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Home My WebLink About6466-z FORH NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N*. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ..~.~...~..~ ..................................... .............. ~..~..~ ........................... ........................ ~o~ ....................................... ~o..~..~..~..,~..~...~.~..~..~...~ ...................................... at premises located at ...... 3.,~.O..~.?.~......f~Z~.....;[~;~.~'3...]~.~]~...~'~.~ ................................................ ...................................................... ~.e...e..o.~.e. .............. ~..,.~.,. ................................................................. pursuant to application dated ..................... "~'~.~ .......... ~. ........... 19~,~...., and approved by the Building Inspector, Fee $.1..0..:.0~... ........... Building Inspector FORM NO. 6 TOWN OF $OUTHOLD. Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OFI OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and sdbmltted in DUPLICATE to the Building Inspector with the following; for new buildings or new use I. 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 disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple I~esidences 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 applicable. 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, istreets, 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 buildibgs 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 $5.00 3. Copy of certificate of occupancy $1.00 Date New Building ................ Addition ................ Old or Pre-existing Building ....~... ....... Vacant Land .............. Owner Or Owners Of Property ....Z.~..~.4 ....... ~.~...Z~.Z~.~.]~. ....................................................... Subdivision ................................................................ Lot No ......... :... Block No ............. House No ............. Health Dept. Approval ............................................ Labor ~pt. ~pproval ................................................ Underwriters Approv~l .............................................. P{anning Boerd Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Certificate .......................................... Fee Submitted $ ...... ~r..~ ........... ~ ..... Construction on above described building on, permit me~ all aoolicable~es and regulations. Applicont ............................................ Sworn to before me this FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE '/ SOUTHOLD, N. Y. Examined ~/~ 19.....:.. ~ ~ ,9...?..~ Pemit No.~.~...~,.,~...~....~.. ........ Approved ........................................ ~ 1 Disapproved a/c ~~~~.~: ............... :~,L ..... (Buildin~ Inspector)/ APPLICATION FOR BUILDING FF. RMIT INSTRUCTIONS Application NO~.,?',.,~,,.,,~, ................ / a. This application must be completely filled in by typewriter or ~n ink and submitted in triplicate to the Building Inspector, witlf~7 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, relationshi~ to adjoining premises or public streets or areas, anc~ giving a detailed description of layout of property must be drawn on diagram whi(~h is part of this application. c. The work covered by this applicatiatn may not be commenced before issuance qf 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 issoanc~ of a Building Permit pursuant to the Building Zone~¢~ Ordinance of the Town of Southold, Suffoik 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. (Signature of applicant, or name, if a corporation) Peconic N .Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... :1::~......~¢.~.~...~.;:1,.~.~1~.~.;~ .................................................................................................... If applicant is a corporate, signature of duly authorized officer. i 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. Map No ........... L.X...x, ............................ Lot No ......~;;~ ............. Street and Number ....~.O.,.!~'.o.....$./~..,l, llgl,i, aza..N~ok...La.tl~ .......... ;:l~e(~l~ie. ..................................................... : Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ,c].}?..e.~._..Z..i.,,n.g...&.-....a...o.g.,e..,.s..s..o..~,.,b.p,.,:j,.~.~ .......................................................... b. Intended use and occupancy ...... a~';~..~z.$l;h...aa..a~l.:L.ti(~..~lc..e,.ge.Laee~>~..b.l~g ................................. Nature~of'work'(check which applical~le): New Building ....................... Addition ....... J~: .........AlteraJ.qot~'. ...... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ............... .1[,~.0..Q9..._+ ...............Fee .....1[Q.,.O.Q ................................................................................. (to be paid on fi~ing this application) 5. If dwelling, number of dwelling units ....... .0.. ....... 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 ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front .......... J. 2 ........... Rear ........ .1.2 ............... Depth ...... .1[~ ...................... Height ................................................. Number of Stories ........ 9.~.~ ........................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth ................................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. ;_Zone or use district in which premises are situated ............. ?.A!!...d.i.,%~. ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... 11;). ............................................... 13. Will lot be. regraded ......... J0,g .................... Will excess fill be removed from premises: [ ] Yes [ ] No (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ......... ..s..~..m..e.. ................................................................................................................................ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctlv all buildings, whether existing 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 wheth'- er interior or corner lot. See filed plan STATE OF NEW YORK. ) COUNTY OF ................ ~.~ ................... ) ............................................ ..~.?...e...d:....~..~...~..c...~...e...~. ............................. being duly sworn, deposes and says that he is the applicant above name~ (Name of individual signb~g contract) He is the .............................................. .~..~..~..~......O...~.....O...~...D:.O...~.. .......................................................................................................................... J. (Contractor, agent, corporate officer, etc.) i of said owner or owners, and is duly authorized to ~erform or have performed the said work and to make and file this application; that ~11 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. 9 April 73 ,~- ~ da of 19 (Signature of applicant) ~__~