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Home My WebLink About9952-z ~OP~I NO. ~ TOWN oF~, $oU~HoLD BuILDIHG D~PAR~M~NT TOWN CL~K'S oFFICE SOUT~LD, H~ Y. BUILDING PERMIT (THIS' PERMI'T MUST BE KEp ' ON THE PAEMISE$ UNTlU ~ULL CQMPLETtON oF THE WORI(AUTHORIZED) 9952 Z Dote .....L.~ ........ : ............. , ....... ................. , ........ Permissi°n is hereby granted to: FO~M NO. 6 TOWN OF $OUTHOLD Building Delm~tment Town Clerk8 Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be fil~ed in typewriter OR ink, and submitted in ~ 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 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 .~..~:.~ ~. c~ ~ .~..~... Date .......... ~..Z ........... New Building .......~.... ........ Old ~r pre-existing ~in~ ............................Vacant Land ........~.....A..~ ......... Location Of Property .............. ~ ........ 5.~ .......................... ~'""~-~"~'~'"~ ....... Owner Or ~ners Of Property ........ t~.~b.~...~/.~.~M.~ ..................................................................... SubdivisiOnperm~t No~.~..~ .................................................... ..... Date Of Perm~t~~Apphcant~ ...Lot No ............. Block No ............. House. No ............. Health Dept. Approval ............................................ babor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... / ~~//~ Co.,,ruction on above describ,d bu/Idin, *d/~mit.~~lez/~es a,d ...... ~,~... day of .~.~.~m~.~..,&.~.~, ...... (stamp or seal) Nota~ Public ...... ~M~.~ ............. County go~. ~p$~e~ 3/30/80 TOWN C]F SOUTHOLD nFFIOE OF ;qUILDINB INSP£OTOR TOWN OLERK'S OFFIF~E snUTHEILD, N. Y. 11971 TEL. FO~M NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............. ~.~ .............. 19 ........ -- roved ,..~/....~... ~ '~' '- 7~Q~ .... ~"~-~,~, '7 . ~ ~Xop .................. ?.~:.. ....... :.., ,¥ ........ rermir 1~o ...... ~....: ......................... Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT /'~ ................. , Date INSTRUCTIONS Application No.'~...~.~ ............ 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 or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port 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 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 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applica, pt/~or nall~e, if a cprporgtio~n) (Addlt'esls of ap~Ji~l~i ........... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... ........ ........................................................................................... Name of owner of premises ..... ~.-]..I....~2.;L..t~.. ....... ..:,~..[~.£&.l.~..[.% ...................................................................................... I f ,~an~~~ture o~thorized off icer. (N9~e~and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ........................................ Lot No ......................... Street end Number .................................................................................................................................................... Municipality 2. State existing use end occupancy of p~tended use and occupancy of proposed construction: o. Exisiting use and occupancy .............. 2~/~.~,7 ...... : ........... '7'~ ............................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... //' ~ ~ (Description) " t ~' .~. ~~' ~-'d~)''~~ -- Fee 4. ~stimeted ~os ........... /. ..................................................................................................................................... (to be poid on filing th~s epplic~tion) 5. If dwelling, number of dwelling un,ts ............................ ~umber of dwelling units on eech floor ............................ If goroge~ number of ~rs .......... .~. ............................................................................................................................... &. If business, commerciel or mixed occuponcy, specify noture ~nd extent of eech type of use ........ ~..~. ............ 7. Dimensions of existing structures~ if ony: Front ....... ~.~.~.~ ........ ~eor ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of seine structure with elteretions or ~dditions: Front .................................... Reor ............................ Depth ................................Height ............................ Number of Stories ................................ B. D~ensions of entire new construction: Front ....... ~..~. ..................... Reef ..... ~ ............... Depth ...~ .............. Height .~.~ .......... Number of Stories .~. ............................................................................................................... 9. Size of lot: Front ........ Z.~.~ ................................... Rear ...... /.~.~ .................... Depth ...~¢.~ ................. 10. Date of Purchase ........................................................Name of Former Owner ........................................................ ~ 1. Zone or use district in which premises are situated ............ /,..~ ............................................................................. ]2. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . ......................... ~--/ raw'Will excess fill be removed from premis~: ,ome of Own , of ..................... Add,,,, ....... "ho.. No. Name of Architect ............................................... .~..~.~.~ ~ ~ ......... Address ................................ Phone ,z~N° ............. ~¢/~ ........ ~ PLOT DIAGRAM Locate clearly and distinctly alt buildings, whether existing or proposed, and indicate ~11 set-~ck dimensions from property lines. Give street and bbck number or description according to deed, and show street names and indicate whether interior or corner lot. ...... ./~.~~ ...................................... being duly sworn, deposes and says that he is the applicant (Nafe~ofr Yndividual signing contract) above named. /m. He is the ...... .(.......¢~......~....~....~.~ ........................................................................................................................................ (Contractor, agent, corporate officer, etc.) of sa d owner or owners and is duly authorized to perform or have performed the sai¢ work and to make and file this application; that all statements contained in this application g4;,e true to the bes~¢ his knowledge and belief; and thor the work will be performed in the manner set fo~h in the ~p~c¢}ion filed th~. Swornt~remethis ~~. ) ~/ /~l r ~ //// / o, of ......................... ' ............................. ~0~ : ' ~ Z~ ~ :-~ m~ c o ~ > ~ ~ m~ 0 ~ 0 ~Oz~o~ ~o~ ~ ' ~ ~ ~ ~ ~ Z ~ < ~ "< Z -r 0