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Home My WebLink About9739-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PR£MISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9739 Z Permission is hereby granted to: .......... G~.-.S~]~ps .............................................. to ........ advt., cm..be., e.. ~ee:eoaa:l....O~e...Farat ly.. ctwe3,l.l~ ...................................................... ~t premises located at .............. .~.~O..I~Ll.~ap,.~P.a.~h...(.acc~s...a.t;...g.75..~.a;JOr.~...~..a.~b.~... .................................................. S o~/~0.1~.~. · .New-- -¥e~k. .................................................................. pursuant to application dated ..... ~,p~.~.'J ............. ~-.~J ..................... , 19.~.J~.., and approved by the Building Inspector. Fee $..$D.,.00 .......... 1000-5/4-1-2] FOI~M NO. 6 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 all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-0 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 1057), Non-conforming uses, or buildings and "pre-existing" land uses: ]. Accurate survey.of property showing oil 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 Building ................ Addition ................ Old or Pre-existing ~.uilding ................ ¥ocont [.and .............. Location Of Property ...... ~.~...'3 .~. ~ ~.. '--~O-~L Subdivision ................................................................ Lot. No ............. Black No ............. House No ............. Perm,t of Permit 'r ..... .................... Heo~th Dept. Approvol ............................................ or ~. ppro al ................... ; ............................ Request ~or Tempora~ Ce~ificate ........................................ Fin~ Certificate .......................................... Fee Subm{tted $ ........... ~ .................... n~~ ~~ I~:able c~es and regulations. Construction on above described building a Jt meets ~ Sworn to before me this Applicant ...... ~.~~~~.~ ................ day of ............................................ Notary Public .................................... County TOWN I-IF ~30UTHOLD OFFICE OF BUILDING INSPECTOR TOWN CLERK'S OFFICE SOUTHOLD, N, Yo 319'71 TEL, '765-2660 'ii< TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined . M.a.~ 22 19.. 78 Approved ...... ~y. .......... ;~. ........... , 19....~.~ Permit No....~).7.~..~ ..................... Disapproved a/c ................. -.;i.~;i~...~.~ '":";~Z[i .................. (Building Inspector) Application No .........~..7...~..~ .............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building Inspector, with 3 sere 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 pn 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 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 far 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 ir~l~ections. ~ ......................... ......... i ,Jgrtaru~re ,~pp ' it/or na~e, if a corporation) ...... ................. / (Address of applicant) State whether/~applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .............. /~/~. ....... ~...~.~...~....~..{~4).,~.~ ................................................................... iiiiiiiiiiiiiii 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 Trode's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ................................................................................................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............ ~...JJ~..~...~...~..g.~..~..~. .................................................................................... b. Intended use and occupancy ............ ~.~... E. ~.. ~ ~. ~)...~......~....~...~.)..Z. L'~ ..%. .......................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition ....:. ............ Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cast .................................... ' .......... Fee ................. !.~.~. .................................................................. (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 ............................................................................................................................................. 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 ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth Height ............................ Number of Stories .................... ? .......... z 8. Dimensions of entire new construction: Front ......... /..~... ................... Rear ........ .~.....~'.. ............ Depth ....../..?. .............. Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... 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 zoning law, ordinance or regulation: ........................................................ 13. Will lot be regroded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ali 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 ~vhether interior or corner Iol. STATE OF NEW ~f.P.P'z~ .,4',~ ~ S $ COUNTY OF ~. ~.~....~.f ................... ~~..~~....being duly sworn, deposes and says that he is the applicant (Ndm~of individual sidnin~contracf) above named. ? ..... 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 aH statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set fo~h in the application filed therewith. Sw°rn t~f°re Z this ...... ............ d e.b c, ............... Cou, ...... ............. ' :. ~T "/ ~..' . . · i "7..;..':t.:: '/''~' / .~:-. ' :~ .'. , h'.:-.,., ~t . ' ~' 5~~. './~ .e~~ 'V': :' .~ .. ~ ~' ?o~.n.~ -/o, ~,: / . .- 't< ' ~,,. ". 'I ' ~ . 'i~ ' - .... , '~ / ~-, {~ - .. . . "' , :',. ." ",~;.~c>~ '.< ~?. "', t ":' 'S'~' /' h ~ / ' -" ' . · Id A ,'q £.--.