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Home My WebLink About10389-z · 'OI~M ~0. 2 TOWN OF SOUTHOLD BUILDIhlG 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°. 1O389 Z Permission is hereby granted to: at premises located pursuant to application dated Building Inspector. Fee $.../....~...~.....~. ·. ...... and approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall [:outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitt%~ dupl~cate~o 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 Residenc,es 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 p~coperty 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 preoare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $ [ 5.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~j~ Date. · ~,). J. ~..~..('P New Building .~ · .~..~ .... O,d or Pre-existing Building ............ VaCant Land ............. Location of Property .. [ .q. 7 ..~.'~. .... ?~...o..~.../~..~ .............. .t. .............. House No. Street Hamlet Owner or Owners of Property . ~ .~ ~ ................................ County Tax Map No. 1000 Section .... )./..~. ....... Block .. O ~'/ Lot. ) .~. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /0,~,~,~)... Date of Permit . .~,°1.. ,Applicant ..~1 .J! .... ~ ~.U ............... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ .............. Fee Submitted $..~ .................... Construction on above described building ~~~c~o~lations.~'~)1~-~ I L~ ~)Lf ~,~A~O. ~g4(~C~ Applicant ~~ .................. Rev. 10-10-78 ,..5 I ~--I 5' o/._.~. T I 0 I--;I Ai~ DITIc__blxJAL ~ t FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ..... ....... (Budding I~ctor) - 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 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 pther 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 necessaw insEec_tion~ ~ ~? j~ (Signatdl~e of applicant, or na~m.~if a corporation) .............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. pre e / (as on the tax roll or latest deejl~l If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate ofhcer) Builder's License No..)~_~. ............... Plumber's License No ..../~/. ~' "t- ................ / Electrician's L~cense No..../ .................. / Other Trade's License No../. .................. 1. Location of land on which proposed work will be done ................................................. ~...~ ~>Tr .~.~...~-~.F-~. House Number Street Hamlet County Tax Map No. 1000 Section .[ .~ .~ .......... Block .. Lot ....... Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. b. Intended use and occupa cy .. ~.~...~.~ ............~ ....,- ¢...~.~. ¢.~ ................ 3. Nature of work (check which applicable): New Building .......... Addition ./.J~...~'.~.. Alteration .......... Repair .............. RemovAl .............. Demolition .............. Other Work ............... ~" ....................... ............................... · .~2~.. (Description) 4. Estimated Cost .... .~/. (9 ..~..~... Fee / (to be paid on filing this application) 5. If dwelling, number of dwelling ufiits . ./. ~..?r-. ...... Number of dwelling units on each floor ............... If garage number of cars Ifl ' ss, c 'al ' d o cupancy pecifyn_atc,r and tent ofe ch type of 6. )uslne ommercl or mlxe c , s e ex a use ................ . .... 7. Dnnensionsofexistingstructures,iifany Front .... .~.~ ....... Rear .... ~.0 ....... Depth .............. Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .~ .~, ............ Rear .... ~. f.) .......... Depth...~ ................ . Height ..... ~-~'..( ............ ~qumber of Stories ...... ~ ........... '... 8. Dimensions of entre new construction: Front .. ~...~..< ....... Rear ............... Depth .... ~.~..~. ...... Height i . ...'../..~ ....... Number of Stories . .. ] .................................................... 9. Size oflgt: Front ............ .......... Rear ...................... Depth ...................... 10. Date of Purchase ............ , .................. Name of Former D~Ja,e,r ..................... ~ ........ 11. Zone or'use district in which premises are situated .................. (7: ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ../~..O. ......................... 13. Will lot be regraded ........................ ~... Will excess fill be removed fr, o;n premises: Yes,_ No 14. Name of Owner of premises .Z.O~.F'./~.~...~...c:... Address ~. ~)..7.. ~Phone No..~Z~..~a~. 7..~.-~. fffi/f.. Name of Architect ................... ,.. ~ ..... Address ..... ~ ............. Phone No ................ Name of Contractor ~ .... ~...~..-e~3~.... ..... Address aff-'~. · ~.~. Phone No. ,~. ~'~./.,g'~. ~.. i [ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-ba~k 4 nalo)s property lines. Give street and block ffumber or description according to deed and show street name,s t/nd interior or corner lot. '" STATE OF NEW YORK, ¢.S ..--- / 5 COUNTY OF .SUFFL1LK ......... I (Name of individual signing contract) above named. of said owner or owne application; that all stal work will be performed Sworn to before me this 4th Notary Public, ...... Linda ,F KOWal~ ~52-452. 4771 . : ~ 1 ~a SU folk Co ] being duly sworn, deposes and says that he is the applicant He is the ....................... 1 ................................................................... (Contractor, agent, corporate officer, etc.) 's, and is duly authorized to perform or have performed the said work and to make and file this sments contgined in this application are true to the best of his knowledge and belief; and that the ~n the manner set forth in the application filed therewith. ..... day o~.. September ~ .... 1979 ......... i ................. Count ki . .. -~.. . .. . ........ : .