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Home My WebLink About10336-z FO~ NO. ~ TOWN OF SOUTItOLD 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) No. 10336 Z Permission is hereby gronted to: ............. ~o ~C~.~.~..~. .4~. ~..~:.~x~.~xc~c~.~-~r~:~..~..~..~.~:/.~..~ premises .... ~....~,~....~.~.. ...................... / .................................................................................................................... ~~....~... ~uildin~ FORM NO. 8 TOWN OF SOUTHOLD Building Departme,n,~ Town Hall SouthoJd, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s a~pfication must be filled in typewriter OR ink, and submitted in duplicate to the Building lnspec- tor,.v~m the following; for new buddings or new use: 1. Final :un.my of property with accurate location of all buiMings, -property lines, streets, and unusual n,~ura{ cr tooograohm features. 2. F~n21 approval of Health Dept. of water supply and sewerage dlsposal--{S-9 form or equal). 3. Acp¢oval of electrmal installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buddings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Suom~t Planning Board approval of completed site plan requirements where applicable. B. Fcr existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre~existing" land uses: 1. Accurate ~rvey 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 buddings or premises, or other pertinent informa- tion reqmred to prepare a certdicate. / C. Fees: 1. Certificate of occupancy $5.00 2. Certd,cate of occupancy on pre-existing dwelling or lend use $5.00 3. Copy of certificate of occupancy $7.00 New Budding .... ,,.,,o,../~ Old or Pre-existing Building(%) ........ :/Vacant Land ............ CounW Tax M~O No. 1000 Section .......... Bloc~ Lot Submw~on ................................. F~led Map ~o ........... HeahhDept Approval ~ Dep~ Approval ......................... Labor ....................... Unde~ ri[ers Approval Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ..... Fee Submitted S ~ O Construction on above described building and permit'mee~s all appf~cable~codes and regulations. ~)e.~, ,"~4-.0. Applicant . .. . ....................... TOWN OF $OUT H OLD OFFICE OF BUILDING L SPEC-FOR N P.O. BO),' 728 TOWN HALL $OUTHOLD, N.Y. ! 1971 TEL. 765-1802 \ Applicant po, .~T,,~S ~ mo a:vlse you that the job un,mr ~-~--- .,mi inspect!on nas : / nas-no%.~ been done. In opder to complete this file, it is necessary that a Certificate of Oc ..... ~ - ~=~=~.cy be issued. Please fill out the enclosed fo~m(s) ~ petuF~ same to the above e , = o.F_c~ wi%h a check fop $5.00 payable to the Town of Southold. Please indzcate to whom the Certificate of Occupancy is to be mailed, and arrange wlth this office ~or an inspecfion date. Thank you for your prompt attention· Very truly yours, Victor Lessard Adm~-nis ~r~ for VL:ec Enclosures FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 . ........ _/ Disapprov 'c .... '.::: ..... : ...... ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . ?../. ..... , 19.. INSTRUCTIONS a. Th~s 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 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 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 ~6rp ' ) · (Mailing address of a~plicant) · ~ ~? ~:./ State whether applicant i~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as 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. Plumber's License No ..... Electrician's Lmense No. Other Trade's License No. 1. Location of land on which work will be done .......................... ~ ..................... c/.m. .d.. :: ............. :. . . .:: .... ............. ..... iaramlet House Number Street County Tax Map No. 1000 Section ..... :fl. ( ........ Block . .-~. .............. Lot .... ./'. ............. Subdivision .................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and ~ntended use and occupancy of proposed construct~°n; a. Existing use and occupancy...~.~, .~.~. .... :~ .... ~.. :.c~...~ ~ ..~..~ .~. :~;:~. 3. Nature of work (check which apblicable): New Building .. ~ .... Addition .......... Alteration .......... Repair .............. RemoVal .............. Demolition .............. Other Work...~".~.~. ~7. Q.. (DescriptiorO 4. Estimated Cost .... ~. .~. ~. ~ ....................... Fee ...................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling pnits ............... 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..~..._~4. ,~. ~, ~ '.'. Number of Stories H eight ................................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i. · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .... /.t .~. ~/~-.~... Rear ............... Depth .../. t~ ~...~/.a ."... Height . . ~.q?/.q.~J ..... Num'ber of Stories ........................................................ Size of lot: Front ........... ~ ........... Rear ...................... DepthA..z,. · · ·; ............... Date of Purchase . . ~.wo~ .~..~. ~..~. ............. Name of Former Owner . . .~,~5~t'X' ................ Zone or use district in which premises are situated ..................................................... Does proposed construction violMe any zoning law, ordinance or regulation: ................................ Will lot be regraded ......... ' ................... Will excess fy1 be removed from premises: Yes No Name of Owner of premises ..... ~ ..... Address .~T/~ .~u~.~.Phone mo.~/. (o.~,'-~ .i. ~ .~..I .... Name of Architect .......... ~ ........... v. ..... Address ................... Phone No .............. Name of Contractor ......... ~ ................. Address ................... Phone No .............. 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether ~ interior or corner lot. . ~~"~ ....... being duly sworn, deposes and says that he is the applicant ....... ''' above named. He is the ........................................................... (Contractor, ~gent, corporate officer, etc.) of said owner or owners, ~d is duiy authorized to perform or have perfo~ed the said work ~d to m~e and file this apphcat~on that all statements contmned m th~s apphcat~on are true to the best of his knowledge and belief; and that the work will be perfomed in the m~n{r set forth in the application filed therewith. Sworn to before me this ........ ....... ........... Notary Public ...... ~ ~ ....... County