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Home My WebLink About7974-z FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 7974 Z Date ............................... j~q.~......~ ........ , 19..~.%.. Permission is hereby granted to: ~L~c~ae~..~..Ath~n~.... ~e&l.i.s .................... ......... ,22._~-.1.$ ............ .-%9.t.~-.~ve .................... .............. ~a~s!~e ..... ~-~.Y-~ ..... *r.~.36~ ................. lo ....e.~.e..~ ~... ?...e..~. g.~.P..g ...~. ~ .. j~ ~ .. &p p.l S.c.a .~.f n~ .......................................................................... at premises located at 1.0/~0. ...... 2:g~..Ro~d. ................................................................................... ......................................................... ~a s.t..~/arion ....... L ................................................................. pursuant to application dated ................ .,~'~a~. ....... ...~O .................... , 19..~..~., and approved by the Building Inspector. Fee $.~.5~.QQ ............ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office $outhold, N. Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This opphcat~on must be filled in typewriter OR in[<, and submitted in DUPLICATE to the Building Inspector with the following; for new buddings 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 cerhhcate 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 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. 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 Date .............. : ............................. New Building ................ Addition ................ Old or Pre-existing Building ............ $.. Vacant Land .............. Location Of Property /~t/~-//~/ 7~OA Z-~7. ~Z--/~r~'-I ../~./...~. ~-¢'~O /~ Owner Or Owners Of Property ............ ..~....(.....~...~..../:~....L~..Jm. ...... ...~......~..~..L..~....~.....~., .............. ..~....L.::.~....L..!.._~...... Subdivision ................... ~ ......................................... L,.9.t. No ...... ',~,,...7-Blodk No ............. House No ............ Permit No .................... Date Of Per t~_.... ................ Apphcont .................................................................. Health Dept. Approval .................. .~...~... ............. Labor Dept. Approval .................. ..~........~. ................. Underwriters Approval ..................... ...~....'....~ ...... Planning Board Approval ........... ..~..Z.....~....: ............ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .... .~,...~ ................. (stamp or seal) ................ day of ..~ ............................. ~'~ Notary Public ...... ~ ...... ~ ............. County FOIlM TOWN OF $OU?~OLD / ~,~..c.,t_.. P ~.o..c,h/O /$~g.K.O-~ BUILDING DEPARTMENT_~ac~ OFFICE'¥.~ /~.~l~/..~ "* Ou'~--R.. /~/~- TOWN CLERK'S ~ P//'P'//$~ SOUTHOLD, N. ¥. Approved ......................................... 19 ........ Permit No....~.. ........... .C{. ..... .~..;..:... Oisopproved o~.....~ ........ ........................................................................ ~ ,'"I'"','XC"'~:~ ................. ........................ ............................ {Building Inspector) A~LICATION ~OR BHILDING PERMIT / INSTRUCTIONS a Th,s applicahon must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildir 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 premmes, relationship to adlommg premises or public streets, areas, and giwng a detailed description of layout of property must be drawn on the diagram which is part of th~s applicatio. c The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector w~ll issue a Building Permit to the applicant. Such perm 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 Occupan~ 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 ti Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alteratmns, or for removal or demolition, as herein describe The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and admit authonzed ~nspectors on premises and in buildings for necessary inspections~) .... ..... ~/'- ~rgr ~ppucanr,-or-n , ' p ' (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build: ............................................ .............................................................................................................................. Name of owner of premises .... J~.!.C.¥'J .~...~.m~ ..... ~. ............... ~. 7~C ... ..................................... If applicant is a co~orate, signature of duly authorized ofhcer. Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1 Location of land on which proposed~_ ~x~ ~, /J~ L-k_, ~,~ ~/~/w°rk will be done. Map ?~o. ............................... Lot No .................... Street and Number ...[...0,...0'..~,.0/,...¢,.u/../~,.,/¥.,~,0.('~/~..;/,.../.~-'qO'~,/'....LUO~.(".I~...('......{~.~.,~..__ ................. Municipality 2. State existing use and occupancy of premises and m*.ended use and occupancy of proposed construction' a Exis,ting use and occupancy .... ...~...~.~..~1....~..~..~.......~Q/~. ~.!..~...~.~...A(.¢. ~ .................................................................. b Inte.ded use and occupancy ........... ;.~.;Eg .............. ! ...................................................................... 3. Nature of work (check which applicable): New Build,ng .................. Add,tion .......... .~..... Alteration Repair ................. Removal .................. Demolit~or. ...............Other Work .............................................. /~'~ ~ (Description) 4. Estimated Cost ......~...~..~.:.;...0....0. .................................... Fee ...................................................................................... (to be paid on fd~ng this apphcat~on) 5 If dwelling, number of dwelhng units.. ......... I. ........... .... Number of dwelhng umts on each floor ......................... If garage, number of ~rs ........ ~ .................................................................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each ~pe of use ........................ 7 D~mens~ons of ex~stmg structures, if any Front ..................... Rear ................................ Depth .................. Height ........................ Number of Stones ............................................................................................................. D~mens~ons of same structure with alterations or add,hans. Front .................................... Rear ...................... Depih ............................... Height .......................... Number of Stones .............................. 8 Dimensions of enhre new construchon: Front .................. , ............... Rear ............................ Depth .................. Height ................... Number of Stones .................................................................................................... 9. S~ze of lot' Front ....................................................... ~.___~ ~ n~ Rear ....................................... ~.~.~__ ~~Depth'* .......................... I0 Date of Purchase ..~~ ..... ~.~.)....l~..I.~ ......... Name of Former Owner ..~.~~..~.[~.~. .......... 11 Zone or use district in which premises are situated ..... ~ ..... ~'~..~.~ ........... , ...................................... 12 Does proposed construction violate any zoning law, ord nonce or regu arian .. ~[~ ......................................... 13 Wdl lot be regraded ....... ~.~ .............. ~dl excess fill be removed frompr~i~esL( ) Yes (~No 14. Name of ~ner of premises k..(~O~k.~.~'. ................ Addre~*~...~,~ ........ Phon~ Name of Architect ..................................................... Address ................................ Phone No ....................... Name of Contractor ................................................... Address ................................ Phone No ....................... PLOT DIAG~M kocQte clearly and distinctly all buildings, whether ex~sting or proposed, and red,cate all set-~ck d~mens~ons from prope~y hnes Gwe street and block number or description according to deed, and show street names and indicate whether ,nterior or corner lot , ~, ' ~ STATE OF NEW YORK, COUNTY OF .~c~ ....... ........................ ~.,~.~¢-~.:.. ~.~.¢,~ ................ duly sworn, ~ . .~ being deposes and says that he ts the apphcani (Name of md~wdual s~gnmg contract) above named He ts the .................................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and file th~s application; that all statements contained i~ th~s apphcahon are true to the best of his knowledge and behef; and thor the work wdl be performed m the manner set fo~h m the apphcahon filed therewith. Sworn to before me this ....... ......... .... ............ ..... ' ,, . _' .~r~ q.//~= r~~ (Signoture of opplicont) Q'F,Fh', I, ,~t