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Home My WebLink About9230-z FOKH 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) ~ N°' 9230 Z Permission is hereby granted to: at premises located at j~.~j~.. _JjJj~l~...~JJ.....~ttFel. ~11~11 ................................................................. ...... .~ .................................... ~t~ ............................................................................................... ~p~rsUant to apphcahon dated ...................... JJ~t""'~' .................. , 19.~.., and approved by the Building Insp~tor ' FOl~l~ NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerk= Office Southold, 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: 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 disposal--(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 certtficate 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 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: J. 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 ...... ~1..~..~.. ..... [.~'.. f ...! .~ .~...?...~.... New Building ................ Addition .,,~ ........... Old or Pre-existing Building ..~ ........... Vacant Land .............. Location Of Property ...... ~,A.,~e..~.....~v. fJ.~.. ........... ~[~.~..~.~].~..~..~. ........~l~.t~....*...~..~/~['t~.~..r.....~...~....~..~... Owner Or Owners Of Property ........ ~.u..~r~...~.. ........... .,,~,/~.~..~...~ ......... .-......~{y/.~7'~ ..... ..~.~..~ .~..~. ...... Subdivision .' ............................................................... Lot No ............. Block No ............. House No ............. Permit No..~....~....~...O.~..... Date Of Permit Jv,~fl~..~....~.~..Applicont .... ~.,~.~.I/~ ....... /,,,~'..~=~. ......................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate ~ ................................. Fee Submitted $ ~...~.. ......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .~~~......~... .................................................. Sworn to before me this ....... ~,.~'..?'. day of ....~?.~.~..~..~..J..~-~'.~ (stamp or seal) CHA'RbES F. ~IOTARY PUBLIC. State of Ne~ 14o. ~2.4S0790O-Suffolk ~ ~4~r~ .March 30. Application .............................. Approved ................... .C~ ....... ~ ...... , 19.?.~.... Permit No...Z..~,....~...,~..~ ......... TOWN OF $OUTHOLD BUILDING DE~RTMEHT~ ~ TOWN CLERK S OFFICE ~UTHOLD, N. Y. Disapproved a/c ~..~.~7 .............. ............. PE~IT ~ ~~-~Z }' ~'' ~dO ~, , 0 ~ Date ...~d~.~ .......~ .................. ,19 .......... a. This apphcatJon must be completely fille~ m by ~pewrffer or in in~ and submitted in triplicate to the ~uildir Inspector, with 3 set~ of plans, accurate plot plan to ~ale. Fee according to schedule. b. P~ot plan s~owing location of ~o~ and of buddings on premises, relationship to adjoining premises or public streets ~reas, an~ ~iving a detaH~ description of layout ofpreper~ must be drawn on the diagram w~ic~ is pa~ of this c. The wor~ co~ered by t~is apphcotion may not be commenced before issuance ~ ~ui~din~ Per~Jt. d. Upon approval of this application, the ~uildJng Inspector will i~sue a ~uil~mg Permit to t~e apphcant. Suc~ per~ s~all be kept on the premises awJlable for inspection throughout the wor~. e. ~ budding sh~ll be ~cupied or used m w~ole or in pa~ for an~ purpose whatever until a Ce~Jficate of ~cupan~ shah have been granted b~ the ~uilding Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to tk Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, nnd other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations, and i admit authorized inspectors on premises and ir~ buildings for necessary inspections. ~>i~nature ' ';1~'~'" ....... : ............... ;"if ~'~;';l~'~';~;i;~'i ...... ........ State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde .................... ..................................................................................................................................................... Name of owner of premises ...... .~..q.~...C.~.'~'.. ............... ~r~/..4..~..~.?..'. .............. :.'~/~.~..m ....... ~ ....................................... If applicant is a co~orate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Lzcense No ..................................................... Plumber's License No.../.%..~...~'..~..~.. .......................... ~"" Electrician's License No. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No ' ....~ .............................. Lot No..~., ................. Street and Number ....~...~..~..: ...... .~..~.. ....... ./..~.. ........... ~.G.~.4~.C ..... ~.A~.~L. .......... /~7~.~.,.~ ................................... Municipality State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a Ex,siting use and occupancy ............. J...~..Q~..//.Z. ........................................................................................ b Intended use and occupancy ........... ~ ................. ~ ........................... [. ............................................................... 3 Nature of work (check which applicable) New Building .............. Addition .................. Alteration ................ ~ CC Repmr .................Removal .......... Demohtmr .......... Other Work ......... /.... ............... ' .................... C~ (Description) 4 Estimated Cost ........................................................ Fee/ (to be pard on filing this application) 5 If dwelling, number of dwelhng unlts ........ / ............. Number of dwelhng umts 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 ......... ,¢,..~1'. ................ Depth .~ ............. He,ght ..... /~., ............. Number of Stones . .~.: ................................................................................................... D~mens~ons of same structure with alterahons or addmons Front .... ~..~ ...................... Rear ....~.~...¢ ........ Depth ...~..¢ ............. Height ............... Number of Stones ................................ 8 Dimensions of enhre new construchon' Front ..~ ............................ Rear ............................ Depth ....................... Height ................ Number of Stories .......................................................................................................... 9. S~ze of lot. Front .... /~.9...~ ~ ~ ............................ Rear .......................................... Depth ............................... 10. Date of Purchase .......................................... Name of Former Owner .... ~..~Z ....................................... 11 Zone or use district m which premmes are situated ............................................................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation' . ...................................................... 13 Wdl tot be regraded ...% ................ Wdl excess fill be removed from premises. ( ) Yes ( ) No 14. Name of Owner of premises ................................................. Addre~ ................................ Phone No ...................... Name of Architect ..... : ................................ Address ................................ Phone No ...................... Name of Contractor .......................... Address ................................ Phone No ...................... PLOT DIAG~M Locate clearly and d~stmctly all buildings, whether ex~sting or proposed, and indicate all set-~ck d~mensions fron prope~y hnes Gwe street and block number or descr~phon according to deed, and show street names and indicat. whether interior or corner lot ~ ~ . , J STATE OF NEW ~¢~4/¢f~., .¢..¢ ~ c COUNTY OF ~.....~¢ S ...................................................... being duly sworn, deposes and says that he ~s the applicar (Name of mdlwdual s~gnmg contract) above named. He ~s the ............................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to oerform or have performed the said work and to make and fd this applicahon, that all statements contained ~n th~s apphcohon are true to the best of his knowledge and behef; an that the work wdl be performed m the manner set forth m the apphcahon filed therewith. Sworn to be4:ore me th~s _ . .~....W?. ..... //~av of ~¢ '~/7~--6~'/--"~ , 19 ~7 ~ ~ \ JUDITH T. TERRY ./~ ~ //'- --(Signature of op~¢o..nt) Notary Public, St3te of New ¥'atR ~ '~ No. 52031~'-963 Suffo'k Cou, m~q Ccmrmsslon E, xp,rcs March 30, ~.9¢./