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Home My WebLink About2794-z FOKM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2794 Z Permission is hereby granted to: Ii ~.:[3,l.e~ - &. · tl~mm. · .Llel~l,e ~.~ .......................... ............ 8out,~ol~l.~ ........ N,.Z, ............................. to .....JJll~..ne3~..J3tlJ;J,tle~l$...13~l,.143~.~...(.e.t, ol, e.) .................................................................... at premises located at ....Jl/f~..l~:l,l~..RJl....(J,-L,$altt~e~rd.-.Br~ek..U"o ......................................... ................................. 3~r.t...o£...l~ta..l$,:L~ss,l.~,:L6, ....... So~thel~r..N,.~., ........................... pursuant to application dated .......................... d'~lJle ....... ~. ............. 19..~., and approved by the Building Inspector Fee $],fl*,OiO ............ ~? , ? .Bu!lding nspect0r / REFERENCE SHEET NO~3 NOTE: This sheet is an essential part of the action taken on this project° It shall be attached to the approved plans along with the Certificate of Approval Plan Serial No,. Date, 'June 28, 1965 L Sanitary facilities shall comply with Industrial Code Rule Noo 90 a0 Walls and ceiling shall be of non-absorbent material or painted two coats of a light colored pa|aL bo The floor and base shall be of non-absorbent material° c. The base shall be 6*~ high and coved where it meets the floor0 do Doors shall be self-closing~ eo Each toilet room shall be ventilated by windows or skylights, the openable area of which shall be at least 1 sqo ft. for each water closet or urinal f0 When windows or skylights are not available a mechanical system capable of exhausting 35° cm fi~ of air per minute .for each water closet or urinal shall be installedo An air intake shall be provided by transoms~ door louvres or supply ducts~ g0 Water closets shall be located in compartments with doors within a toilet room~ ho If both sexes are employed~ separate toilet rooms shall be provided (and the lavatories shall be located in a toilet room or in a wash room°) (Matter in parenthesis~ factories onlyo) i0 Water closets and urinals shall be separated from spaces in which unwrapped food products are handled by vestibules constructed of fulluheight partitions and full-size self-closing doors° j~ A dressing room for women employees shall b~ provided~ having a net floor area of at least 60 sq~ fro for the first ten employees~ plus 2 sqo fro for each additional such employee0 k0 Women's dressing rooms shall be ventilated by a window or skylight having an area equal to at least 1/20 the floor area~ or by a mechanical system of ventilation capable of exhausting 1 cm ft0 of air per minute for each square foot of floor area° g Where more than one and less than six women are employed~ a substantially screened space of at least 35 sq~ fro shall be provided for use as a dressing room~ mo Toilet facilities shall be located nor more than one floor above or below the regular place of work of the persons using them~ n. Toilet facilities shall be located in and be accessible from within the building, o~ Toilet facilities shall be separated from dressing rooms by solid, full=height partitions and self-closing, full-size doors~ p~ Toilet room partitions shall be solid= Interior sash will not be permitted unless of the fixed type and with translucent but not transparent glass lights at least 6~ above the fioor~ q. Trough urinals are not permissible° Urinals shall be of the individual type with sides to give privacy. ro Wash rooms shall be enclosed by solid partitions to a height of at least 7~ (to ceiling when separating an adjoining men's wash room)° Openings in such enclosures shall be closed by solid doors equipped with selbclosing devices The space above the partitions may be used for ventilation purposes as permitted by Rule 9-1L3 s0 The number of fixtures shall be in proportion to the number of each sex as required by Rules 9-4.1~ 9-1002~ 9-11.4 and 36-11.2 where applicableo t~ Toilet rooms shall be enclosed by solid partitions from floor to ceiling with ceiling at least 7*6" high° If the boiler generates steam at a pressure of more than 15 lbs. per square inch, it will be necessary to provide the fol- lowing as part of the requirements of Code Rule No= 140 a. Two means of escape fron, the room located remote from each other consisting of outswinging doors at least 36" wide0 bo A space of at least 24" around and between boilers far inspection and maintenance, except boilers other than horizon- tal, tubular or watertube type or not exceeding 30" in diameter may have 16" clear spaceo co A clear space of 6~ above any valve or other fitting at point of rnaximum extension° do Where it is necessary to go on