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Home My WebLink About9058-z FORM NO, 6 TOWN OF SOUTHOLD ~ece~pt No. 33/I~ TOWN of $OUTHOLD OFFICE OF BUILDING INSPECTOR Town Hall Southold, New York 11971 ,//77 . Date ........ ~.~...~.~.....~.. .................. ~ece~veO o~ ..... ~ .... ~'~'"'"~' '-- ~' - ¢~. ~, - / OtC ~ /100 Do ars '~-~.~ c~.'] ~ . ........ i.../.. ...................................................................... ~ ,,.~ -~7 ,,_~,~,.- @,,.,,.~/~...~ ~ .L e.,,./~.~,z ..D~..'~.~¢...~..~¢.:~.-: ..... r" . ~.cz. ~ t..~..'~..y...~. ....... .~....~....¢¢ .~.~. ...... ~';=.". ........... ;;'":"~;'~'~'t'"F:;..: ..... :O ............... ~,.~- a-~.~.'~-- ~.S"a~¢~.~¢~__ ~¢/o ~"' ~ Feeler Fee for Fee for ~:z.~ r:_~rtihcate [_~ Yard Sale [] [] L-~ H.I.C. E~ Building Permit L~] of Occupancy ~] Misc. Fee for Cash ................ &.d...,...~..a ................ Building Department 1. Certificate of occupancy New Dwelling $25.00, Accessory ,$ ]0.00 Business 850.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... New C on .~ t r u c t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................................................................... House No. Street Ham/et Owner or Owners of Property i_'b/', t'/1 )."/.~ /~( I /~ /-~- /~ County Tax Map No. 1000 Section ...~.-i~, ........ Block .- .............. Lot... i/. .Vi. // Subdivision ................................. Filed Map No ........... Lot No .............. Permit No .......... Date of Perm{t .......... ApDlie~nt Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described bu lid lng and per,~t ~¢/~et~j~applicCble codes and regu lations. ,,,,,ca,....///./.. './. ................................... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-- :&~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date O(~X)b~~, ,~ j,~)~*~ Application No. on file ~7~/87 Ng v ~ ~ '~ u THIS CERTIFIES THAT o~y the electrical equipment ~ ~scrlbed below a~d intr~uced by t~ ap~icant ~ed on ghe a~ve appllcatJon number in the prem~es of in thefotlowlngh,cation; ~ Basement ~ lst FI. ~ 2nd Fl. Section Blm:k Lot ~ , ~ and found to be in compllauce n'ith the ~equirements ~f this Board. ~s examined on [~ ~$ (~'1[')(~~ ~ FIXTURE OUTLETS RECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS INCANDESCENT FLUORESCENT DRYERS SYSTEMS NO. OF FEET E R C NO, OF CC COND A W O A W O, NO OF NEUTRALS A, W G. PER ~ OF HI-LEO OF N~UTJJAL OTHER APPARATUS: ~,~ *~'.~,~ '~,l · ~C'o' GENERAL MANAGER ~l~ This certificate must not be altered in any manner; return to the office of the Board if in~o~rect. InspecLors may be identified by their credentials. ~ ~J . CO. Py FOR BUI~IN~ DEPA?~ME~T/. THI~ CO~ ~.~F;~?~IC~?:0~{~_~Z~E~o IN ANY ~NNER. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. E o ,ned ................. 90 7 Approved .................. ...~../Z.....~....~., 19.~..Z. ~-cc~ ~(J~'g~ 7~ Perm t No ..................................... Disapproved (Building Inspector) Application .......... APPLICATION FOR BUILDING PERMIT Date ....................... INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate 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 ofproperty must be drawn on the diagram which is part 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 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 buildings for necessary inspections. ........ ............. ....... ............ ................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general .cQ0.tJ:o_ctQr~ electrician, plumber or builder. A~PP, ov£D~ AS NOTED ................................................................................................................. B.,~T.~,~7.~. ~. .............................. ~N o ow p .................................................. :.~ ........ ~.....~ ................. ~.>..~ ............................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .................... ...-~....~...~...;.~..(.'.?~/.~.. .... Plumber's License No .......... .~ ..................................... Electrlcian's License No ...... ..~..z. ...... .L....r?....~...E'....,J~,!../~r..P,~ NOTIFY BUILDING DF. PARTMENT AT 765-2660 9AM fo 4P,M ED INSPECTIONS: I. BEFORE EACKFI[I.~N~ ~'.O'.~'~A, TION OR 5'F/,RT F 2. FRAMI~G 3. BEFORE COVEP. I~,~C 4. FINAL WH~:N NOT RESPO~'JS{~}L~ OR CONS'f~UCTJON 5. ALL CON:;'rRUCT~f~ MUST ~."~"1' Other Trade's License No ............................................... REQUIREM~N*' r. ""~ F N.Y. STALE '~""' Location of land on which proposed work will be done. Map No.: /~D..T.Q.'~N../J~S~ ~.,_ :~ L~T ~q:~.,.,.,~(~ ........... Street and Number ~V~ ~k~(~ '~J~ ~0~ ~o~ f~ Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ~ b~ ~0 ~ ~ ~ ~ . 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost .....~....~....0..?.......?.~' ~' ' .......... ~--~'~..o~......U.. ............ Fee ............. ''~-!...?_. ........ ...~.....(...O.. ......... ~.....~.....~.i...~.. ................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number af dwelIing 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 structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..................... (..! ........... Rear ................. ~ ........Depth ,....(....O. ............. Height .................... Number of Stories .... ~ .......................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................Name of Former Owner ....... ..J~..~ .......~ ................ 11. Zone or use district in which premises are situated ................ .~....k/r:~.....~.~..~.~.~...~ ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ......... ...~... ............. Will excess fill be removed from premises: f ) Yes ( ) No 14. Name of Owner of premises ..... %.~,~... ......... ~..!.~..E...,...~.. .......Address .....~....~.,..~-....¢. ....... Phone No. ...................... Name of Architect .......................... ~ .................................. Address ................................Phone No ....................... Name of Contractor ..... ..,~...0..~..h¢., ........... .FT.!...~..?..~...r!..~...~,.. ....... Address ................................Phone No?...~..~.:..~.~.(--~. 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. STA~I'E OF NEW'~"~-, .,,/~ [c c COUNTY OF . .~.. ~.~./~. ....... -- -d0bkf ................................................................................................. being duly sworn, deposes and says that he is the (Name of individual signing contrac¢ above named. He is the ................................................................................................................................................................................. (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 ail statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .................. of .................................... .............................................. ..... .................................... ~ . ~ture of o~plicont) ELIZAflLTH ANN N~ILL~ - / NOTARY P/If]~[C, State 0f New ~f~ [ No, 52-8~2~, S~ff01k C0untv ~erm Expires b~arch 30. 19~