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Home My WebLink About9057-z FORM NO, g TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 765- 1802 ~LICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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 features. TOWN of $OUTHOLD OFFICE OF BUILDING INSPECTOR Town Hall Receipt NO. 5 5 ~; ~ ;I Southold, New York 11971 Date ........ .................. Receiva~ o~ ...... ~:"=~""7 ..................... ["~ ..........7 ............................... ~ .................. ~ ~, ~ /10~ '~ /lOODolla~ ~o ....................... ~'~"~7~ ...... ~'~'iz~' ~/~ '~ ~' F~*o~ Fee for Fee for ~rttficate ~ H.I.C. Yard Sale [] [] eck I ¥f'¢, ................ /~.¢...,...~..(~ ................ [~ Budding Permit ........... ..... Building Department · .......... :l County -Fax Map No. 1000 Section .. ~ Block ............ Lot... :'?. ~ ~ ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ......... Date of Permit .... Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planoing Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ................ . ............. ~/ P~ ./.~./~.: ./~...: .~.~.:~... :-, .............................. Rev, 10-10-78 / THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy ~- '~:~ 85 JOHN STREET, NEW YORK, NEW YORK IOO$e .at. N , 548 THIS CERTIFIES THAT only the electrical equipment ~ ~scribed below a~ introduc~ by t~ applicant ~med on ~he a~e application number in the prem~es of in thefollow,ag t,,cation; %Basement ~ lat FI. ~ 2nd FL Secth, n Bl~:k Lot ~ ~ c e~ and fouad to be in compliance with the requirements of this Board. a~sexaminedon L~}~;(~kb~k~ ,~ [~l ~IXTUR$ FIXTURES RANGES DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS SYSTEMS NO. OF FEET OTHER APPARATU$: E R 'V c NO. OF Hi tEG A- W O NO, OF NEUTRALS A W O O~ HI-LEG OF NEUTRAL IPOBM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ................. proved .................. ; ............... ,,.., Ferrnit No ..................................... ............. ~...............~.... .......................................................... Disapproved a/c (Building Inspector) q~ ~7 Application No...?...O,.....~...~... .......... 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 of property 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 Deportment 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. ~///// (Signature of~'pplicant, or name, if a corporation) ............. ~.!..~.J..~ ...... .~.~ ............ ~..u..~.~..o..~. ................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician alumber or builder APPROVED AS NO~ED ' Name of owner of prem.ses .................I.~..:..X ......... '..:.:....~..M..~...'..~.~ ....... F. EJ~,. c~~~: .......................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .................... ...~.....~...~.....~..!.[..~..~T-.... Plumber's License No .......... .(.~.~...;...?~.....~.l..!...~-.~.~ .......... Electrician's License No ...... ~.~. ...... .L...~.~.~..Z!.~.L~ Other Trade's License No ............................................... NOTIFY BUILDING D,flp/.~,~TME[',~T AT 765-2660 c)~\M fo 4PM ~:OR ED INSPECTIONS: 1. BEFORE BACI~FILLf~,~ TION OR S'I'3qT 4. FINAL VVHEN JO3 CC ~)' NOT RESPO~5~LE FOR D~ OR CONSTRUCI'IO~ 5. ALL CONSTRUCT~J LII]ST ~"t~T 1. Location of land on which proposed work will be done. Map No.: AJ~D.X.kx,~q.N..Ht::T3~, ~.s:,.~..,. L~t ~(h¢,.;.:;?~G .............. .C6.~.Y~T..s. Street and Number .................... ...... ........... ../~...?,..~, ....................... Municipality 2. State existing use and occupancy of premises and in,~ended use and occupancy of proposed construction: o. Exisiting use and occupancy ........................... ~..?..?.4....,..b....~J. ............. .~.. ........ .~...~..-~...f)...C...(~ ........ ~../~....~..~f L: ... b. Intended use and occupancy ~.. bD ~Z0 (~gu/ L~' ~j~ ~ ~ 3. Nature of work (check which applicable): New Building~· ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4, Fstimated Cost .....C~....~....O....O.......~ .......... ~...O.. ............ Fee ............. !...~. ........ ...~.....(.,.O... ......... ~......~....>.i...~... ................ (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 oars ............................................................................................................................................. 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 ............................ Deptb ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..................... (..! ........... Rear ................ ..>~-.. ........ Depth .....(....O. ............. Neight .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ....... ,.J~.....°z:~... ....... ~ ................ 11. Zone or use district in which premises are situated .................~....k"~-~.....~.~.~ ....................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........ ...~.., ............. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..... ~.~.~,.. ......... ~.~..!..k..t:..~.....~. ....... Address .....~....~c....C~.....,. ....... Phone No. ...................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ..... ..'~..?..~..~.. ........... ~T!.~.?.~...~..~...(~.. ....... Address ................................ Phone No?..~...5'..Z.~.~.!~'~. 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. STATE OF COUNTY OF . .~.. ~.~'.L~. ....... ................................................................................................ be ng duly sworn, deposes and says ~hat he (Name of individual signing con~rac~) above named. Pie is the ................................................................................................................................................................................. (Contractor, agent, corparate officer, etc.) of said awnar or owners, and is duly au~harized ta perform or have performed the said wark 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 thai' the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this .................. ~.~ay of .................................... ~.~ ~erm ~xpires ~rch 39,