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Home My WebLink About9956-z I~ORI~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTfiOLD, N. Y. BUILDING F,ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9956 Z Permission is hereby granted to: ..?..3.~7 ~. 2......~.~..~ ....... ..z...!.~..2.~/,Z!... - ~t premises lacated at .................... ..L?-.:,5~,',5. ......... .~..~.....TS,..,/3:.X .......... ~.Y...~'7. ............................................. ........................................................................... k..~.~.~.~.~ ............................................................. ~E~r 2~ 9.7.~ pursuant to application dated ........................................................ , I .... and approved by the Building Inspector. Fee ,...../...e......'Z ..... Building Inspector ~O~M NO. 6 TOWN OF SOUTHOLD Building Deportment Town GJerks Office Southold, N. Y. 11971 APPUGATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in 'n'J~"~e 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 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. Capvo cert,f, ateofo upanov__ * .00 pAL Date ........................ New Building ....~ ......... Old or Pre-existing Building ............................ Vacant Land ............................ o, ...... . Owner Or ~ners Of Property .... .~.~ ., ~.~.....~~.~1.~. ......................... Subdivision Lot ~o B ockjI,- I~N° Housg ~o ~ ~ Permit No..~.~'~.Z. Dote Of Parrot ~: ~ App cant Health Dept. Approval ............ L"..~ ........................ Labor Dept. Approval ................................................ Underwriters Approval ................. ~ ........................ Planning Board Approval - Request For Temporo~ Ce~ificoto ........................................ Final Certificoto .............................. Foo Submittod $ ...~.0.~ ...................... Construction on obove described buildin~nd per.it ~et~ all applicable c~es an~regulatlons. ~pp~i~..~ ._~..~.~....~-~.~ ........................... Sworn to before me this ....... ..... day (stamp or seal) MECISLAUS WINIARZ Notary Public ,State of New Yor~ No. 52-9703725 Suffolk County '~mm. Exp~re~ h~rch 30, 19~) NOTIFY BUILDING DE~ '7~AM to 4PM FOR ~EQU~R.. ED ~NSPECTIONS: 1. B~FO~ BACKHLUNG FOUNDS. TlON OR S'i'A~T 2. FRAMING 4. FINAL VVHEN JOB NOT RESPONSIBLE J~OJ~ DESIGN 5. AIL CONSTRIJCTiO~ MUST MEfT R'~q'Ji~EM~NTS OF N.Y. STATE COD~ AN~ "OWN HOUSING CODE ~ FOBM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N: Y. Examined ................ ~ ....................... , 19 ........ Approved ........................................ , 19 ........ Permit No...~ ........ ~ ........................ Disapproved a/c ............................................................................................ Application No ................................ ~ APPLICATION FOR BUILDING PERMIT ~ °ate ....... ............... INSTRUCTIONS a. 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 at areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part 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 permitl~_ 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~j~ 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 aH applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. * (~ignature of applicant, or name, if a corporation) ......... ....... aT .............. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................................................................................................................................. Name of owner of premises ~A E~ Zl~Al~. ................................................... ff *pplicont is o corporote~ s~on~ture of duly outhorized officer. (Name and title of corporate officer) Builder's License No...?...~.(......~...~,. ....... ~.~-/~.0]~......7~ Plumber's License No ................................................. Electrician's License No. ~.~.'~.......~.14. L.../?.....~..........E'.~.fc,-t"/¢/'C CO Other Zrade's License No...~(~6~ ............. .~....~..O......,~u~cJSd'~L Location of land on which proposed work will be c~one. Mop No.: ...............................~ ...... Lot No ......................... Street ond Number ..~.i~'".)L.~J.~/....~l."~..I/K£~......~.f.~,y,~ ....... ~.~...~.J..~....~D,~.....~..~. .................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ..... .~.. 19. ~'.~ .~. ~......'/:.....s~..~ ~'.~.~.~.. ............................ i .......................................... 3. Nature of work (check which applicable): New l~uildmg......~ .......... Addition .................. Alteration Repair .................. Removal .................. Demolitior, .................... Other Work ................................................ .... (Description) 4. Estimated Cost ..~).(;~.,..,~. ......................................... F ,e (to be paid on filing this application) 5. If dwelling, number of dwelling anits ............................ Nurnbcr of dwelling units on each floor ..... , ...................... 6. If business, commercia[ ~)l mixed OCCLIparlCy~ SI~)Q(.IJ')z nahJre and extent of each type of use ............................ 7. Dimensions of existing stJuctures, if any: Frot~t ........................... Roar ................................Depth .................... Height ........................ Number of Stories .......................................................................................................... Dimensions of same structure with alletatiorm or uc¢oritiom;: IZJont ................................... Rear' . ........................... Depth ................................kleight ........................... I',lumber of 5iories ................................ 8. Dimensions of entire new construction: Front ...... ~-(~ ...................... Rear ..,.,.~&.~, ...............Depth .....,~..O. .............. Height ..... !.~. ........... Number of Stories ...... ~ ........................................................................................... 1 1. Zone or use district in which premises are situated ..................................................................................................... 12, Does proposed construction violate any zoning law, ordinance ar regulation: ........................................................ 13. Will lot be regraded ......... .~..O. ............. Will excess fill be removed from premises: ( ) Yes (~') No Name of Architect ............. ~.~./~/~ Address ................................ ' Phone No ....................... Nome of Contractor ............ ,$..~J~.,~ .......................... '~ddress ................................ Phone No ....................... PLO-f DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frore property lines, Give street and block number or description according to deed, and show street names and indicate whether interior or corner STATE OF NEW~.YORK, 1 c q COUNTY OF ..?...~...~...~,.'~..~..,.~ .........i ..... (Name of individual signing contract) above named. Fie is the ............................. ~.~ ........................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, aad is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ .......... ~.r ......day of ,..~~-.., 19.Z~fl n ~ ~ ' ~,~ ~ ~ ~ ~ ~ ~gnolur~ or oppncnnr~