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Home My WebLink About8932-z BUILDING PER/VdT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8932 z Permission is hereby granted to: · ..w...~.'.c.c .~ ..~.~ ...... ¢.....~.~..~...~.! ...... .~.!..~. E. ~ at premises located at ............... .~....~. .......................... ..~...~'.. ............................ : .................................... ~0 ~ -r ~...o...~ ~ ,.....~.:..::.'. .................................. pursuant to application dated ................................ ~..~. ...... !..~.., 1~....~....., and approved by the Building Inspector. Fee ........................ ............ ~.....~.J..~......../Z.'./..:../~.. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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 featu res. 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing ali property lines, streets, buildincjs and unusua~ 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 informa- tion required to prepare a certificate. C, Fees: I. Certificate of occupancy $5,00 ~ / 2. Certificate of occupancy on pre-existing dwelling land use L~/5-/$5.00 3. Copy of certificate of occupancy $1.00 D ate (~; .,,~/.--. 1~.~./..~..~.5 ..... New Building ............. Cid or ~re-existing Building ............ Vacant Land ............. Location of Property..~.~.. ~ ~.~ ~..~Z ..... ~... ~ ............. ~ Hou~ No. ,~ I Street ~ ~, Hamlet Owner or Owners of Property..~.~ . ~ .~. · ~~ ................... County Tax Map No. 1000 Section .... Q.¢.?. .... Block ...... ~O ..... Lot...~.t.~ ....... Subdivision ~ .Filed Map No. ~ .Lot No. ~ Permit No ~.~5 Z:~te of Permit/~ Z~ ?~ ........ ~/~-/4. Applicant ...~.'~, ..................... Health Dept. Approval ......... ~ ~ ....... Labor Dept. Approval ........................ Unde~riters Approval .... ...~.~ ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. ~ Construction on above described building and~e~t meets all aped r.egulations. Applicant,.. ~.~..I/N..~.c~ ............ ~'" 'l' ....... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. , pro, ed ..................... ,er it ......... Disapproved a/c ............... ................~....~............... ................... (Building Inspector) Application No. APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building 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 or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port 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· ~-~ ~m ~i~nature of ¢~ppppp~/cont, ~~'~tion) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. :.:...i ....... ............... ... ........ ............... 0......: .......................................... Name of owner of premis'es ........ ~...~....~....~....~.:....~.......~..:........~...4.?.....~... ........ ...~...../.....~..6C..~... ................................. iii.iiii If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................... ...~...~ .... Plumber's License No ................................................. ElectriciQn's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will ,b~done. Map N9.: ....................................... .~L, ot No ......................... "'r ,' nd h-'umber ~"3~' ..~...r~. //~7~J/'[~/4/ D~[~ ~ L~ [ Municipali~ State existing use and occupancy of premises and intended use ~d occupancy of proposed construction: a. Exisiting use and occupancy ........................................................................................................... b. Intended use and occupancy ~OO~ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ........... '.,.2. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... Ir~ ~ , (Description) 3 0o , Oo _t G. O0 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, specify nature and extent of each type of use ............................ 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 ............................ Humber of Stories ......... r.%...i .............. ~, ~ 8. Dimensions of,entire new construction: Front ....... I..~.., ................ Rear ...... J. .................... Depth ........................ Height ...... .~..'. ........ Number of Stories .... I .................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 1 1. 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 premises .................................................... Address ................................ Phone N6 ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-bock 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. STATE OF NEW '~olk ~-'-~ ~ , , (Name of individual signing contract) duly sworn, deposes and soys that he is the applicam above named. ~ .~.. ~ ~_~_~ ' " He is the ............ .~ ...................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application that oll statements contained in this ?pplication ore tr~e to the best o~ledge and belief; and tha~ the work wilt be performed in the manner set forth m the~atio~ filed there~h.~ Sw~r~before me this ~ n day of October ,~ 76 ~ ~ ~f - ~o~*~ ~mbhc ............. 7?, ................ C.~ ........... C u ~ ........ . ............ . ....................... [LIZ~B~H ANN NEVILL~ NOTARY ~BLID, Stste of New Y~f~ No. 52-8~25850, Suffolk