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HomeMy WebLinkAbout7688-z ]~Ol~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7688 Z Permission is hereby granted to: .............. ,!~ ~t~t.t~J~....: ....................................... to ~ild..an...a~(ti.ti~m...mx..e z~is.t ~-ng--.d~,¢elt J~g ................................................................. at premises located at ..S~.S...Gld...t~:l.t...Eo;i.¢l ....... S~[L.t..~k~...V.i~La~e ................................. ............................................... ~.,a.t ~£t,~k..... N. ~ ... ~ ............................................................................. pursuant to application dated ................... ~.~...._~.3 .........., 19~.~...., and approved by the Building Inspector. Fee $ J.~.e.O~. ........... Building Inspector I~ORM NO. 6 TOWN OF SOUTHOLD , Building Deportment 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 loc6tion of all buildings, property lines, streets, and unusual natural or topographic features. 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 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 us 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 Date ..... ~......~. ~. ~.~.. ~..~..... ............. New Building ................ Addition ................ Old or Pre-existing Building ....~Vocant Land .............. Subdivision .................................................... ~ ........... Lot No ............. Block No ............. House No ............. Permit No.7~...~..~...~2.~.. Date Of Permit ....Z../..'~.../xT.u~.~pplicant ~.~ .,~..~4/. '~....~....~.Z~.?./~.~.ZC......~........~.~../.~.....~../£ ~/Nr ~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Swo,n ,o before me ,h,s L'4 ~/7~ IC~/ *'. ............ ~7 ............................ ,~. LT/'~Z'~3~_ ,4,~?~,~. ~,o~ Notary Pub,c ........... .O....~....~....~,.... Cour,,y 7~,-,Z ' ~, "-/ ~ Approved ........................................ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.?.?~... Permit No...Z.5.~.~ ........ Application Ne ................................. Disapproved (Building Inspector) '/ / APPLICATION FOR BUILDING P~RMIT Dote INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink end 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 od o n no orem sea or oublic str~t, areas, and giving a detailed description of layout ofproperty must be drawn on the diagr;3m wh-ic'h is part of t'his · c. The work covered by this application may not be commenced before issuance Of Bui ding Permit. \ d. Upon approval of this application, the Building Inspector will issue e Building Permit to the applicant. Such permit~o shall be kept on the premises available for inspection throughout the work. shalle' haveN° buildingbeen grantedShall bybe the°CCupiedBuilding°r usedlnspector.in whole or in part for any purpose whatever until a Certificate of Occupancy 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. The applicant agrees to comply with all applicable laws, ordinances, buildihg code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. Penny Lumber Co (Signature of applicant, or name, if a corporation) ~tate whether applicant is owner, lessee, agent, architect, engineer, gener agent of o~aaer Name of owaer of premises Edward Richards ~3~_[. If applicant is a corporate, signature of duly ricer. (Nome and title of corporate Builder's License No. Tonk Chituk }4att Plbg Plumber's License No. Electrician's License No. ? contractor, electrician, plumber or builder. Other Trade's License No ...................... :;:;:T,,..~::.7:T..Q..L-..':: ................................. Locat,on of,and on wh,c.h proposed work w',"J"be done. No.: ..... Street and Number .... ~/.~..Q~.f], ~.~.~g...~...o.~.~ ~.~.~.~.J:~.~...o..~. ...l ......................... -- ...................................... ........ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exlsiting use and occupancy DweZlin~, b. Intended use and occupancy sa~e with an addition. 3. Nature of work (check which applicable): New Building.. ................. Addition .....~.....X~...... Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................ (Description) 000 + 4. Estimated Cost ................ ~.l ...................................... Fee ~.~.A.0.O. .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .o...~.?. ............... 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 ............................ Number of Stories ................................ B. Dimensions of entire new construction: Front ..']..c2 .............................. Rear ....... .'J.c) ................ Depth ...,2. .................. Height .................... Number of Stories ..... .O.~,~. ......................................................................................................... 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 ...... !!..~.!~....C]:.J....S..~.. ........................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ,,q.O. ......................................... 13. Will lot be Fegraded .....~...o. ................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ....~cl,~.,,..~::L.o.ha.z:.~L~, ................ Address ...~.~.~.~.g. Clc .......Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..... ~.~7....~'/lb.~.Z' ./...~.,....(].~'J:[]~.CAddress ..... ~.~.~,.~;.1-?-.C,,1¢ ..... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give s;rreet and block number or descript~en according to deed, and show street names and indicate whether interior or corner lot. ' I STATE OF NEW Y,QRK COUNTY OF ....... b~[.o..Z...k ........ ................................................................................................ being duly sworn, deposes and says that he Js the applicon! (Name of individual signing contmcf) above named. He is the ....................... &~.e~.~....q,~...~.q~0.fl~...~.Cl .............................................................................................................. (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 confained in this application are true to the best of his knowledge and belief; and tho{ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this .~u,u,y"rublic,~~Z:.~~ Coun~ .,, (Signature of applican~¥ ............................. JUDllH T, BoKEN N~ia~ ~ubJJc~ Sta~o ~f New York No.