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Home My WebLink About13886-z I~OR~ NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13886 Z Permission is hereby granted to: ~- ~J) ~ . ...... at prem,ses located ot ..../.~...~.~. ......~~~i, ........................................... ......................................................................................................... pursuant to application doted ...~......./.....~.. ................. , 1 .~....~.., and approved by the Building Inspector. ~ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Bu ilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted i ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of properW 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-iS-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 p{an 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 topograph ic 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $1 5.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 9% /.71' ~,~. New Building .... . .~'.. ......Old or Pre-existing Building ............ Vacent Land ............. Location of Property .,.,...-. .. ~ ...................... House No. Street Ham/et Cou.ty axMap,o. 000Section ...Z/ ........ ,,oc .........Lot..'. .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit NO./.7. ~.~/,~-Date of Permit .~./E .~t~...Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted Construction on a~bove described building and permit-meets all applicable codes ar~Yregulations. A ,ca. j '- ~.~, DTq pp ~/~~' '~ .................. Rev. 10-10-78 , FIELD INSFE~TIO~ ~OUNDATION (2nd) ROUGH FRAME & PLUMBING NSULATION PER N. Y. STATE ENERGY C,ODE FINAL COMMENTS ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined/~!.t(' . .~..7~.., 19 .~. "" Approved y/~..~..d.~.'..~..77., 19 .~. Permit No, D,sapproved a/c . .~:-. ........... .,~ ....... APPliCATION FOB BUILDING PFRMIT INSTRUCTIONS Received.~./~. ...... ,1 .~.. a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- bation. 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 hall 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 hall 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described· ?he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections._=_~_._.-~ //~ (Signature of applican.t, or name, if a cor!2oration) (Mailing address of applicant) ;tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... .~.r~.¢..~. .............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. /zx.. .o. ....... ......... .............................. House Number Street Hamlet County Tax Map No. 1000 Section ..... .~..7 ·~. ...... Block .... .~..7 ......... Lot...~...~..~. i ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: ..... M'... a. Existing use and occupancy ............. _ ..................... b. Intended use and occupancy .... ~.T9..~.q .~. 5... ~.?. ~./..C) .¢'.~..~... zqq.C. ¢ .~ATO.~...~.." .~..--5~../'ff..... Nature of work (check which ~pplicable): New Building ..... Addition ..... : .... Alteration .......... Repair .............. Removal .............. Demolition Other Work ......... 14_~ ~ (Description) Estimated Cost. f.~.tP..~. ,: .......................... Fee..~..~..~.'. ....................... (to be paid on filing this application) If dwelling, number of dwellidg units ............... Number o f dwelling units on e~ch floor ................ If garage number of cars' If business, commercial or miled occupancy, specify nature and extent of each type of use ...................... Dim6nsions of existing structures, if any: Front ............... Rear .............. lJ~p~h ............... Height Nhmber of Stories Dimensions of same structure ~vith alterations or additions: Front ............ Rear ................. Depth Height Number of Stories Dimensions of entire new conltruction: Front ' ' Rear Depth Height ............... Ndmber of Stories ........................................................ Size of lot: Front ......... ! ............. Rear ...................... Depth ...................... Date of Purchase ' Name of Former Owner Zone or use district in which premises are situated ..................................................... Does proposed construction viplate any zoning law, ordinance or regulation: ........ ' ........................ Will lot be regraded ....... i .................... Will excess fill be removed' from premises: Yes No Name of Owner of premises ' Address Phone No Name of Architect .......................... Address ................... Phone No ................ Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM 10. I1. 12. 13. 14. 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 NEW YORK, i S.S COUNTY OF ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..................... i .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this application; that all statements coniained in this application are true to the best of his knowledge and belief; and that the work will be performed in the man'er set forth in the application filed therewith. Sworn to be/ore me this .......... ( ............ day qf....(' · .t/Pr~. ·., ............ 19 Notary Public,. ..... ~. ~...~..~;..~.~--~.... County~-~ ~[L~.N~.D[¥0[- '~" . ~............. NO'[~,R¥ CtjBLtC, State o~ Ne~" ¥o¢~ ..... , .... ; .... I No. 4707~78. Suli~ c0~nt~, ~ (S~gnature of apphcant) lc, rm Expires Ma[cll 30,