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Home My WebLink About7121-zNO. 4 TOWN OF $OUTHOLD BUll'.DISC. DEPARTMI~T Town Clerk'~ O~ice $outhold, N. Y. Certificate Of Occupancy No. ~.(~6~.~. ...... Date ...............AI~ ......11.19..?~ THIS CERTIFIES that 'the bui]&Jnf~ located st ~la~t .~o~ ............... S~ Map No. ~ ......... BI~ No..~ ...... ~t No ....~ .~t.. ~,~, ........... ~o~ su~y ~ ~e App~cafion for B~di~g P~t h~fore ~ ~ thi~ offi~ ~t~ ......... Ji~r...a0 .... , 19. ~.~ p~t ~ w~ B~ding P~t No... 7~21Z da~ ....... ~Y ....~ ......, 19~[., was h~, ~d co~o~ ~ ~ of ~e ~ m~ of ~e app~cable p~io~ of ~e ~w. ~e ~p~ for wM~ thi~ ~ h .. .b id s ................................... ~e c~ica~ ~ ~u~ ~ .Jo~ph. ~ .~w~. ~l~. .. ~ers ................ (o~er, l~s~ or ~t ) of ~e ~o~d b~ai~. S~o~ C~ Dep~t of He~ Approv~ ~.~ ............................... ~~I~S C~ICA~ No. N'~' HOUSE ~ER ... 1~.1~ ...... S~t .. ~..~ .... ~rl$~ ............... Building FO~lw NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7121 z Permission is hereby granted to: ~f.~dfi~ ...... ~..~..~.~.:.~.~ ...... .~!.~....T..~'* ~, pursuant to application dated .......... ~(.'.: J~'7.~...,~, , 1~.c./...., and approved by the Building Inspector. Fee $ ........................ Building Inspector .................................................................. (Building 'Inspector) SOUTHOLD~,,_~L,~/~'~... . TOWN OF BUILDING DEPARTMENT~ -~- ~ "'"~ ~ TOWN CLERK'5 ~Fi~ ~/ ~.~ ~ ~ ~UTHOLD, N.Y. ( ~~~ ~ . Applic~tio~ No. ~..~. ........ (.. ................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Building~.~ Inspector, with 3 sets of plans, acRur,ate plot plan to scale. Fee according to schedule, a'~ >~ ~. P~ot'~l~n showinq location ~f lot an8 c~f buildings on pre~nises,~rela~i0nst~i'l~ to adjoining premises or public streets o,~ areas, and giving ~detaded description 0f tay~bf ofproperty 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. ! 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. ~Signafure of aPplicant, or name, if o corporation) ~-/./~ .~__ __ (A~dress of applicant) / ¥, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ................ Name of owner of premises ............... ~ ...... ~ ................................... ;...; ...... ........... /.'~..~ ............. ~ ............................................. 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 prpl~.osed work will be done. Map No.: ............... :; ....................... Lot No ...... ~.~.~ .............. Street and Number/, ~'/~..~.~- ...~....~ ¢~..~. j..~..../~...r' ........................................................................................................................ Municipali~ State existing use and ~cu~ncy of premises and intended use and ~cupancy of pr~osed construction: a. ~isiting use a~ ~cupancy ~ ~ ~ . . b. Intended use and ~ou~ncy .............. ~.~ ~ ............................................................................................... · 3. Nature of work (check which applicable): New Building ............. Addition .................. Alte~atio ................· Repair Removal .................. emolition .................... Other Work .......................... ~.....~. ................. · (Descrip~on) ' 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, spec/fy nature and extent of each type of use '~z~4, ~.~'~ 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 ........... ./..~.. ................... Rear ...... /...~.. ............... Depth .....1~....~...(. .......... Height ...../.~....'.~.... Number of Stories .................................................................................................................... 9. Size of lot: Front ...................................................... r~eor ........ './_.~...?..~,..~,../. ................ Depth ....~.....~...~...~.../..~ ....... 10. Date of Purchase ..... ~."...C..~...T. ............. /..~ .............. Name of Former Owner ....... ~.../~......~...,/K~.. ................. 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 ....... .~/...~.. ............. Will excess fill be removed from premises: ( ) Yes ( ~ No 14. Name of Owner of remises ~...~...~'A~' /~, .~_!~',~ Address.~..~..~.~-,,,~u,,~/~r~l~P~l~' P ............. i ........... ' ........................~,~ ~:~ ~Jj~'; Y~k ........................... 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 whether interior or corner lot. ~9~, .'DC)' S~E3 e lZ· STATE OF NEW'.~OB4~., .~ / I ~ ~ COUN~ 0~.~ ................................................................................ :....~..~.t.~:~.~ing duly ~n,'~s gnd soys that he is the oppmicam (Name of individual signing contrac~ above name. He is the ................................................................................................................................................................................ (Contractor, agent, corporate 6~fi~er, 'etc.) of said owner or owners, and is duly authorized to perform or have ~rformed the said work and to ~ke and file this application; that all statements contained in ~i~ ~DplicatiOn are t~e 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 ...... / , Nota~ Public, State of New York No. 52-0344963 Suffolk Coun~ ~mmi~bn ~pires March 30, I~ FORM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE 'OF OCCUPANCY Iflstrucf'Jons 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. 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, 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. 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 Da,e ...... ~. ¢..~.~.T......C.,(..C~~- New Building ....~.~... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .......J ~ Owner Or Owners Of Property Subdlvis,on ................................................................ Lot.o ............. B,oc~ ~o ............. .ause .o! ..~Zg ................... fPe ' ~'~7 ............................................................ ~m,,.o. W~IZ~eO r~.~ .................... ~.~ Z~ ~'~ .e~:~ ~e~. ~row~ ............. ~...~ ................... ~.~or ~. ~o~.: .............. ~...:~: .................... U.de~w~,~ ~ro~, ................... ~:...~:. ............ ~'.nn,n, ~ ~ow' ~...~. ................. Request For Tempora~ Ce~ific~te ........................................ Final Certificate ............ ~ ..................... Fee Submitted $ .................................... Notary Public ..... ~'~County Construction on above described building and p~nLc~t~vall applicable codes and regulations. Applicant ......... .....~__~. ~,,,, .~.7..~. ..................................... Sworn to before me this /~' ~'~/~7~, (stamp or sea') ~ ~'~