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Home My WebLink About15538-z FO]I{~ NO. 2 TOWN OF $OUTHOLD i~lJIt. DING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15538, Z Permission is hereby gronted to: ..~..~..~..~.L~~...~...... .................. ~~...~._....~.:....,.:.~..~.~ ......... . ,o at premises located at ../..~...~..~"'~ ............................... County Tax Mop No. 1000 Section ..... /,,,~,.,.,~,. ....... Block .... ..~....I ........... Lot No ...... .~..'7. .............. pursuant to application dated ...~...~........~t..-...~, ........... , 19..~....(~., and approved by the Building Inspector. Fee $.~.:..~ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~ ~ 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. B. 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 p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated CoO. $15.00 $15.00 Date.../'././~.. ~. '~'~' / ~ ............... NewCons truc t;[on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...................... ~ ....................... House No. A Street Ham/et Owner or Owners of Property /~./. ,~...'~...~...~...~, ./~.. ,~, ~'~, ,/~'. ............. County Tax Map No. 1000 Section./.Y.~. ....... Block.. (J). L ........ Lot ....//....~. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant/~./. ~./¢'../~..C~.~...C(~., .z?~. ~..~ .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant .~.~~ ............................ Rev. lO.10-7a 76S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND,[ ] INSULATION ROUGH PLBG. FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. 11971 TEL.: 765-1802 Received ........... ~19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurhte 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 issued 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, housing c~e, and regulations, and to admit authorized inspecto rs on premises and in building fo rnece ssary insp ....... ......f 'do;' ;ia'tidd .... (Signature of applicant, or name, i a p ' ) ....r .............. ....... [mai±ing'~fia~g~ of ~p~li~&~5 ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ............................................................................ Nd,ne of owner of premises ~. ]..~.]?t..~?.~..~..O../~..~..~.. '.. N.~'..t~...Z~.~...7'~..~.~'. ................................ (as on the tax 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 ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done../57..3.'~.....,_~?..l/..~.....~....~.~..,,,"~-../~...b~.. ::... House Number Street Hamlet County Tax Map No. 1000 Section ... Z .~...~. ....... Block .... ~../ ......... Lot.. ?..2 ............ 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 ...~.~ ................................ b. Intended use and occupancy ................................. 3. Nature of work (check which applicable): New Building .......... Addition...' ....... Altemti~... i ....... Repair .............. Removal .............. Demolition ............ :.. Other Work..~.~.. ~(.~'~. (Description) 4. Estimated Cost .~.0..0 ................................ Fee ........... . ........................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling unit~ on each floor ................ If garage, number of c~s 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 ............................ ; ........................... D~ensions of same structure with alterations or additions: Front ............ ; .... Rear .................. Dep~ ...................... Height ...................... Number of Stories ...................... 8'. Dimensions of entire new construction: Front ............... Rear ........ ~ Depth Height ............... Number of Stories ...................... ~ ......................... 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Foyer Owner .., ........... 11 Zone or use district in whic remises are situated .......................... . ............ 12. Does proposed construction violate any zoning law, ordinance or regulation: .~ .~ ....................... 13. Will lot be regraded ............................ Will excess fill be removed~ from premises: Yes '~ 14. Nme of Owner of premises .................... Address ................ ~... Phone No ................ N~e of Architect ........................... Address ................ ... Phone No ................ N~e of Contractor .......................... Address ................... Phone No ................ I5. 1s th~s property located w~th~nL00 feat ~ If yes, Southold To~ Trustees Permit may be required. PLOT DIAG~ Lo~a~ d~uly ~d d~sfin~fly ~1 bulldogs, whether ~xisfing or proposed, and. ~nd~at~ ~1 s~-back d~nsions from prope~y ~nes. Give street and block number or description accord~g to deed, and sho~ street names and indicate whether inte~or or corner lot. AJ OVEO NOTF. D 7~-180~ 9 A~ TO ~ ~ ~R THE r:OLLOWING INS~C~ONS: F~NDA'rlON TWO REQ~RED STATE OF NEW YORK,. S.S FOR Pi)OREo CONC~E'I E COU~Y OF ................. ' ' ~OUGH F~AMING ~ ................................................. duly that ppnoant (Name of individual signing contract) ~, ~l~ ~()~S'r~tJC'I'~O~ MUST above named. AL~. t:0NST~tlCTiON S~ALL M~ET He is the THF ~tltJ~NTS ~ rH~ ........................................................ s~:er~s,~c,l~'~ '~ ..... (Contractor, agent, corporate officeG~.: t~t~T ~8~SlSt[ ~fl of said owner or ownem, ~d is duly authorized to perform or have perfome~~[,:,a~ ~{his application; thai ~1 statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this , ........................ day of ..................... ,19..'. (Signature of applicator)