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Home My WebLink About9815-z FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9815 Z Permission is hereby granted to: ........ ~.en.al.~..&..I'/11 .~r .~.~... ~r .~...~;o ................... to ........ huil~l,..a..JRrl~at e...On e.. ~ am:L1L D~elll~g ............................................................... at premises located at ............... pS/+O....Gz, ea4;...peeon~,e..Ba¥...Jtwd.~ ........................................ ................................................... ~.gL,...tte~...York ....................................................................... pursuant to application doted .......... ~'i~'"'2'"1 .......................... , 19...7~, and approved by the BuiJding inspector. Fee $ ......... 76¥20... 1000-128-6-12 H.S. 8-80-'1~ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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 installa- tions, 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 peoperty 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1,00 $5.00 Date..~, .~.~.. ~.. ,~,¢.. t. (.~,, '-~"?. · · · New Building V/ Old or Pre-existing Building Vacant Land Location of Property ............................................. f ....................... House No. Street Ham/et o, o, ........... County Tax Map No. 1000 Section ..,J.%.~. ...... Block ,.,~ .......... Lot,,~, .......... Subdivision ................................. Map No ............... Lot No ............... Permit No..~...~. ! .¢~... Date of Permit ('.~./?.°./,?.~.Applicant .'~..~..¢..b,.L.l~...J.:..'.~...~,~..0..~I~..t~. .... Health Dept Approval OO ~ O /9 ~/'~¢/'~ Labor Dept Approval Underwriters Approval .~, .~.! .~.G. ,O.J .............. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ~ Fee Submitted $ ............................. Construction on above described building and permit meets all~pplicable codes and regulations. Applicant....~. ?.'.~_...~.....~. ,, . . .1¢~...~ ...................... ~ TOWN OF -c::;OUTHOLD IIFFIOE OF BUILDING INSPEOTOR TOWN CLERK'S OFFICE SE~UTHt'ILD, N. Y. 11971 TEL, 765-2660 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Examined .... ~g.~3,e.....].0. ................. 19....~.~ Application No ....... ~.~..1. ~ ................. Approved .... ~e......~0 ................ , 19.~,.. Permit No ......... .~.'I.~Z ................ Disapproved a/c '~........~ ~ ....................... ................................................ Z./iii. Ziiii .... (Building Inspector) APPLICATION FOR BUILDING PERMIT ....... ................ INSTRUCTIONS 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 az areas, and giving a detailed description of layout ofproperty must be drown 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 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 o 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 oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, geheral contractor, electrician, plumber or builder. .............. ........................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~toldC-C.--~l~'~¢'T'o~. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done, Map No,: ...~..',-~...~.{~.-.~.~..~ .............. Lot No...J.,.~.,. ................. Street and Number ..................... ,,,~.~-.~..~..~.J..~......~....~ ....J~..?.~..~..; ............ .,~,~U.].~....~..~ ............................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............................................................................................................................... b. Intended use ond occupancy I ~,~,~l..L.t(...~....~..~__(-/'j.,~...~ 3. Nature of work (check which applicable): New Building~ )(~ Addition Alteration Repair .................. Removal .................. Demolitior, .................... Other Work .................................................... (Description) 4. Estimated Cost~...~....~,~...~....O.. .................................... i...Fee ~' (to be paid on filing this application) 5. If dwelling, number of dwelling units f Number of dwelling units on each floor I 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, Jf any: Front .......*: .................... Rear Depth : ................... Height ........................ Number of Stories ..: .............................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ' Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...~'..~. ........................... Rear ...~...~.. ................... Depth .....~....O. .............. Height ..... '.(:'.~.. ........ Number of Stories I ...................... ............................. 9. Size of lot: Front ........ ..O...~.. ...................... Rear .....~...~... ............................... Depth .....~.,~,~......~...~:: ........ 10. Date of Purchase ..,' -- ~.~..~.~..:[.~. ~.~ ......................... Name of Former Owner ................ ~t'~.l..~.tl~. ........................... 11. Zone or use district in which premises are situated ...... !.~.:~..~:..~..~:..'~.l...~.~.kl..~-{,~.~ ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .....~'..~. .............................................. 13. Will lot be regroded ...... .V.~'~ .............. Will excess fill be removed from premises: ~) Yes ( ) No J No.~...' .~....'...~..~.~.. 14. Narne of Owner of premises ......... Address ..~-'.:.".~..i,.::'.:..~.: ....... Phone Nome of Architect ......~...~.'li~.T~ .......................................... Address ................................ Phone No ....................... Nome of Contractor .....'~/~..~..~.. ......................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions frorn 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_YORE,, ,, [ c S COUNTY OF ................................ f .............. ..~.~...~...~-..1=.1~. ....... J.:........~.....l~......l~..'...~.~ ................. , ...... bei,ng duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named. He is the ........... · .~....(-~..~.,..~...~'.. ............................................................................................................................................... (Contractor, agent, corporate officer, etc.) · ~e~=~, and is duly authorized to perform or have performed the said work and to make and file th s opp cat on; that all statements contained in this ~applicotion are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the app ication filed therewith. Sworn to before me this ~ ~ ....... ........ do 2f ................ , .... O. hJota~, Pub ic ~ ~,....~/./~ ....... :. County ........... ~:;~...~.*..v'~a,~-.*,.7--: ..................................................... " " ' ~~'""""""""~' ~ (Sig~ture of app cant) / BETTY W. SEIZ No. 30-8912740 //