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Home My WebLink About8847-z FO~M NO. 2 TO~VN OF $OUTHOLD BUILDING DEPARTMENT TOW'bi CL£RK~$ OFFICE $OUTROLD. N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF: THE WORK AUTHORIZED) N? 8847 Z Permission is hereby granted to: tO ~/~'.~.:~ :~ _ - ..................................................... ; ................................................. ~: ..................................................... a~ plemises l~ated at ................ ~ ....... : .................................................................................................. to~pJication~ do~ 19_ ,, and approved by the Fee $ ...... , ...... ~. ....... :.. Building Inspector FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southoid, N.Y. 11971 APPLICATION t:::OR CERTIFICATE OF OCCUPANCY Instructions Ac Th~s application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tot with the following; for new buildings or new use: 1. Final survey of property with accurate location of ail buildings, property lines, streets, and unusual natural or topographic features. 2. F~nat approval of Health Dept. of water supply and sewerage dlsposal-(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 installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submtt Planning Board approval of completed site plan requtrements where applicable, For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~sting" land uses: 1. Accurate survey of peoperty showing all property lines, ~reets, 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 inspect~on of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Co Fees: 1. Cemficate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $t.00 $5.00 FlewBuild~ng ...~. ........ Old or Pre-existing Budding(X) ........ ...... ..... Owner or Owners of County Tax Map No. 1000 Section .. ~Z.~. ...... Block ..... ~ ...... Lot...~ ........ Subdiws~on .... .Filed Map No ........... Lot No ....... ' ....... Permit No.Z(~'.~. / .~.... Date of Permit ?./. ?'/~..Applicant. Z~'.~. ,/.. ~...Z/: ~../~ ........... Underwriters Approval ..... ~/. / .~.: ........... Planning Board Approval ...~./4~ ......... Request for Temporary Certificate ..................... Final Certificate................. Fee~ubm,tted$...~...~.~. .................... Construction on above described building and perrp~t' meets atl,aP/'p~ca~/~odes andjregulations. · -. '-' Apphcant . ,. ...~... R~,v 10-10.7e -¢ o f O a. / FORM NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT Exom,ned ................. .~ 7, ,~ 7/o ~T,O~'. N. '~. App,cotion ~o. g'~' 7 ......... '"?i., ,,.o ............................. D~sapproved a/c .......................................... ....~ ............................................ APPMGATION FOR BUILDING PERMIT ate ..................... ....... ..7., INSTRUCTIONS a. This apphcation must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Buildi~ 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 areas, and g~wng a detailed description of layout ofproperty must be drawn on the diagram which rs part of thru applicatio c. The work covered by th~s applicatmn may not be commenced before issuance of Building Permit d. Upon approval of th~s application, the Building Inspector will issue a Budding Permit to the applicant. Such pern 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 Cert~fmate of Occupan, 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 tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulahons, for the construction of buildings, additions or aJterahons, or for removal or demolition, as herein describe The apphcant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, and adm,t authorized inspectors on premises and in buildings for necessary ~.~spections. (Signature of applicant, or name, if o ~rporotion) .............. 'ir~;;;;'a'a;;ii~;';i ......... 77¥5~'" State whether apphcant is owner, lessee, agent, omhitect, engineer, general contractor, electrician, plumber or build, Name of owner of premises .................... ..~,...,E~.,.,~....J ............. ~.~..,..~.....~....~,. ............................................................ If applicant is a corporate, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................... ..~....~.....P(....~.....~ ............ Plumber's License No ......................... .~.....0.. .............. Eleclrician's License No ........................ .,/~....,9 ............ Other Trode's License No ............................................... Location of land on whmh proposed work will be done Map No ............. ~ ............. Lot No .~ ........... Street and Number ............ ~...~..~....~........~....~...~..T..~. ..... ...'~..~..~..~......~.....,.'~...~....~...~..(.~..-~... .......... ...'~..~../~..?.,.~....~...~... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Ex,sit,rig use ond occuponcy ............. .~........~,?..../?../...~,..~/'.. ........... ..~..,./~....LT.'~?,.../':.../..?~/.. ~.....~.......~....~.~...'..~. ........ b Intended use and occupancy .......................................................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............. Repair ............... Removal ................ Demolmor. ......~ .......... Other Work ................................................. c~ (Description) ~, Estimated Cost ...................... ~...O...~..'..-~.. ................... Fee -"-./.....~.. .......................................................................... (to be paid on filing thts apphcahon) 5. If dwelling, number of dwelhng 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 ............... Height ........................ Number of Storms ....................................................................................................... D~mensions of same structure with alterations or addmons' Front ................................... Rear ................... Depth ................................ Height .................... Number of Stories ............................... 8 Dunensions of ent,re new construct,on' Front ................. ~,..~.. .......... Rear ....... ../...~.": .............. Depth. / Height ...... .~...~. ......./,,~-,-'Numberl /_~ - ~,r~°f Stories ~ ............... ~ ........................... .~ ....................................................... 9. S,ze of lot Front(.~...~. ....... ~...:..'..:.-....~-Rear ............ ~.....'~....~.. ................. Depth 10 Date of Purchase ..................................................... Name of Former Owner ................... .~..~.....~.....~.. ................. 11. Zone or use dlstr,ct ,n which premises are situated .......... ~.~.~'../...~ ...... .--.. ..... ..~.....~....'~='.../. ................................. 12 Does proposed construction violate any zoning law, ordinance or regulation: 13. W~II lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ~ Name of Owner of rem,ses J--c-l/'/ .~...Z'...'~...~x/' _,,A/~h,-r/~'D,'~(J 14 p .................................... ~ .............. ~oaress .....~'m~.?:..[Jn.~ x~ ..... Phone Name of Architect ...................................................... Address ................................ Phone No .................... Name of Contractor .................................................... Address ................................ Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and md~cate all set-back d~mens~ons fro property hnes G~ve street and block number or description according to deed, and show street names and ind~ca whether interior or corner lot STATE OF NEW~[~j~__~_i~,, leS COUNTY ..... .............................. ..L....~....~../ ........... ..~....~.....~.....~....~. ............... be,ng duly sworn, deposes and says that he ,s the apphca (Name of indiwdual s~gnmg contracO above named He is the ........... (Contractor, agent, co~orate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to ~ke and fi this application; that all statements contained in th~s apphcat~on are true to the best of his knowledge and behef, that the work w~ll be performed in the manner set fo~h in the apphcat~on filed therewith. Sworn to bef~ me this .................. .~day of ............................. ~, 19 ./.~ ~~~ignat~e ~ Z~o~applicant) .............................................. ........ ............... ~ ELIZABETH ANN HEVILL NOTARY pU~IC S~te ~t New Yot~ Ho 52-8125850, ~,~to~k County Ye{m SURVEY FOR LEVI L. 5 CAROL SOUTHOLD TOWN OF SOUTHOLI SUFFOLK COUNTY, SCALE' I"' I00' JUNE 23, 1967 JULY' 12,1967 AUG. 4, 1975 Unauthonznd ~[lerahon or od[~tllon lo Ibis survny is a v,uluhon c; s~.d,,n 720'" old,-} f4e,,,. York S'ote E(~l,'.~'ia~ Law