top of a boiler for maintenance or operation, a clearance of at least 7~ of headroom shall be maintained except for an installation in an existing building where clearance may be eo The boiler shall be enclosed in a room used for no other purpose having walls~ floor and ceiling of 1 hL construction and self-closing 1 hro fire doors° (26q5A) 3. If it is desired to obtain the credits allowable for a completely sprinklered building, it will be necessary to submit plans of the sprinkler system in triplicate for examination as to compliance with the regulations set forth in Industrial Code Rule No0 20. ISS-640.3 (1-64) REFERENCE SItEET NO, 3 (CONT.) 4~ It will,be necessary to install a fire alarm signal system covering all areas of the building and otherwise complying with the requirements of Industtial Code Bulletin Noo 50 N. Bo S~pecifications in triplicate for submission are enclosed herewith~ See instructions on reverse of form ISS-604o 5° Flamniable liquids storage (Paints~ etco) shall comply xvith Rule 12-25~7. a~ Quantities exceeding 220 gallons shall be stored in a storage room0 6~ Copies of Industrial Code Rules referred to may be obtained by written request to the office of the Administrative Director, Department of Labor~ State Campus~ Albany~ New York 12226~ 7. Chapter 1008 of the Laws of 1960~ amending the Education Law~ now requires that plans submitted for approval bear the seal a~d signature of the architect or engineer responsible for the preparation of the plans~ The a~tion taken in this letter shall not be considered effective until the proper seal and signature are affixed to the plans ~returned~ These plans do not have to be resubmitted to show seal and signature~ 8. The sewage disposal system shall be installed in comformity with local ordinances or the rules of the New York State l)epar~ment of ltealtho 9~ The radiological portions of the structure shall comply with Rule 38~ It ~ill be necessary to register the installations with the Division of Industrial tlygiene~ 80 Centre Street~ New York, Ne9 York 10013° b~ This letter does not constitute an approval under Code Rule 38. There are many factors affecting the installations which are not determinable from the plans~ You should seek advice and counsel on this matter at the above address° c0 A swinging door at least 30" (36~ if subject as a factory or mercantile exit) wide shall be provided as an emergency exi~ from the radiation areao A maze or baffle wall to shield this door is recommendedo No,required path of exit from the floor area of this building shall be required to pass through a radiation area nor thrgugh a radiological portion of the structure if avoidable. 10, It app?ars that the processes to be conducted in the building will produce air contaminants which may be injurious to the healt~ of the employees° Plans for exhhust systems to remove dust, gases~ fumes, vapors, fibers~ or other impurities shall ibe submitted in triplicate for approval to the Division of Industrial Hygiene~ 80 Centre Street~ New York~ N.Yo 1001 11. Incinerator and heating installations or other equipment discharging pollutants into the atmosphere must be approved° Plans foe such installations in factories or connected therewith~ shall be submitted to the Division of Industrial Hygiene 80 C~ntre StreeL New York~ NY. 100130 If in other types of structures~ submit plans to the Bureau of Air Pollution Control Services, Department of HealtlL 84 Holland Avenue, Albany~ N.Yo 12208~ 12o This ~cti~t ~;ha~l n(~ be considered aa approval of the fallout shelter facilities~ Plans for the fallout shelter shall be aubnl~tted for applt'oval to the Ic~cal aulhoritie,, having jurisdiction fox the locality involved~ This local authority shall inclade the depa~ct'~ 'at~ bure.~t~ dlvision~ ngency~ or person~ including any joint agency or a county~ city, town, or village, charged wi~h gbe enforcement of the ~applicable building code, multiple dwelling law., multiple residence law or othe~:[aw~ as def~ne,~ in Secglofl 3 o£ the Se~le,e Defense Emergency Act, relating to the cor~st~uction~ maintenance and use of btl~ld~ngs;, s~c!.~ci~.ees or o~her real prope~t?