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Home My WebLink About5904-z FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No..~..Z"?..,~.. ................................................. .............. .. ........ ..... .. ................ ~ .......... ~** ~s~;~';;;~ ........................ i~'~ - s _,_/ APPLICATION FOR BUILDING PERMIT Date ...~1~..~.,~ ;, ig...~...~.... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to t~fe Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ' ,,; ,' b. Pict I~l~n showing location cf.'lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an giving a detailed description of layout of property must be drawn on 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. ~uch permit/?all be k~pt o the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whateve~ 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 tq th~ Building Zone Ordinance of the Town of Southold, SuffoJl~ County, New York, and other applicable Laws, Ordinances or Regulations, fo~ 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 insDections. (Signature of applica~, or name, if a corporation) ..... (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ... ~..~...~..~..+.~..t~4 .............................................................. If applicant is a corporate, signature of duly authorized officer. Name and title of corporate officer) 1. Location of land on which proposed work will be ~one. Map No.: .................... Lot No .............................................. Street and Number ..i..~....~.0 .~......~....~.~ ................................ i....~_~J~..~.. 2. State existing use and occupancy °f I~emises and~,)n,~ ~- ~,1~ o e n ~ ~ ,,~ Z~_ ~% , ~_,~ n ~~intended use and occupancy of proposed constructibn: ~ '3.~~ Nature of work (check which applicable): New Building . . . Addition ..................... Alterat~oF,;....' .......... Repair ............. · ............ Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ~..~....~..~..~'~f,~..~.... 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 ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ......... .~;;,.; .......... , .................. Height ......................................... Number of Stories .............................. L. .... 8. Dimensions of entire new construction: Front .....~..~..-' ....... Rear ...~...~ .......... Depth ..~¢~.~...~......i... Height ................ ~2..~f~. ................. Number of Stories ................................................................ ,..~ .................... 9. Size of lot: Front....J...~...tB! ~......~...-...... Rear....~..}..~....,~..~ ............. Depth...~...~...~...~ ................ Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ............................... ~ ......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ~ .............. ~-~7'; ............... 13. Wi)llotberegraded ~..,,~ .................... Will excess fill be removed f.rom, premises:[ ] Yes ~] No 14. Name of Owner of premises~/~~(:/~~(-~d~{~:~~-~?~/~`~---~ ~ (Address) ~ (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ................................................................................................................................................... (Address) (Phone No.) 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 nur iber or description to ~ ~ and show street names and indicate wheth- er interior or corner lot. OF NEW YORK, sTATE COUNTY OF ...................................................... .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. {Name o/ individual ~igning contract) He is the ................................................................................................................................................................................................................. {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 ara 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. -7 k/Es FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ................. Date ............................. THIS CERTIFIES that the building...S..t.o.r.a./~ .e..S.h.e..d ............................... Location of Property ... ).7.0...W.e.s.t Road. ......................... .C.u.~.c..hpg. u.e. ........ House No. ' ..... Street Ham/at County Tax Map No. 1000 Section ....1.3.0. .... ;Block ..... .5 ......... Lot ... 4. ~ ............ Subdivision ........................... ;...Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. ,H.a.g..2.6 ............ ,19?.2.. pursuant to which Building Permit No.. 5 9.0.4.~ .............. dated ...... H. ay..~ ............... 19 .?.2., 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 ......... Ac. cessorg sto..r.a~.e eh.ed The certificate is issued to ... ?.a.l.m.e. ?..R.y.. ~..a.n.d..q .r ./.~.~ o. .1.d .............................. (ow~er,~e~ ~/W~k~ X X of the aforesaid building. Suffolk County Department of Health Approval N / A ..... UNDERWRITERS CERTIFICATE NO...................N/A .............................. . Building Inspector Rev. 1/81 lrO~l,M NO. t~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 590~ Z Permission is hereby granted to: ~.s:...,.~...~..:~...~....e..,..~.,......~... ................................. at premises located at .......... 9.~).....1~.~tlt~J~llil~ ......... ~1~..11~11~ .......................................... ................................................ ~.