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Home My WebLink About7756-zTOWN OF $OUTHOLD BI.m.r~lNG DEPARTMENT Town Clerk'~ Office $omhold, N. Y. Certificate Of Occupancy THIS CI~?IF~I~S that the bui]&Jng lo~ated at 'P&~kw&)' .................. Street co~o~ su~y ~ ~e App~fl~ for B~g P~t h~fo~ ~ ~ th~ ~ ~ ........ ~a~ .... ~.~..., 19.~., w~ ~u~, ~d co~o~ ~ ~ of ~e ~ m~M of ~e applicable pro~io~ of ~e hw. ~e ~up~ for wM~ !hi, ~ ~ (o~, I~ or ~t) of ~e ~o~d ~ding. S~o~ Co~ Dep~-hxmnt of He~ Appmv~ · ~ ~R, .............................. HOUSE ~ ...... 1 ~ .... S~ ... Pa~y .............................. FORI~ NO. 2 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? 7756 Z Permission is hereby granted to: · J,~u.~ ~..&..~ ~a...J~r~_~g s ...................... ........... ~ox~tholcI ................................................ to ..b.~.~..~..~d~t l.tcton**~n...axls.t~,ng** clue 11/:ag .............................................................. at premises located at ...~,.Q.~,..~....~ .......... ~.OU.~.OOCl ........................................................................ ................................................... ~.ax~-~ .y..D.r. ............. ~ ~ut~o-lA ................................................... pursuant to application dated ..........................~..~.1~. ....... J.~. .......... , 19'Z.~...., and approved by the Building Inspector. Fee $..~,~.*~ .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN a. ERK'S OFFICE SOUTHOLD, N. Y. Examined .........~,-t~/ ............. .~...., 19~ proved ................. r.! ......... "/"7'"'" P,,,,t No. ......... Disapproved a/c ........................................................ ~-- APPLICATION FOR BUILDING PERMIT Date/..~......./..~~ - - /' "' ............. , 19..~..~.. ..... INSTRUCTIONS ~) a. This application must be completely filled in by typewriter ge in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may nat be commenced before issuance of Building Permit. ~(~ d. Upon approval of this application, the Building Inspector wJJl 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 Occupancy 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 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, 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 necessa~ inspections. (Signature k~applicont, or name, if a corporation) (AddrEss of applicant) State whether applicant is own, er, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ................................................................................................................................ Name of oWner of prem ses ...~...~,~ .~.~ ..~.~....~..~/.~1~./.~!~..~..~. ................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and tJHe 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. AAop No.: ..... ..-~...,~;..~'....°~T..../...z~..../. ........ Lot No....~.....~./.. ........... Street and Number'~..Z'.~........~.~/~,~.z~..f~.....~.(./~.~......~~....x~.,.~:...../../..~..~;~/.. ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of pro~ed construction: b. Intended use and occupancy ........ .~..~/~t ....... ~..~ .................................................................................. 3. Nature of work (check which applicable): New Building, ..~ ...... Addition .~......i."...i... Alteration .Z .............. Repair ..~ ....... : ....... Removal ~ Demolition.~L~ ..... Other Work ..... (Description) 4. Estimated coSt ~-~/4~....~-f~ ....... .'~...~..O...~...'~.~. ............ Fee ......... Z ............................................................................. (to be paid on filing this application) 5. If dwelli~, 'number of dwelling units ...~'......Number of dwelling units on each flor ...-[ ....................... If garage, number of ~m ............................................................................................................................................. 6. If business, commercial or mixed occupancy, speci~ nature and extent of each ~pe of use ..[ ......................... 7. Dimensions of existing structures, if any: Front ............ ~;~..~ ........ ' Rear .............. ~.~ ............ Depth ......~.~. .... Height ~' Nu~er of Stori~ D mensions of same structure with alterations or additions: Front ...: .......... .~.Z......; ......... Rear .......... ~../ ........... Depth .....'...'....~..~ ............. Height ........... ~.;~L~Numbe'r of Sto~ies ........... ~ ................... 8. Dimensions of entire n~ construction: Front ............. ;./.~ ............... Rear .......... ~.~ ........... O~th .......~.~ .......... Height .....w.,.,:. ....... N~mbero~ 4°f Stories ...................................... % ........ 7..,,v/,Z .......... ; ........................ ;'""7"~ ........... 9: S ze of lot: Front ~...~..~..,~.~.....(.~.~:,~,~ ........ Rear ,~.~,...~..~....~Z~ Depth ~.~..~:~.T;~,~ '~ ~ "/~' /~'~-~,j;~.~.....~ Name of Former ' 11. Zone o~ use di~ricf in which premises ore sifuefed ..................................................................................................... 1~. ~oes propased censfrucfion violefe eny zoninD Iow, erdi~nce or reDulefi~: ............. ~...: .............................. 13. Will lot be regrad~ ............................ Will excess fill 14. Name of ~ner of premises ~..~.:...~.~ ...... A~r~ ..~~ ....... Ph~ No. c..~.~,,.,.~--~-- Name of Architect ......... ~; ................................................ A~re~ ...' ............ Name of Contractor ....~ ............................................ A~re~ .~.....~ ................. ~o~ No ....................... PLOT DIAG~M' Locate Clearly and distinctly all buildings, whether existing or proposed, and indicate all sotek dimensions from prope~ lines. Give street and bilk number or description according to d~, and show street names and indicate whether interior or corner lot. LoT' I COUNTY OF ....... · .......................... ~(-~.~/~,~[,;...;,, ,~......t;,.:. ............ being duly sworn, deposes and s~ays that I is the applicam (Na~ ~f individual s~nlng contract) (Contractor, agent, corporate qfficer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and , make and file this application; that all statements contained in thi~;~pPlicotion are true to the best of his knowle~ ~ and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~//. Notary Pub c, .~../x-~/~,/. ........ County ...../s~....~ ...... :..~¢..~¢~.c.:.%'::;......-::~ ......................... NOTARY pUBLiC, State of New Yo~ No. 52-8125850 Suffolk C0uJ3,~Y, Term Expires March 30, ~-DJ~, FOIL~[ NO. ~ TOWN OF SOUTHOLD , Building Department Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructlons A. This apphcahon must be filled in typewriter OR ~nk, 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 Underwnters. 4. Commercial buddings, Industrial buildings, Multiple Residences and s~milar buildings and installations, a cert.ficate of Code comphance from the Architect or Engineer responsible for thi~ building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings end 'pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buddings 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 inspechon of buildings 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 . "~,~. ~.' New B~uldmg ................Addition~... Old ar Pre-existing Building .....~../ / ...... Vacant Land .............. Subdivision .,~..,~ ................ Lot No .....~. ..... Block No ............. House No ............ Health Dept. Approval ....... t..;.. ............................... Labor Dept. Approval ............................................... Request For Temporary Certificate ........................................ Fincd Certificate ......... ~ .................... Construction on above described buitding and permit meets all~pplicoble codes and regulDt, jonJ