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Home My WebLink About9340-zTOWN OF SOUTHOLD BUILDING DEFARTJ~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9340 Z Permission is hereby granted to: nt premises located at ...]i.O:{;..]ylF_,69..&..~l~O ....... ~,a]~.-~'._~ ...................... , ....................................... ~- ~--,. ......................................... ~..&..~t .................. t~t~tuek...., ................................... ,... .......... ~---.~..-.: ......................................................................................................................................... :.--- ~~ pB~tJ ~o ~lic~tion d~ted ........................... --~......~. ........... , 19,~,., ,nd oppr~ed by ~he~ .... ~U~lding Inspmor. . ....... IrOUM NO. S TOWN OF SOUTHOLD Building Deportment Town Glerk~ Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter O~ ink, and submitted n triplicate ta the ~uilding Inspector w,th the following; for new buildings or new use: 1. Final survey of property with accurate Iocahon of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispos~l--(S-9 form or equal). 3. Approval of electrical insta[tation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certmfmcate 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 oll 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 prermses, or other pertinent in- formation required to prepare o certificate C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00: ............... New Building .................... Old or Pre-existing Building 4~.4~ ........ Valcant Location Of Property ..................................................................................................................................... Owner Or C~.,ners Of Property .~...~..~.. ........ ~..&~.. ....... .~_~-...4C~¢4,~1~... ..... Subdivision ................................................................ Lot No ............. Block N, .........~~... Permit No..7~.~.~. Date Of Permit .~i~pplicant ..~~ ............................... Health ~pt. Approval ............................................ Labor ~pt. Approval ................................................ Unde~riters Approval .............................................. Planning Board ~prov=l ........................................ Request For Tempora~ Ce~ificate ........................................ Final Ce~ificat, Fee Submitted $ ~ Construction on above described building and permit meets oil aDplicable ,~es and regulati~s. I Apphc~nt ................................................... Sworn to before me this ........... ..doyof ..... ....... .... Notary Public ..... .~.~..u~.~./: ........ County TOWN OF SOUTHOLD o~'/~.~.,~ BUILDING DEPARTMENT TOWH CLERK'S OFFICE ~~ .. ......... ~rov~ve~~J~...~...., 19~... ~ermit ~o .... ~.~.~...~~~ ............................................... .................... I NSTRU~IONS o. Th~s 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 buildings on premises, reJationshtp to odioimng premises or public streets areas, and g~ving a detailed description of layout ofproperty must be drawn on the dmgram which is part of this applicatio 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 wdl issue a Building Permit to the applicant. Such perrr 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 a Building Permit pursuant to ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions ar aJterations, or for removal or demolition, as herein describe The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. --' ............. ....................... , ..... (S~gnoture or applicant, or nome, ir a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budde Nome of owner of premises ,/~~~ ...... .~.......,.~.~//-'~...,~ ...................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............ ~'.....J. ................................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... -'~ ----, . /) - ~ - -- Loc~t,OnnOcf land on whlc~propo_sed work w, IIb done, MapNo ..~'...~.~..¢4 .~. ~'~/ Lot N~....~..../~'...~../~d) Street a d Number ...~...'.~.. ...... Municipality State existing use and occupancy of premises and intended use and occupan~:y of proposed construchon: a Exisiting use and occupancy ...~~ ~ ........................................................................................... 3. Nature of work (check whmh apphcable) New Bu,ld,ng ............... Add,tion.. ........... Alteration ......... Repair ............ Removal .......... Demoht,or .............. Other Work ........................................... 4 Estimated Cost ................ : ...................... Fee (to be pa~d on fihng th~s apphcahon) 5 If dwelhng, number of dwelhng units .............. Number of dwelhng umts on each floor ......................... If garage, number of cars ................................................................................................... 6 If bus~ness, commercial or m,xed occupancy, spec,fy nature and extent of each type of use ........................ 7 D~mens,ons of exmtmg structures. ,f any. Front .................... Rear ........... ' ..................... Depth ............. Height ........................ Number of Stones ......................................................................................................... D,mens~ons of same structure with alterat,ons or additions' Front ................. ~ ................... Rear ..................... Depth ............................ Height .....................Number of Storms .............................. 8 D,mens,ons of ent,re new construct,on: Front ....... ~:~../'....~;:2~... ........ Rear ..... ~ ....................... Depth .................. He,ght ............... Number~j~ Stones ............................... z~z ....... : ..................................... 9 S~ze of lot Front .......... ~..~. ................................ Rear ....... .~.~.. ........... ! .............. D,epth ...~..~....C~.. ............ 10. Date of Purchase ........................................ Nome of Former Owner ........... ,..~'..~....q;Fr..?...~....~?2..~ ................. 11 Zone or use d,str,ct ,n which premises are s~tuated ..................................... : ................................................... 12 Does proposed construction wolate any zoning law, ordnance or regulation' . .................................................... 13. W~II lot be regraded .......................... Will e~xcess fill be removed from premises. ( ) Yes ( ) No 14 Name of Owner of premises ~/')l.'/...f-..'~t4v_~...~.~~- ....... Address ............... ~ ................. Phone No ..................... Name of Arch,tect .....~.~...' ' . . .~.._.....,... ........ Address ................................ '~ Phone No ..................... Nome of Contractor ......... Address .............. : ................. Phone No ..................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~stmg or proposed, and ~[nd~cate all set-back dimensions fror property hnes Gwe street and block number or descnphon accordmg to deed, &nd show street names and indicat whether interior or corner lot STATE OF NEW~qDRI~mx'-' I L ~ S S COUNTY OF ...~.......c~Zf-~°. t.~.....~' .... .~....~.x:;~-~....k ........... ~.E~.~...qc.~....¢~n .~. ..... bemg duly sworn, depo!es and says th~:t he ,s the apphca. (Name of md~wdual s~gmng contract) above named. He ~s the .................... Oc~(...~ ...........~ ~. ...... .~-....~....~. k-.~..cn~... ..................................... ~ (Contractor, agent, corporate officer, etc) j of sa~d owner or owners, and is duly authorized to oerform or have performed t~e sa~d work and to make and this applicahon, that all statements contamed m thru apphcat~on are true to the I~est of h~s knowledge and belief; ar that the work w~ll be performed m the manner set forth m the apphcot~on filed therewith Sworn to before me th~s .... doy of ............ .... Pub ,c, ......Coun ............... ELIZABETH ANN NL~VILLla NOTARY PUBLIC, State of New York No 52-8125850, Suffolk Cou.N~' Term Expires i~larch 30, 19....~./ NOT£$ ~/.tBDIVISIO.V ~D c £~ ,.~/ TH6' OFFIC~ OF THE C£E~A' OF ,~$ 4~,~P tV~ I£7£ SURVEY FOR fJ.'HCL. A:'f."; /SS~RIS t~ f, LOT ,',", ;",:: ~ ?A,~'T O?' L~?T N2 6'~';' ,,, "CAP T~II/; /(/OD' ESTATE$" - ~ ~ow~ o. SOU TH~)L D e 5:'.,r~5.~ ~'z~sa~,~'~, '., , .