The URL can be used to link to this page

Home My WebLink About9009-z TOWN OF:$QUTHOI~D : BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEP'T* ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9009 Z Permission is hereby granted to: G?...o.......~.~ .s....~..t..z.~ ~.. Z..q.e....~.c... ~.o.~.. ?~nne ll~ ............... ~.~...o....9..o.~...~. ............ .o.:~?..o..~...~. ....... Build an addition on existing dwell at premises located at ....P~r~..6ise..~.J!.9~?,..$....R..o.~,~. ... .................................................. $.o.~.~.h.~ ........................................................................................... pursuant to application dated .............................. .~..e.°.......1..~. ......... , 19...~.., and approved by the Building Inspector. Fee $'}.~..?..0..0.. ........... ' -- Building Inspector/ ' TOWN OF $OUTHOLD , 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: 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 disposals(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 o 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 oo, ..................... New B~ilding ................ Addition. ..~... ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property~.~..~.~,~/~..~.....~...~.~/..~...~.~.,~ ........ ..~...~..~...~...~..,/..~.~.. ...... ~'.../...~..~./.~?~.........~..~..,.......~.~..~.:.~..~.4/~ Owner Or Owners Of Property ...~.~.H..~.......22.~.~..~.~.~..~,..~ Subdivision .......................................................... ~.....Lot No. ............ Block No ............. House No ............. Permit No. ~.~.~..~....~... Date Of Permit~.~l./..~..~.~...Applican, '"~' .~...~. ................... ~ .~... ...... ~.~...4.~.~,~ ............. Health Dept. Approval ............................................ Lobar Dept. Approval ................................................ Underwriters Approval ....~.../..././.~...~..~.. .................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate ,,,~J~, ................................... Fee Submitted $ ..~.~.. ............................ Construction on above described building and permit meets all applicable codes and regulations. Applicant ...~.,.~....~..~..~ ....................................................... Sworn to before me thais ~ ........ day of TOWN OF $OUTHOLD ~ ~ .~,~ -- ~'/~/~ ~:~ ~/~'~" ~'~ BUILDING DEPARTMENT~_~ ~ '~/~ ~ . . MUTHOLD, N. Y. ........................................ , ..... ............ .................................... ..... ......... APPUCATtOH FOR SUtLDIHG Dote I~STRUCTIO~S o. T~is opplicotio~ m~st be completely filfe~ in ~y typewriter Inspector, wit~ 3 se~s of pMns, occur~te plot p[on to ~ole. Fee occoF~n~ ~o schedule. ~. P~ot p~on s~ow]~ location of [o~ on~ of ~ui]~ngs oreos, o~ ~vin9 o de~oHe~ description of layout o~property c. T~e wor~ cove~e~ ~y t~is application may not ~e commenced ~efore ~ss~once of ~ui]din9 s~oH ~e ~ep~ o~ t~e premises available fo~ inspection t~roug~ou~ t~e work. e. ~o ~uH~n9 s~ot~ ~e occupied or use~ in ~ole or i~ po~t fo~ any purpose w~oteve~ until o Ce~ifico~e of ~cuponcy s~oll ~ove ~ee~ ~onte~ ~y the ~uH~in~ Inspector. ~PP~C~T~O~ r~ HE~E~ ~E ~o the ~uil~J~ ~epor~en~ fo~ ~e issuance of o ~il~in~ ~one O~inonce o~ ~e ~own of SaurianS, Suffol~ ~e~io~ions, fo~ t~e construction o~ ~uH~in~s, od~ffJons o~ o~e~o~ions, or for removal o~ ~emolifion, os ~erein ~escri~e~. T~e ~ppHco~t e~rees Yo compJy wJt~ otJ opp)ico~le ~ows, o~inonces, buH~in9 code, o~mit ou~orize~ inspectors on p~emises and ~ ~u~ldJn~s ~or n~esso~ inspections. (Signature of applicant, or nome, if a corporation) q ..... ::~.;~i~.....<..:~..t.....z.~*~/..~.......C~./.~..f.~/.~: ...................... q (Address of applicant) ~-~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .~J.~/..V.~/L/ ......... ,~'~.Cal~..~'./.~.**~,,.~/~,,.~. ........................................................................................ If applicant is a corporate, signature of duly authorized officer. ....... ~r.~:~.~:...../.~/~l~.~ (Name and title of corporate officer) Builder's License No. Plumber's License No. ..~,~,,.r'../X.]/~.,/:t ...... /.:-..;~..~x'...~.,....61 L Electrician's License No ...... /~,~./,~./.¢...7~,..~?.~ .............. Other Trode's License No ............................................... Location of land on which proposed work will be done, ~op No.: ........................................ Lot No ......................... Street and Number ..17/3..?..!..l~.L.~..7~7. ........ ,'~L';/.O...,'f).i~,L~. ........ ,~..~Z:2 ......................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b, Intended use and occupancy .............. i)...D4',~.LZI,~..(zL.. ............ ~.~...[~.,ad...~...l.~,Li, d.. ................................. 3. Nature of work (check which applicable): New Building'· ................. Addition ..;,,~ ........... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ ~ .... (Description) 4. Estimated Cost .... J../...C;~,?~J:.(~J.~ .............................. Fee ...L~ (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 ..... ~.~..~...~...~...~..x ...... Depth .~mS..~ ....... Height ..... /.¢~.../. .......... Number of Stories .......................................................................................................... ,¢ ..... Dimensions of same structure with alterations or additions: Front ....... ~/'¢..~..~....'.:'" ......... Rear .....~.~...~. .......... Depth ...~.~)..:../.~ ........... Height ....... /..C~. .............. Number of Stories ....... ./. ..................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 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 violate any zoning Jaw, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........ ,! .................. Will excess fill be removed from premises: ( ) Yes ( ) No Address ,~:~.~....~..)'..I.~£~.~ ~L T'~, ~ V~-Phone No. 14. Name of Owner of premises .x/~J~.....Q.¢.~../j~'~:..L...4...)( ....... Name of Architect .............................................................. Address ........................ ~ ...... Phone No ....................... Name of Coritractor (~-,f,~.C~,~..8~...~5....~J/~.c/.~.z~.$ .......... Addresse.,.~7~,N[~[~.~-~ ........... 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. , /00 STATE OF NEW Y~).g~_~,~ /-c c COUNTY OF ....... .~...~..~. ff..~. ~.~ ........ F~'&~k ~rtur&no ................................................................................................. being d~ly sworn, deposes and soys that be is tbe applicom (Name of individual signing contract) above named. He is the ............................................... .~...~..~...~..~....~.~.....~.?..~..~.r.~.~.~..O..~. ................................................................................. (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 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 forth in the application filed therewith. Sworn to before me this