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HomeMy WebLinkAbout9744-z FORM NO. ~B TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PER/vtIT (THIS PERMIT MUST BE KEPT ON T,HE PI~EMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N9 974 Z Permission is hereby granted to: ...... Kd~avd. ~e~-'~': at premises located at ....... ~.~..,.~O.,...~q..~....~.....~.~.?..~.....~..~...~. ....................................................................... -. .......................................... :B..e. co~..g.,..~ ...................................................................................... pursuant to application dated ..... .~...~.~. .......... ! ................................ , 19.?..~...., and approved by the Building Inspector. Fee $,,,J.O.,:,O.,O., ........ /, Building Inspector 1000-68-4-I]5 & 16 FORM NO. 6 TOWN OF SOUTHOLD Building Depar~men~ Town Hall AP, ,-,C~i ,ON FOR ,-R~h IC,~T~ OF OCCUPANCY instructions A, This applicat on must be filled in Wpewriter OR fnk, and submitted in duplicate to the Building InsoE tor,,vi~h the following; for ne','/ buildings or new use: 1. Final sur'/e,/ of prcperty with accurate location of afl ' bund ,,gs, property lines, streets, and unu% 2. Finalaoprova of HcaJth ~ ' Dept. oT water supp y and saweraqe dispose --(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Undep~vriters. 4. Commercial buildings, IndustriaJ buildings, Multiple Residences and similar bu[Id[ng~ and instalJ tions, a certificate of Code compliance from the Arch[tact or Engineer responsible for the 6. Submit Plannina Board approval of completed site plan requirements where ~ r ~ ~ a~pdc~b/e. B. Fcr existing buildings (prior to April 1957), Non-conforming uses, or buildJnas ahd "pre-ex~stmc 1. Accurat~ ~nzey of peoperty showing all prooerW lines, ~reats, buildings and unusual natural topographic features. ' 2. Sworn s~a~ament of owner or previous owner as to use, occupancy and condition of buildings. 3. Oa~a of any housing code or safety inspection of buJldincs or premises, or other pertinent inform~ tJon required to prepare a ce~ficate. / - C, Fees: 1. Ce~if~cate of occup3ncy S5.00 2, C~r~ific:[e of occuoancy on pra-exis:~ng d,,veH[ng or land use S5.00 3, Cea,/of certificate of occupaac,/ St.C0 ~,~ ~ Date.. './~( (~ ~ · ............ ~u~Jc.n~,.) ........ : /Vacant Land ~/:: ~o~o~,~ ~. ~:q~.. ........ Location of ProperW ........ . ............................ ~ ............. Owner orOwnersofProperty ... ~' ~* ~1~ co.~tv T~ ~ No mOO S~t~o~ O~ ~:~ ~ Lot. 4..~. Subc[,,qsion ................................. Filed Map No ........... Lot q?~Y a~ ~ ............. ~ ~ ~ ~ ..... ~.. ......... ......... ......... / ..... Under,vritersApproval ~0~~ Z~ ............ - ......... Planning Board Approval ................. Request for Temporary Certificate · .................... F~nal Certificate ........ - ......... Fee Submi(tad S ~¢ ~ Construction on above described 5uildmq oqd pern~i~ me, ts all aool~cob[opod~s ~Rd regulations. ..... ............... . ..... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 .JOHN STREET. NEW YORK, NEW ~ORK 1OO38 Date Jm%l~ ~0~ 1983 Application ~o. o. /~ ~18/83 N 590517 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of was examit~ed on J~%~ 17 $ l~ and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS DRYERS ~ECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FAN FLUORESCENT SYSTEMS NO. OF FEET OTHER APPARATUS: E R V I C NO OF~EC~C~CONDc.~ A W.G. J NO OF HI-LEG O~ CC COND AWG OF HI.LEG NO OF NEUTRALS AWG OF NEUTRAL GENERAL MANA?JER ~ / gou~ld, N.Y. 11971 Lic#578E ~. // ~; / This certificate must ilar be altered in any manner; return to the office of the Board if inc~rrecf. Inspectors may be identified by the r credentials. FOR,M~ NO. ! TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..........y .......... ............ , 19.,,~.o... Approved ...~W~.."....~._,.~.. ........... , l~,,..ff., Permit No, ....?.Z?...~..~. .......... ............ Application No..ff../.~.~.....: ................ APPLICATION FOR BUILDING PERMIT / ...... , Dote ....................................... INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ 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 o 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. '"4; ,..T,; ..................................... (Signature of applicant, or nome, if a corporation) (~,ddress of applidant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... .............................................................................................................................. Name of owner of premises ............ ff~.f..~:~4-..,~. ....... ~..¢;,'~'~.,-~.-~.. .................................................................................... If a~plicant is a corporate, signature of duly authorized officer. ~ ~ p ~ ~ ~'(H ~ ........................................................................................ To (Name and title of corporate officer) ~TI~'~E~ ~Ui~l~-~ ~ Builder's License No ................. ~.~ ............................. Plumber's License No ................................................. Electrician's License No ............................................. t 000 -- G~'--ff - I ¢ ~z ~ G Other Trade's License No ............................................... ~ I 0 1, Location of land on which proposed work will be done. Mop No.: ........................................Lot No ......................... Street and Number ........ ~}..g~ ......... ~.~l~.~/.~.c~ ........ ~, ...................... ~CFi:,4.~,2..~..,.~L~ .... MunicipaliN 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ....................... ff~.~..4.~a?.~.~ ......................................................................... b, Intended use and occupancy .............................. ~..~.e .................................................................................. 3. Nature of work (check which applicable): New Building.'/'"'~' ' Addition Alteration Repair .................. Removal .................. Demo]itioc .................... Other Work .................................................... (Description) 4. Estimated Cost 3/ ~.~.Z......'~... ..................... Fee ~' (to be paid on filing this application) 5. If dwelling, number of dwelling uni,~/,~.l//)\] ........................... Number of dwelling units o~each floor ............................ If garage, number of cars ............ (...~.~..~..~..'(..~....~.....~.....-~.2~//.-~-..:t....~..~. -~..'~-.Q.*4'~..~) ............................................. 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 .........6./..?..2 ......... Depth Height ...... /..~...~. ...... Number of Stories I . 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchase ........................................................Name.,~. ,~ j/of ,Former ,Owner ........................................................ 11. Zone or use district in which premises are situated ........... x~..~.-.~.-LCC.e.~..1Z.-?..~.J. ............................................................... 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. Narrle of Owner of premises ....~.J.~.~-¢..~_z..~.~,...,.~_~.~..Z.~. ......... Address ~f;,~'~/...~.~.,,~.~.~ Phone No. ,~.....,6..~'./~..L~... Name of Architect .............................................................. Address ................................Phone No ....................... N o. ~. ~.5..'.T...Z~,, ~,/.. Nome of ontroctor ...... ...... ................ Address Phone PLOT DIAGRAM ~ocate clearly and distinctly oil 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 NEWr~'O~JE, n/'~ ~ c c (~me of individual signin~ contr~c¢), above named. ~ ~.~.~.' the ............... ....................................................................................................................... (Cootractor, 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 thar the work wilt be performed in the manner set forth in the ~pplication filed therewith. Sworn to before me this .................. co.. .... . .............