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Home My WebLink About8409-z FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 8409 Z Permission is hereby granted to: ..~..L.~..E..~IZ.4'~...!....o..~ .............. ~.1..~.~..s at premises located at ............... ~ 'T ~ T~ ~. ~ 0 ~ ~> E AS"r' I~ ARI 0 r~l ............................ · ~ ....... ~.~ .............. .~.~ ....... ~.....~ ............................................................................. pursuant to application doted ~ ,1~'~ ~ 1 ., and approved by the Building Inspector. Fee $...../. ................. Building Inspector FOILM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be fdled 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 d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buddings, 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 Rte New Bqilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....................... .,~...-~..~..-~'....-~.. ....... ..?.....b...-~...~..! ........... .~ ...... .b..~..~..~....(..o..~l .................. Owner Or Owners Of Property .... ..~..~,..~....~....~..,.~...!.~.~. .......... ..,~...!...,'~...,.~..,.-~.. ................................................... . ..... Subdivision ................................................................ Lot No. Block No ............. House No ............ Permit No....~...~...~..~..~-~4~ate Of Permit ............. ~ ...... Applicant ...... ~...- ...... ..~...~ .................................. Health Dept. Approval ............ ..~/...:.,~....'. ................... Labor Dept. Approval ...............~../..r.,.~...: ..................... Underwriters Approval -.:.....~. ..................... Planning Board Approval .............. ~... ...................... Request For Temporary Certificate ........................................ Finql Certificate .......................................... Fee S bmi.ed $ ....... ................ Construction on above described building and permit meets all applicable codes and regulations. ........................................................ Sworn to before me this / ................ doy ~. .................................. (stamp or seal) Notary Public . ./......~ ............. County leOZlM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...................... ............................. ........................ ..... ='= ................. APPLICATION FOR BUILDING PERMIT Dote ................................................ INSTRUCTIONS Application No .... ..,~....~...~..~.... ............. a This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin., Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premises, relationship to adlo~nmg premises or public streets o areas, and giving a detailed description of layout of property must be drawn on the d~agram which is part 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 wdl issue a Building Permit to the applicant. Such permi 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 Occupanc' 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 th- Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in, buildings for necessary inspections. ..... (Signature; ~c' '~'1~'~¥i'~ ~ ~'i ~' '~' ' ~'~1~ i;~'~ ...... (Address of applicant) j I ~ 77 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builds .................... .~.~.~. .......................................................................................................................................................... N me of owner p em ses ............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done Map No ....... ~...~..§...~. ..................... Lo~t No..!;~ ................. Street and Number ...c~.'..~fS~....~ ......................................................................................... ..~.~.~ .J~.%.YA~..v~. ...... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ...~.~ .... ..~..'~...qJ~.(zJ~'~ .......................................................... b. Intended use and occupancy ....... ..~..~..~.~.~...~.~ ................................................................................................. 3. Nature of work (check which applicable) New Building ................ Adder,on .................. Alteration ....... Repair ................. Removal .................. Demol,t,ar ............... Other Work ~.~3 ..~.0~.~C...~o...~.e_.~-.~.~. ..... (Description) 4. Estimated Cost ..................... ..~....~.?.....~ ................ Fee J07 (to be pa~d on filing th~s application) 5. If dwelling, number of dwelling un,ts ........................... Number of dwelhng un,ts on each floor ......................... If garage, number of cars ........................................................................................................................................ 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 Dimensions of ex,st,ng structures, if any' Front ...~.~...J~r. ............... Rear .~,.~..~.~. ...................... Depth ..~,S...~.~- ......... Height ..... '.....~..~.~ ........ Number of Stones ........................................................................................................... Dimensions of same structure with alterations or add,hans. Front ................................... Rear ........................ Depth ................................ Height ....................... Number of Stones .............................. 8 D~mensions of entire new construction: Front ................................... Rear ............................ Depth ...................... Height ................... Number of Stories ............................................................................................................ 9 Size of lot. Front ....................... [...0...? ...................... Rear .......................................... Depth ....~...~..~...-~. .............. 10 Date of Purchase ....~..!.I..~..l~.~ ..................................... Name of Former Owner ..~.C)..'t.T..~.~.....~...T.~.~..S. .................... 11. Zone or use d~stnct in wh,ch premises are s,tuoted . ~ ~ ~ I ~ 12 Does proposed construction violate any zoning law, ord,nance or regulohon: ....................................................... 13. Wdl lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...~...~..~..~..~L'~:L~..f~....~.~.T.T.~:.~ .......... Address~rZ~.~7.?.L.~.~....~.~'... Phone Name of Architect ................................................ Address ................................ Phone No ..................... Narne of Contractor .................................................. Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and d,st~nctly all buildings, whether ex~st~ng or proposed, and red,cate all set-back d~mens~ons flor property hnes Gwe street and block number or descr,ptlon according to deed, and show street names and ind~cat whether interior or corner lot STATE OF NEWY~;k~K~-~ ,~, ~ COUNTY OF .... ~-~. LT,~..I.~.....~'Q'~ ............................... ~..~.~.~..~.'~.~.~...~.t..T..T.~.~ ........................ being duly sworn, deposes and says that he ,s the applicar (Name of individual signing contrac~ above named He ,s the ....... .~.~ ................................................................................................................................................... (Contractor, agent, corporate officer, etc) of said owner or owners, and is duly authorized to perform or have performed the so~d work and to make and f,I this application; that all statements contained in th,s applicetion are true to the best of his knowledge and behef; an tha~ the work will be performed ,n the manner set fo~h ,n the application filed therewith Swam to before me th,s ~day of ~ 19~ ~~ .......................................................... ......................................... .,... .............................. ~~~~ ~~ ~ (Signature of applicant)