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Home My WebLink About7212-zl~O~M NO. & Certificate Of Occupancy No. Z 7.~7/ Date T~ZS CERTZFZES ma~ me b~ ~at~ at ~.. ff~...~ .......... Map No. ~ Bl~k No. ~ ~t No, co~o~ subst~y to the Applica~on for B~g Pe~t heretofore ~ ~ ~!s o~ dat~ ......... ~...~..., 19~ p~su~t ~ whi~ B~g P~t No.7~.I~.~ dat~ ......... ~.~...~..., 19. ~.~was ~u~, ~d co.om ~ ~ of ~e r~ ments of ~e applicable pro~io~ ~ the law. ~e ~cup~cy for wM~ ~e certificate ~ ~su~ to LE~O~ ~O0~E~ of ~e ~ores~d b~d~g. S~o~ Co~ty Dep~ment of He~ Approv~ ~'~ ' ~WRITERS CERT~ICA~ No. ~N ~ HOUSi ~la ...! ~ ~ ...... S~t .. ~ ~.~ ...... ~X R~.7 ........ '. , Building Inspector Tmm aak, Offlee Soullmid, H. Y. 11g'71 APPLICATION FOR CERTIFICATE O~ OCCUPAHCY I/ A. This application must be filled in t~pewriter OR ink, and mbmitt~ in DUPUC~TE t~ th~ Buik~ing Impector with the ~ollowing; for r~w building~ or n~w u~: i. Final survey of prope~y with accurate location of oil buildings, pro~mty lin~, ~tr~tl, unusual natural or topographic f~tures. 2. Final al~roval of Health D~t. of water supply and mm~ng~ di~oma~(S-9 form 3. Approval of electrical installation from Board of Fire Unden~ite~. 4. Commercial buildings, Industrial buildings, Multiple Residences and . similar -. b~ clnd installations, a certificate of Code compliance from the Architect or F,J~~ for the building. 5. Submit Planning Board approval of completed site plan requirements whom B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and land uses: 1. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic featum~ 2. Sworn statement of owner or previous owner as to u~e, aCCUlxmcy and cQndiflan of buildings. 3. ~ of any housing code or ~fety Inlp~ctlon of buildingl or pr~m~, or olf~', ~ i~. tormation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 ' 2. Certificate of occupancy on pm-existing dwelling or Iczncl use $5.00 3. Cagy of certificate of occupency $1.00 New Building ................ ,~,~dition ................ Old or Pm-~xi~ting Building ................ Vor~n~ L~nd .............. ..... ............ ........................................................... Permit No ................... ~ Of Permit .~....~....~?.(.(.~.!~:~plicent ...... ..~..~...~...~..~,..,..~...,....~....~.,.: ........... ~ ~. ~a~ ................ ~. ........................ ~ ~. ~ .......... ~ ..................................... U~i~m ~al .............................................. Pla~i~ ~ ~1 ................................... R~ ~r T~m~ ~ificme ........................... .. · ... . ...... Fi~ ~if~ ~ Construction on Qbove described building ~ permit rneets~ all 9pplicable coclm and reguk~ian~ Appl ca t .......... ......................................................... Sworn to before me thi~ Notary Public .................................... County (mam~ or mai) 737/ Approved ........................................ , 19...(..[. Permit No. Disapproved a/c ..... ~- .................. ~ (Building Inspector) Io APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~. 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 o~-~. areas, and giving a detailed description of layout ofproperty must be drown on the diagram which is part of this application,ci~ 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 t~& 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 aUthorize~ inspectors on premises and in buildings for necessary inspections. .... ............................ (Signature of applicant, or name, if a corporation) Orient (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................ bm'LLO, ez. ...................................................................................................................... Name of owner of premises ......... .L...e.?...o.~'.....C.?..O.~..?.?. .............................................................................................................. 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 ............................................... Location of land on which proposed work will be done. Map No.: ~-~ Lot No. 31:z Street and Number .R..O,.~li,.....~.t~..~'l~..~t, ......... /~l~;l~:D,t, ............................................................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy .~lR~,~,;~q~ ................................................................................ ........................... same v~th &dd~t~o~., ......................... b. ~ntended use ond occupancy ...................................................................................................... 3. N~tur~f work (chec~ whic~ applicable): New Building .................. Addition a~L ............Alteration 2....;~ ........ ~, Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (DeScription) 4. Estimated Cost .............. ,~t:....~..... ................................... Fee ...1.:..~.R.0...O. ........................................................................... (to be paid on filing this application) 5. If dwelling number of dwelling units .......... ¢~,~1~ ............ 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 alterationa or-bdditions: Front .................................... Rear ............................ Depth ................................ Height ..Z... ..................... Numbler of Stories ................................ 8. Dimensions of entire new construction: Front ..... ]]2 .......................... Rear ............. 1_2. .......... Depth ....... ~ .............. Height .................... Number of Stories ...... ~ ......................................................................................................... 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 ......"..~..."....d...~..s...~. ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... /I,O ......................................... 13. Will lot be regradecf .......~ne~ ............... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises ...T~L~..J~Oape/~ .................... Address ....0:~te~1~, .............. Phone No ....................... Name of Architect ................................................. : ............ AddreSS ................................ Phone No ....................... Name of Contractor .....0.~.~.tk.~.~g~.l..~.~..~...C...°..~..~.t'.. Address ....~,e~l; .............. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. , _! · Ill STATE OF NEW,.Y~, COUNTY of ....~...~..~.~..~... ........... Robert ................................................................................................. being duly sworn, deposes and says thor he is the opplican! (Name of individual signing contract~ above named: con,fac'cot 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 ore true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .............. ....... Notary Pub I ic~ ,,,Z'..:..Y~/n~Y... ~ou nty ,~"',y~./.F.~.J{../;;,.'......bl,,.~....~,...~..."~. ........ JUDITH T. BOK[N T ap~l~:~nt] u' V ' I ' (Signature o ldota~y Public, Slalp of New U Ida. 52.0344963 Suffotk Count/~'~ ~eommi~ien Expime Mo~h 30,