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Home My WebLink About10232-z FORFI NO. 2 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERICS OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~.EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~.. ~zz ~e~.. ~/p. ~ ~ z. . . ~ ~ . . ~o ..~ ~ :~ :....xz.. ..~ ~ ~ ~ ...... ~ z~.. .~/~> x ~.. . .>D~ : /z x ~:~ ....... at premises located at .~.,/~......~.g~,~~...../~X~....:.. . ~.: . pursuont to application dated ............. ../. ..................... 19~..'~.~.., ond approved by the Building Inspector.. L~ Fee $....,~?~..,..,."~,.... 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: I. 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. Commemial 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 all property lines, streets, buildings and unusual natural or topographic featu res. 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 3. Copy of certificate of occupancy $1.00 ,~./i.~./~.~. Date ............... New Building ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... .~. .... .~. ,~. ~..~..C~. ,t~., .~..~.,,, ./~,, ~. ...... ...~.,~.~.. I.... ~ ....... ¢.~ House fro. Street Hamlet Owner or Owners of Property . .~. ................. ~./,.~..~-~ ......................... County Tax Map No. 1000 Section . . .J.l.I .......... Block ....~. .......... Lot ................ Subdivision ................................. Filed Map No ........... Lot No.. ?~...~. ....... Permit No..~.0.'~.~..'~.. Date of Permit .~'/~...'~/.7.¢.Applicant..~. [.~.O .... ~.~..~..~...-~c~... ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building an~ t~,.[t mee~ll a~iCable codes and regulations. Applicant... ~ ~&.... fC,~~. .......... ,~....~.~.L . . f,~u I. --/ FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined....~-.Z .~..~.. ..... , 197.? Approved...~7-...~..27... ~ 19ZfPermit No.../.~'. d .'?.°~." ~ __ .............. /' '~Disapproved a/c .. ;~ .~....' . '-(Building~Inspector) APPLICATION FOR BUILDING pERMIT Date . ![ ......... Application No. r(..~.d.~..d ...... 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 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, hou~g code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspection. ....... ........ (Signa-tt~e of applican/t, or name, i~ corp/o~ation) · ./~. 7...~.~ ~.¥,../~/c~.. 6 ~,... ~.~ ~...~.~- · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, enginee~"~enera_l c~lectrician, plumber or builder. Name of owner of premises ~.O. LT.[~..~.~.~.. .~...l~..t.~....~.~7..~. (as on the tax roll or latest deed) If applic~ i~__orpora~,~g a~uly authorized officer. ...... ........ Builder's License No. - Plumber's License No.-.~.,. ~t0(.~ .T~f.t~l~ .t~. [i~t. C Electrician's License No. ~.'...~.~/~. [?.~Q. {.P{. C Other Trade's License No ...................... Location of land pn which proposed work will be done. .a.~.~..~/~." ..... House Number v Street .......... .......... ~.s.~. ~.e. . . .~ot ~ .... ~~ Hamlet 0 C u Tax 0 ~ g~' ¢ o nty ~ N_o. 100 ~o~(~ ........ ~ Block. ~ ............. Lot. ~ .......... Subdivision-.j. ~.d~..~/~. ~ ~... Filed Map No. ~ ~ ......... Lot..~ ~. ..... ' t (Name) ~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ando= n. ......... ................................... b. Intended use and occupancy ...... l...~ ~ ~ ................. [~.[.~.~~ ....... ,,/ 3. Nature of work (check which applicable): New Building .../~N .... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... · ~.¢0, /'_ (Description) 4. Estimated Cost. t~)~_'_'_0 .......................... Fee. ~f' ~:~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each fioor ................ 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 ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ....... ,._., ............ Number ~f Stories ........... t ......... 8. Dimensions of~ntire new construction: Front...~.~.: ..... Rear...~.~. ......... Depth .~.~ .......... Height . .~.0. ......... ~Number of Stories ...... o~. ...... ~ .......................... t ............. 9. Size of lot: Front . .t0.~..". .............. Rear .... ............. Depth ...~q.~..~. .............. 10. Date of Purchase ............................. 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 .... .t{~, .............. .....,.~ }Vjll excessfill be relaove~L fr~.r~ttises: Yes_ 14. Name of Owner of premises ~('0...{~..~..Vr~./~./~../~qt.~ess/qo~.T./~...~.~.....~../Pr~gne No..~.~.r .~/~2.~'...~Q'.. Name of Architect ........................... Address ................... Phone No.. Name of Contractor [Z,j~M/~.~..2p...~./~ . . .~. Address/~r7 C~t?~/~ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail 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. ...... .~..L~.~.....~. ~.~. !~.~?~. · .-~. ................... being duly sworn, deposes ~d says that he is the applicant (Name of indNidual signing contract) abow~ named. He is the ................ ~~.~ ~ ....... : ......................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file ~is application; that ail statements contained ~ this application are true to the bes~of his knowledge and belief; and that the work w~l be perfo~ed in the m~ner set forth in the application flied therew~.. to;5