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Home My WebLink About7702-z FOII3~ NO. 2 TOWN OF $OUTHOLD 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) 770'2 Z Permission is hereby granted to: Cutehogme Build an addi%ion on exi~tin~ d;~elling '~/8 South Harbor Road at premises located at ............................................................................................................................ pursuant to application dated ~roJ~ 2it' 1~....., and approved by the Building Inspector. Fee $ ........................ Building Inspector[ FORM NO. $ TOWN OF SOUTHOLD ~ Building Deportment Town Clerks Office $outhold, 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: ]. 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 disposol--(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), Nan-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 New B~ilding ................ Addition ~ Old or Pre-existing Building ................ Vacant Land .... (/ Subdivision ..... ...................................................... ....Lot No ............. Block No ......... .~,,J-Iouse No Permit No?...~.~.~....~...~'....~i Date Of Permit ~7.:.~:....ApplicantJ ./.?~....~..~..~...: .~..,....~...~.-~.~.~...~.. Heo th Dept A rovol b~bor De ~ ~'~ · PP ................................/ ........... pt. Approval ................................................ Underwriters Approval ..~....~..L.~.....~...~.. ...... //.'~Z.7.~ ...... Planning Board Approval ..~...'....~..! ....................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .....~.~.~.....~...~... ................ Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ......... of Notary Public ' ~' County (stamp or seal) c'~.~. ~- ~"7 3 9 Examined ..... G.~....~. ...... Approved .../~.. ........... r.~ ......... ! ......... , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No .... APPLICATION FOR BUILDING PERMIT % Date ~*~ J 9. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to s~ole. Fee according to schedule. N b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. ¢. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will ~ssue a 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 part for any purpose whatever until a Certificate of Occupancy ~j shall have been granted by the Building Inspector. p · A PLICATION IS HEREBY MADE to the Budding 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to~ admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (~(Address df applic~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , .............................. "'~..~i -_~.)~ ~-~' "~',~' .,~. :~ ...... : ..................... -~ ............................................... Nome of owner of premises .~..~..../~.~.-.:....'~.....~'..~Z.....~..~......~.~.?..~.~.~...~....%...~....~.'..~..~.~.~..~ ................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate offi~,~), Plumber's License No .......... ,~,,~/.~:/~i1 .......................... Electrlcion's License ~'~ ....~ ........................................ Other Trade's License No ............................................... Location of land on whichj~roposed~work will be done. M~p No.: .......................................Lo.t,. No .......... Municipality State existing use ond occupancy of premises and intended use and occupancy of propc~ed construction: o. Exisiting use and occupancy b. Intended use and occupancy ............... /~y.~7..~:. :.: .::....~...~....~....~...~....~. .................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition ~ Alteration Repair .................. Removal .................. Demolition .................... Other Work ................................................... .~..~ -- ~ ~ (Description) 4. Estimated Co ......... ~!. ................................... Fee ../.~ ................................................................................... (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 ..... ,.~.ff...~. ............. Rear ...~.~.. ......................Depth ~..~...~ ....... Height .~.~...!..~. ...... Number of Stories ............ ./,., ................................................................................................ Dimensions of same structure with alterations or additions: Front ....... .~...~...~ ................... Rear (/O / Depth ..... ¢~,,..,/. ...............Height .... ,~, ..-,~,. ................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .... ,~. ............................. Rear ..~....'~...f. ............... Depth../.'~...'~.. .............. Height ,..~..,~,....~ ...... Number of Stories ................ .~, .................................................................................................. cL Size of lot: Front ......... ~..~Z~.-'~...~ ............................... Roar ...../,~...O~'...~ ................. .~,... pepth ... ,~....~....~?....~. ............ 'lO." [)ate of P~rchose ........................................................ Nome of Former Owner ~ ............... 11. Zone or use district in which premises are situated ............................................................... ,~ .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ~.....~... ................................. 13. Will lot be regraded'. ................. ~ ........Will excess fill be removed from premises: ( ) Yes ( ) No · ' ............... ./. 14. Name of Owner of premtses ............... Address .~¢ Phone Name of Architect .............................................................. Address ....... ~ .............. Phon~ No..,~ ................... Name of Contractor .~,~....~f.~.~.~..~.... Address .~.~-~..~hone No.~..?.~,.~..~..~--- PLOT DIAGRAM Locete 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 Io~. ,l" 1-36t OF / COUNTY OF .................... 2.', ...................................................................... !.,.,belng',duly sworn, deposes and soys that he is the applicant (Name of individual signing contract) above named. He is the ....... .......................................................................................................................................................................... (Contractor, agent, corporate'officer, etc.) of said owner or owners, and is duly authorized to per, form or have performed the said work and to make and file this application; that all statements contained in this appiic'a~ioh tire true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to be~are me this ...... of ..... Notar Pub,i :CTadS . r.. ............... ~/ "- JUDITH T. BOK~N (Signature of applicant) No, 52-0344963 Suffolk County'~C--~-'~