Loading...
HomeMy WebLinkAbout7989-z FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTt~ENT TOWN CI.ERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT Oi',l THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7989 Z Permission is hereby granted to: ~r.~e ne ~.. ~t ~;~he4L ~ ....................................... .............. ~.u~h~id ............................................ to .... ]~ ~ J_d..~n..a~.df~t to~-..[, f~e~ ~-~.. ~)... ~n.. ~,x& s.tj.r~.,~..~u~.~.~.;~..b~.i.,~,~... at premises located at .~...BD.~..~..~:~J~..[~.e.a...t!rJ[~. ....................................................... ................................................................ ~a~J:o/c~....~. ~. ................................................................ pursuant to application doted ....................... 19..~.~.., and approved by the Building Inspector. Fee $1 ~. ~ .0.(~ ............ Building Inspector ~ FORM NO. 6 TOWN C)P SOUTHOLD , Building Department Town Clerks Office Southolcl, N. Y. 11971 APPLICATION FOR C[RTIFICATE OF OCCUPANCY In:structions A. This apphcation 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 location of all buddings, 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 mstallahon from Board of Fire Underwriters. 4. Commercial buildings, Industrial buddings, Multiple Residences and s~mdar buildings and installations, a cerhficate 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), lXlon-conforming uses, or buildings and "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 insl:ection 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 / j NewBLuld,n Addition ~OldorPree,st,n Bu,ldl:te '''~'~'' ................ · · g ................ .. . .............. - ¥' ' g~ ' g ................ . .............. · o~o,,on o, ~ro~r,~ ..c..~.....[.<.~.~.~:~....S..x. ....... z.:....l.{.~.~....,...~c...~....~.~. ............ O~,ner Or O~ners Of Property .... ....~.. ~.~.~.:~....~.=..I.~.=~.~.~..~..~.t ................................................. Subdivision ................................................................ Lot No ............. Block No ............. H, ous~ N.o ............ Health ~pt. Approwl ............................................ kobor ~pt. Approwl ............................................... Ur~derwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate ......................................... Fee Submitted $ .................................... / Construction on above described building end/5~rmit meets all ,applicable~co4~s o,.nc~ regulations ^~,,~on, ..... ....~~.~.....~.:....~~ ............................. Sworn to before me this .... ././..~. day of .~?~...Z.~.~..¥. Notary Public ...... ~. County ~stamp ar seal) ~cter/ Pubhc, Stat~ of New No ~2.03442:3 Suflc[k Cou~t~ Ccm~;~q E~ p',e~ ~rch 30, 19~/ I~R,M NO. 1 TOWN OF SOUTHOLD BUILDIN(; DEPARTM£NT TOWN CLERK'S OFFICE APPLICATION FOR BUILDING PERMIT ....................... INSTRU~IONS a. This application must be completely filled in by t3/pewriter or~ in ink and submitted in triplicate to the Buildin Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. PIoL plan showing location of lot and of buildings oq premises, relationship to adjoining premises or public streets c areas, and g~ving a detailed description of layout ofproperl¥ must be drawn on the diagram which ~s part of this applicatior c. The work covered by th,s application may not be commenced before msuance of Building Permit. d. Upon approval of this application, the Building Inspector will 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 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 th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances · Regulations, for the construction of buildings, additions (ir alterations, or for removal or demolition, as herein describer The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and ir~ building.', for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu~lde Name of owner of prem'sl es ..... ............ ~"~. .............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title 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 ~r osed work will~be don Ma~ .. ,)~:t~ ........... .~ ...... Lot No Street and Number .... / ~ / Municipality ~~r 3. Nature of work (check which applicable) New Building .................. Addition .................. Alteration ............. Repair .................. Removal .................. Demoht~or. .............. Other Work ............................................... (Description) 4 Estimated Cost ........................................................ Fee (to be pa~d on fihng this application) 5. If dwelhng, number of dwelhng 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 b/pe of use ................. ~ .......... 7 Dimensions of ex~stmg structures, ff any' Front ...................... Rear ................................ Depth ................ Height ........................ Number of Stories ............................................................................................................ D~mensions of same structure with alterations or addmons: Front ................................... Rear ................... Depth ................................ Height ........................ Number of Stones ................................ 8 D~mensions of entire new construction' Front ................................... Rear .......................... Depth .................... Height .................... Number of Stories ..................... '9 Size of lot Front ........................................................ Rear .......................................... Depth ................................ 10~ Date..of Purchase .................................................... Name of Former Owner ....................................................... 11. Zone or use distr~ct in which premises are situated 12 Does proposed construction viotate any zoning law, ordinance or regulahon 13 Will lot be regraded ............................ Wdl excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ................................................... Address ................................ Phone No ....................... Name of Architect .................................................. Address ................................ Phone No ....................... Name of Contractor .................................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~stmg or proposed, and red,cate all set-back dimensions from property hnes. G~ve street and block numb~ or description according to deed, and show street names and indicate whether inter,or or corner lot .~..~, ~'~ ~J~ . STATE OF ~z~c.,-~-~ ,~ / - .................................................. being duly sworn, deposes and soys that he ~s the apphcom (N,a)/~ of individual signing contracf) above named He ,s the ................................................ ~~...c~......-. ............................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, end ~s duly authorized to perform or have performed the said work and to make and file this apphcat~on; that all statements contained m this applicahon are true to the best of his knowledge and belief, and that the work will be performed in,he manner set forth ~n the apphcat~on filed therewith. Swomtobef~r~methis ,~ ~ ~ .~ ............ ~ ................. doy of ....... .... , ~/__/~ (Signature of applicant) I~RM NO. It TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............................................................................................ t. ~Building Inspector) ( Date ............................... , .... INSTRUCTIONS a This application must be completely filled in by lypewriter or in ink and submitted in triplicate to the Buildin. Inspector, with 3 sets of plans, accurate plot plan to scal~. Fee according to schedule. b Plot plan showing location of lot and of braidings on premises, relationship to adloming premises or public streets o areas, and giving a detmled description of layout ofproperty must be drawn on the diagram which is part of this applicatior c. The work covered by this apphcat~on may not be commenced before ~ssuance of Braiding Permit. d. Upon approval of this application, the Building ln.~.pector will ~ssue a Budding Permit to the apphcant 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 Jn part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buil&ng Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions cr alterations, or for removal or demolition, as herein describer The apphcant agrees to comply with all applicable laws, ordmances,J~/ilding code, housing code, and regulations, and t admit authorized inspectors on premises and in, buildings for ~ inspections. ~ j~ ...... ................... ~ (Signature of applicant, or .name, i~_corpor, ation) /[Address of apphcant) State whether apphcant is owner,~,e, agent, architect engineer, general contractor, electrician, plumber or builde, Name of owner of prem,ses ........ t,.~..~.~ ............... .~'.'.~,~. ................................................... If applicant is a corporate, s~gnature of duly authorized officer. Plumber's L,cense No ............ !~.,../ ............................ Electrician's License Na ............................................ Other Trade's License No ............................................. ] Location of land on whlc. Aq proposed work]v~ill be done. Map Nc~ .. A ............................ Lot N9 .................... ................... ........... "";/"J: ..... --~"'"~ ..... "G'"~'"' Municipahty Street and Number 2. State existing use and occupancy of premiss an~dzj~ntended use~nd occupancy of proposed construction: a Exisiting use and occupancy ............. ti/ ~--~ J .~..~.../, ~..~..., ...~-. ,../~. (~..~....~..." ........................................................................ / / 3. Nature of work (check which applicable) New Bu~dmg .............. Addition ............... ; Alteration, .......... Repair ................Removal ............. Demoht,~r ........ Ot~r Work .~.c-k.[[L...!.v.'....?..~.~.~.?.(.'~...~.....~.. J j,~ (Description) 4 Estimated Cost ............................ c'~ ~-O,~ ........ .......... ............ Fee ................................................................................. (to be paid on filing th~s apphcat~on) 5. If dwelling, number of dwelling umts"~./.,~. .............. Number of dwelhng units on each floor If garage, number of cars ............... /~"/"'~'// ..............................................................................................~ 6. If business, commercial or m~xed occupancy, _specify nature and extent of,.each type of use .~....~..-~'~.. 7 D~mens~ons of_existing structures, if any' Front ........................ Rear ....%..~ ...................... Depth .... ..~...~. ....... Height ....... ~...!. ......... Number of Stones ~....~..~..~.. ......................................................................... D~mensions of same structure w~th alterations or addmons Front .... ~~ .............. Rear ..-~....~..~ ......... Depth ...... .?.~.~ ......... Height ....~.....~ ..... Number of Stones ...~.~...~....../~...'~.. ........ 8 Dimensions~.f ent,re new construct,on' Front ....... : ............................ Rear ...... l....~:.. .............. Depth ....~.... ........... V Height ...~ .......... Number of Stories ...... ~ ................................................................ ). 9 S,ze of lot Front .[~.~ .... /~'"~'"'--,---~ zz'~ ............... Rear /..~..'.~ .................. ~ ........Del)th .../'....7......./...~...~'~.~?... 10. Date of Purchase ...... ~g.~./..:~..-..~./'..i..J...~.~. ................. Name of E. orme. r_Owner-,,[~.~..../~.;....¥....~..~.....~.._~_ ]1 Zone or use d,str,ct in~'- --which prem~ses are situated .... .~. ........."' ~.~.~/..~.~..~i---, -- "-"--' '"""'~/..._.), ................................ ..... 12 Does proposed construction via ate any zon ng aw, or d nonce or regu arian' . .................................................... regraded ..~...N. .................. Wi ll .ex_ce.~L be removed from premises: ( ) Yes (/J~ No 13 Will bt be ; 14 Name of Owner of premises .'.J~'..~..~.....~:..~..~./...~...~..(.Z./.. Address .~.~..~.~/....~.~,~.~ Phone No. Name of Architect ................................. Address ................................ Phone No ....................... Name of Contractor ............................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~sting or proposed, and red,cate all set-back d~mens~ons frorr property lines Gwe street and block number or description according to deed, and show street names and indlcat.-_ whether inlerior or corner lot STATE OF COUNT~'OF ..: ...... ~,~..~. ......,~ '~"~ ,, ~ .............. ':...: ................................... ~....,~,,~ .,~... being duly sworn, deposes and says that he ~s the apphcan (Name of indw~dual signing conlracf) above named He ~s the ....................................... ~~ ........................................................................................................ (Contractor, ager,t, corporate officer, etc ) of said owner or owners, and ~s duly authorized to pedorm or have performed the sa~d work and to make and fil this application; that all statements contained ~n th~s apphcat~on are true to the best of his knowledge and behef; an tha~ the work wdl be performed ~n the manner set fo~h in the application filed therewith. Sworn ~before me this x-~, ,-. ,~ / ......... z ......... o, ..... ................ , / / ..........