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HomeMy WebLinkAbout16117-Z i FORM NO. a 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) Ivy 16117 z Date ............ :... .............. 199.7. Permission is hereby granted to: ^ ..... ........(�.... ...... ................................. 1� ........1. ............................................................. 41 . .......ar..s ........ . .... . . . �� a-n..... . ..'... ... to ......................... .... .... .. ........: .... ......... ....'.. ,.... ....cif ... .... ................................................. atpremises located at .. R.-D..... ..................... ........................... County Tax Map No. 1000 Section ......L!�...... Block .....0.a........ Lot No. . ............ pursuant to application dated ........... ..44t.'.'�.�3........................ 1917, and approved by the Building Inspector. 1-11 Fee $..,. . ..... ...... 4 .......................... ........ ......................................... Building Inspector Rev. 6/30/80 /A� , - 3 - / o �r���rr������r�����r �r�� ��r ��������r������r��rsr�r����r� �����r�r�� oc 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 5 5 � BUREAU OF ELECTRICITY 5 5 40 FULTON STREET - NEW YORK, NY 10038 c� CERTIFIES THAT 5 5 55 5 Upon the application of upon premises owned by 5 5 5 ROSLAK ELECTRIC LESTER JR HUBBARD 5 P.O. BOX 164 900 ALBO DRIVE 5 5 CUTCHOGUE, NY 11935-2453, MATTITUCK, NY 11952 r5 5 00 ALB 9O DRIVE MATTITUCK, NY 11952 5 5 Located at 5 5 2070984b N ti li Appcaon Number: 2070984 Certificate Number: 5 5 e5 5 Section: Block: Lot: Building Permit: BDC: ns11 S 5 5 Described as a Residential occupancy, wherein the premises electrical system consisting of Cj electrical devices and wiring, described below, located in/on the premises at: 5 service only, Outside, 5 5 5 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 5 herein, was conducted in accordance with the requirements of the applicable code and/or standard S promulgated by the State of New York, Department of State Code Enforcement and Administration, or other 5 55 authority having jurisdiction, and found to be in compliance therewith on the 27th Day of December,2005. 5 Name QTY Rate Ratin Circuit Type 5 Service 5 5 1 Phase 3W Service Rating 200 Amperes 5 5 Service Disconnect: 1 200 cb 5 5 Meters: I S 5 5 5 5 5 5 5 S 5 5 5 5 5 5 5 5 5 5 5 seal S 5 5 1 of 1 5 5 - 5 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 5 o �Ln��Ln�LnLn��������L L Lis ����������������� ���������� o TOWN OF SOUTHOLD BUILDING DEPT. '-'>765-1602 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [` ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: A_," 6 DATE �� INSPECTOR 3 � H UNDATION ( 1st ) c UNDATIO14 ( 2nd ) m _ z o UGH FRAME & - PLUMBING C/3 y r J . [*7 vim/ SULATION PER N . Y. STATE ENERGY CODE x -------------- a s ' FINAL . I � ADDITIONAL COMMENTS : e,vl7 QD x H 16 a � H O 1� z _w - ob x a • r H � - x d -o • H BOARD OF HEALTH ` 3 SETS OF PLt1, - "FORM NO. 1 SURVEY . . . . r(( I TOWN OF SOUTHOLD CHECK JUN 81987 BUILDING DEPARTMENT SEPTIC FORM , . . . . . . , , . TOWN HALL NOTIFY TO6;e'.d ,a�, SOUTHOLD, N.Y. 11971 . . . . . . . . . . . . . . —_- TEL.: 765-1802 CALL MAIL TO : Examined . . . . . . .. . ., 198? r � Approved . . o . XA. ., 19V1. Permit No. .1.(.�! 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,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 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp[[ecc�tion llJ'7� �htor . . . . . . . . . . . . . . . . . . . . . (Signature of appl' ame, if acorporation) a k is . ... . . .S� u T(fo , N. . . ./. . . . (Mailing address of applicant) State whether applicant is-owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 'j. . . . . .LSaL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . L�Si L . . . . � u!��}A��� . �/�pe,. . . . . c d,�rr+ f fiu��:��e . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - (Name and title of corporate officer) ALL CONTRACTOR' S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. . . . Jr 3 7.- . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f®. �. . . . . . . . . . . . . . . . . �L'.1130 .'p�... . . . . . . . . . . . . . . . . . . . - . . L.? Fes. . . . . . . House Number Street Hamlet ' ! 9. . County Tax Map No. 1000 Section . . . . /r� .��. . . . . . . . . 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 . . . . . . .�! E S,i�c N i. � . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . Si t? ,v, u..? �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition . . . Alteration . . . . . . . . . . Repair . . . . . . . . . .... . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . ,.(Description) 4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . .: . . . Fee . . . . s . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . If garage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use' . . . . . . . . . . . . . . . . 7. Dimensions of existing strictures,if any: Front . . . ?.7 .. . . . . . Rear . . : 7. . . . . . Depth . . a. . �. . . . . . . . Height . . .A®... . . . . . . . . Number of Stones . . . . . . . . .". . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . --,8. Dimensions of entire new construction: Front . . . . . . . . . . . . Rear . . . . ..?-A . . . . . . . Depth . . . ! ?-. . . . . . . . . Height . . . a!•.i. . . . . . . . Number of Stories . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . .l.00' d. 'Rear . . . . . . !cv _ : . . . . . . . . Depth . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . ':ac.�.� • . . . . • , , . , • . , , , . • . , , _ , . , . • , . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . AJ . . . . . . . . . . . . . . . . . . . . . . . , 13. Will lot be regraded . . . . . ."J.0 . . . . . . . . . . . . . . . . . . . Will excess fill be rem ve rom premises:NCN-6 Yes No, 14. Name of Owner of premises .k 5' . ttk0rVAu� . . . Address .�! A �J.(.. ..Phone No. . .�g.5� Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . Name of Contractor . tea�? . �'���`'.'j `'s. . . . . . . Address $bx��3a-a :�K?����.Phone No. .7t�� 15. Is this property located within 300 feet of a tidal wetland? *Yes . . . . . No .✓. . . *If yes, Southold Town Trustees Permit may be required. 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. Aff A C H (ED S dtf 4Ls7 STATE OF NEW YORK, S.S COUNTY OF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, 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 file this application; that all statements contained in this 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 . . . . . . . . . . . . . . . . ;� . . .day of. . . . . . . . . . . . . .119 V Notary Public, . . . . 1i�-� . .1l: . . . . . . . . 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