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Home My WebLink About11541-zNo. 11541 Z BUILDING D~P~RTM[NT, TOWN HALL SOUTHOLD, H~ Y. BUILDING ~E~i~: Permission is hereby granted to: ......... ...... ~t pr~m~s~s CouO~ T~x Mop ~o. 1000 5*croon ................... Block ~;...~ ..... ~...~ ~t No. ~ ............. pursB~nt {o oppllc~tion~ d~t*d ......................................... ............. . , ,., ~nd ~pproved by the Bull Ino Fee :$ ........ ~ :ii [; B~ldln m~ector Rev. 6/30/80 (THIS PERMIT MUST BE KEPT ON THE PP, E/~llS~S UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ,,e~. ~...., ............... .~ ............................ FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: t, Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1,00 $5.00 Date New Building ............. Old or Pre-existing Building(X) ......... .~ ZVacant Land ............ Location of Property ................................................. ; ........ ~ .......... House No, Street Ham/et Owner or Owners of Property ........ , ........................ County Tax Map No. 1000 Section .... ,/'. ~. ....... Block .... '7. ....... Lot . · ~. · .4~/ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~.~/~.~/.~, Date of Permit//~.~z~.~. ~pplican,, .~. Health Dept. Approval ........................ Labor Dept. Approval ......................... Underwriters Approval ........................ Planning Board Approval ................... Request for Temporary Certificate ..................... Final Certificet~ Fee ~ubmitted $ .~': 9.~, . .. ~ ................. Construction on above described building and permit~meets all apl~l~cable~co_des and regulations. 1000656 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEON YORK 10038 ..re J~uary 27, 1982 Jppllc.tlo. No. onl,e 145393~81 N 5 4 9 2 S 3 THIS CERTIFIES THAT only the elec trlcal equipment as described below and introduced by the applicant named on the above application nu~nber in the premises of Y=s. Dorothy A. Adams, Montauk Ave., Fi~her~ Island, N.Y. in the following location; [] Basement wasexaminedon J~r~ 21, 1982 [] ~.d rt. Outside Section BIo~h and~found to be in cornpllance with the requirements of this Board. Lot FIXTURE OUTLETS ~ECEPTACLES SWITCHES FIXTURES RANGES NCANDE$CENT FLUORESCENT OVENS DISH WASHERS EXHAUST FANS DRYERS FUTURE APPLIANCE FEEDERS TIME(~LOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E I C E A. W.G. NO, OF HI-lEG OF CC. COND 2 A W,G. NO OF NEUTRAL$ A WG, OF HI-LEG OF NEUTRAL Z & S C~ntractir~ Inc., Whistler Ave., P.O. //ox 202, Fishers I~laDA, N.Y. 06390 COPY lNG ANY MANNER. FIELD INSFECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY COMMENTS QODE FINAL ADDITIONAL COMMENTS: IPOBM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMI:NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..!.c.[?i!~.. ........................., 19 ........ Application No ....... (./....~.....~.(Z ......... Approved .......................... I...! .~... ...... , ,9....~....~ermit No ........ !.!.....~....~./../....~ Disapproved a/c (Building Insp~:tor) APPLICATION FOR BUILDING PERMIT ,o, .......................... , INSTRUCTIONS o. 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 o~ 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 oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ................. ISig ,ur.,of app,eant, or nome. ifa corpora.on) - /~, ...... ....... (Address of appli~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... . .7../~/,~-~......' ..~...:.~.'....~..~ ........................ : ............................................................ If applic, pnt is a corporate, signature of duly authorized officer. .... ~d ';i;'l'~";~";o;l~;'r;te officer) ' Builder's License No ................................................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ....................................... Lot Ng ......................... Street and Number ........................ ~.~..~., ...................................................................... '.~... ........................... .~....., Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and ogcupancy .,. ,~..',~.~'.,~..'. .................................................................................................................. b. intenaea use Gna occupancy ................. .~.7...r.:..~...~.:: ........ ~z.......;. ................................................. r ................... 3. Nature of w~,~check whirl' Repair .................. Removal 4. Estimated Cost ............. [~ applicable): New Building'. ................. Addition ..................Alteration .......~.... .................. Demolition .................... Other Work ..................................................... (Description) tee .......................................................... (to be paid on filing this application) ~5. If dwelling, number of dwell ng 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 structures, if any: Front ......~../. ................ Rear ....... ~./.. .................. Depth ...... .~...../.. ....... ........... Number of Stories .............~. .............................................................................................. Dimensions of same structure with alterations or additions; Front ......... ~?/. .................... Rear .....~./. ................ Depth ......... ~.~ ................. Height ......~ .............. Number of Stories .........,;~ .................. 8. Dimensions of entire new cogstruchon: Front .................................... Rear ............................ Depth ........................ Height .................... Numbei of Stories ...................................................................................................................... 9. Size of lot: Front I ................ , ....................................... Rear .......................................... Depth ................................ 10. Dot? of Purchase ................ l ....................................... Name of Former Owner ........................................................ 11. Zon]e or use district in whichjpremises are situated ..................................................................................................... 12. Doe~ proposed construction v!iolate any zoning law, ordinance or regulation: ................. ..../~..X~.. ............................. 13. Will lot be regraded . ............. ~ .............. Will excess fill be removed from premises: ( ) Yes ( ~ Name of Architect ..............L ............................................... Address ................................ Phone No ....................... Nome of ................ ........ Phon ~z PLOT DIAGRAM Locat~ clearly and d~stmctly a I buildings, whetaer ex~stmg or proposed, and ~ndmate all set-back d~mensions 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 NEW YORK, COUNTY OF ..... ~OgN .......... 'N~r±o Zgnghett± iS.S ................ ............................................................................... being duly sworn, deposes and says that he is the applican* (Name of individual mg~mg contracf) above named. Contractor He is the, ....................................... ~ ......................................................................................................................................... i I (Contractor, agent, corporate officer, etc.) of sold owner or owners, and is d~ly 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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this J November 19.8,.~... 16th day of .................. k ......................... , ' Suffolk Notary Public, , ........... ~ ......... ~'"'t .................... County [ MAP,~ B. PANKIEWICZ J Nq'rARY PUBLIC, STATE OF NEW YOR~ NO. b2-8267950 -- SUFFOLK COUNTY CqMMISSION F. XPIRE$ ~ARCH 30, 19~",~