/o STATE OF NEW YORK DEPARTivlENT OF LABOR DIVISION OF INDUSTRIAL SAFETY SERVICE 80 CENTRE STREET NEW YORK° N.Y~ 100~3 CERTIFICATE OF APPROVAL (BUILDING PLANS) Address Reply To: DIVISION OF INDUSTRIAL SAFETY SERVICE BUILDING PLANS ENGINEERING UNIT L The plans and specifications bearlug the stamp and serial number of the New York State Department of Labor cited above are in compliance with requirements of the Labor Law and the Industrial Code and are APPROVED as submitted APPROVED with conditions. Valid only after the conditions set forth on attached Reference Sbeets are complied with. This determination is valid only on the basis of the statements set forth in the application for ex- amination of plans bearing the same stamp and number and to the extent that such plans are subject to the provisions of said Iaw and code and within the jurisdiction of the Industrial Commissioner. Notify the Building Plans Engineering Unit of any proposed deviations fi'om these plans; filing of revised plans may be required in these instances. A set of plans should be retained on the premises at all times so that inspectors of this department may consult them in the course of their inspections. A certificate of compliance must be obtained~ PRIOR TO OCCUPANCY, for: Any building to be used as a FACTORY with more than f~ff employees~ Apply at least ten days prior to occupancy, to the Supervising Factory Inspe ctor~ Divislon of Industrial Safety Service at Any building to be used as a place of PUBLIC ASSEMBLY~ Apply to local building official or~ if noae~ to Supervising Factory Inspector, Division of Industrial Safety Service at This is not a building permit° To obtain required permit take this certlficate~ with the approved plans, to the local official° The Department of Labor assumes no responsibility for the adequacy of the structural elements involve~l.&a ~he constructioa. O~ ~ FOR TIlE CO~ISSIONER ISS-640 (7-64) REFERENCE SHEET NO~ 2 NOTE: This sheet is an essential part of the action taken on this project° It shall be attached to the approved plans along with the Certificate of Approval° Plan S~rial No. June 1965 Date , 10 Exits and other features of gasoline service stations shall comply with the requirements of Rule 26-16o a. The exit doors from the office shall be not less than 28" wide and the door to the lubritury~ if of the sliding type, shall be held in the open position whenever .anyone is employed in the building° b. The grade door from the lubtitory shall be not less than 28" v~ide, and located on either side of the overhead door furthermost from the office unit° co The wicket door shall be (1) at least 24" wide, (2) at least 68" high~ (3) within 4" of the ground, (4) arranged to swing outward, (5) located in the overhead door furthermost from the office exit° do All permanent electrical installation below and within 4' above the uppermost fi*or shall be of the explosion-proof type° eo Underground gasoline storage tanks shall be vented at least 12' above ground but no such vent shall terminate under an cave or within 5' of an opening through which fumes may enter the building. 2. Protective features shall be provided for all warm air, hot water or low pressure steam, central furnaces and all direct fired floor mounted space heaters and suspended heating units as required by Rule 26-16o a, Floor mounted furnaces shall be so constructed or enclosed that all interior openings for intake of air which may come in contact with flame ate at least 4~ above the floor° bo Suspended heating units shall be jacketed and so mounted that the flame is at least 8~ above the floor° c0 Ceilings~ partitions and walls within 6" of the top, bottom and sides of the suspended unit shall be of fire-resisting (1 hr°) construction or protected by a shield of incombustible material° There shall be at least 1" open air space be- tween the shield and the material it is intended to protect and shield spacers shall be of incombustible material and at least a 3~ clearance between the unit and any shield° do Floor mounted furnaces shall be jacketed and shall rest upon a floor of incombustible material or upon a concrete base at least 2** thick entending at least 18" about the perimeter of the furnace° e. Ceilings~ partitions and walls within 18'* from the furnace shall be of fire-resisting (1 hr.) construction or shall be protected by a shield of incombustible material. There shall be a 1~' open air space between the shield and the mate- rial it is intended to protect and shield spacers shall be of incombustible material° There shall be at least 6~* clear- ance between the furnace and any ceiling, partition or wall and between the furnace and any shield° fo No combustible material shall be stored within 18" from a floor mounted furnace ot within 48'* from the burner side° g0 No combustible material shall be stored within 6" from a suspended heating unit or within 48" from the burner side° Protective features shall be provided for alt warm air, hot water or low pressure steam~ central furnaces and all direct fired floor mounted space heaters and suspended heating units as required by Rule 26~15o a° Furnace shall rest upon a floor of incombustible material ur upon a concrete base at least 2** thick extending for a distance of at least 24" about the perimeter of