The URL can be used to link to this page

Home My WebLink About6881-z FOi~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI'tOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 6881 Z Permission is hereby granted to: ........ ./..Z/_zL~..u..~ ........ ~.../..~..~.~.d' ....~.,J'..~/./.5~....L~..~..~,/..~ ..~ ..................... ~~_~... ~....~z~..9 ~ .................................................... ~.~__~ ~,~- pursuont to opplicotion dated .................................................... ond opproYed by the Building Inspector. Fee $. ~....~....'~...~ TOWN OF SOUTHOLD Building Deportment Town Clerks Office 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 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 sewerage dispasal--(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 approvat of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex'st'ng ' land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic f~atures. 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 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 $5.00 3. Copy of certificate of occupancy $1.00 Dote · .~/.~.. · ,~,. · ,,~,, ,:...../,..?, 7/ / New Building ................ Addition ................ Old or Pre-existing Building ................ ¥ooant Lond .............. Property. ~..: ... ~./jt~'~/. ~..~.~../..---~,~.~......~ xt/O. ~.....: ............................. Location Of Of Property ~,~¢~-~..(.Z~.../-.~ ......../~.~,..~,,~,~.,~?~,.,/,....: ................................... Owner Or Owners Subdivision/~-/,~/~..~,~'~..~..~....--"~.....'~...~..~.. ........... Lot No-.~..~.. Block/No ...... ...~..___~.ouse No.~- Permit No. ~,~,..,~,,,,/,..... Date Of Permit../.~../.~..~/~.~...-~.Applicant//~.~....~/~..~.~/~.~.,/~/.../...~...C Health Dept. Approval ..~ ............................ Labor Dept. Approval ..... ~ .......................................... Underwriters Approval .............................................. Planning Board Approval .~..~ ..................... Request For Temporary Certificate ........................................ Final Certificate~ .......................................... Fee Submitted $ ~--~'~' C°nstructi°n °n above described building and P~7 t m/et~/ll,,~, cplic~ljlle codes and regulations. worn to before me this,~ Applicant '~" ......... /~'F'I~'~'"'Lv'~'"" ~'""~" ~'l - .................................................. S ....... c~.~., day of ...... ~,.,,L~..~./. .... (stamp or seal) · - .440 .a oo i n't~ct,~ fO FOn. M' NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, ¥. ........................ 7... Approved ............ ..~..." ' , 19.(.*. .... Permit No. ..~..~. ................ Application No. APPLICATION FOR BUILDING PERMIT Dote ....................... .~...-%...]~..~.. ........ , 19..~.~..~l INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in nk 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, relationsh p to adjoining premises or public street~l~, areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applica~on, t." c. The work covered by this application may not be commenced before issuance of Building Permit. shadl.i beUl~n_.taoPnPr~h~al_rOefmtih~s appl~,ca, t~on; th.e Build.!ng !,nspec,tor .wi!,l issue ,a Building Permit to the applicant. Such pe~rnit~ ~ p es avatmom Tar tnspecr~on rnrougnout the WORK. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupa~n/cy%, 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. , · ~6me, if a corporation) ....... (Address of applicant) -'7''~ ...... (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... ..~,~,4~.s~......~....,~-~.~-,,/-T~wr....~.i .~'.~l~l~.,,~yt~ta~r.....~.~.4,Z~_~.~?~. ............~ If applicant is a corporate, signature of duly authorized officer. . ~ Electrician's License No ............................................. Other Trade's License No ............................................... land on which proposed work will be done. Map No.: ..~.. Lo'or/' o1~./ Location of Street a~d Number ..... ~'ll~'~' '~'"'" '/~"'et~;em'~'.-..~:~ / N~unictpality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ...... ~r*'~4~.~.~..~.~..~.w~.~`-~;~.~.~`~T~.;;~f~r`~3~ea.x~mm:..~ ' 3. Nature of work (check which applicable): Addition .................. Alteration ................. Repair .............. ~ Removal .................. Demolition ...... ...~, ......... Other Work .................................................... ~', ~ )~. (Description) ' 4. Estimated Cost .......... .................................................. 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 .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ........................y_..l~mber of Stories ............... r ................ Rear ............................ Depth .............. '" 8. Dimensio,~s ~f entire new construction: Fron~ .................................... ! b,~ ..~...4~.. ! Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ...~.....~.. ............................................. Rear ...../... ~. .......................... Der~th ~ .................... 10. Date of Purchase ..... ~ ....... ./...~....7/ ................... N~e of Former Owner ...~~ ............................... 1 1. 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 ...... ........... Will excess fill be removed from premises: ( ) Yes 14. Name of Owner of premises .~........~..~.....~...~. Addres~ ........... Phone I~1O ....................... Name of Architect .............................................................. Address ................................Phone No ....................... Name of Contractor ............................................................ Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exi_~ting 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. ~/~ ~,~,.~_ ~ ~ ,~,~._~ j~,,m~,, STATE OF N EW_YOR~,, _ I. ¢ c COUNTY OF .SL~.~...~....~ ...... ~'~ · ........... ./~;~..~..L....~...'~.......~.....~'~.~.~...~Z:~. ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contrac~ above name. 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 ~d to ~ke and file this agplicatJon; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fodh in the application filed therewith. Swam to ~efore me this ...... ........ ........................... , , ........... ........................... c ..... .......... ................... NoraPublic aunt ' ~ ~~. ~. (Signature of applicant, ~ 52~3~49~-~ Coun~ / Commission ~pir~a~h 30, ~'~ ~ !.i .... / ........ /, \ \