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Home My WebLink About9273-zT~N OP ~)UTHOLD 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? 9273 Z Permission is hereby granted to: ...&.~...J~.~,Y...~..Jt~lt..~a~.,..~,~lae..~le~ ........................ ~.~X~ ................................ ~ ~.!.a......~......a.~.~.~.o..~....o.a...~.t~..~l..~Ltaj ............................................................... at premises located at ..J~J~...J~L...JJ~..~JJElJJ~JJ~...J~ ..................................................................... .......................................... .~.~ .J~.....~...~. ......... ~1 ................................................................... pursuant to application dated ........................... ~.~LLjJ~...~ ........... ~, 1,?~_..., and approved by the Building Inspector. ~ ~uilding Ir~spector ~OitM NO. 6 TOWN OF $OUTHOLD , Building Deparfment Town C:lerks Office Southold, N. 1'. 11971 APPLIGATION FOR GERTIFICATE OF O¢¢UPANG¥ 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: I. F~nal 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--(5-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, /V~ultiple Residences and similar buildings and installations, a certificate 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: 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 .... .O.. ....... ~.. .......................... New Building ................ Addition ................ J/'/' Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....~.~..T~'...../..~.~, ......... ~:~..~.~.~...~ ......... .C..'..~....~...,~...~..~,.-7.. ........ ..~....~...~....~...~.~ ..... Owner Or Owners Of Property ....'.~.~.....~....~. ...... .(.~...,~.'..c?...w...x?..?.....~.. .................................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No .... .~...~....7....~....Z'Date Of Permit ...~"//..?.?,7..AppIJcant ..4x,~../....,~...~.../.'..~...'7.. ~.....'~....,.~..~....A(.'...~.../../~..~..~ - Health Dept. Approval .... .~-....~.. ............................. Labor Dept. Approval ................................................ Underwriters Approval ..... .~..,~.~.~ .............................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate ~ Fee Submitted $ .......... . ...~... .................. Construction on above described building and permit meets all applicable codes and regulations. ..... ............ , ..................... Sworn to before me this ~2~, ' ~7 ~ .......... ./..(.. dayofd'~/~///~'.//~ ....... .('....~....?...~ (stamp or sea~~, /,,~_~C_) Notary Public .... .~9-...A.~/~..., County Examined Approved TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Per , t ........ Application No....~....Z...7,.~ ............... Disopproved a/c ............................................................... ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This application must be completely filled ~n by typewriter 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. Plot plan showing locat~on of lot and of buildings on premzses, relationship to adjoining premises or public streets o areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apphcatior 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 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 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 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 or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a c6rporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrioan, plumber or builde, ........................................ ......................................................................................................................... Nome of owner of premises ....... ~.'.~...~....% ...... ..K....~...?...~..~....~..?.~.. ............................................................................... applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officJr) Builder's License No ............ J...~.. .................................. Plumber's License No .... ~...~..~.. ................................... Electrician's License No ..X~....~..,q..~...~.~.~.... ................. Other Trade's License No ............................................... ~ J,~..~.. Location of land on which proposed work will be done. Map No .......... ./..~...~..( ......... ~... Lot No. .. Street and Number ..... ~/.'.~..,..~...[~.~.?..5../:L:..(:...~..?...~H~ ......... ..~'....~....~..../_¥...~.....~n. ........................... y~~....f~...... Municipality State existing use and accupancy of premiss and intended use and occupancy of proposed construction' o Exlsitin use and occu anc ~t_~~ b. Intended use and occupancy ..... ~..~.~..L?...!..~.~...~.~. .......................................................................................... ~ Nature of work (check which apphcable) New Bu~ldm~ ...... Addition ................ ~ Alteration Repair ........... Removal ............... Demoht~or .......... O~her Work (Description) 4 Est, mated Cost ............. ~ .~...~..q.?....e...? ....................... Fee ../.C.~ ................................................. (to be pa~d on fihng th~s application) ,~ 5 It: dwelhng, number of dwelling un,ts ........................... Numbcr of dweihng umts on each floor .................. If garage, number of cars ................................................................................................................ 6 If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use ................ 7 D~me,~s~ons of ex~stmg structures, ff any' Froni' ........................ Rear ............................... Depth ............. Height ........................ Numbe~r of Stones ................................................................................................ D~mens~ons of same structure with alterations or additions. Front ............................... Rear ................... Depth .............................. Height ......................... Number of Stones ......................... 8 D~mens~ons of entire new construction: Front ......... j.O ...................... Rear ....... ]..~. ................ Depth ..Z'./..:.~ . .. I-ie~ht ............ Number of Stories . ..,/. ................................................................................. 9 S~ze of lot' Front ........................................................ Rear ........................................ Depth ............................ 10 D~te of Purchase ....... .~..~, ................................... Name of Former Owner .................................................... 11 Zone or use d~stnct m which premises are s~tuated ............................................................................... I2 Does proposed construction violate any zoning law, ordinance or regulation' . .................................................. 13 W~II lot be regraded ....... ~.~ ............. Will excess fill be removed from premises. ( ) Yes 04) No 1 ¢ Name of Owner of premises .... ..~.'~...~...~....¢-. .... .~....~...?.??.i. ?.~..... Address ....~...~.¥...~....e.....~.. ...... Phone No ....................... Name of Arch,tect ............................................. Address ................................ Phone No ....................... ..... ~..~./'~./.~./-...~/...*..J'O...~. ~' ........ Address ....... ...~...~..?q...7~'.. ........ Phone No ....................... of Contractor PLOT DIAGRAM Locate clearly and d~st~nctly all buildings, whether existing or proposed, and red,cate all set-back d~mens~ons from property hnes Gt~e street and block number or descr,pt,on accord,rig to deed, and show street names and indicate whether ,nter,or or co~ner lot . ·~: OF NEW ¥ORI(, (SS CGL;N*i'¥ OF. . · ........... . .. /~r, ~, ~ XiL.~. ~ ........ being duly sworn, der~oses and soys that he ~s the apphcar, t (1~; of in~,~ld~al's~gnlng contract)'"' above named. l-le is the ..........~....~../....~...~.~..~ ...................................................... (Contractor, agent, corporate officer, etc) of sa~d owr'or or owners, and ~s duly authorized to ~erform or have performed the sa~d work and to make and file th~s apphcat~on, that all statements contained ~n ~h~s apphcet~on are true to the best of h~s knowledge and behef, tha~ the work w~ll be performed m the manner set forth ~n the apphcat~on filed therewith Sworn to before me th~s ................... day of .................................. ,19 .~~ ~ ~~ Notary Pubhc, . .................................................. County .. .~ .................... (Signature of applicant)/'