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Home My WebLink About11269-z FOEM NO. ~ TOWN OF SOUTHO~L~ BUILDING DEPARTMEJqTi~ TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) , Permission is hereby granted t~ ....... .......... ......... .~.....c<.,.~,~.~,~.,~.~......~..~. ............ .......... ~..Y~ ~ .. ~o . . ~a~zo.c.~....~o..~.e~.=s~...?.~ro~7~:......~.~.c~x-~ at premises located at .~.. ~. .............. ~ ............. County Tax Map No. 1000 Section ........... Block .~.., ). ........ lot No ..... pursuant to application dated ....... ;~.~/,w..~.,.,....~, ........ .~,...;,.,..., Building Inspector. Fee $...../~.. ........ and approved by the ~? FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This apphcation must be filled m typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following, for new buildings or new use: 1. Final su~ey of property with accurate location of ali buddings, 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 buddings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code comphance 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 Aprd 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing ali 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- t~on required to prepare a certihcate. Fees: 1. Certificate of occupancv $5.00 2, Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 ............ Old or Pre*ex~sting Building ............ Vacant Land ............. Location of Property .~.~ ~ .......... House No, Street Nam/e t County Tax Map No. 1000 Section 1. ~ ,~ ........ Block ............... Lot. ~-- ~ Subdivision .. ~. ............................. Filed Map No ........... Lot No .............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ~ Fee Submitted $....~..~.~. v/~ Construction on above described budding and permit meets all applicable codes and regulations. ................. FIELD INS?ECTIQN 1. FOUNDATION (lst) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 E,,am,ned Approved..~c~../.~... ~ I Pemit No. Disapproved a/c ~_: .ff~ .............. ~ ....... f' 1 (Bnilding Inspector) APPLICATION FOR BUILDING PERMIT Ap plication No. d/d.d.~.. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or fn ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Hot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn ou the diagram which is part of this apl: cation. c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d Upon appm,'al of this application, the Building Inspector will issue a Buildzng Permit to the applicant. Such peru shall be kept on the premtses available for inspection throughout the work. e. No building shall be occntned or used in whole or in part for any purpose whatever until a Certificate of Occupan s!'.all have been granted by the Building Inspector. APPLICATION IS tlEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to cmnply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inst~ections. ~> //2 ..... ....... (SibSflature of applicant, or name, if a c~r'f~oration) ~. ~/9 (Ma~iling ad~ress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, ~lectrician, plumber or build, Ntune of owner of premises . .(.~..w.'z_.~.~:~.~_~..,.. (as on the tax roll or latest deed) If applicant is a corporation, siguature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... ~ ............. Plumber's License No.. .... d/ .............. Electrician's License No ....../.. .............. / Other Trade's License No ................. 1. Location of land on which proposed work will be done ............................................. House Number Street Hamlet County Tax Map No. 1000 Section .... .... ,... Block .... ././. Subdivision ..................................... Filed Map No.. (Name) ........... Lot ................. State existing use and occupancy of premises and intended usc and occupancy of proposed construction: b. Intended use and occupancy 4?.'r.e;..;d-7:q';.~~. .~-r,l~.~.~..~ .~.q~.~:~'.F~;. ~-~ z, ..... .... Nature. of work (check which agphcable): New Building .......... Addinon .......... Alteration .......... Repair .............. Removal ........... Demolition .............. Other Work ............... ' /o 2 (Desoription). (to be paid on filing this application) If dwelling, nvmber of dwelling ?nits ............... Nmnber of dwelling units on each floor .............. If garage, number of cars ..................... [ ................................................ If business, commercial or mi~ed occupancy, specify neture and extent of each type of use Dimensions of existing stn,ctur~s, if any: Front ............... Rear .............. Depth ............. tleight ............... Number of Stories ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth .................... :.. Iteight ...................... Number of Stories .................... Dimensmns of entire new constrnction: Front ...... ~ ....... Rear ...:t!i~. ......... Depth ../Z~) ........ Height ....... ~.: ..... Number of Stories ...................................................... Size of lot: Front ...................... Rear ...................... Depth ..................... Date of Purchase ........... . .................. Name of Former Owner ........................... Zone or use district in which prqmises are situated ................................................... Does.. proposed construction vjoiate any zoning law, ordinance or regulation: ... ~.~. ....................... V, ~p lot be regraded ..... .,~.~7~.. ............ , ......Will exce~ss ill[be.removed from.~rerrdses: Yes No Name of Owner of premises . ¢-~.,td. vFAt)/.~.. Address Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......... ................. Address ................... Phone No ................ PLOT DIAGRAM Locate .clearly and distinctly atll buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block~number or description according to deed, and show street ,lames and indicate whether terior or corner lot. I'ATE OF NEW I¢"'OIRK, ,, .rt. , OUNrrY-/ . , , S.~ ~-.../(Name of indMdual sig,ling contract) )ove named. / being duly sworn, deposes and says thane is tile applicant e is the (Contractor, agent, corporate officer, etc.) f~plication;Said ownerthatorallownerS,statementsm~d iScont!aineddUly authorizedin this applicationt° perform are°r trne- to the best oe'/:~ "-owledge hav..e peifformed the said work andandtO belief;make andand file this ttlat the 'ork will be performed in the manner set forth in the application filed tb. erewith. worn to b~fore me this ' ot a_rg.~Public, ...... ~. -.,~'h ....., ~ .... County I T6rm Expires March , ~ (Signature o~i~'plicant)