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Home My WebLink About10866-z FO~ ~. ~ TO~N OF BUILDING ~ TOWN HALI~ SOUTHOLD, N~ Y. BUILDING P,£RMiTi Re~,. 6/30/80 (THIS PERMIT MUST BE KEPT ON T~HE PR IS S UNTIL ~UL COMPLETION OF THE WORK AUTHORIZED) i , · N9 10866 Z, , ¢ot~ ...... ~....~. ......................................... , ....... Permission is hereby granted to: DAVID ........................................... ~/~... .......................................... to ............................................................................................ ,.-.~, ~ ................. ~ .................................... at premises Iocotod ot ............................................... "-.;.- ..~.. ~ ................ ..................................... ,~ ............................................................................................... · ..?...~ ................ 9 ........................................ ....................................... ~ ..................................................... ;.,~..*.~..,.~ .......... .? .................................. COU~ Tox ~p No. 1000 Section ...................... L Bilk :....~,~ .............. ;Lot No ....................... pursu*nt to ~pplicetion deted .......................... L..~ ............ ...~....~ ..... ]9....~;..~ on~ opproved by the Building Inspector. '~.Uu 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: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 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 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. Fees: 1. Cerbficate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 SB.00 Date...~/~'j.~ ............. New Building ............. Old or Pre-existing Building . '.~, ......... Vacant Land ............. Location of Property . .~2.~.~.~. ............. .~. ~.~..~.~.. ~../~., ....... j~..~c~.~....~..1~. House No. Street Hamlet Owner or Owners of Property . .... ...................................... County Tax Map No. 1000 Section .... ~.[.~ ........ Block ... Z.. Lot Subdivision .......................... , .... Fded Map No ........... Lot No .............. Permit No../~..~.~.~. Date of Permit..~.~.1 .~]~. ·Applicant.. ~)~'(~t~... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. ~ ................. Fee Submitted $... ,~..' .0,0 .................... Construction on above described building a~,per~it meets all ap~plicable codes and regulations· Applicant, ~J ,~..~, ~.~1~.. ................... 5 - 0 ~ ...... ~ FORM NO. 1 ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 766-1803 Approved ........... 19~. Permit No../.~ .~. ~. ~. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No .... /.~..ff~..~. ~. ..... 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, ordinance~g code, ja~us'kv~g)cq~.g/,/and regulations, and to admit authorized inspectors on premises and in buildings for necess~!on~/fl/,~ / , (Signature of t(ppli&[nt, or name, if a corporation) ..... .... (Mailing address of applicant) State whether app~licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..'~ ~.~-.<]~...~. ~-... ~..~. ~.~ .... ~.~. ~).t:3. ~.. ........... ~' (as on the l~x roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ..... --t~" '/'l'(~' Electrician's License No ....................... It Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ....................... CT.. ....... k] .. 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. Existing use and occupancy ..... 1. .... . .~'..~..v~Q... :~...{2~.. ~. 1.{. ~/~.<~.~.{. ........................... b. Intended use and occupancy ........ · ~.~2...~ . :'7; ..................................... 3. Nature of work (check which applicable): New Building .......... Addition ...... Alteration .... * ..... '. Repair .............. Removal .............. Demolition .............. Other Work ........ . ..... ! (Description) 4 Estimated Cost.. ~ .... ~ .................... Fee ........ i (to be paid on filing this.application) 5. If dwelling, number of dwelling hnits ............... Number of dwelling units on each floor ....... : ........ If garage, number of cars ..... i ................................................................... 6. If business, commerciai or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure's, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... I' ' Height ...................... Number of Stones ...................... 8. Dimensions of entire new construction: Front ............... Rear .... ./~.. ....... Depth ..../.-~,.. Height ............... Number of Stories ........................................................ 9. Size of lot: Front .../,.,~/ .... ! ........... Rear.. /..~ ............... Depth ./.,.,.~?....~7./~.~. ....... 10. Date of Purchase .............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vioiate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... .................. ~ -- Will excess fill be removed from premises: Yes No of Owner of premises ~J-~ .(:a~o ~'. ~q~.~... Address ................... Phone No ................ 14. Name Name of Architect ....... ?..i ........ i ........ Address ................... Phone No ................ Name~of Contractor ......... : ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all' 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 iNEW YORK, id ~ cou rff. OF 1 .... .~. tq..d. ~. ~..~., . ./~, 0..~.".~.d,d .................. being duly sworn, deposes and says that he is the applicant (Name of individual sigmng contract) above named. He is the ..................... of said owner or owners, and is application; that all statements cont work will be performed in the manta Sworn to b~fore me this (Contractor, agent, corporate officer, etc.) y authorized to perform or have performed the said work and to make and file this dned in this application are true to the best of his knowledge and belief; and that the r set forth in the application filed therewith. Quala~ea m su,o~ ~&~,'.. ,".~' .2 / ~ (Signature of applic~t) Commission Expires Mar~'~;.~ ~