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Home My WebLink About9737-zTOWN OF SOUTHOLD BUll. DING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) No. 9737 Z Permission is hereby granted to: ............. Leoz~o~..Camphe]~ ............................ to ........ Add..On+-,O.. a..P~i.v, afce.. Ona..F~m~ l~t.. D~/elltng ........................................................ at premises located at ............. ~.Q..FI;I,.~CI,~.~..1;.O.I;I..Roe~I .................................................................... ................................................. G~.ee~po~..Ne~...Yo~'k .................................................................. t4~p.. ~...~,.~ ...Seo~t.o~ ...I.];..I.....T~o~ .*#...~ .................................................................................... pursuant to oppllcotJon doted ...... ~]~:~J~ ....... ~'~'. ......................... , lc).~**, and approved by the Building Inspector. Fee $..~ ~.'.~..Q .......... Building Inspector 1000-40-9-9 TOWN OF SOUTHOLD , Building Department 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 oil 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 New B~ilding ................ Addition .....~... ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~.~.~.~! ../~../Db,~i~'/~4,/ .~./). ,~/p~2,~-~ // y/ Owner Or Owners Of Property ........ ~..~..~.,:6../~;.~/~. ........ ~.~,.~.~.~.~.~ ........................................................ Subdivision /.~,9~ ............ ~go .............. · /. .............................................. Lot No. ~' Block No ............. House No..~..:. ...... Permit No. ~./~.~.//.~,,~'...... Dote Of Permit .~.~..~..~.~.~...Applicont ..,~,~..~..~... ~2 ,~ .... ......... Heolth Dept. Approvol ............................................ kobor Dept. ^ppro¥ol ......................... x ...................... Underwriters Approval .............................................. Plonning Board Approvol /(/'~ /~ ' Request For Temporory Certificate ........................................ Final Certifi¢ote .....~ ............................... Fee Submitted $ .......~z...~ ................. Construction on above described building and permit meets all applicable codes and regulations. Apal,cont ............. .............................. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) ~%- ~-~' - 7~ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Yo Examined ....... .~..~.~. ....... . .~..2. .............. , 19...7.,.8. Approved ....... ~9,~ ........ ~ .............. , 19...~...8. Pemit No ...... cJ.~.3.~.Z, ................... Disapproved a/c .............. ~:.~.~. ~ ............. ~ ....................... (Building Inspector) Application No ...... ~..~..~..~. .................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Budding 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 of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the applicant. Such permit shall be kept on the premises avadable for inspection throughout the work. e, No building shall be occupied or used m 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 apphcable 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,~ff a corporation) 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) Location of and on which proposed wor wi, be done. Map No.: .............. Lot No. . ........ Street and Number ....... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~.f~.f~.(~.~..%~ .......................................................................................... b. Intended use and occupancy ........... .'.~.~ .................................................................................................. 3. Nature of work (check which applicable): New Building ....................... Addition.....................~ Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~.../g..~ Fee ~.. {Description) 4. Estimated Cost .. ....................... ltD 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 ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..... ~...~. ......... Rear ..... ~..,~,, ........... Depth ....... .~,.~.. ................... Height ............ a'~~...../.~,.! ........... Number of Stories ...........t~. ...... /., .................................................. Dimensions of same structure with alterations or additions: Front ......... ~;iL~.. ......... Rear ....... ~.,~,, .......................... Depth ......... ~ ............................. Height ........... ;~-.-5 ........................ Number of Stories ...... ~ ............................ 8. Dimensions of entire new construction: Front ........ ~.,-,L,.! ....... Rear ,,~.. ......... Depth ................................ Height .......... ~,~ ...... ~ ........................ Number of Stories ........ ~ ........................................................................... 9. Size of lot: Front ............ ~Z2 ...................... Rear ~t~ n~th /~ . 10, Date of Purchase ........... ~,.~.,.~,.~, ............ Name of Former Owner ................. ~...--, ...................................................... 11. Zone or use district in which premises are situated ...................... ;~,~'d..~-,4~.;~,/,~ ........................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: .............. ,/~, .~. · ...................................... 13, Will lot be regraded ....... /~,,0 .................. Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ...... ,~, ,~.~).g,Z~.~.¢~. ....... ~.~.¢~,~.~..~.~', ~..2.."Z..~ ~.~, .~,.,, .......... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... _ (Address) (Phone ~o,) ~,,~, Name of Contractor ~' 0.,~..,~.,~d~,~,, ~ .~ ~ ............... ,~.5~..~,. ~,.~ Phone ~o.~ (Address) PLOT DIAGRAM I'ocate 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 wheth- er interior or corner lot, STATE OF NEW YORK, ) SS COUNTY OF ...................................................... ) ..................... (Name '~]"~'~i~. '~'~'~[~$~i) .................... being deposes He is the ....................................................... ~ ..................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and 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,~l~lkt~e~,will be performed in the manner set forth in the apphcatlon fled therewith. , .o, 4~4300 /