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Home My WebLink About10353-z FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH~OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10353 Z Permission is hereby granted to: 2L.~....~.~.~ .......... ~.~.~ ....... ..................................................... ~LC~.~.L~ . n ~ .......... ~ ................. ~: ......................................................... ~. ........ ~.......~..~ .......................... _. _ z./ / ~ ~/ ~ /~ ';~O A b . . et premises ocaTea aT .......................................................................................................................... ......................................................................... ...~...(~ ..C~.,~..f.~ ................................... pursuant to application dated ..................................... ~.}.~*~ .......... 19£./.., / Building Inspector. Fee $ ....................... and approved by the -,,¥ // ..'./.....~....: ' . .............. ~::.4..,. .......................... ~ ....... Building inspector FORM NO. 6 TOWN OF BOUTHOLD 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. For existing buildings (pr~or 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~ $5.00~. U'/.. ~..~/..~.. '~.~ 3. Copy of certificate of occupancy $1.00 Date .......... New Building ............. Old or Pre-existing Buildings.. ~.. V~cant,~d ............. Location of Property ~A ; ~ :~... Owner or Owners of Property ~/.~/~(.,. ~~c¢~ ¢ .~ .......... ./ ..... Subdivision ........................... 't ..... Map ~ ....... Permit Nol~ 5~. Date of Permit, ~l~..Applicant ~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $....~ .................. Construction on above described building and permitp~e,fits all applic/a~e codes j~fd regulations. Applicant ..~. .......... BEAUTIFY AND PRO TEC T YOUR NOME · COL ORFUL .DECORATIVE. PERMANENT WITN A RAIN CONTROL A i/YNING YOU WILL SA VE ON NIGH NEll TING/COOLING ENERGY COSTS · ENJOY SNEL TER FROM SNOW, WIND, RAIN AND SUN AVAILABLE IN 15 CUSTOM COLORS * PORCH 8, PAtiO ENCLOSURES · ALL SEASOII ROOM Vacation at home in comfort and privacy · Jalousie · Self Storing · Interchangeable Glass & Screen · Solid Screen · Awning Window InsuI-Wall · Full View %" Insulated Glass Rolling Walls -others- RAIN CONTROL AWNING$ L TO. Free Shop-aJ-HomeDesJgner Servic®! SHOWROOM & WAREHOUSE ~ 270 W. JEOICHO TPKE., SMITRTOWN, N.Y. 11787 FINANCING ARRANGED UPTO 10 YEARS ALUMINUM, SIDING -AWNINGSs~,..o.,~AND .,cENCLOSURES~,cE.sE ,,,o. ,,~,,,,,'STORM, WINDOWS, , AND DOORS, ?34-7380 ,.%~thold FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined Approved ..... ._~..q :~..[..~., 19 ~i~Pennit No../? .c?.~?... ~----- Disapproved a/c ..... '7:.. 2~': :.-..~.___ ._ .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. ~/[) '~ ~ '~ .... 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 this apphcation 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?e 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 co:de, and regulations,~d to~ admit authorized inspectors on premises and in buildings for necessary in. specti, on.~. ~/L, r-~w~ / ~- ~ %(~i~{u/~¢'(~f ~pp~lcaht, or name, l{a corporation) ........................ I ......... ~'~ .... .' (Mailing address of applicant) / / State whether applicant i~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.¢ Name of' owner of premises ................. ~ ..................................................... (as on the tax roll or latest deed) If applicant is a corporation, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ' .~.'~../?.. f... ~.? ?.l... F"DPvtT*~-~ 0 L~_ Plumber's License No ........................ Electrician's License No ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .... :? ........... .... .?.1o. >). ............. .................... H?nseNumber Street,¢.~/'io J Hamlet . .~.~.~. / Subdivision ..................................... Filed Map No ............... Lot:5-:. ': .......... (Nmne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy ...... ~ .................... 2.:.; .................... , ................. 3, Nature of work (check which applicable): New Building .......... Addition .......... Alteration ........ Repair .............. Removal .............. Demolition .............. Other Work ............. ~oOt3 '[-~ /~-- (Description) 4. Estimated Cost .............. ~ ....................... 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 pccupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures,lif any: Front ............... Rear .............. Depth ............... Height ............... Numb&r of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth . Height Number of Stories ' ' pth 8. Dimensions of entire new construction: Front ............... Rear ............... De ............... Height ............... Number of Stories ........................................................ 9 Size ofl0t: Front ' Rear Depth 10 Date of Purchase Name of Formar Owner 11 ~.. 7Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zomng law, ordinance or regulation ................................ .. Will excess fill be removed from premises: . ~ Yes 2/0 14. Name of Owner of premises Name of Architect Address ..... Phone No ................ ~ Address Phone No Name of Contractor ............................................................. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, 'S.S COUNTY OF ................. ........... ~...J~.?.?..~. .... (xlE£'V~l~ }..Utx[b beingdulysworn, deposesandsaysthatheistheapplicant (Name of individual signing contract) above named. (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 apphcat~on that' all statements contained m this application are tree 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. Sworn to before me this l [ ~ day of '7~ 0..~., 197~