The URL can be used to link to this page

Home My WebLink About7817-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTFIOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7817 Z Permission is hereby granted to: l~c/~e~..~c~e...Zmp~.ovement,..C~....~/..Q..Ernest Richter ............... ~.e..e...~.9.~ .......................................... to ....e..r...e..c...~...p..gM...~.eDg.~g ............ w.~s.t...p~.opa~:.ty..ilr~ ........................................................ at premises located at ..$ .~.$...~T',...T~l....(.~e~b..~.:~/:;;~...S.t,~..&...~$.~, ........................................ .............................................................. ~'.~..~X~ 9.::1::.~ ....... ]~.~Y.~. .............................................................. pursuant to application dated ........................~;I;'.~L ...... ~.1 ........ , 19...~.~'., and approved by the Building Inspector. Fee $.15...Q.O ............ FOR3~I NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This opphcatlon must be filled tn typewriter OR ink, and subm,tted in DUPLICATE to the Building Inspector w~th the following; for new buildings or new use' 1. Final survey of property with accurate location of all buildings, property hnes, streets, ann 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 buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code comphance 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 19§7), Non-conforming uses, or buildings and 'pre-existing" land uses: 1. Accurate survey of property showing all property hnes, 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 buddings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: I. 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 Date .....,Lf./...2..cJ../..~, .5.. ......................... f~n~e New B~tilding ................ Addition .... .X. .......... Old or Pre-existing Building ................ Vacant Land .............. Locat,on Of Property ......... ~.5.....F_~g..n..~.....S.~..z'..e...e.~ ......... .G.~.e..e...n.~g..z,..~.. .......................................................... Owner Or Owners Of Property .....E.~p.~..~..~....F.......R..~..~..e.~ .............................................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No .......... Permit No ...~.~..~..~....~ .... Date Of Permit ....tt/..~]/.7..5...Applicant .....E.~.n.§D..t;....F.......R..~g..h.~.~..~ ......................... Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate ........ .X. ............................... Fee Submitted $ .... .5....p..O.. ....................... Construction on above described building ~¢~)rmit m.ee~ll(~na~, ~odes.~ ~r~, ulations. Applicant ...~,,:./~.~ ...... V...'.~zJ-~ ......................... Sworn to before me this ......... ..... Notary Public .......... ~County (stamp or seal) TOWN OF $OUTHOLD BUILDING DEPARTMENT ( ~ "~ TOWN CLERK'S OFFICE ~'~ ~UTHOLD, N. 19..~.~. Applicat,on No..Z..~.~.Z .............. 19..~Permit No. Disapproved a/c _ APPLICATION FOR BUILDING PERMIT .... .................. , INSTRUCTIONS a. This application must be completely filled in by typewriter or ,n 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 showmg lecat~on of lot and af buHdmgs on premises, relationship to adjommg premises or public streets or areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of th~s application c. The work covered by this applicahon may not be commenced before ~ssuance of BuHdmg Permit d Upon approval of this application, the Building Inspector wdl issue a Building Permit to the applicant Such permii shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m 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 thc Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in buildings for necessary inspections, .../../..(..C.'.~'.~...~...~...~....../..7. ~:..~..:.C .~(~....L.:.~.~ ...... /...):,..¢_ ........... (Signature of applicant, or r~ame, if a corporation) ............ z..'...Lx.../. ............... T ......... State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bumlder, ........ ........................................................................................................................ Name of owner of premises ...... Z~...~.~ ..... ~ ~.. .................................... If appJjlicant is c; co~porate~,~signa~r,~ of duly authorized officer. (Name and title of corporate officer) Plumber's k~aense No ................................................. Flectrlcian's License No ............................................. Other Trade's License Bio ............................................... 1 Location of land on which proposed work will be done. Map No .................................. Lot No ..................... MC[nicipality 2 State ex~sting use and occupancy of premises and intended use and occupancy of proposed construcbon' a ExlsltJng use and occupancy // 3. Nature of work (check which applicable). New Budding ........ Addition ...............Alteration . f Repair .................. RemoYal .................. Demahtlor, ................. Other Work .,C'..~.~..~...x.~. ~.~ .............. ?...(:....~.. 4 Est,mated Cost .... ~ . ./~.....~....C?...~. ....................................... Fee (Description) (to be pa~d on flhng th~s application) 5 If dwelling, number of dwelhng umts ............ Number of dwelhng umts on each floor ....................... If garage, number of cars ..................................................................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each ~pe of use ......................... 7 Dimensions of ex~stmg structures, if any. Front ....................... Rear ................................ Depth .................... Height ........................ Number of Stones ............................................................................................... D~mens~ons of same structure w~th alterations or addmons Front .................................... Rear ...................... Depth .............................. Height ........................ Number of Stones ........................... 8 Dimensions of entire new construction' Front .................................. Rear ........................... Depth ................ Height ................... Number of Stories ....................................................................................................... 9. S,ze of lot. Front ............ -- ~ ............................. Rear ............. ~ .................. De~th ..... ~.~..~ ... 10. Date of Purchase ......... ~.'~..~. .............................. Name~ -- , ,°f For~er Owper ....... --q-F',~'7";"'""'"'~.~.~.E....~.~Z~.~.~.~..~..' 11. Zone or use district in wh,ch premises are situated ....... ~?.~.~..~.~.~...~C~.~. ......... )~ ............................. 12 Does proposed construction wolate any zoning law, ordinance or regulation ........ ~.~ ....................................... 13. Will lot be regraded ............................ ~ill excess f~ll be removed from premises. ( ) Yes ( ) No 14 Name of Owner of premises ......... ~.~/~.~. Addre~ ~.~.__~Z ........... Phone No...................~.. Name of Architect ........................... Address ................................ Phone No ...................... Nome of Contractor&~.~*... ~ A~,~ ~ .... ¢ .~ ..... AddressG. E.~.~N~ Phone No. PLOT DIAG~M Locate clearly and distinctly oll buddings, whether ex~sting or proposed, and ~nd~cate all set-bock d~mens~ons fron prope~ hnes Gwe street and block number or descnpt~on according to deed, and show street names and indicot whether interior or corner lot. STATE OF NEX6Z--¥O~, Zg/ ~ S S COUNTY OF ~Z'z'>~...c:~.. ....... f-'~-~ ~ ...................... .~../...~...~...~....~....~T. ............... be,ng duly sworn, deposes and says that he ,s the oppl,car (N~ of mdlwdual signing contract) above no meal ~~ He ~s the ................................................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or hove performed the so~d work and to make and fil this application, that oli statements contained m th~s apphcohon ore true to the best of hm knowledge and behef; an tha~ the work w~ll be performed m the mahner set fo~h m the opphcat~on filed therewith. Sworn to be~re me th~s ~ , ~ ~ . .............. ~.~. day of ......... ~ ....... , 19~T~ ~ ~ ~1/~~ ~ ~~, ~ ~ - ................. .... co,, ..... ............. ~~/~ . (Signature of opphcant) ~6 No, 52-0~44963 Suffulk Coun~ ~ ~ ~mmtsslo~ ~pJre~ March ~0, 19~