient t~ouse No, Street part of Ham/et County Tax Map No. 1000 Section ' 026 .Block 02 .Lot 039:.5 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .J.u.l.y. p ........... 19 .8.4. pursuant to which Building Pemdt No...1..3.2.9.7,. ~ ........... dated ...~g~-3.. 2. .6 ................. 19 .8.4., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .. ~. p. riw.~. 9~.e.~ ~ ~.m.i.z.y..d.w.e. % ~!.n.q..w.i.%h., .s.e.a.s. 9.n.a)..u..s.s..o..n.~7..' .............. The certificate is issued to ....... WILLOW TERRACE FARMS, INC.. ................. (owner, le~ee~F-tem~) of the aforesaid building. Suffolk County Department of Health Approval . .8.-.$0r.1.~ ~ ,..8./. 1..3/.8.4. t..S.t.e.p.h.e.n...A:..C, qs..ta, UNDERWRITERS CERTIFICATE NO N 6.5334.4 P.E Building Inspector Rev. 1/81 THE NEW YORK BOARD OF FIRE UNDERWRITERS ' BUREAU OF ELECTRICITY g Jl~y 2"~, ~L~(,~ 85 JOHN BTREET, NEW YORK, NE~ YORK 10038 · .,s c~.~,.,~.... N 653344 only the electrical equipment as described below and int~duc~ by the applicant nan~ed on t~ above appl~catlon number in the prendses of ~~ ~., ~ and ~ound to be in compliance with the requirements of this Board. SWITCHES FIXTURES RANGES :OOKING DECKS OVENS FIXTURE OUTLETS RECEPTACLES DRYERS lO MULTI-OUTLET SYSTEMS NO. OF FEET EXHAUST FANS OTHER APPARATUS: ~otors ~l-:F Z-G.F oC. t E R V I NO O COND. OF CC, COND. C AWG, OF HI-LEG NO OF NEUTRAl 1 OF NEUTRAL This certificate must not be o feted in any manner; return to the office of the Board if J~correct Insnector~ ma be identif~ ~NG DEPARTMENT. THIS COPY, O[CERTIF~CATE ~U~T NOT BE &LTERED l~ ANY MANNER ORIENT TRUCKING & CONSTRUCTIDN gO,, IN[::. ORIENT, LONG ISLAND, No Y. 11957 ttEAL%'H OEPARTMENT REFERENCE NAME OF APPLICANT Willow Terrace Farm PHONE __ ADDRESS Willow Terrace, Orient NY :!.1957 PROPERTY LOCATION (include tie distance to nearest cross street)_i'lfj__2.}i_'!.~_oY-~0~O ....... Sect - 026 Block - 2 PCL - Part of 39.5 off Kinq St. 1200 PT HAMLET Ori ent SgBDI VI SION Willow Terrace TYPE OF oYo 1 ..... INSTALLEI): TOWNSHIP Southold Town LOT NUMBERjspc__r2~b~ q_d Septic Tank (a) Volume 900 Gal. (b) Type (precast, equivalent, block ) _~?._e_q a_~_tk Leaching pools: (a) Number and size of pools 2-9' High X 8' DJa (b) Type (precast - block) Precast £ hereby certify that the private subsurface sewage disposal system described above has been installed according to current criteria of the Suffol]< County Department of Health. Already Inspected and Approved~ DATL. ORIEH~ TRI<. and CONST, CO. TITLE 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 fitled in typewriter OR ink, and submitte~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 bu ildings. 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: I. Certificate of occupancy $5,00 2. Certificateofoccupancyonpre-existingdwelling/landuse--Pre-Existing C.0. $15.00 3. Copy of certificate of occupancy $1,00 / Vacanf. ~_and C,0. $ 5.00 New Building ............ ~ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ........... House No, Street Hamlet Owner or Owners of Property ~//~ Z c~ ~ ~/-Yd' ~- ~x~ ~-~,/E . County Tax Map No. 1000Section ,~, ~-~C Block ,~,~.. .... , ~/o Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval . .?.. .... abet Dept. Approval ................. Underwriters Appr0va .................. ?..¢ .r. .¢. anning Board Approval ................... Request for Temporary Certificate ....... . .~... ......... Finat Certificate ....................... Fee Submitted $. ~..~.' ........................ Construction on above described building and. permit meets all applicable codes and regulations, C~_~-- "5-0~,~ ............ ~"> ~, ~ .~. ,.~-- ............ 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, [ndustria~ 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 p:Coperty 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 $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~-- .Lq ..... New Building ............. Old or Pre-existing Building ....~. ...... Vacant Land ............. · ooat onofProper .... ............ ................ ..... Houee No. Street Ham/et Owner or Owners of Propertv ..... /~ .f'.' ......................................... County Tax Map No. 1000 Section .... ~O~ ..... Block ..... ~ ....... Lot ..... .~'.'.~.. Subdivision ~ Filed Map No. .Lot No. Permit No ......... ~/ ~"~,,~: ~, Date of Permit ./~,~..///~,/... pphat ............................... .?~?c~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Bequest for Temporary Certificate ..................... Final Certificate ..... ~...'. ............. Fee Submitted $ .................... Co~.struction on above described building and per, nit meets all a~pplici~bl.e~codes and regulations. 0~ 0.c~:~ 1~(~(o A Hcant ...(~'~-/.~.~ dA') ..~.~.J~' ..f~...~ ..... ..~..~, ~0, ~(o~7 ~j~. pp . . .~.~.~.~.~.~.~.~.~..J .L~.' .... : ........... ./. ......... Rev. 10-10-7S F L NSP CTION COMMENTS FOUNDATION (1st) FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL. ,' ADDITIONAL COMMENTS: TOWN OF SDUTHDLD OFFICE nF BUILDING INSPECTOR ToWN P. LEI~K'S I-IFFI[~E SnUTHOLD, N. Y. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWIq HALL SOUTHOLD, lq. Y. 1197! TEL. 765-1802 I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. praved ............... ....... Pe,mlt No ............ : ............... Disapproved a/c . ~ ~ ... ................................................................ ..........._ ......- .... (Bu,d~.g' I;;;~;~ .............. Application No. /000 7 APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ............... //~..'/~ ....... ,19..~ o. This application must be completely filled in by typewriter o~. 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 oF areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which [s part of this applicotlon. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon appraval 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 Jn 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 ora 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary in~pect, i~ .... ~. (Signo ure ot~;;~plicont, ~ corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises~.......~.....~.~...,,~...~t~ ~ ~-'--') ~,'~ ............................................. I f ~,~~~sig n~f~du ~d of ficer. ~~;'~ '~;"of ~~'",;e~7~ ...... Builder's License No .............. ~.'....~... .......................... Plumber's License No ............................................. Electrician's L'cense No ........................................ Z~~~ Other Trade's License No ............................................... ,. ' ,, ..,~.. ~ 1. Location of land on which propo,sed work~JJ, be dene.~b6pp t',~9.' .//~,~~~:__~ Street and Number ~~..~..~~i~...." -' ~,/ ~'~' {~7 Municipality ,~- 2.State existing use and occupancy of premises and intended use and occupancy Of proposed construction: a. Exisiting use and occupancy .................. ~¢;~;~,..~ ......................... i ....................................... b. Intended 3. Nature of work (check whicJ'! applicable); New Building. ~ Addition Alteration ................ ,, Repair ............. =.., Removal .................. Demolition .................... Other Work ................................................ , .... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ../.. ................. Number of ¢}velling units on each floor ............................ 6. If business, commercial or Im~xed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structgres, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structur~ with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ...., ........................... lO.' Dote of Purchase ..~.~ ............. .~..,~..~ .~..Name~.g,f Former Owner~~ 11. Zone or use district in which jpremises are situated ........ 12. Does proposed construction violate any zon ng aw, ordinance or regular on: .................. ~ ..................... 13. Will lot be regraded . ............. Will excess fill be removed from premises: (~J Yes ( ) No Name of Architect .............. ! ................................................ Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property I nee. G~ve street and blpck number or descrlphon according to deed, and show street names and md cate whether interior or corner lot. ~S.S :,.. being duly sworn deposes and soys that is the applicom ning contr~tO ' ' He ls tho ........ , ............ * .... * ...... ~ .... ~ ..................... o{ said owner or ownors~ end i~ d~ly authorized to p*r{orm or h~vo ~r~orm~d tho ~oid work end to re, ko ~nd file this ~ppl~cofion; that oll statement* contoln~d in thi~ application ore true to tho~b~st o{ hl~ knowlod~* ~nd bo~e{; ~nd th~ tho work will b~ p~rformod in tho m~nn~r ~ot {adh in tho .gpplicotion fil~d th*r~with. Sworn to,before m* ~ ........ / ~ r (~gnature of ap~cant) ~., OF NE\ YORK, COUNTY ,OF .............................. (Name of individual si ~O~,~ 70. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................. ~proved /~ ~ '. I~..A~. ~rmit ~o ..................................... Disopprov~d a/c .................... ~.~'22~ ............................................................. / (Building InspectS" APPLICATION FOR BUILDING PERMIT Dote INSTRUCTIONS o. This application must be completely filled in by typewriter o~ 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 pubJlc streets or areas, and giving o detailed description of layout ofproperty must be drown on the diagram which is part of this application. 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, a~d other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for nec,,~ess_ory~\ns~te~,~t~o~ns. -- , o~';ot~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... '~¥~'7 ....... ~/'--~jz.'"~:T'_~ ....... ~"Z~' ........ ~z~~: '" Name of owner of premise~..~..~... ~ .................... ~..~ ........... ~...~..~ ....... If appl~ cor~rat~g, ture of duly?uthorized officer. .,.~.~...,~.~..o ................................. ~~~ . ............................. ~~~_~ ~,~,~ ~n, ~,~ ..~.....~....~..,..,~~~ ............................ ~ '~ f ~ ~ Municipalik 2. State existing use and occupancy of premises and i~tended use and occupancy of proposed construction: a.Exisiting use and occupancy ............. ~~...~ ......................................................... ,. ............................. 3. Nature of work (check whichlapplicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~~ ~/' (Description) . (to be paid on filing this application) 5. If dwelling, number of dwelli~ng units / . Number of dwelling units on each floor If garage, number of ~rs ..~.....~.~.~..~....~.....~ ....... ~..~ .................................. 6. If business, commercial or =:mixed occupancy, specify nature and extent of each ~pe of use ............................ 7. D~mensions of existing structu;res, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structur~ with alterations or additions: Front ........ ~ ...... Rear ..~~ .... Depth ................................ Beight ............................ Number of Stories ................................ ~. Si~e of ~ot: F,o,~ ...... ~.....~..~...~ ..................... ,~r ........... ~:~.~.:......~.__ ..... Dept~ ...... ~..~...:. ......... ]0. ~,e of ,~ha,e ............... /~..~ of ~o,~r Ow,~~~~~ 1 ]. Zone or uso district in which ~promis~ ore situated ......... ~....~ ................................ 12. ~oe~ proposed conslrucfion 14. , ~m~ of Owner of premise ..~,~Z.~.~.... Addre~~~one No ....................... ;:? Name of Architect .............. ; ............................................... Address ................................ ,Phone No ....................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ! c% , INTY ~OF YORK, ;S.S duly sworn, deposes and says that he is the opplicanl i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is doly authorized to perform or have performed the said work and to make and file this application; that ell statements contained in this application are true to the'best of his knowledge and belief; and ti,ar the w,~/'k will be per~ ,rmed in ~he manner set forth .