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Home My WebLink About10328-z FORM NO. 2 TOWN OF SOUTHOLD BUI£DING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10328 Z Building Inspector. / 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 inspecti?n of buildings or premises, or other pertinent informa- tion required to prepare a certificate. 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 New Budding ............. Old or Pre-existing Building(X)., ....... ~/Vacant Land ............ Locat,on of Property ...~r-O~ -~... ~//~.P...~i~.~.~.H..~.~ .~ ...... .~..~x~..............~('~'~ .~..~.~/z~. ...... ..,. .......... House No. Street Hamlet Owner or Owners of Property~//"~'/,... ~ .~ ~...~?~..[.~Z'~/:~.... ~_.~¢~r-. ~.~.: ................. County Tax Map No. 1000 Section .. /./~ '?. ........ Block .. ~. ........... Lot./4¢. ,~.~'~ ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~..~.,¢.,~.4~. . Date of Permit .Applicant .... .~L~,... q-:cT.C' ....... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ....... .~ ................ Planning Board Approval .............. ' ....~ ,. ~ Request for Temporary Certificate ..................... Final Certificate t~// * Fee Submitted $... ~., .o. 42. .................. Construction on above described building and permit'meets all app~cable~co_des and regulations. Applicant . .~ .................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 ×amined... Disapproved a] c .......... ................ ~ ........ (Buildiffl~Inspector) APPLICATION FOR BUILDING PERMIT 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by th~s 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 applicant, or name, if a corporation) (Mailing address of applicant) g/,~..¢,-~,z'~d~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. f~..c~ ~ ~.F.. ........................ Name of owner ofpremises . ! .......................... (h~ on the tax roll or latest deed) If applicant is a corporahon, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. .;j~t2.... ..../~- . ...... . . Plumber's License No .......................... Electrician's License No ...................... Other Trade's License No ...................... Location of land on which proposed work will be done .... .~.-.~..~. .......~Z.. Co..X ...................... House Number Street Hamlet County Tax Map No. 1000 Section .J.,~.7. ............ Block .... ~ ............ Lot../.~-5.../.~. ........ Subdivision .................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occtlpancy of proposed construction: a. Existing use and occupancy,..~!¢..<;....P'7.c4-..t4~,'./.~/.. ................................................ 10. 11. 12. 13. 14. Nature of work (check which applicable): New Buildi : Addition .......... Alteration .......... Repair .............. RemoVal .............. Demolition .............. Other Work ............. (to be paid on filing this application) If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ If business, commercial or mixedloccupancy, specify nature and extent of each type of use ..................... Diraensions of existing structures.., if any: Front ............... Rear .............. Depth ............... Dmaensions of s. ame structure with alteratmns or ad~hons: Front . .~.~[. ........... Rear .................. Depth .... /. ................ Height ..... / ................ Number of Stories ...................... Dimensions of entire new constrtlction: Front ............... Rear ............... Depth ............... Height .............. .~u~be, r of Stories ........... ~ ...~ ......................... .r ............. Date of,Purchase ........... /, .~..70~ ........... Name of For~,,er~Owner ...... .d-~. ~../,'~/d,g'~/.~. ......... Zone or use district in which premises are situated ............... ~ ................................... Does proposed construction violfite any zoning law, ordinance or regulation: .............. .............. Will lot be regraded ....... .ZJ. ,c-). ................. Will excess fill be removed from premises:' Yes Name of Ow of pr mise ' Addres Phone No ncr e s .................... s ................................... Name of Architect ........ ~. ............... Address ................... Phone No ................ Name of Contractor .... .~ ~: .......... Address ................... Phone No ................ PLOT DIAGRAM Locate qleariy and distinctly all lbuildings, 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 whether interior or corner lot. ' /x/ STATE OF NEW)g, ORK, - - ......... ~ ............. being duly sworn, deposes and says that he is the applicant (15rfime of individual signing contract) above named. He is the ........... ~ ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui3, 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. Swam to before me this .................... ,