The URL can be used to link to this page

Home My WebLink About7187-zNO. 4 TOWN OF SOUTHOLD BUr[.nING DEPAR~ Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~9 ...... Date ............ Jtme...30 ...... , 19.7~. THIS CEI~TIFIES that ~e b~g l~a~ at ~/8.3~..Tie~ .A~ ...... S~ Map No .... ~ ....... Bl~ No .... ~ .... ~t No .... ~ .... ~e~ ·. N.,~, ....... %co,om subsidy W ~ Application for B~ding P~t ben, fore ~ ~ thi~ o~ '~'dat~ ............. ~rll'- .~9.~ p~t ~ wM~ B~ Pe~t No..~Z. da~ ....... ~il...17 ..... , 19~., was ~u~ ~d ~om ~ ~ of ~e ~ men~ of ~e app~ble pm~io~ of ~e ~w. ~e ~p~ for wM~ thl, ~ ~ ~u~ ~ . Pr~va~ .o~..~y. d~ll~. · .~ .ad~t~ .................... ~e c~ca~ ~ ~ ~ .~. ~~. v ....... ~ ...................... (owner, l~ or ~n~t) of ~e ~or~d b~. S~o~ Co~ :Dep~-h~ent of He~ Approv~ .... ~,F, ........................... ~~I~S C~T~ICA~ No. N,R, ........................................ HOUSE ~..~ ....... S~ .... S~ .VZ~ 'A~ ..................... FOB, M NO. 2 TOWN OF SOUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7187 Z Permission is hereby granted to: Richard ~avsevere .............. ~ .r...o..o.,k, .~..~.. .............................................. Build and adAition (deck) on existing dwelling pursuant to application dated ................... Apr4.~l ....... .1.~. ............ , 19.7~..., and approved by the Building Inspector. Fee :~.,~.,'..,,(~., .............. BUILDING DEPARTMENT I TOWN CLERK'S OFFICE SOUT. ^p cat,on ................ Disapproved a/c .......... ~ .................. APPLICAT IT .......... ........ INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building;~' Inspector, with 3 ~ of plans, accurate plot plan to scale. Fee according to schedule.. b. PI0t plan' ~t~owing Iocati0r~ Of Iai and Of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofpr°Perty must be drawn 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 a Certificate of Occupancy shall have been granted by the Building Inspector. .A.P. PLIC~ATIO~N .IS HEREBY /V~ADE to the Building Department for the issuance of a Building Permit pursuant to the ~oui~aing ,~one ~Jrainance at the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or~e~'emoval or demolitior], as herei.n descr bed The applicant agrees to comply with all applicable laws, ordinances, b~ding/code, housing codes~ncl regulahons, and to admit authorized inspectors on premises and in buildings for nec~~ ~,5fgnature of applicant, or name, if a corporation) ............................... .............................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .....Name'"' ........ of owner' ......... of'"'"'""'"'"'"'-rem ses ~' ...... '"'"'"'"'"'"'"'"'"'"'"'-~'~ ....... '"'"'"'"'""'"'"'"'"'"'""z-- - '" '""'"'"'" "' If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Locat on of and on wh ch proposed orwork~w be done. Map No.: ...... ~ ...................... ' '..~. Lot_bio, ...~.. ~C~ ............... Street and Number .~.t..~..:...f~..:.....~..~........~...~......~...~.....~ ......... ~ ........... Municipality State existing use and OCcupancy of pre~ded use and OCcupancy of proposed construction: a. ExJsitJng use and occupancy ..................................... ~J, sJ-~--{~-,,-~.~ ..................................................................................... b. Intended use and OCcupancy ................ ...~.....?~..;;~;Y.~.........~...~.......~.....~...~.....'.~....~...'.~.. ........... .9. 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building .................. ^~lition ............ Alt ration .~. .............. .~.~ Repair .................. Removal .................. Demolition .................... Other Work ....................... ; ............................ (Description) Estimated Cost Fee ............. L. ............... .....................(to be paid on filing ~'J~i] app!ication) If dwelling, number of dwelling units .......... ............... Number of dwelling units on each flooI ............................ If garage, number of cars .............................................................................................................. i .............................. If business, commercial or mixed occupancy, specify nature and extent of each type of us~ ............................ Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories .................................. ................................................ 1/ .............................. Dimensions of same structure with alterations or additions: Front .................................... Rea~ ............................ Depth ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front .......... ................. Rear ........ ............Depth .../..,~.. ................ Height .................... Number of Stories ......... ~ .............................................................. i .............................. Size of lot: Front Rear Depth ~ Date of Purchase ............................. Name of Former Owrter ......................... ~ ...... Zone or use d str ct n wh ch prem scs are s tuated ............................ j .............................. Will lot be regraded. ............ ,4Y....~., ..... WiJJ excess fill be removed from premises: ( ) Yes i ( ) No Name of Owner of premises .l~..~..e~...~~... Address ..... ~.c~..:. Phonel No ....................... Name of Architect .............................................................. Address ................................ Phor~ Name of Contractor ........................ ~L...~...~. ................. Address ................................ Phor~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-lx~ property lines. Give street and black_number or description accordi~ng?~9~o deecl~_and~stJee whether interior or corner Io~ --~ ~ ~ ~ ~ ~ ~ /I ! I :k dimensions from ame~ and indicate .................. ~1~.~ ........................... being duly sworn, deposes and says that ~e is the applicant (Nam& of individual signing contracf) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) : of said owner or owners, and is duly authorized to perform or have~ ;l~¥ormed the said work and ito make and file this application; that all statements contained in this application are true t~9~the best of his knowle~l~le and belief; and that the work will be performed in the manner set forth in the applicatioj>d~l~ith. Swam to before me this, /-// \ // .................· Notary Public,,~-/~~.....~,~.~.,~.~.... County I ........ /~~~ .',~rm~......~.~..¥. ............... c,- ' '~ (Signatu?_~e)6'f applicant] JUDITH T. BOKEN r FORM NO. 6 TOWN OF $OUTHOLD ~ 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 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. S. 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, 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 in- formation required to prepare a certificate. C. Fees: 1. Certi{icote 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 ........... New Building ................ Addition ..~ Old or [~re-existing Building ................ Vacant Land .............. Location Of Property ~**~...~...:. ............... ~f .~..~.. ...~ ..~. ** Owner Or Owners Of Property ......~.'~'~{l]~.......~.d~S..~'...~..~.....~:.. .............................................. Subdivision ............................................................... Lot No ............. Block No ............. House No ............. Permit No.~.~.~..7...~.... Date Of Permit ~./...'~.~...~.. App' cant .~..~..~.!~....~... .............................. Health Dept. Approval .... :.../~..:..~..:..*. ........................ Labor Dept. Approval ............. .~....:.1...~... .................... Underwriters Approval ...... .~.....~.1.~...~ ........................ Planning Board Approval ......... ..N....~...~ ................... Request For Temporary.~C~a?e ........................................ Final Certificate .......... .I.~ Fee Submitted $ .......~........~.~.'~" C'~ ~L" ............ :~ ...... Construction on above described building~,n~ p~ ~app~odes and regulations. A p,,cant ...................... (stamp or seal) Sworn to before me this dov of Nota P-b,e ...... Count EDWARD A. QUIMBY NotarY public, Stale of New Yol'k No. 24-3183500 Qualified in Kings County ,.~ Commission Expires March 30, ~.eJT~/