The URL can be used to link to this page

Home My WebLink About10215-zTOWN CLERK'S OFFICE SOUTHOLD, N. YL IIUILDIN$ PERMIT ~ (THIS PERM!T MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10~5 Z Permission is hereby granted to: .........~_~/c~.....i~ ..... ~/~.~./..~...'..' ........ .~./.'.-...~.C,~...- ...... ..... ~.~.....Z~.~..~z...~ ~z,~ ....... ~o .~.~.... ~.~.~ ~.. ~...~.~Zx~1...~/z~ ...~r ~ ~ ..~.~...,.~.....~c~.....~....~.zz...c~x~ ........ ~ ........................................... ~uildin~ ~nspector FOR~ NO. 6 Bui d ,g~Deba~tm~ht Town hall South01d,'N!Y. 1197t APPLICATION FOR CERTIFICATE OFiOCCUPANCY Instructions A. This appl cation must b~ filled in typewriter OR ink and submitted in duplicate to the Building Inspec- tor with the following; f~r new buildings or new b~: 1 Final ~ey of property with accurate location of all bu~ld~hgs, prope~y lines streets, and unu~al natural or topographi~ fee~res. 2Fna approval of Hea~th Dept. of water supply and sewerage ~i~posal-(S9 form or equal). 3Approval of electrical~in~allation from Board 0f Fi~e Udd~i~ers. 4. Commercial buildings~ Industrial buildings, Mul~ipie R~s~de~cbs and ~i~dar buildings and ~nstalla- fions a cart f cate of ~Code compliance from the Archi~e~t ~r Enginee~responsible for the building. 5.Submit Planning Boar~ approval of completed site plan requirements wh~re applicable. B. Fo[ existing buildings ~prior to April 1957), Non~0nfor~in~ U~s, or ~uildings and "pre-existing" land u~s: 1. Accurate ~ey of p~operty showing all property lines,~ ~e6ts, buildings aad unu~al natural or topographic features. ~ 2.Sworn statement of owner or previous owner a~ to use, oc~u~oy and c~ndition of buildings. 3 Date of any housing ~ode or safety inspectio~ of buildings ~r premi~sl or other pertinent informa- tion required to prepare a ce~ificate, C. Fees: 1. Certificate of occupan~cy $5.00 2. Ce~ificate of occupancy on pre-existing dwelling or land use ~ $5.00 3. Copy of certificate of bccupancy $1.00 ~ ~Dato.... .................... ~w Buildin~ ............. Old or Pre-ox[stin~ 8uildin~ . .. ~ ~ ..... V~cant Land ............. ........................ ....... ........ Owner or Owners of Proper~ ...................... .7'.:. ~ .~,'. .............................. Cou,ty Tax Map No. 1000S~ctlon ..... ~ ..... .. Block .~.~ ..... .. L t..~ .......... Subdivision ' Filed Map ~o.~ ...Lot No. Permit No./~Da~e of Per'mit ~,A~plicant ~. ~ ~..~~ .......... Health Dept. Approval .... ~. ~.~ .......... ~Labor Dep~ A~pmval .. ...................... Unde~riters Approval,. ~ .~.~ ....... Plan~ing B~ar~ Approval ...................... Reque~for TemporaryCerti~ica~ ...... ~ .............. F~n~l~e~ificate'...~'~ .............. Fee ~mitted $. ~'. ~ ...... ,' Construction on above described building and p~rmi~ meet~ all ap¢l'i~able cod~ Applicant . ~~ ] .... ......... SOUTHOED, N.~. 1~g7i~ ~ . . TEL 7eS-~S02:'~ ~ ~~~ ........................................~~::' :4, : ~ ~: ~ ~ '' ~:- ,~ ,.,, ,~4 ,, : .... .... (Building InsPector)~' APPLICATION FORBu~ LDIN~ ~ERM IT . // ' ...... ~ [~ST~UCT~OSS : a. ~s application :must be c~pl~t~ly filled in by typewriter and m~mit~ed in triplicate to the Building Inspector, With 3 sets of plans, accurate b. Ptot p[~ show~g loca~on ~ lot ~d of buildings or ~eaS~ ~d ~ving a deta~ed desc~ption of layout of cation. c. ~e work covered by this apl ,lication may not 5~ co~, : d. UpOfl ~pprov~ of ~s apph~tton, ~e Bu ld~ sh~ be ~ePl;,~ the premises availed? for inspection ~ e. No b~il~ing s~all be occupie~ or used in whole or i~ :sh~l have beeg granmd by the Bu]~g inspector. ~MPLIC~iION iS HEREBY M~DE to ~e Bufidin~ Z~fie}Ordin~nee of the Tqwn of Southold ;RegUlafibn~, ~r the .construction ~ build~gs, additions The ap~Bc~t ~agrees to comply wi~a ail applicable laws, :admit auth6flZed inspectors on pre~ ises and in buildings for nZcessa~ ~ Sta~e whe~er: applicant is owner, ~essee, agent, architect, en~neer,~ Nme of ow~e~ of prbmises ......................... ~ ........: ~, · ·: ..... ~ ................... .. ~as :on the ta~ ro~l or latest;, t;~)' If applicant ~ a co~oration, signatu :e of d~y authorized officer, ...... ; . ..:. ~ .... , ............ ~ .................. ~ , ~ } (Nme and title of co~o 'ate officer) Bu~de~*~ License No. . ..................... .... , elumb~:~ License No. B~ r~ &~B; ' ~ ( Electrician's License No. ~ I Other Tfade's License No... , .................. _ _.____ _:;' , 1 done,, 47~ Locatiofl Of land ' ~ ' 1. on which proposed work will be ..... H°use Nll~ber ' i Street Courlty ~a~ Map No. 1000 Sectibn .~ .~.~ ...... .:, .}~Bi~dk Subdivision ................ ~. ~). · · : 2. State ex~fing Use and occupanc~ of ~remises and intend~g a. ~x,stm~ gse and occupancy . .................. ~ ;.. b. Intended u~ and occupancy ......... adjoining premises or public streets diagram which is part of tiffs appli- , issuance o(Building Permit. a Building~permit tO the applicant. Such permit ]pd~ose~ what~ver until a Certificate of Occupancy Bhi~ding Permit pursuant to the Ordinances or 1 Or, demolition, as herein described. code, and regu/h~ns, and to Or name, if a corporation) pplicant) plumber or builder. l-I~mlet : · ...I'. .... Lot. ./... ' .:, Lot : ~ construction: 3. Nature of work (check which a~plicable): New Building .......... Addition .......... Alteration ../.. ...... Repair .............. Removal ....... v ...... Demolition .............. Other Work ............... ! (D ripti ) 4. Estimated Cost . 3..I '0o ... ~ Fee ' . ~: (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ...... / ........ Number of dwelling units on each floor If garage number of cars ' ]f bustness, commereml or mixe~ occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front Rear .............. Depth ............... Height ............... Number of Stories .... ]. ................................................... Dimensions of same structure with alterations or additions: Front ...... .J~..o'?. ..... Rear ... Y~:¢/. ~' ......... Depth .. ~&~ ............ +.. Height .... ..~./~.~.~. ............ Number of Stories.. ~'.~./.% ,~.. ............. .8. Dimensions of entir6 new construction: Front .. ~C~.~ ....... Rear ............... Depth ............... Height ............... Number of Stories ........ l ...... i ........................................ 9. Size of lot: Front ....... .~.0~ ........... Rear ...... .~./.ff. ........... pe, pth . .,~.~4'~.. ?7..~. ?-.~. ...... 10. !)ate of Purchase ...................... : Name of Former Owner .... i ................. 11. Zone Or use district'in which pr~mises are situated..~q~. ............................................... 12. Does proposed construction viqlate any zoning law, ordinance or regulation: ................................. 13. Will 16t be regraded ........ 2 ..... ' ............... Will excess fill be removed fro~l~e~mises: Yes No 14. Name of Owner of premises~.'~. ,'.~4 (<O./.~...,{....~.,,~...~ ,d,. Address 4~'A~-~ ~.o../.~./e..P.rl~hone No...4/. 7. .7.7 ./. 7. .6..4~.. Name of Architect ............. . .............. Address ................... Phone No ................ Name of Contractor .~.Ct ~. ~J~,~..~,~ ......... Address ......... ..... Phone No ................ / ? PLOT DIAGRAM Locate' clearly and distinctly alI 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 YOlk, ~ -- S S COUNty OF. : (Name ofi~dividual sighing contract) above named. He is the . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulY authorized to perform or have performed ~he said work and to make and file this application; that all statements conlained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manger set forth in the appl!cation filed therewith. Sworn to before.me this : · ........ :. . .... Notary Public, ...-~.~... County , ~ . j~c/_..-~//'//'~ (S~gnature of apphcant)