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Home My WebLink About10191-z FORM NO. 2 TOWN OF SOU?HOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 10191 Z Permission is hereby granted to: /' /~ / ...... '~'~ -7 ................. :"":'"'~,'"' ?'7' ~.~'"'";"' '" .............................................. ';.t~:~; ......... )" '"?C? ,, ' ,o ................................................... at premises located ot~?~.....~~.-. ....... ~<. '~."~.~"/"~~' '~"~ ~//~'' · pursuant to application dated ............. .~..'.'~...~....~..~.. ....................... , 19Z~...., and approved by the Building Inspector. Fee $ .~..('~ ~ Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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, propertv lines, streets, and unusual natural or topographic features. 2. Final approvat 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 (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing ail 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, 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 House No. Stree,~ Owner or Owners of Property . .~~_~,..~..:. ~'~..~ ....................... County Tax Map No. 1000 Section ....4~.~..~. ..... Block ..... ~'. ........ Lot....~,~ .......... Subdivisior~c~-~?~.~ ........ Map No ............... Lot No ............... Permit No..~?...'~..'?.~.~-----/gate of Permit . .~..~. ~,~..,~pplicant .~~... ~..,. ,~..-~... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certihcate ..................... Final Certificate .~ ............... Fee Submitted $.....~/'~.'....~.. ................. Construction on above described building and permit meets all applicable codes and regulations. Apphcant ~ . . ,~....~.~ ............... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ..... , Approved...~..~...~.:~ ...... 19 ~. Permit No. Disapproved a/c ............................ ..~? .....,~ .................. ............ (:::, .... / A (Buildidg ~spector) APPLICATION FOR BUILDING PERMIT Date ..... INSTRUCTIONS a. This application must be completely filled ~n 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 tot 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 ~nspection. 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 premises and in on buildings for n e c e_s~s.a ry~,~e~ · . ~..inspecti:~ ~'~' ' 'c~ i': .... // (Signatu.!~,ofapplicant, orname, ifa p at'o ) (Mailin~q~l'dress of applic~ (Name and title of corporate officer) Builder's License No ........................ Plumber's License No ........................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner o f premises (~<- .~...~.' ........ .~. ~.-~--~-~,~ .~. ................................... ~' (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Electrician's L~cense No ..................... Other Trade's License No..e~-~-~.~-.-'"~ * J"~' ............ ~ ~/ , /2 ,-'~ 1. Location of land on which proposed work will be don~. -~.~.'~· .~-~. .~./.~~ '~5~'~-~':' ' '~.~. · · . · .~- · ...... - -- 2 .... . . . . ..... . . .... :... House Number Street c:~tamlet County Tax Map No. 1000 Section ...~. ~.~.. ........ Block ..... /. ............ Lot .... Z2. ............. Subdivi~.~~. ~ ......... Filed Map No ............... Lot.....~,.~2. ........ (Name) 2. State existing use and occupancy of pTises and intended use and occupancy of propos.ed construction: a. Existing use and occupancy ~~. ~~......................~,r .................... b. Intended use and occupa~ .... .~.~.. ~~.-:... ~.(~. · · ~..~..~ ........... 3. Nature of work (check which applicable): New Building . . ~.. Addition ......... Alteration .... Repair .............. Removal .............. Demolition .............. Other Work ............... "~ r/~,/~°(F~.j c5--° (Description) 4. Estimated Cost .... .'~..~.. ?¢..~. :.~. ..................... Fee ...................................... i (to be paid on filing this application) 5. If dwelling, number of dwellingl units ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify natur~¢ a~d extent of each type %f use ............... _ ...... 7. Dnnenslon~of existing structures, if any: Front ...... ~./~..~. .....Rear ..... .~..~. ..... Depth ....~f.~.. ...... Height .c~.~... Number of Stories ..... ~. ................. ~ ................... ~..; ....... · .°-- z .... alterations additions: Front e::/~..q- ~/ Rear .~.? Dlmenslonsot sam~ructure with or ...... ....... .... .......... Depth c~-/~ i . Height ................ Number of Stories ...................... 8. Dimensions of entire new construction: Front .... .~5~ .~. ....... Rear ..... ./.?. ...... Depth . .. ~.~ ........ Height . ../...errS../. ......Number of 8totles ........ ~ ............................................. 9. Size of lot: Front ..... ?..~;~... ~ Rear ,~. ~'-~ *' Depth .../q~-~/.. / 10. Date of Purchase .......... i ................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ........ ~ ........................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................. 13. Will lot be regraded ...~.....~.. · ............. /2... Will _e,5,c_~s fill be re. moved ~r. om premises: ~Yes 14. Name of Owner of pren~e~)~~../~. · ~dres~~. a~ Phone $o.~.~. · · Name of Architect .... ~.........,: .............. Address .~7-. ~. ~ .... Phone No ................ Name'of Contractor ........................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildh~gs, whether existing or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether property lines. Give street and block interior or corner lot. STATE OF NEWyyO~yK~,/~ i S.S COUNTY OF ~ .....i ......................... i being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing c(~ritract) above named. ~ He is the ..................... ' .................................................................... : (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dally 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. Sworn to before .m~his N~tarv Pubhc, ftat~ of New York 'Z~''''''''~ ' N~. U2-O3,:4So3 suro.x Coun'l~7/ .,~......~)~..~ ..... (Signature~of applicant)