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Home My WebLink About9289-zTOM/'N OF SOUTHOLD BUILDING DEPARTIViENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS.~I:>ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMi~'LETION OF THE WORK AUTHORIZED) Buildin~ Ihspector 1~0~ NO. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks 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 dispose! (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 s~te 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 properh/ 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 inspechon of buildings or premises, or other pertinent in- formation required to prepare o certificate. C. Fees: ]. Certificate of occuponcy $§.00 2. Certificate of occuponcy on pre-existing dwelling or lend use $.5.00 3. Copy of certificate of occupancy $1.00 .... blew BUilding ................ Addition ........... Old or Pre-existing Building ................ ¥ocant I.~nd .............. Location Of Property ........................... C' ........ ~ .................................... Subdivision /~..~./.o.,....L~.~...o..~...o.Z. ...........................Lot No...8..Z/..VBIock No ............. House No...~.../..~. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Ce~ificate ........................................ FinoJ Certificate .......... ~ ..................... Fee Submitted $ ..,,~. .............................. on described building an~J~ermit meets all applicable codes and regulations. Sworn J~ before me this ~/~/~?/ ......... ~ay of ..~...:..: .......... (stamp or ~a,) ~~: Nota~ Public ~ ..... Coun~ ~:~ IPO~W NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE /, SOUTHOLD, lq. Y. .... ( ~- 77 ^ ~,ca~,o. ................ ~o~i.~ ....... ~ ............. .,, ........ ~, 2 ~. · ~o. ~~ ..... ...... ... ........................ D~sopproved ~/~ ........................................... ~ ........................................... ............. ~' '"" ........ "":" J''' {Buil~ Ins~ctor) APPLICATION FOR BUILDING PERMIT ~/ · D~te ............................................ , 1 ... I~STRH~IO~S a This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildir Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of braidings on premises, relationship to adjoining premises or public streets, areas, and giving a detmled description of layout of property must be drawn on the d~agram which is port of thss applicatio~ c. The work covered by this apphcation may not be commenced before issuance of Building Permst. d. Upon approval of this application, the Building Inspector wtll ~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 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 · Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply with oll applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for n,~essary inspections. ....... .................................. '. J(Signature of applicant, or name, if a corporation) ..... U..~:.O.~....~.o.,,~. ...... (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buflde Name of owner of premises ..d.~?-rf~r~,~ ...... ~ ....... Z~./~.~Z~. ..........~.....~.~.?.,.~ ......X~.....~Z/~//~. ........................ If applicant is a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's License No ............. ..~...'.Z~. .......................... ; Plumber's License No ......... .~.:...~. ........................... Electricmn's License No ...... .~..'...~... .......................... 'bther Trade's License No ......... ....~./.~ .......................... '7- 2-// 1 Location of land on which proposed work will be done. Map_No ...... .~.~.-.~....~..7... ......... Lot No...~....-.~.~.. ...... Street and Number ......... ....... ~eR.~...¢~....~....~ ............... ........ Municipoli~ 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisiti~g use a~ occuponcy ............. ~z.~.~.~ .............................................................................. ~ ,n,..ded ~,, =~ o~c=,=c, ............ ~.~.~..~:.~....~~...~, ............................... / 3 Nature of work (check which applicable) New Budding .............. Add,hen ................. Alteration .............. Repair ................ Removal ............... Demoht~or ..... ; .... Other Work ................................................ ~, ~ ~ (Description) 4 Estimated Cost ................................................ Fee ..~..~... ................................................................... (to be pa~d on fihng th~s apphcahon) 5 If dwelling, number of dwell,ng units ....... ~.~..~. ....... Number of dwelhng un,ts on each floor .... ~...,c/~ ........... tf garage, number of cars ........ .~... ~. , 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ..... ~...~.~1 ......... 7 D,menslons of ex,sting structures, if any. Front ..... ..~Z...7 .~. .... Rear ...... .~..~...~..~.. .......... Depth ..~, ~,..~...~... Height ...~..~...?.~.. ..... Number of Stones ....... ./ .............................................................................................. D,mens,ons of same structure with olterat,ons or add,tlons Front .... .~. ~...~...~. ........ R. ear ..... Depth ..... ~./~....~..7~...... Height .... /..~.~......¢T.. Number of Stories ....... ~. ................ 8 D,mens~ons of entire new construct,on Front :_...~.¢~ '~..,.Y7.. ........... Rear ...... ..~....O...~... ..... Depth ....~..~..c~..~.. Height ...~-./..;~ ...... Number of Stories' ......... pz~t~c~/¢ .... ..~f~.¢/~ ..................................... 9 S,ze of lot Front ....... /...4~2 .....~ .................... Rear ........ .~.~ .q ~...1~. ........... Depth ..... ./.~-.~.~.~..... 10. Date of Purchase ........... ../.~..~..7.. ................... Name of Former Owner ...~.:...~.~ ................ 11. Zone or use d~stnct in which premises are s~tuated .......................................................................... ]2 Does proposed construchon wolate any zoning law, ordinance or regulahon .~.. .................................. 13. Wdl lot be regraded ..... ~..~., ..... Will excess fill be removed from premises: ( ) Yes ( 14 Name of Owner of prem,ses ...~.~1'Z¢~ .~. ~.~ ..Z~./.~.].~... Address ~.~.~.~..,.~.~.~',~.. Phone No. Name of Architect ...... ./'../. ......................... Address ................................ Phone No ...................... Name of Contractor ............. //.. ......... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~st~nctly all buddings, whether ex~sting or proposed, and indicate all set-back dimensions fra~ property hnes Gwe street and block number or descr~phon according to deed, and show street names and ind~cat whether interior or corner lot STATE OF NEW YORK., [ S S ................................. being duly sworn, do~oses and s~ys th~at he ~s the apphca~ ]Name of individual s~gnm§ eontracf) above q_q~ed He ,s the ............ .~.../I~?~t...l~'~.... (Contractor, agent, corporate officer, otc ) of so~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work end to make and this applicahon, that all statements contained ~n th~s apphcchon are true to the best of his knowledge and behef; ar tha~ the work will be performed ~n the manner set forth ~n the opphcahon filed therewith Sworn to before me th~s ......... ~.~..~ ...... day of .'~..'-'~'2..~_~ ..... , 19 Nota Pub,,c, ............... Coun ............ ..................... ~o 52-4643721, Suffolk Coun~ Term Expires March 30,