The URL can be used to link to this page

Home My WebLink About6720-z TOWN GLERK'$ OFFIGE (THIS PERMIT MUST BE KEPT ON*TH~ PnEglS~S COMPLETION OF THE WORK AUTNORIZED) : ;720 Z UNTIL FpLL Date ...~/~,t.,(-.. '"'"I ..... 0 19. ~ pem~ission~i$ hereby granted t~: : i : ~ ¢, r c t~ f ,. ~ X Z ..~..~....~.~o.~.~ ....... to ~ ............... ' a~ p~omiso~,locatod ot ..~ ............... ...... .....- .. :~.~,..,/ ............... :~. ................................. ......, ......... ~ ..................................... ...... ~t..~o..~. , .............. :. ...... , ................................. ............................................... , ............................ ~ .....~: - .~ pUr~u*~t ~0 applic*tion dotod ................ ~,,~ ......... ~,...:, ] ., ~nd ,gpproved by the Building I~pector. ,, Approved , l~oig,~ NO, 1 TOWN OF SOUTNOLD BUILDING DEPAIITMENT ~N C, LF. RK'S OFFICE SOUTHOLD, N. Y. Peru,,* ..... Disapproved o/c ....................................................... (Budding Inspector) APPLICATION FOP. IUILDING PEIIMIT Date ........ ...~. ...... , 19...?...~.... INSTRUCTIONS a. This application must be completely filled Jn by typewriter o~, Jn ink and submitted in triplicate to the Building Inspector, with 3 set~ of Plans, accurate plot plan to scale. Fee accord!ng to,schedule; b. Plot plan showing location of lot and 6f buildings on premises~ relationship to adjoining premises or publ c streets areas, and giving a detailed description of layout ofpraperty must be drawn on the diogram 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 Bailding Permit to the applicant. Such permit shall be kept on the premises available for inspection througl~l~t the work. e. No building shall be occupied or used in whole or in pa r~for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Bud ng Perm t 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 heroin 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. ..... ...................... (Signature of applicant, or name, if a corporation) (Addmss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ .............................................. . ................................. Name of owner of premises ....~'~..C...~..~..?..~.......~.~.~...~...~.. ........ ~....'.~..~...~...'.....~..:.......~...~....O.~..../~..~.. ............................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... ,-~,,,~',.~. ,~,, ............................. Electrician's License No ................... Other Trade's License No ........ ..~..?..~....~.. ....................... I. Location of land on which propos~ed Wo~, will be done. Map No.: ........................................Lot No... ...................... ~ ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of prOP°sed construction: a. Exisiting use and occupancy ................................ ~ .............................................................................. b. Intended use and o~cuppncy ................................................................................... L ...................................... 3. -l~etwq, of work (check which applicable): New :Building' ..~ ............... Addition..................t/ Alteration .......... .~..,....~ Repair .................. Removal .................. Demoliti0~ ......... ~ .......... Other Work ................................................. ~.~ (Description) 4. Estimated Cost ........................................................... ................... ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......~.../...~..~.4..~....~. ....... Number of dwelling units on each floor ............................ If garage, number of ~,~,~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... ~ ................ ¢ ~ tt ¢ te t 7. Dimensions of existing structures, if any: Front ....~'~...I ................ Rear ...~.......~. ................. Depth ....~,.~.. ........ Height ......O~..[ ............. Number of Stories ~' ~/-~- Dimensions of sc)me structure with alterations or additions: Front ....................................Rear ...... x~. ............... .......... ~. .............. Number of Stories ....... ~ ............. Depth ....~9-.~...' '. ................ Height ' 8. Dimensions of entire new construction: Front ......... .~ ......................... Rear ........ : ................... Depth ........................ Height .................... Number of Stories ...... ' ................................................................................................. 9. Size of lot: Front ............. L ........................................ Rear ........ ~..~...0. ............ Depth. ~.~..~. 11. Zone or use district in which premises are situated ........... ,,~d~./....~..~..~7...'~. ~. , 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~)....o. .................... 13. Will lot be regraded} ........... ~L' .............. Will_excess f~ll be removed from premises: ( ) Yes ( ~/"No - . ............................................................... ,n ....... Name of Architect ................ ~ ................................... Address ............ ~. ................... Phone No ......... ~ ....... Name of Contractor .......... ~,,e,~,,..~.~ ................. ... ........ Address ...,,,~_~,.~-,. ............. Phone No....,,~',,,,'"~,,,.,~, ...... PLOT I~GRAM Locate clearly and distinctly al bud ngs, whether exq~tinn or nrnnn~ed property ines. Give street and block number or descril~ion according t° deed, and show street names and indicafe whether interior or corner lot. (Signature of applicant) TEIIRI LEE ELAK NOTARY PUBLIC, State of New York No, 52-616~;55 ~ualified m ~ulic;, County STATE OF NEV(~..~_,~ ! L ¢ ~ ...... 0-~ · ...................... ~'-~.~....Off;-...--~w......~.~...(';ff~..J.. .................. being duly sworn, deposes and seys that he is the applicent (Na~4e of individual signing contracl0 above named. He is the .......... i' (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 be performed ij~e manner set forth in the application filed therewith. Sworn to befor~ne this ................. Z.%O, ay, n. of .......... APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspector 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 sewed'age 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 installations, 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 apptlcable. B. For existing buildings (prior to April 1957), Non-conforming Uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, sYreets, buildings and unusual natural or topographic features. '~ 2. Sworn statement of owner or previous owner as to use, c~cupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation 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 occupancy $1.00 New Building Old or Pre~existing Building / i Vacant Land Location Of Property ~.~:~?~..~/~4:~?~.~.~.~i~! ...... ~..,.,~.,,.~.~,.,~,, .................. ~ner Or ~ners Of Property ..~.~..~.....~.~.~.....~.>.....~..~.~:~ ....................... Subdivision ................................................................ Lot No ............. Block No. House No..~ H~alth Dept. Approval ............................................ Labor Dept. ~pprova ......... ~ .................................. Underwriters Approval ......... ~,~ ............................. Planning Doa~d Approval ........................................ ~equast For ~ampara~ C~fficate ........................................ Final ~ Certificate F~e Submitted $ ....... ~, ........................ Construction on above descnb d building and pe~if ~eets all ~pphcable cod~s and regulations. Sworn to before m.~is ......... .... ....................... Nota~ Public .................................... County