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Home My WebLink About8801-zTOWN OF SOUTHOLD 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) N? 8801 Z Permission is hereby granted to: Jew aeees.o Itoz'a.J,e billd...b...~ ......................... at premises located at 321~ Dee~ ~le Dz'~.ve /~ ~'~ pursuant to application dated ......................... ~ ............. .1.~.. ...... , 19.?.~..., and approved by the Building Inspector. 10,,00 Fee $ ........................ ........... ~.....:...:; ............. Building Inspector Approved ....................................... , FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N, Y. Permit No.... ,~,..~.,..~.....~...~ ...... Applicotion No ................................. ( luil~'ng Inspectffr) APPLICATION FOR BUILDING PERMIT Dote ..................... , I(] ............ INSTRUCTIONS e. This application must be completely filled in by Wpewriter or in ink end submi~ed in triplicate to the Building Insp~tor, with 3 ~s of plo.ns, accurate plot pl=n to ~ele. Fee according to schedule. b. Plot pl=n showing location of lot end of buildings on premises, rebtionship to =djoinin~ premises or =ublic streets o~ crees, end giving e deteil~ description of layout ofproper~ must be drawn on the diagram wh-i~h is ~ of t'his epplic=tion.~ c. The work covered by this application may n~ be commenced before issuance of Building Permit. d. Upon epprowl of this application, the Building Inspector will issue e Building Permit to the applicant. Such permit shell be kept on the premises oveileble for inspection throughout the work. e. No building shall be ~cupied or u~d in whole or in pe~ for any purpose whoever until e Ce~ificete of ~cupency shall hove been granted by the Building Inspector. APPLICATION 15 HEREBY ~DE to the Building Department for the issu=nce of e Building Permit pumuent to the Building Zone Ordin=nce of the Town of ~uthold, Suffolk County, New York, =nd other applicable Laws, Ordinances or Regulations, for the constru~ion of buildings, additions or elter=tions, or for removal or demolition, es herein described. The epplic=nt agrees to comply with ~11 applicable lows, ordin=nces, building c~e, h~sing c~e, end r~uletions, end to admit ~uthorized inspecto~ on premises =nd im buildings for n~esse~ in~ections. ........... ............................ ~Addre~ o{ ....................................... ............................................................................. ........ ............................................................. If opplicont is o corporote, signature of duly authorized officer. (Nome ond title of corporote officer) Builder's License No ........... ~'. ........ ~ Plumber's License No ................................................. Electricion's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed wo. rk will be done: Map No.: ..... .C~..,,~.....-~.....,~.. ............... Lot No...~ .......... Street and Number .~.~.....~..~......~ ...... ~ ........................... ~~.~..~ ..... Municipali~ 2. Stere existing use end occupency of premises end infended use end ~cupency of proposed construction: o. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ........ .."~'....~.: ~ . .-~'.~i.~) ................................................................. 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolitio~ .................... Other Work ................................................ ~ -~' O Fee O'O (Description) 4. Estimated Cost ........... ~.~'...~.. ........................................... ~..O.~ .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .~....x/~..~.. ........... Number of dwelling units on each floor ............................ If garage, number of cars ....... . .~..z~..~. ....................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front .......~..:O~.:. .......... Rear ...... .~....O..../. .............. Depth Height ..../...~..~/ ............ Number of Stories ...... ./.....f.~..~..f/' ........................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ....... ~ ................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear .......... ~ ............. Depth ..~........'~...~.. ...... Height ~ · Number of Stories ~./~.../~. lot:" ................ Front "~ ~ r '" ......... Rear ~....o...O.. ~ Depth ~...~...~... 9. Size of ........ ~:~.O..~ ............ _. ..................... ..... ..............;,- ....... ...... ........... 10. Date of Purchase ....... .~...~...~..]....Z.~... ...................... Name of Former Owner ~.~.t~.~..~.G~..,['...~..~.~......~......'?~'.~.~ 11. Zone or use district in which premises are situated ................................................... ~, ............................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ./.Z...°. ........................................... 13. Will lot be regraded . ........................... Will excess fill be removed from p. remises: (. ) Yes ( ) No 14. Name of Owner of premise~tE.~./..~....~r..~..~.~.....°..'Z.....P'L.. ................. Address ..................... , ......... Phone .... /-¢~-1"~ ~fc/a. ~-~ ~, Nome oT Architect .............................................................. ~aaress ................................~'none rio ....................... Nome 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. _ _ ~:~ ~ f STATE OF NEW Y,~RJq,, . ~ I S S COUNTY OF ..2~:~..{~¢:c.... ....... ~ ' ................................................................................................~P' being duly sworn, deposes and says that he is the applicam (Name 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 performed the said work and to make and file this application; that alt statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to be~ me th~ ~ ~ ~ -- FOlh~ NO. 6 TOWN 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 submitted in DUPLICATE to the Building Inspector w~th the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, aha unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters 4. Commercial buildings, Industrial buddings, Multiple Residences and s~milar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the budding. 5. Submit Planmng 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: I. 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 .............. Location Of Property ...~..~.,?~..,.'~..4..-~....~..~.,.~.. .................................................... ' .............................................. Owner Or Owners Of Property .,~,.~,..~... ,,~,,~..,~,. ,/~,,..,J, ........ ~ ....... ,,~....~....,~,.,,~,.'.~..,,,'~,,~,~. .................................. Subdivision t. ............................................................. Lot B ock ............. House Permit No.~.~...,~../.....~... Date Of Permit .~..'.~./, ,/~.'.~..Z.,~Applicant .... ~../..,<./"~".d....~.../~....~. ...... ..~..:......-~....~..~...~..~'7'~/ Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwnters Approval ............................................. Planning Board Approval ........................................ Request For Temporary.C;ertificate ........................................ Final Certificate ......................................... Fee Submitted $ ....?,... ........................... Construction on above described building and permit meets all ap~cabl%code~s and regulations. Sworn to before me this ' ~ :~/~-x/'~cz¢'C~' / ........ ~::':,.~... day of ,..~. .......... Z .......... (stamp or seal) _.~ Notary Public ............... ~ County ~.~----2~/,~ (' ~-~/ /.