the unit° bo Units shall not be located nearer than 6" to ceilings or partitions of combustible material, unless such construction is protected by an incombustible shield mounted on incombustible spacers so that there shall be at least 1~' clearance between the combustible material and shield° Where such shield is used~ clearance between the ceiling and the unit shall be not less than 3" and between the partition and the unit shall be not less than 2~'~ Clearances shall be meas- ured from the outer surface of the unit to the combustible material. Ceiling protection shall extend at least 18'~ about the perimeter of the unit. Co No flammable material shall be stored within 5* of a furnace or heating unito do Where ducts pierce a floor, there shall be provided heat-actuated dampers of No. 10 U°S. gauge steel or ~" thick rigid- asbestos sheet material° 4° The central heating furnace shail not be located in an area where persons are intended to congregate and shall otherwise comply with Rule 36-10olo a0 Floor to have incombustible surface° bo Insulated and located so as not to overheat adjacent combustible material° c0 No combustible material to be stored within 5* of such furnace° do Chimneys and connections shall be smoke and gas tight~ firmly constructed and located or insulated so as not to over- heat adjacent combustible material° 155-~40.2 ( 1-64} REFERENCE SHEET°NO. 2 (CONT.) e, Cedtral furnaces in theatres, motion picture theatres and other places of assembly of over 600 capacity, shall be enclosed by construction having a fire-resistive rating of at least two hours and self-closing fire doors having a rating of 1 hr. f. Ceqtrnl furnaces in places, other than theatres or motion picture theatres, having a capacity of 600 or less, shall be enclosed by construction having a fir~-resistive rating of at least I hr. with self-closing rite doors having a rating of 1~ hr. g. Op6nlngs, other than doors, penetrating the construction of central furnace rooms, shall be provided with incombus- tibl? self-closin8 dampers equipped with heat-actuated releasing devices of an approved type° h. No ~oil, radiator or pipe shall be placed so as to encroach upon the required width of aisles, passageways or other means of exit° i. No floor register shall be placed in any aisle, passageway or other means of exit. 5. Direct fired space or unit heaters shall comply with Rule 36-10.2. a. Direct fired heaters shall not be located in auditoriums of theatres. bo Sha~l not be located within 7' of the floor where persons are intended to cangtegate~ co guspended direct fired space or unit heaters may be used without individual room enclosure under the following con- diti~ns: 1. 411 portions of ceilings less than 5' above the unit for a radius of 5' around a point directly above its center shall Re of at least fire-resisting (! hr.) construction, or protected by a shield of incombustible material. 2. l?artitions less than 18" from the unit shall be of tiro-resisting (1 hr.) construction or protected by an incombusti- I~le shield. 3. The protective shield shall be mounted on incombustible spacers to provide a 1" space between the shield and the material it is intended to protect. 4o If unit is located closer than 6" to a ceiling, a shield of incombustible material shall be interposed between the ~nit and ceiling° 6° Kitche!~ns and other hazardous spaces (such as garages, incinerator rooms, refuse rooms, receiving and shipping spaces etc0, &co) shall be separated from the ~emainde~.of the strncture by fire-resistive construction and otherwise comply with ~ule 26-5.2 or Rule }6.12.5. a. Partitions and ceiling, 1 hr. rating° bo Pariitions and ceiling, 1 hr. rating or covered kitchen side with sheathing of 3/16" asbestos board or equivalent. Co Floor construction, 1 hr° rating with finish of fire-retardent and non-absorbent material. do Do~s, ! hr° fire doors. eo Do,rs, swinging, self-closing to effect full closure of the opening° fo Do,rs, I hr° self-closing or self-closing sheathed kitchen side, with No. 26 gauge met~l or equivalent. go .pennings, other than doors, automatic, incombustible shutters or dampers arranged to close by the action of heat to effdet full closure. ho Ranges to have metal hoods and ducts vented to an independent chimney or insulated metal static. DEPARTMENT I~F LABnR DIVISION OF INOUS'TRIAL SAFE'TY SERVICE 80 CENTRE STREET NEW YORK, N.Y* 100t3 Reply To: BUILDING pLANS ENGINEERING UNIT I- L Ton of 5outhold Office of Building Inspector t~ATE: To~n Clerk' · Office $outhold, New York ATT: Mr. Hoard Te~y, Bldg. Insp. REQUEST FOR PLAN EXAMINATION FEE, ADDITIONAL W, ATERIAL, OR INFORN~ATION New Building ~lllia~ 4. & Rerm~n K. Llebl~ N/s Rain Road To~n of So~thold, Suffolk Co. New Y~'k June 18, 1965 Your application for approval of pimps is being held without action pending receipt of the items checked below. In order to expedite procesalng, please submit the items requested as soon as possible AND RETURN THIS LETTER WITH YOUR REPLY. 