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Home My WebLink About7971-z FORM NO. 2 TCYWN 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) N? 7971 Z Date ............................... ~Ti~m~ ....... 9....., 19...'~'.~ Permission is hereby granted to: .............. .~..~ko.~.e. .......................................... ~a .... .s....~...x...a.....e~.....~..¢.a.!~&.o.~....o.~....J.~.s..~.%..n.g...a...w.e...z.~.n.~ .......................................................... ~,~, p at premises located at .~.Q.~....~.Lx.....~da~.l~..~..Q.:J~.~.....'.~.Q~ ............................................................ .......................................... ~_~new. e ~a..~..L~.t.t !~,. Re ~an~c...~....~ ....................................... ........................................................................... E'~tc~o4p_~ _~. ................................................................. pursuant to application dated ............................... ~,~'. ...... ..~0. ..... , 19..~.~., and approved by the Building Inspector. Fee $.'J ~..*. ~ ............ Building Inspector TOWN OF $OUTNOI.I) ~ Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfructions A. This application must be filled in typewriter OR rank, ond submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate location of oll 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), 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 os 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: 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 v,/ New Bqilding ................ ,4//~_/_ / /__~ __~ -,~/~-~rz'/~r ~--.-,A. ~----~. ~ ~::~ ,-,~ .-~ zAdditi°n ................ Old or Pre-exi~ting Building ................ Vacant Land ........ · o,.on o, Owner Or Owners Of Pro err ..'~,,7,...'~..i,....'~.,.~,~?....,/~.'.~.:....~...;~..~...,...'~..,.~.'~...,.,~.....,./~,., ........................ ............. Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ,..'~.,../...~.....~.. ................... Sworn to before me this Appl,cant* ~~***~.'.~.~.~//~/¢ ......... C~.~... day of .~.[~YI.~..~......,~..~...CL?~ (stamp or seal) ~/~ 9,' . ~¢ ............. ,, TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. ×omined .. ........ Approved ...... Disapproved a/c .......................................... ':;.~.._.,.,_...~ INSTP, UCTIONS a. This application must be completely filled tn by typewriter or in ink and submitted in triplicate to the Buildi~ 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 adjoining premises or public streets areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this 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 pern 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 o 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 alterations, or for cemoval or demolition, as herein describ~ The applicant agrees to comply with all apphcable laws, ordinances, building code, housfng code, and regulations, and admit authorized inspectors on premises and in, buildings for necessary inspections. (Signature of applicant, or nome, if a corporation) (Ad~Jress of applican~c) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncion, plumber or build If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ .~.~....?....~.':.=..~..._L. ........ Plumber's License No ................................................. Electric,an's License No...~.,..,L/(...~..:....~ ................. Other Trode's License No ............................................... 1.. ] Locat,on of land on which proposed work will be done. Map No .... ~....(~ ...................Lot No, ./...~.....~.. ..... Street and Number .~v~¢'~~.~ ..... R.~.,.~.~...~.~..:...~.J~l~.l.h.:.¥...~ ' (~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction' o Exisiting use and occupancy ................. ~' ,~ ............................................................................ 3. Nature of work (check which applicable) New Building .................. Addition ................ Alteration .... Repair .................. Removal .................Demoht~or, .................. Other Work ............................................. ~' (Description) (to be paid on filing this apphcat~on) 5. If dwelling, number of dwelling umts ............'~. ............ 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 .....~. ................ existing structures, if any: Front .... ~:~....~.~ ............ Rear ........... ,~....~. ............ Depth ..~ ....... 7. Dimensions of Dimensions of same structure with alterot,ons or add,tJons. Front ......... .~.....~. ................ Rear ....~....7.. ............ Depth ......~ ................... He,ght .......... :~_~t.! ...... Number of Stones ........ ~....~ ........... 8. D~mensions of entire new construction Front .................... . .............. Rear ............................ Depth ........ Height .......... ..~. ....... Number of Stories ................................................................................................................. 12 Does proposed construction wolate any zoning law, ordinance or regulation ...~.....-. ....................................... 13. W~ll lot be regraded .............. '~. ............ W~ll excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of prem,ses ~,~....j~.~ddress .~~.:~Phone No ....................... Name of Architect .............................................. Address ................................ Phone No ...................... Name of Contractor .............. Address .~.~ hone No.?.,~..¥..':'.~.~..,~,~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and ~ndicate all set-back d~mens~ons fron property hnes Give street and block number or description according to deed, and show street names and ind~cat.- whether interior or corner lot STATE OF NEW YORK, COUNTY,,OF ........... ...... (.....~.~....(..~~.: ............................. being duly sworn, deposes and soys that he ,s the applicar (Name"-'~ - -' of ~n~Jw~dual s~'--~' ~ ' 'gning contracf) above homed. He ~s the ............................. .-,~,~....~.m.z:..~ ...... ?. ............................................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and fi this application; that all statements contained m th~s application are true to the best of his knowledge and belief; ar tk, at the work wilt be perfa, Ft~d in the manner set forth in the apphcat~9,q filed therewith. Sworn to before me thi~ (, J . .................. Notary Public, . .......... ~ . County ..... .",.-,~.....~........~......~?.~. ......................................... (Signature of applicant)