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Home My WebLink About9068-z FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9068 z Date ........................... },b.Zne h .......... ? ...... 19...~?. Permission is hereby granted to: Le. sta~...Seaman ..................................................... ............ J~e~b~..D.~...&..~i~.~o~..~g...R~ ....... Cutehogue at premises located at ..... ~9.....J.Q.....~.~....~ko.~e.s ....................................................................... ......................................... Be~..D.r.. &...~ i.l.z e~a...t~1..~ · · ~ .......... g.~%. e-h~e .............................. pursuant to application dated ...................... ~-~,~. ....... ~ ................. , 19....~.~., and approved by the Building Inspector. Fee $.1 D.~O.Q ........... · Building//~ector ' TOWN OF SOUTHOLD , Building Depmtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY InstructiQns 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 disposals(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 19.57), 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 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 BHilding................J Addition ..............- Old ar Pre-existing Building~ ................ ¥6cant Land .............. Location Of Property .... ~ ....................................................~.,.. ............................... ,...,...; .................. Owner Or Owners Of Property .......... ~.~..~.: .~.~,.'~.....~...?..~..~..~ ........................................ : ............................. Subdivision ...... ~...~...~,./.6!,~....:.:.7.~.,.C~,,,,~..~.....~,..~,.,.Lot No.... ,.~...~,.. Block No ............. House No ............. Permit No..~,,.,~'.~',,~.....?~,, Date Of Permit ?,.Applicant ......... g.~,..,~,,.'~.,.~,,~ ....... ¥?,~,.~,,x,~:~,/,~.~ ..... Health Dept. Approval ....................................... ~ ..... Lobar Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........ ,..,,_~ ............ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ..... ~.....-. ....................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ............................................ ~~.~ ............................... Sworn to before me this~~:~ ~d -"~'~'~'~'~'~'~'~- ~~ :.t~... day of~~"6'~'g'2 "(sm~p or ~o') Nef~ pu~l~c~ Sfe~e of New FOKM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 .... Permit No ................................... APPLICATION FOR BUILDING PERMIT Date ....... .......... ¥ ......... , .... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building 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 os 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 not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit 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 o 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buil.ding code, housing code, and regulations, c~nd to admit authorized inspectors on premises and in, buildings for necessary inspections. ....................... .......... ................... (Signature of applicant, or nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generpl contractor, electrician, plumber or builder. ................................. ............................................................................................................................................. Name of owner of premises ....... .......... 0....~:..~.;..W.:.~.,~.. ............................................................................................ 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 ............................................... t. Location of land on which proposed work will be done. Map No,: .~..C~..~.U..~..~,...~...~...(d.~..~'..~.... Lot No..../.~! ................ Street and Number .............. ~.).~..~..~...~ ............. .~...~.. .................................................." '" .~.'-'.<~...7.-~....~.~.,~.: .M..~ ................ Municipality 2. State existing use and occupancy of premises and in,~ended use and occupancy of proposed construction: o. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ~ .~:./,~z(/ ~-'~,z~,(~- ~ ~ 3. Nature of work (check which applicable): New Building, k// Addition Alteration Repair .................. Removal .................. Demolitior ..................... Other Work ................................................. ... ~.-9 r~ (Description) (to be paid on filing this application) ' 5. If dwelling, number of dwelling 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 type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories .................... 2 .......... 8. Dimensions of entire new construction: Front ........... ~..~. ................. Rear ......... ~..~ ............ Depth ...... R..~ .......... Height ....... ~ ........ Number of Stories .............. ( ...................................................................................................... Date of Purchase ...... ........... .~... ~...~.a~../. ....... Name of Former Owner Zone or use district in which premises are situated .......... ~¢~¢.~.¢.~.Zf'¢'E ......................................................... Does proposed construction violate any zoning law, ordinance or regulation: ...... ~ ........................................ Will lot be regraded . ......... ~ .......... Will excess fill be removed fr~¢mi~s: %_),Yes ( ~ No Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names ~nd indicate ~TATE OF NEW,aRK, ~ . ~cS ................... ~%~.~.C~ ....... ~~ ........... , ............. b,in9 duiv sworn, deposos OhO s*ys thor he is the (~me of individual sionin~ con,mcr) obovo namod. He is the ................................................................................................................................................................................. (Controctor, o~ont~ corpomto officor, etc.) o{ s~id awner or owners~ ond is duly ~uthodzed to perform or have performed the soid work *nd to m*ke end this o~plicotion; thor oll statements contoined in this opplicedon oro true to the best o{ Inis knowled~o ond belief~ ~nd tho~ ~he work will be performed in tho monner se~ {o~h in tho ~p~Hcodon filod thorewith. Sworn to ~o~ore me this ....... .... ¢ x . .......... .......... ................................... ' '" DHIRLb~Y I~RON Nota~ PuNk'. Stateof New Y~ , . '15 rm ~ Xnlres triarch 80, 19~ ~ 10. 11. 12. 13. 14.