1. EXAMINATION FEES ~-~ a. $ plan examination fee is required. Please forward a check or money order payable to the Industrial Commissioner to cover the fee for examination of plans in accordance with section 204-a of the Labor Law. ~b. 2. PLANS [] a. The Department requires sets of plans for additional sets. Please submit ~ b. Your plans are being retmcned for the seal and signature of the architect or pto(csslon- al engineer who prepared them. [] c. Your plans are being returned for compietim~ with rospeCt to (1) Plan views of enttr~ structure (present and proposed) (2) Elevation views (~) 3. APPLICATIDN ~ a. The Department requires copies of applicatio.s Please submit additional copies. b. Complete item numbered c. Complet~ plot plan, and give specific add, ess, showing distance and name of nearest ~c. apple. Very truly yours, carl ]. MatteA Director STATE OF NEW YORK DEPARTMENT OF LABOR DIVISION OF INDUSTRIAL SkFET¥ SERVICE BUILDING PLANS ENGINEERING UNIT ALBANY, N.Y. 12226 APPLICATION FOR EXAMINATION OF PLANS Factories, Mercantile Establishments and Places of Public Assembly DATe 3. Lessee .................................................................................................................. Address ................................................................................................... 4. Doing business as ~ ~-. ' ........................................................... OCCUPANCY g. ,.Approval of plans is requested for use of building in accordance with the following statemcnts: 7. Total number employed at office work*.....~.~ .............. 7a, Total number employed at ~nanufacturing*.*......lt[Ol~O ............ ~ n r dml ~ al dewces or radioactive materials be oeerated, used, repaired or stored in this stmgtur~? .,.~. ..................... 8. Will a y a ' og'c ~ - ~O~" ~ ...... Merehand se rets led ~Ve~$ g. Nlaterials or articles manuracture~ ............................................................................................................................................ wholesaled ........................................................................ PROPOSED CONS/gU~. ~0. New building -'~ AddRion ~ ~lteration ~ Estimated cost~-.....~~ ...................................................................................... H. Number of Seers above ground..._ & , Be ow ~. ~? 12 At tomatic sprinklers ~ ~ All areas ~ ~ yes No yes No 13. Floors O~r~S ~ , Roof ~ Materials of "' ......................................................, ......................................................................... 14. Roofing........~...-., Flo~ramin~.......~. .......................... Roof framing ..........~...~...~ .......... Windows....~..}~...~.., 15, Access to adjoining building ................................ What floors .................................................... By what means ............................................................. 16. Heating system: Type D ~ ~ Distribution D D ~ D 17. 18. ns and methods used for window cleaning: Working from safe surfaces [~Working from wlndowsills or ledges [~Worklng from ladders: Greatest height - Top of window to floor: ft* [] Working from boatswain's chair [] Worl~lng from scaffolds: Height to suspension point: By powered scaffold: ~ Yes Applicants building in communities which bare accepted the STATE BUILDING CONSTRUCTION COD. E must complete the following /or factories and mercantile buildings: Give name and number designation of standards used for: SANITATION AND HEALTH FACILITIES COMPLETE REVERSE OF THIS FORM * Office employees include stenographers, accountants, typists, engineers, surveyors, designers, draftsmen, bookkeepers, clerks, etc. ** Manufacturing lflcludes making, alterlng~ repairing, finishing, bottling, canning~ cleaning, laundering, packing, sorting, crating, etc. ISS-6OO (7-64) i EXISTING PART OF BUILDING When' ~,~ ~ .. ~ [ "' ' Between 19. erccte : Prior to Between Oct. 1, 1913~ . '* July 1, 1924~ I After .......................... Oct. 1, 1913 ................ July 1, 1924~ ................... June i, 19351 ................... ~ June 1, 1935 ................ 20. Was tl~e structure occupied as a factory on July 1, 1948 [~ [] by whom ..................................................................................................... 21. Most ~ecent ooenpant ..................................................................................................... Type of business .................................................................... 