The URL can be used to link to this page

Home My WebLink About8849-z · 0~ NO. ~- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ,~ ~ .................. .......................................... to B~rlld .o.~.en deck addition ~ ex~st~g bulldog , .. ......................................................... ;,;~....~; ........... ~ ........ ;;?; ....... ; ............................. ; at premises I~ated at ...... ~.....~..,..~.~:.a~..~.~.~,: ....... ~(~.~Cm~,,[ .................... 2 ' ...................... J ....... [ .............. ~"'"'""; ........ ~ ....... :': ................... ~-7 ..... ~--..~...-v .......... ~ ............ ........................ ; .......................... .~....~....;..;.:¢?....;.::.~ ...' ....... ........ ;;;.*'..;[.;;....;.~ ............... ~ .....~ .............. ;... ·ORM NO. 6 TOWN OF $OUTHOLD , Building Delm~tment Town Clerks Office Southold, H. 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 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 disposol--(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 New BLdlding ................ Addition ...... ..~:.... .... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ............ ../~....~?..../~.. .......................................................................................................... Owner Or Owners Of Property ........ .~.~../...c'..~..~.../?..~. ...... ..~'..d..~?..C./?.......v....~.. ........................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. ........................................ Pormit No ~.,~..~...~...~.... Date Of Permit ......... ~.. ........ Applicant H~alth Dept. Approval ........ .~...../Y..: ......................... Labor Dept. Approval ................................................ Underwriters Approval ......... ~.~..~./.:T ....................... Planning Board 'Approval ...... ./X..~L'.¥&~ ..................... Request For Temporary Certificate ............ 7...:Z: ..................... Final Certificate .......~..'[ ............................... Fee Submitted $ .................................... Construction on above described building and per,nit meets all applicable codes and regulations. App I icant ........ .//~'.¢... ¢...~.....i.. ~ .................................................................. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~.....~.~ ............ 19...~. Approved ............ !.! ....... i..~/ ............. , 19".,//.?. Permit No .... .~.~__--~-..~...~...~,.....~......~'~... ..... Application No...~...~.....~.. ................................ ................................. APPLICATION FOR BUILDING PERMIT Date ........... ........ INSTRUCTIONS a This application must be completely filled in by frypewriter or in ink and submitted tn 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 giving a detailed description of layout of property must be drawn on the diagram which is part of th~s apphcatic c The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector w~ll issue a Building Permit to the apphcant. 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 tn part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to t, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterahons, or for removal or demolition, as herein describ- The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. ................ .............. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electricmn, plumber or build~ Name of owner of premises ..... /~/'C/'~At'~P ~ ~O~/~ ~ ~ ~L=~ if opphcont is a corporate, stgnoture of duly authorized officer. Builder's License No ..............~...~..r-~ ............................. Plumber's License No ................................................. Electrician's License No. Ar ~xr~ Other Zrade's License No ............................................... ~ ~ Locahon of land on which prczoosed wor}~ will be done. Mc~ No ................................... Lot No ..~ ..... Street and Number ........ ~.....~.~..~..c2...~.~.~....~. ..... ~.~...~..'.~...~....~....~ ...... ~ Municipality State ex~stmg use and occupancy of pre~s ~ intended use and occupancy of proposed construction: 3 Nature of work (check which applicable). New Building .................. Addition .................. Alteration .............. Repair ................ Removal .................. Demolmor .................. Other Work ............................................ // ~ -~__ (Description) -, Estimated Cost ............................................................ Fee ................................................................................... (to be pa~d on filing th~s applicahon) 5 If dwelling, number of dwelling umts ............................ 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 ........................ 7 Dimensions of ex~stmg structures, if any: Front ........................... Rear ................................Depth .................... Height ........................ Number of Stories ........................................................................................................... D~mens~ons of same structure with alterations or addmons' Front .................................... Rear ................ Depth ............................... Hmght .......................... Number of Stories ................................ 8 Dimensions of entire new construction. Front ................................... Rear ............................ Depth ................ Height .................... Number of Stories ............................................................................... 9 S~ze of IoL:. Front ........................................................ Rear .......................................... Depth ............................ 10. Date of PuX'rchase ........................................................ Nome of Former Owner ..................................................... 11. Zone or use district m which premmes are s~tuated ............................................................................................ 12 Does proposed construction wotate any zoning law, ordinance or regulahon' . ..................................................... 13 Wdl lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ................................................... Addres_s.< ............................... Phone No ..................... Name of Architect ............................................................ Address ....... :-. ..................... Phone No. Name of Contractor " Address ~" P n .................... .................................................. ~-~. ..................... ~'Z ..... ho e No. PLOT DIAGRAM .~' ~.~. Locate clearly and d~stmctly all buddings, whether ex~sting or propose~nd property lines Gwe street and blocl~'~nber~a~ ~cordmg ta deed, whether interior or corner lot red,cate all se(-b~ck dimensions fro. 'and show street nam~es and in&ca / / STATE OF NEW YORK, ~ COUNTY OF ...S..k~,[.~ L.,¢ .............. ~' ............................ · q,,~.c:~-~..2'.....Ga,,~z; ..................... being duly sworn, deposes and says that he is the apphca (Name of indiwdual signing contract~) above named. He ~s the ..................................... ..o..?.....~,1;' ..................................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f~ th~s application; that all statements contained in th~s applicahon are true to the best of his knowledge and belief, ar that the work will be performed in the manner set forth in the opphcation filed therewith. Sworn to before me th~s ........ 7.. Y..~ ......... day of .... Notary Public, . ............................... ~¢.,¢~&~... County (Signature of applicant)