~pplication filed therewith. Sw°rn t° ~/f°re me this/ .~.~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 E×amined. .. Approved ~...~.~.., 19~.~. Permit NJ .~..2L.~ .~. ~.~.. Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT IN STRUCTION S 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 Law% 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 building for necessary inspect, ions. ~,.~.~, ~ . ,.. (Signature o~ applicant, or name,~ a corporation) (Mailing address of applicant) State whether appiicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name ofownerofpremises ..?~1,'~'~~~,~,. ,;.t~..~~ ..~.: ........... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· (Name and titl~'of corporate office) Builder's License No ....... .~. '~. · ........ ,~.' ~.~, Plumber's License No. ~...~.... <~ . . .:j,~. ~, E,ectrician's License Other Trade s License No ...................... 1. Location of land on which proposed work w, ill be done ........ Hamlet House Number Street ¢/ ' -~ County Tax Map No. 1000 Section-/~Z:~.."?. ~. ,~ ~... Block ...... ~,~ ......... Lot .~__~.~., ,~. ....... Subdivisiorf~'.~.,~. ~__~".'.~;~ ........... 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 .......................................... . ........................... b. Intended use and occupancy .... f,~....~J~..~~.~..~.~ .................. f ' ' ' ' Addition .......... Alteration .. ......... 3. Nature o work (check which apphcable): New Building .......... Repair .............. Rem,Oval .............. Demolition ............. Other Work ~.~ ' ~ ~_~ (Description) 4. Estimated Cost . ~..O.O~ ...o..~s, .................. 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 .... !..~-'~-1,~-~ ......................................................... 6. f business, commercial or m~xed occupancy, specify nature and extent of each type of use ..... . .W .............. 7. Dimensions of existingstructur~s, if any ~:ont....~....... ~ Rear ..~..~...t .... Depth.....~..'.... Height .. ~, ~.: ...... Number of Stories ...... ~.~ .............................................. Dimensions of same structure with alterations or additions: Front ..... ~..~.." ...... Rear .... ,a~ .~..~ ........ Depth .... ~L ~<. F ........ i'" Height ..... ,~o ._...;~ ..... Number,~f Sto~es~.. ~.. ~ ......... ~.. 8. Dimensi~ns~fentirenewc~nst~ucti~n:Fr~nt...~Rearc:~.-~k~..~'~t~x~..~. . . Height ............... Nut, bet of Stories ................................................ ~ ....... 9. Size oflot: Front ...... ~... Rear ...... ~q'.........." Dep .... , . 10. Date ofPurchase,,.~.O~. !o~,~-~ ..... Name of Former Owner .... ~ .................... 11. Zone or use district in which premises are situated ' . ~ .,-.~...~,~-~ 12. Does proposed constructi~on w01a~ any zomng law o~di~anc~r~t~l-a~i~'n.'~., i.. ~~ ~. .......... Will lot be regraded ~...e't. eqa ......... Will excess fill be removed from premises: 14. Name of Owner ofpremises'ib,~' ~ ss . .~.~..~ .Phone N '~. Name of Architect ................. Address ...... ~ ............ Phone No ................ Name,of Contractor .~.,. ' · . ~ .... Address . Phone N PLOT DIAGRAM L ' ocat.e, clearly and distinctly al! buildings, whether existin_.g or proposed, and. indicate all set-back dimensions from property lines. Give street and blocki number or description ac~_,~rding to deed, and show street names and indicate whether interior or corner lot. : STATE O 'NEW YORK, S.S COU. N,T)'..OF ................. '-- ~ '~("l~nT~'of ifi'~v'id~i~si~ni~con r~-c~TM ' ~'~4:' ' being duly sworn, deposes and says that he is the applicant above named. He is the of said owner or owners, and is duly authorized to perform or have p~formed the said work and to make and file this application l 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 mannqr set forth in the application filed therewith. Sworn to before me this No. 4707878. SulfoIk County .~ t---' / ~/ ' (tSignature of applicant) ] lerm txp,res Marcln 30, 19~g