22. No. ot~ stories above ground.......' ..................... , Below ............................, Sprinkler system over all areas [] [] 23. Materials of walls ........................................ , Floors .......................................... , Roof .......................................... , Roofing ............................................. 24. Itave ~ny variations been granted relative to features of this stmcture? ................................................................................................................... 25. ALTI~RATIONS. Descrlhe in detail all proposed alterations. PO)NTS OF COMPASS SCALE: .................................................... IN SPACE ABOVE DRAW PLOT PLAN OF PROPOSED WORK AND ALL CONNECTED STRUCTURES Designatei each section hy proper number and name; indicate height in stories of each section; give date of erection of each portion; plan mu show entite outline of connected structures and approximate overall dimensions; show north point; give name of and show location of adjure streets, railroads, canals, rivers, buildings, lot lines, ere. Distance to nearest intersecting road or street must bo shown. LABO,R LAW ~ DEFINITIONS Sec. 12.-9. "Factory" includes a ~nill, workshop or other manu£actaring establishment where one or more persons are employed at mamffa raring . .I, and includes all buildings, sheds structures or other places used for or in connection therewith, except (a) dry dock plants engag{ in making repeirs to ships, and (b) power houses, generating plants and other structures owned or operated by a public service corporati~ other tha~ construction o.r repair shops sub'ect to the urisdiction of the public service commission, . . ." Scc. i2.-11. "Mercantile establishment" means a place where one or more persons are employed in which goods, wares, or merchandi are offer&l for sale and includes a building, shed or structure, or any part thereof occupied itl cmmection with such establishment .... ' Sec.~ q-12. "Place of public assembly" shall include (i) a theatre, (2) mpving picture house, (8) assembly halls ma ntained or leased pecunlar~.'gain where one hundred or more persons may assemble ~or amusement or recreation, except (a) halls owned by churohes, religio orgamzatt[ms, grange and public association and free libraries as dcllned by section two hundred fifty-three of the education law, (b) hotl having fi'fry or more rooms, (c)' sta,,te anti .county fair grounds and buildings connected therewith, (d) grounds or buildmgs of agricultural soctet~ or aasoci,~tions receiving state aid. INSTRUCTIONS 1. FILING REQUIREMENTS. Filing of plans and specifications is required for new or altered buildings to be used aa (1) factories or mercantile establishments except fdr buildings located in the City of New York, and (2) places of public assembly except for such place/s located in the City of New york or in other cities ha~rlng a bureau of buildings which is charged with the duty of enfotclag a building code enacted by the legislative body of such city, or in a city~ town, or village which has assumed responalbillty under sec. tlon 472 of the labor law. 2. ARCI;IlTECT~S SEAL AND SIGNATURE. The seal and signature of a New York State Registered Architect or professional Engln*ez are r~quired on plans and specifications when such plans and specifications are subject to examination by the Department. 3. EXA"~INATION FEES. plans will not be examined until the appropriate fee is received by the Building plans Engmeerlng Unit. a. B~ildlngs to be used or occupied as factories or mercantile establishments. T~e following fee, based upon the estimated cost of construction or alteration, must be submitted together with the plans and a Lqss than $10,000 $1~),000, or more but less than $20,000 $2~,0,000 or more but less than $30,000 Estimated Cost of Fee Construction or Alteration Fee $ 10.00 $30,000 or more but less than $40,000 $ 40.00 20.00 $40,000 or more but less than $50,000 50.00 30.00 $50,000 or more but less than $75,000 75.00 $75,000 or more 100.00 p~aces of public assembly. ~fee of ten dollars ($10.00) must be submitted together with the plans and applications. FORM NO. 1 TOWN OF SOUTHOkD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................ , ....... : Examined *~'" / ] 19 ~ ..... No. ~pprovea ...................... ~ ......... f....., ly ........ ~ermit ~o ............................. ........... 9 - ' .............. ............................. ............... ............................................... (Buildin~ ~spoctor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is pa:rt of this application. 