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Home My WebLink About8976-zSOUT,O'~. ,. ¥. BUILDING P E~.MIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8976 Z '-, '~Z 22 Date ....................... ]{ D.~:.-~ID.'~ ......... , 19..-..~.6 Permission is hereby granted to: Ed~...,,L¢:i,;,,4,:;rr...;.....'~,r.m.t,r.~.,,.ti.~...Irzc.....~4.~ Mrs. A. Straussne:~ at premises located et ..~!~..~.g:~:l¢-..}.,.-..~[~ ......................... ......................¢...,~..,,~.~ ~ ........................................................................................ pursuant to application dated ........................... '~e't~"-'-'~ .............. , 19.~.., and approved by the Building inspector. Fee $..~.O.o.Q0 ........... Building Inspector TOWN OF $OUTNOLD , 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 with the following; for new buildings or new use: I. 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 disposals(S-9 farm 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 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 $1.00 Dote ...~ ......................................... New Building ................ Addition ................ Old or Pre-existing Building ................ V~cont Land .............. Location Of Property ......... s~.~/..$.: ........ ~.~....~...§~...~....~. ....... ~'~.~_,...~ ...... ~~ .................... Owner Or Owners Of Property ..... ./..~.C~.. ....... .~....~... ....... ~ ............................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. ..................................................... Permit No..~.'..~.?.~..~... Date Of Permit ./~..~.'.,.7...'~..~.~....Applicant Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate //~' Fee Submitted $ .....~..:...-~... ...................... Construction on above described building and permit meets all applicable codes and regulations. Ap p, nt .... :.. ....................................... Sworn ,o before me this ............... Y ................. '....: ..................... ,stamp or ~1)~, Nota~ Public .................................... Coun~ Z/'Z~/~/~ TOWN OF $OUTHOLD /,~/0../:~.~.~- . /'~.f/~/ ~ TOWN CLERK S OFFICE ~~ Examined ......... ~..~.~. ............ 19.7~- Application No ..... M...[......Z.~ ......... ~proved ....... ~..~ ........ , 7~ 77z 19 ........ Permit No ..................................... a/c .......................... ............................................... .................................. .Z ............. {Bui~din~ Inspector) [ .............. APPLICATION FOR BUILDING PERMIT 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 ~ole. Fee according to schedule. b. Plot plan showing locoHon of lot and of buildings on premises, relationship to adjoining premises or public streets ureas, and giving o detailed description of layout ofproperty must be drown on the diagram which is po~ c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval o~ this application, the Building inspector ~11 issue o 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 port for uny purpose whatever until o Certificate of ~cuponcy shall hove been grunted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or ~egulotions, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with oil applicable lows, ordinances, building c~e, housing code, and regulations, and to admit outhorJzed inspectors on premises and in buildings for n~esso~ in~ec~ions. ........ ....... (Si~noturo of opplic~nt, or no~e, ff ~cor~rotion) ..... . ......... (Address of'~pplicont) State whether applicant is owner, lessee, agent, oi'chitect, engineer, general contractor, electrician, plumber or builder. ................................................. ....................................................................................................... *~'~'~e of owner of premises J~. it.~ ........ ...~...~.~ ........ .~....~....~. ~.~..~.. U.~-~ .......................................................... If applicaqt is a corporate, signature of duly authorized officer. ........ ......... Builder's License No. Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Location of land on which propose~ sYPl'~, will be done. Map Nq~ .z.~....//~'~.,.nv ............. ~.,~Lot N~p.~!...?...~ .............. Street and Number ................... Municipality State existing use and occupancy of ~an~ded use and occupancy of proposed construction: a. Exisiting use and occupancy ................... ;/ ............................................................................................ b. Intended use and occupancy ............ ~(~,.*- ............................................................................................. 3. Nature of work (check which opplicaNe): New Building,. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................... c~) (Description) 4. Estimated Cost ..... ..~.~.O....O..~.....'Z~... ............................... Fee ...[...O..... ............................................................................. (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 ears ............................................................................................................................................. 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 some structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ Rear ....I....~.. ................. · Depth .....~.....~...I ......... 8. Dimensions of entire new construction: Front ....... l~t,...,,......, ................ Height ...... [.~.. ......... Number of Stories ........ I ............................................................................................................ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................... 12. Does proposed construction ,vi~late any zoning law, ordinance or regulation: ../..l~..~. .............................................. 13. Will lot be regraded . ......... /.K.~.i ~' ~-.Will excess fill be removed from~., ~//~premises: ( ) Yes · (X) No 14. Name of Owner of premises .j~.~.S......~...u~.....~.u..~..~..~.~..~.. Addressc.~9.?..//~....~.~T....~..r.(,.~one No ....................... Name of Architect .............................................................. Address ........... ~....(~ ............... Phone No ....................... Name of Contractor ...~.~.bb.~ ......................... Address ......~..R~..~.~ ...... 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. STATE OF NEW YgRK//~/// [ ¢ c COUNTY OF .... ~ ............ ~ :_ , ..................... ~.CC~.:.....~.~~ ................. being duly sworn, deposes and says that he is the applicam (Nome of individual signing contract) abow~ named. ~ He is the ............................................... ~.~..~.~ ............................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hav~ performed the said work and to make and file this appUcation; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h Jn the application filed therewith. Swam to b~7~me this ~ , . ......... ......... .......... , ~ ~ ~ ~ ~ (SiOnor%e or applicant)