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Home My WebLink About7497-zFORM NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISI~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 7497 Z ~ate . ........................ , ~.~....~ Permission is hereby granted ~ . ~ . ,/~ ,' ? .......................................... ~.~,. ........................... ! ................ : ............ ,: ........................ ....... ........... Fee $./~.. ............. .... .~ i~ii~.~._' ........... FOItM NO. $ TOWH OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF. OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and sdbmitted in DUPLICATE to the Building Inspector with the following; for new buildings or new rise: 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 sewbrage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire U~hderwrters. 4. Commercial buildings, Industrial buildings, Multiple I~esidences and similar buildings and installations, a certificate of Code compliance from thJ~ 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-ex'st'ng' 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. Dote of any housing code or safety inspection of buildihgs 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 New Building ...~-~.~.¢¢~.. Addition ................ Old or Pre-existing Bu~ilding ................ Vacant Land .............. Subdivision .............................................. ;.~. .............. Lot No ......... i'" Block No ............. House No ............ Health Dept. Approval ..'~,~'~,-,,,,..,,,-~. .......................... Labor Dept. ~pproval ................................................ Underwriters Approval ..~...~...¢......~.. ................ Planning B ,rd Approval .... .~....~%.. ......................... Request For Temporary~C~ertificate ........................................ Finczl Certificate Notary Public ....... ~/~... County FORM NO, 1 TOWN OF SOUTHOLI~ BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Examined ..... .:~.. 19 ........ ...... ;: ...... ........................................ , 19 ........ Permit No ................ ~ A~proved APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 2/...e.Z ......... , Application , ~ a. This application must be completely filled in by typewriter or~ inink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accord nG to schedule. b. Plot plan showing location of lot and of buildings on premises, re a~ onsh p to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application., c. he work covered by thru apphcation may not be commenced before issuance of Building Permit. Upon approval of thru appl cot on, the Budd ng nspector w issue a Building Permit to the applicant. Such permit~ shall be kept on the premises available for inspection throughout the wotek. e. No building shall be occupied or used in whole or in part for any pt~rpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. ~ ~.PLI~ATI~N ,IS HERE~Y MADE fo the Building Department for th~ issuance of ~ Bud na Permit ~ursuant ~ulla~n~ ~on~ gr?nance at the Town of Southotd, Suffolk County, Ne~ York, and other appli~ab e Law~. Ordinan~-"~ J Kegu~ahons, tar the constru~ion of buildings, ~dditions or alterations or~for removal or dem~ ifinn n~ h~,~;n A~ ~ ~'~ J The applicant agrees to comply w~th all apphcable laws, ordinances, budding code, housing code, and regulations, and to~ J admit authorized inspectors on premises and i~ buildings ~or. n~ igspections~ (S~gnatUre of ~pplicant, or ~ame, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N~ of ow,~ of p~i~....:~.~.~.. ... .......... ~.....~.~. ............ ........................... J+ applicant is a corporate, signature o~ 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 wor~ will b~ rl?~ne. Mop No,:' ...~ ............... Lot No.~-,~ Street and Number,,~.~, ./..~.~....~......,~./2......,,~,,~4~..,~.~..~..L.../..~,/s~,~(,d, ................ Municipality State existing use and occupancy of premises and intended use an~occupancy of proposed construction: o. Ex,s,ting use and occupon z..c 2'//'~J .... '"7/ ........... ' ......... ' ........... '~" ................ b. Intended use and occuponc-y/,/~,~..~..~.t4[4..,/~~...I ......................................................................... / 3. Nature of work (check which applicable): New Building'~..~..4~4.. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition ....... u~ ......... Other Work ................................................... ~ ~ ~ (Description) 4. Estmoted Cast ......................................................... (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 L'.L~ ............... Height .~. ................. Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ..... ~'../../. ....................... Rear . ..~... ..................... Depth /O/! Height .:..7..: ..................... Number of Stories 8. Dimensions of entire new construction: Front ....... .~. ......................... Rear ..... ~..~, ................ Depth ./'.ft.." Height ...~..i ............. 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 .............. ~ ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.~.../~...¢~... ..................................... 13. Will lot be regraded . ....... ../~..q...: .......... Will excess fill be removed from premises: ( ) Yes (X) No 14. Name of Owner of premises .~.~..R.~.~.:..~.~/~t~/ ..................... Address ..~).~.~/;/-~. ........ Phone No.'~.~.~...-:.~l~(.~.? Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ 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 ,vhether interior or corner lot. · ~- I p~'6z ~OUNT¥ OF~....I'°''~ ................................................................................................. ~oinfi dul~ sworn, deposes ond so~s thor he ~s the oppl~con~ (~ome o{ individual sionin~ contract) above named. 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 ail statements contained in this applicatign are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to befo~ me this ~ __ _ ~ ~ ........ o,? ........ ...... , ............................