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 progress of the work. e. No building shall be occupied or used in whole or in port 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,.,~ilding code and regulati, o~rsr.) (Siqnature of applicant, or name~if a corporation) ........ ....................... ...... (Addres~ of applicant)-- State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done .Map No ' -=:-"~' Lot Nn - ~ Street and Number ............ : ..v, ~ ~' Municipality 2. St&te existing use and occupancy of premises and intended us~ and occupancy of~Rroposed construction: a Ex st ng use ond occupancy ~.~.~...O,~/A/~*X ~7~t~/~,/~~'~ '~ '~C ~jJ~J'--~ b Intended use and occupancy 'J~)O ''~ ~/k) ~'~,S ~ 3. Natu~ Repoi 4. Estim 5. If dw If 6. If bt 7. Dime Hei¢ Dime Depfl 8. Dime Heigl 9. Size . 10. Date 11. Zone 1 2. Does 13. Nam Nam Nam Locat~ property Ii whether iht STATE OF COUNTY above nar of said o~ this appli, of work (check which applicable): New Buildihg ...... ~.......... Addition .................. Alteration ................ .................. Remo, Cal .................. Demolition .................. Other Work (Describe) ...................................... · ed Cost ........ .~... ~.O..C) .......... Fee .... ........................................................................ (to be paid on filing this application) ,,lling, number of dwelling units ............................ Number of dwelling units on each floor ......................... number of cars .......................................................................................................................................... age, siness, commercial or mixed occupancy, specify nature and extent of each type of ~sions of~lll~l¢~ structures,,.'l~: Front ........ /.~". .............. Rear ....... /..~'. ................... Depth .. ,¢¢~,.,~. ...... ~.._ * f t ...~/.2~;.. ............. Number o Stories ....... / ...................................................................................... .............. ~sions of same structure with a.lterations or additions: Front .................................... Rear .......................... ................................ Height ............................ Number of Stories ................................ .sions of entire new construction: Front .................................... Rear ............................ Depth ..................... .................... Number of Stories ................................................................................................................... lot: Front ....... ..~. '...""'~. ........... Rear ........ ~,2~.~...4~ .................. Depth ..... ~/.~r:.. ~ .............. Purchase ...../...~.., .~..~... .................................. Name of Former Owner ...... ..~-~..~,..../~....~....~..~....~.. .................. or use district Jn which premises are situated .....~....O...,~..: ................................................................................ )roposed constructi~n_.~io, laIe. any zo?ng law, ordinance or regulation? ...... ~...~ .......................................... ,,., , ~4/:'~_ ,'~/f'~/~,,/-,~ ~'~Z~/~Address ~:~ ~'-~"~...0, ..~..~, Phone No.~7.,%~...~.~'.~'~ of Architec~2. ~.~.'~"Z~"~''~''' *ddres'~"~:""~'"'~""3"]'"?"?'"~'"?" ........ Phone of Contractor ..... ~ ..............": ........ Address ............................................ Phone No.'~... .............. PLOT DIAGRAM :learly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro es. Give street and block number or description according to deed, and show street names and indicc ,rior or corner lot. .k x NEW,YORK, , ~ c ¢ ,., .~ .~,.,,~.....:~.;,~. ....... .~.'...,:w:,.(;..6~,., ........................ being duly sworn, deposes and says that he is the applk (~ame of individua sign ng app icat on) ~ed. He is the .................. ~,x, .,~?/. ...... , ....................... (Contractor, agent, corporate officer, ~tc.) 'her or owners, and is duly authorized to perform or have performed the said work and to make and ation; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ ~rk will be performed in the manner set forth in the application filed therewith. Sworn to [ elate me this ./...~ 7/'~ day of ....... '..(~.~.~...,~¢ .................. , fg.~':.~,.-.' ' ............... ,'" ~-, ,, j , .. ,r':" ' . ; ;.. /o.] "~ ) ' , ('/ ( C~ ~: "~c~unt '~,. -F[~' (S, I applicant) Notar P bhc¢).~.., ~'x,,.,., ............ (..,.../......., .......... [. .... 14,A,:,0~ a .... ., ,, g J No. 52-3233120 Suffolk C2uh. ty Term Expires Marcil 30; TOWN OF ~O~ZTHOt. D ~JH.D~N~ ~ARTM~NT *~M~N ~'S OFFICI Sou'r~.~, N. Y. ~ ...................... ~ ............... , 19 ........ Permit No ......................... ..... .................... ................................. All. LIbaTIOn4 ~ BUILDING PIRMIT .' ' ; "' , ' · INSTRUCTIONS a. This application must be completely ftl~ed in by typewriter or in ink end submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a datoJled description of layout of property mUst be drawn on the diagram which is po~t of thi~ application. 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 progress of 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 I~uilding Department for the *ssuance of a Building Permit pursuant to ~he Building Zone Ordinance of the Town of Sc~thold, Suffolk County, New York, and other applicable Lows, Ordir~nces or Regulations for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil appJicable lows, ordinances, bs~ding code and regulotiope~. ~-~ , ........ State whether applicant is owner, lessee, agent, architect, engineer, general contractor;, electrician, plumber or builder. ............... ............................................................................... - ............................................................ Nameofownerofpremises ~..~.'~.L''/~ /~t~ .~. .'~.t. ~ ~....~...k~t~.~ U ~ ~ ; ~ ~ Z ~'~l If ~licont is a c~rate, sig~ture of duly authoriz~ officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. N~ap No.' .............. ~ ................ Lot No.: ..... ?~ ..... ............... '" Street and Number i ....... ~.....'~.. ..................................... .O.....~.. .. Municipolil'y 2. State existing use and occupancy of premises an.d intended use and occupancy oft~ioposed construction; a. Existing use and occupancy ...... ...~.....~...,,~..J....~...~..L~...~...,..~.. ~ .~.....~,.....~......v,....~..~...j.j~. ~,. ,.~... ................... b. Intended use and occupancy ....... ..l~..~J..~..~..~......~....~.....-~.. ................................................................... 3. Nature of work (check which oppIicoble}i New BuildiNg ...... ...~....... Addition .................. Alterotion .................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each ~l~r ............................ If garage, number of ~rs ............................................................................................................................................. 6. If business, commercial or mixed ~cupancy, speci'y nature and extent of each type of use>~.~.,..~.~ ..... 7. Dimensions o~ structures~: Front ........ ~ ............... Rear ....... ~.~ ...................Depth ..~.~ ........... Height ...~..~.~. ........... Number o~ Stori~ ....... / ...................................................................................................... Dimensions of same structure with alterations or odd,hans Front .................................... Rear ........................... Depth ........................ Height ........ ~umber o{ Stor~es ............. 8. Dimensions of entire new construchon: Front ................................ Rear ............ D~th ....................... Height .................... Number of Stories ........................................................... 9. Size of lot: Front ........ ~ ........... Rear ....... ~ ............ Depth .... ~ ~..~ .............. 10. Date of Purchase ..... ~.~.~. ........................... Nome of Former Owner ...... ~;~ .................... J 1. Zone or use district in which premises ore situated .. ~..; ................................................................................. 12.. ~s pr~osed constructi~n~iola~, ~'~ ~' ~) ~ ~/~AddressanY zoning law, ordinance or~regulation~ ...... ~"~ ............................................. Phone No~ 13. Name of ~ner aT pr6mises ................. ~ .......................................................................... Name of Contractor ........ ~; ........... : ................... Address ........................................... Phone No.~ ........ PLOT DIAGRAM L~ote clearly and distinctly all buildings, whether existing or pr~osed, and indicate ali set-~ck dimensions from pr~erty lines. Give street and bilk number or description according to deed, and show street names and indicate whet~er interior or corner Jot. s-rAzE OF N W.¥ORK, - eS S COUNTY OF ... ,.~,5~,.,,~,~.,,.~.~.....././)..~......Z~.¢..(..~.~.../,_~'-III .................. being duly sworn, deposes and says that he ,s the apphcant (Name of individual s~gning apphcohon) above named. He is the .......................... ~-'* · ('C'ontractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and hie this application, that all statements contained in th~s application are true to the best of his knowledge and belief, and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this