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Home My WebLink About9932-zNO. ~ TOWN oF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. BUILDING PERMIT (TH$S PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 9932 Z Date ...... ................................................... 19 ........ Permission is hereby granted to: · .H~..T~E~T' . ~ lrO~l ~i'O. C TOWH OF $OUTHOLD Building Depafl'ment Town Clerk~ Office $outhold, N. Y. 11971 APPMGATION FOR CERTIFICATE OF OCCUPANCY Instructions ~ _ A. This application must be filled in typewriter OR ink, and submitted irr~ 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 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 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey df 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 Building .................... Old or Pre-existing Building ............................ Vacant Land ........., ................... Location Of Property .~.,(.2~~ ,~.f~.~.~. ..... ./~..~.¢~..,~.~ .................. ~Z ~ ................... Owner Or Owners Of Properly .~../..~.~V../.? ......... .~.~.¢.~.:~..~...~.~.i.~... ....... ~...~...~. ........................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.?...~.~..?.--..'.'~-.... Date Of Permit .................... Applicant ...~,.....:~..~.. .............................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......... ~..... ................... Fee Submitted $ ..~.*..~.~. ...................... Construction on above described building and permit meets ali app. licable codes and regulations. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) FOBM NO. ~ TOWN O~ $O~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................... ...~....;,....,? 19 ....... :~ Application No. ~ , Approved '" ........................ /. ............. , ~ , 19....v. ', ..ermit No...~.;; '.~,,'::~.,4~;/? ,2..,;.:....::.~ z .......... ...... Disapproved o/c ............................................................................................ (Bu~ildihg Inspector) ' ..~:,.~r ~'t. APPLICATION FOR BUILDING PERMIT Date ................................................ , 19 ............ INSTRUCTIONS o. This application must be completely filled in by typewriter or~ 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 areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this opplication.~j)~o 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 a 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 Bud ng Zone Ord nonce of the Town of Southold, Suffolk County, New York and other applicable Lows, 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, building code, housing code, and regulations, and to~ admit authorized inspectors on premises and in buildings for necessary inspections. ...... ....................... (Signature of applicant, or name, if a corporation) (./(Address,of apJ)licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... ......................................................................................................................... Name of owner of premises ~~.,~..'.. ~ ................................................ 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 ............................................... Location of land on which proposed wo~rk wi,II be ~one,~ep No.: ......................... z ............. Lot No...: ..................... 5tote existing use and occupancy o{ prembe~nd in~ended use and occupancy o{ proposed construction: a. Exisiting use and occupancy ......... ~~~ ...................................................................................... b. lntended use ond occuponcy ............................... Repair .................. Removal .................. Demolition .................... Other Work .~....~...~...~.......,¢r~..~.~ .............. (Description) , ~..~....~.., O O Fee 4. Estimated Co~t ..................................................................................................................................................... (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 ............................................................................................................................................ 5. If business, commercial or mixed occupancy, specify nature (znd 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 ............................ ~..~/.~/zNumber of Stories ........ ~;~';~'~7 .......... 8. Dimensions of entire new construction: Front ....7......'~..-"..,. ............... Rear ......~ ..................... Depth ...,~¢...- .............. Height ~.' ....... Number of Stories ..... ~ .................................................. ~.,~ ........... ...... ,~ / ,~ ~=~"~, '~ '~ / z~r, ~ ~ 9. Size of lot: Front ..... ,-d~...0. ....................................... Rear ....c~...~ ............................. Depth ..... ..'~...~.. .................... 10. Date of Purchase ....... ~..~.~.....~...~... ............................ Name of Former Owner ...................... 11. Zone or use district in which premises are situated ..................................................................................................... 12, Does proposed construction violate any zonlr~g law, ordinance or regulation: ...... ~ ........................................ 13. Will lot be regraded ~.~..,~ ~ -~,~ "~ ~'WiJI excess fill be removed~,~ ~-~fr°m p~m~is~s~(/~)~Yes ( ) No 14. Nome of Owner of premises~,~.:..~ ..... Addres~/'/'/'/'/",~.~. ,~.q'~,. Phone Name of Architect ............................................................. Address ................................Phone No ....................... Name of Contractor .x:",',',',',',','~...~ ........................... Address .~,4~t,¢~'~ ........... Phone No~.~...~.Z.~..~. 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 and indicate whether interior or corner lot. STATE OF NEW YORK¢ I S S uName of indiviaua~ s~gning contract) above named. of said owner or owners, and is duly authorized to ~erform or have performed the said work and to make and file this a lication; that ali statements contained in this applicution are true to the best of his knowledge and belief; and PP that the work w~ I be performed m the manner set foffh n the apphcat on filed therew~t . Sworn to before me this ~ ; (Signature of applicant) ~A~Y PUBLIC, Slate of Now York