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Home My WebLink About10806-zN~ BUILDIHG ('THIS PEK~IT ~UST BE ~P~ ~ THE P~E~IS~S CO~P~ETIO~ 0F THG ~O~E ~U~H0~ZED) L 10 8 0 6 Z Date ......... ..? ................ ~ ........................... , Permission is hereby gro~ted~ /'7) i ~o .......................................... ~. ............ ~:..~ ................................ .......................................~,~ ~2~ ............................... ~. ~,~ .~/s~ "?'~..~. ~., ~./~-/~ ........... C*un~ Tox Mop No. 1000 Socnon .......................... ~ ~ }.., ~ ........... } ....................... , ~, a:. 1. ~'~. '~ ~.d ~ roved b tho pursuant to app~icaHon oared ...................... ~..~...,.?.~....., I ..... .., pp y Building Inspector. - ~ ~:. Rev. 6130180 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, 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 ~imilar 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copv of certificate of occupancy $1.00 $5.00 New Building p..o.o,1..&.,. ~.e.~,zc. ~)ld or Pre-existing Building ............ Vacant Land ............. Location of Property . 53.7.(t. I.~¢.s.q,t~..~.q J,B.~..~O~,d..&...2.2;5.5.. ,~.~.t.t;[..e..~.e. qp.~.J..q .~.~.ay..~.~ .d.,.,.C.u. tchogtte House No. Street Hamlet Owner or Owners of Property I.~.,. ?~e. g.e.~. .................................................. County Tax Map No. 1000 Section , ].[~L ........... Block ..... 8 ......... Lot .... ,~9 .......... Subdiwsion ................................. Filed Map No ........... Lot No .............. Permit No..~0~.0,(~ .Z.. Date of Permit .7./.~.[/.8.0..Applicant ...~.k.J,.~.q~. ,D.~.p.. ,~.o.o.]:.s. ............ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ~ .................... Fee Submitted $...~ .5...0.(! .................... Construction on above described building and permit meets all applicable codes and regulations. Applicant Rev. 10-10-78 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be hlled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor w~th the following; for new buildings or new use: 1. Final ~rvey of property with accurate location of alt buildings, property lines, streets, and unusual natural or topographm features 2.Final approval o~ 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 approva{ of completed site plan requirements where applicable. B. For ex~stmg buildin.~s (pr~o~ to Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses' 1. Accurate ~rvey of peoperty showing all property lines, streets, buildings and unusual natural or topograph m featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. bate 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. Certifmate of occupancy on pre-existing dwelling or land use $5.0.(~, 3. Copy of ce~t~hcate of occupancy '~$1.00 /' ) ,t,.% .... .... New ~uild'ng,/~ ........ Old or Pre-existing Building ............ Vacant Land ............. County Tax Map No. ~ 000 Sect,~n ........ Block ..... ....... Lot .... Subdiv,siong~'7 ~.~.~. (rCF eOMapNo Lot No Nealth Dept. Approval .. .kabor DeOt. AO~roval ........................ Unde~riters A~proval ......... Plannin~ ~oard Approval ...................... ~equest for Temoorarg Cert~hcate .................. Final Certificato Fee Submitted $ .... ~.~.. ~ ........... ..... BUILDING DEPT COPY OF APPL~ICATION FORM 46-EL~ NEW ¥OF[K BO/~RDr~F ~JRE UNDER FILE THIS ~COPY WITH BUILDING DEI~T ~VH~EN REQ~,I~ED~ J,, I~ NEW ~ OLD ~ REMOOELEm ~ IS NEW , REMOVED LIST BELOW ALL EQU PME~IT WHI~3H 'YOU INS;AL -ED No ofF,xtmss&! MOTORS I' H~ATER~ ~' BA .~1 DF ~RK : CONCEALED TRanSfORMERS OE ~ ~ , ; V~ SERVICE ~AKER ENTERS OF SIGN FO~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19..~ 0 19,.~.]~'~'~Permit No..L. ............................... Disapproved a/c ................................ ] F;;.~?,~. ................................................. {Building Inspector) APPLICATION FOR BUILDING PERMIT 'Date ..... . ..~.../.L.~...~ ............. , 19..~. INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink and submi.tted in triplicate to the Building Inspector, with' 3 sets of plans, accurate plot plan to scale. Fee acco~dihg to ~chedule. b Plot plan showing location of lot end of buildings on premises, relahonsh~p to adjoining premises or public streets o~eas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. ' c. ' The ~vork covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector w~ll issue a Budding 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 fbr the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town .of Southold, Suffolk County, New York~d'~ther applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~for~m, ov,a] or demol~ion, a,,s~erein described The applicant agrees to comply with ali applicable laws, ordinances, buildi, l~ code, ,housing cj;~d/, an~F~gulations, and to admit authorized inspectors on premisei; and in buildings for necessary~spec~,n/ · ,, ........................... (Sign~ff~'~c'~'~l~'~{ion)~ ........ .'..] ............................................ (Address of applicant) State whether opp~is owner, lesse~orchitect, cng,near, .,general contractor, electrician, plumber or builder. ..............................................."T' "'"/ ................ ..................... :- ..................................................... Name of owner tf F re/~ises ......... ...... ]~] .~..~..l.(~...?.. ............................... / / If apphcant is c~ co ~o~te/-s-mnature of duly authorized officer. ~ , ,, (Nai~e~'"~ ~dL~itle ~~- · Builder's License No ..................................................... Plumber's License No ................... ~. ............................. Electrician's License No ........ Other Trade's L,cense No ~....~......... · · .................................. ? ..... o / I I Location of land on which proposed work wdl be done. Map..~ .....: ................................... Lot No ............. ~ ....... Street and Number >,~.~..~;~....~.~...L~.. ........ .~....~'~..?. ....... 2. State ex~sting use and occupancy of premises and imended use on~J occupancy of propelled construction: a Exisiting use and occupancy ............ ~ ................... ~ ......................................................................... b Intended use and occupancy ............ ]~.~....~...,..~... ....... .~.........~...~....,: ........................................... 10. 11. 12 13 14. property lines. Give street and block Nature of work (check which applicable). New Building.. ................. Addition ....~ ........... Alteration ....... Repair ................ J~emoval i ................. Demolitior ............. · ....... Other Work ~.~..~..'...°..L......~........~.~.~../~..C,~-,~ .. . ~/~ : . ~ ~ _ ~ (Description) Estimated Cost .......~.~.~...I. ..................... Fee ....... ~.~.....', ...................................................................... , (to be paid on filing this application) f, dwelling, nu;be~,of dwelh~g~its_].......,.....ff. .........Number of drell,ng units on each floor ......... ~ ....... If business, commercial or mixed occupancy, specify nature and ~xtent oJ each type of use ........ ~..~ ............ Dimensions of existing structures, if any: Front .......~.~ ......... Rea~ ........ ~ .................... Depth ...~.~ ........ Height ....... :'..;....: ........ Number of Stones .. . ( .............. D,~ensions of same structure .with o terati~ ~'; '~ ~ ~} ~.~Z~.~}} ~ ~}~}~}} }.}~} Depth ................ ~ ............... H~ioht .......... ~ ................. ~umbor of $~ories ............ ~ ................... ~m~on~ o* ~ ~ ~o~,o~: ~o~* ..~,.~.C...~~ ....... ~op~ ....................... Hdoht .................... ~umber o{ Stories ........................................... } ........................................................................ s,~ of ,o~. ~o~ ..... .,...~..~........., ........... , ....... ~.....~.~..~. ...................... ~h ............ ........ ~ of ~h~ ....L...~..'Z,Z......m...~..~.L ..... ~ of ~o~r Ow~e~ ........................................................ Zone or u~ d~stnct m which pFem~ses are s~tuated ......... .~ ....... ~.....+ .................................................................... ~oes proposed construction vioJate any zoning law, ordinance or regulation .......... ~....~. ............................... Will bt be ~egrad~d ~ ~ Will eLc~ f,U be ~e~o~ed f~om prem~s: ~ V~s ( ) ........... ~ ........... ~1 ~ ~ , ....... : .................. Name of Architect ............................................................. ~ ' Address .J .............................. Phon~ No Nome of Contractor J..~):~.~ ..... [.~ ...................... Address ..~ ............ Phone No.~:~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or propose~, and indicate all set-back d~mensions from number or description according td deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y..~RK~'>-~ couN'rv _o£ ...x~..~,./~.....~, ........... '....~.:.~c:?-K.. ........ ..~..'./.'.~..~. r..~. ~': (Name of individual signing contract) above named. He s the ..................................... :,~.~...¢.~.J..__ ........ ' ( ;6ntractor, agen of said owner or owners, and Js duly]acthoHzed to pert this application; that all statements car that' the work will be performed in theJ m Sworn to~b~e me this rained in this ~nner set forth · .~.~.A..., ~ County ..... being duly sworn, deposes and says that he is the applicant · , corporate officer, etc ) )rm or have performed the said work and to make and file )plication are true to the best of his~knowledge and behef; and ~ the application filed therewith. /~/ ~ ~IZABETH ANN NEVILLE / NOTA JY PUBLIC,State of New York No, i2-8125850, Suffolk Coup,) Tel ~ ~xp~res March 30,