~l,~ll~l~l ....... I.Z. .......................................................................... pursuant to application dated ...........................l~,...~. ......... ~ ......... , 19.~....., and approved by the Building 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 feature~ 2. Final approval of Health Dept. of water supply arid 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 ~Jrvey 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. Co 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 ~/(~0~ Date . ~43~u,s.t..2.2~. 7~.8.4 .......... New Building .. :.~...m~.~,.~. :.. Old or Pre-existing Building .. ~ Vacant Land ............. Location of Property .... s.~...~3.a~.,. 9.u~c..d3.ocj~e../...~..Y.o..z~. .................................... Hou~ No. Street Hamlet Owner or Owners of Property .P~.~, ,Ry,~.a~, ~ .(~. ~, .s~.[..d ' County Tax Map No. 1000 Section . [[0 Block 5 Lot....4.5 Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.5.9.0.4~ ...... Date of Permit . . .Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval.. ................... . Request for Temporary Certificate ..................... Final Certificate . ~ .................... Fee Submitted $ 5,00 ......................... J Construction on above described building and regulations. .... ..................... Willi~m~ Wi~h~ ~ A~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ,;~ TOWN CLERK'S OFFICE SOUTHOLD, N, Y, xom,ned .... ............ Approved ................. {J ..................... , 19.../..~. Pemit No....~....~..~..?...~. ......... Disapproved a/c ............................................................................................ (Building Inspector) Application No......?...~..?..,~ ............. APPLICATION FOR BUILDING PERMIT Da,e .................. , 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 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 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. · (Si;nature o;';pl~;i~e, if a 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 ...(~..'~--~....~.. ...................................................................... If applicant is a corporate, signature of duly authorized o~lcer. (Name and title of corporate officer) 1. Location of land on which propose~,~ork will be did, ne. Map No.: .................... Lot No ........ ,. ..................................... Street and Number ........ -~-2.~-. ........... ~-.-..[~ ....................................... .~.~ ......... 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 occu pansy ~'[~1~1:3/~,-.~.~~/.(1~~.?"~g;t,,j,l[~ .... 3. Nature of work (check which applicable): New Building ..... ~..... Addition ..................... Alteration ............... Repair ............. ............ Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ~.~.~ Fee ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwe!ling units .................Number of dwelling units on each floor ......................................... If garage number of carl .......................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ............................... ;... Height ......... Number of Stories ...... ..~..../3/cu~_~.. 6~I,L~. ~.. ,~,~.,~ ~ ................ Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ............... _ ......... ...... 8. Dimensions of en~ire r~ew,//_~construction: Front ..... ."~".t ..... Rear ....~..~.x ..........Depth .../.9~..//..~.,~L./ ~'~ ....... Height ............ ~,.~[~J.-..-: ................ Number of Stories ................. ,. .............................................. ~.e ................... 9. Size of lot:/~Fr°nt ....... ,~,.v /...~...~.. ....... Rear .......... ~,~.'.J~......~..., ..... Depth..~.......~.. .................. Height ........ -'~';t ..................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ~/,',~../. .................................. 13. Will lot be regraded ................................. WiJJ, exqess fill be~emoved f~om premises: [ ] Yes [j,]/No 14. Name of Owner of pmmiSes~,~.~.'~.,.~..~/~...~..~l.~t'~-,/~z'~. ....... ~..~).~...~..,.~;~...~J.~,. 0 (Address) ~ - (Phone reo.! Name of Architect ............................................ (Address) (Phone No.) Name of Contractor .................. ~ ................................................................................................................................ (Address) (Phone No.) 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 numb er interior or corner lot. STATE OF NEW YORK, )~/~ ~'' I~ ~ ~/' ~) COUNTY OF ...................................................... ) deed, and show street names and indicate wheth- .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. {Name of individual signing contract) He is the ................................................................................................................................................................................................................. {Contractor, agent, corporate offtcer, 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. ...................................... day of .................................................. t9 ............. ~ ~ _ ~ Notary Public ...................................................................... County ......... ./~~ ...!..! .~ · ~..~ .~. ............. (Signature o.f al~icant) ' ' I )O.O I~'OA.D LEOHAi2D ~? .OF PE{~PE~TY ,, 2'! -'~,VE,~,:,~:'.-:- ~LE'A A~N INF~AF~CA cure;-, C.C,.LJ£ ..... -;v,/',. Ot- _--7.. -t-*~C_~ 'I~b'MONIU 3~3", ' -~ CO. ND. TJ28~-