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Home My WebLink About11552-z TOWN ;o~ BUILDING TOWN ~HAI~L $OUTHOLD, N(¥. BUILDING P,ERMIT!i (THIS PERMIT MUST BE KEPT ON . THE PR~IS~S UNTIL ~ULL COMPLETION OF THE woRK AUTHORIZED) ~1552 Z Per~issiori is hereby granted to: at pl;'emise$ located at'..~'..:~ ........ COu~ Ta~ Map No. 1000 Section 4.~...~.. ........... ,;. glo~K ~..~.:~'¢, ..: .. ~' ~: ~.,~o~t ~o o~,co,o~ doted ...~.~.:. ...... g. :...-.:.' :..4,.., '~.~ Balldlng I~spector. Rev. i6/30~80 .,,~ and ~pproved by the FORM NO. 6 TOWN OF SOUTHOLD BUilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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: I. 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. 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 New Building . ¢¢~OId or Pre-existing Building(Z) ..... =/Vacant Land .......... House No. Street Hamlet Owner or Owners of Property .. .~ ............................. County Tax Map No. 1000 Section ...(~.,.O-~.~ ....... Block ,..~ % ....... Lot...~..~ ....... Subdivision X .Filed Map No. X" .Lot No. )4' P erm,t No D ateofPe,mt .App,,eant ........... Health Dept. Approval . ...~f'¢~' ................ Labor Dept. Approval . ¢'~?/~'. ................. Underwriters Approval .~/~'~ .................... Planning Board Approval ~,~z~¢4 ............ ~ ,., Request for Temporary Certificate .~. ................ Final Certificate~¥ ...... Fee ~ubmitte~ $ ...... ~'.: · .~.)....~. ............ Construction on above described building and permi'(mee~s all appl~cable~co,de~ and regulations. Applicant., .... ,~ .~..~. _. ~'.,¢~. ........................... Rev, 10-10-78 m F' THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK I00~8 ,ate -~'~- ~, Zg~;Z App'icationNo. o.~,le :~61218-82 N 555760 THIS CERTIFIES THAT only the electrical equipme~nt as described belotv and introduced ~¥ the applicant named on the above application number in the premises of in the following location; [] Basement [] 1st FI. ~ 2nd FI. Section Block Lot was examined on ~CCl% '29 ~ 198~ and found to be in compliance witk tke requirements of tbis Board. FIXTURE OUTLETS 2 DRYERS IECEPTACtES 5 FIXTURES RANGES OVENE SWITCHES FLUORESCENT SYSTEMS OTHER APPARATUS: S E R V I C AW.G, OF HI-LEO NO OF NEUTRAl 1 AWG, OF NEUTRAL Sal Prat:o Elec., Wig~Lr~ Laae, Greenpor=, N.Y. 11994 L:[c, 1049E G~NEEAL MANA~II/,// This certificate must not be altered in any manner; return to the office of the Board if incorrect' nspector~ ma be identified b the ~ cre /' Y y denhals. COPY FOR BUlL lNG DEPARTMENT. THIS COPY OF CERiI'IJ~IC~AT~E M i~ ~, ,B ~A TER~D ANY MANNER. - FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION {2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: I~OB,I~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .....~.~....~.........~... ............... , 19...~.~.~. Approved ,......~.~......~ ................ , ~Permlt No.....~../....~-..~....'~..~.....~.... .... Disapproved a/c .......................................................................................... (Building Inspector) 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port 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 oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, ~'~name, if a corporation] ........... ....................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......,' .......................................................................................................................................................................... Name of owner of premises ....... ..~...~..~..~.~.. ......... ...~.~..~.~ r.~.~7~./.~........~.....~ .......................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... /....~..~.. ...................................... Plumber's License No .... ...~.q..~.C .................................. Electrician's License No...~.~../.. ....... ..'~.~(-~-.~... ............ Other Trade's License No ..... ~..~ .............................. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ...... /~.~../'..~..~7....../~.. .......... -r.~-~'ff.~./..~...~....~.~,c.¢.~'.d.~,~.~....~J~.~./... ...... .~C~¢¢.Z~.~',~/~.......~...../~.~.. 7 y ~~7 Municipali~ / State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... ~...~ .............................................. J ...................................................... b. Intended use and occupancy ..... ~....~z.r~. 3. Nature of work (check whichiapplicable): New Building.. ................. Addition ..~ ...... Alteration ................ Repair .................. Removal ................... Demolition .................... Other Work ................................................ . .... (Description) (to be paid on filing this application) 5. If d~el[ing, number of dwelling units ...../.. .................... Number of dwelling units on each floor ............................ If g~ ' rage, number of cars ..... i ....................................................................................................................................... 6. if bbsiness, commercial or 'mixed occupancy specify nature and extent of each type of use ............................ 7. Dimens~ons of existrL_g/g structu.res, if any. Front ........ -~..~. ............ Rear ................................ Depth .................... Height ....... ~,.~,. .......... NumBer of Stories ........ ./,, ..................................................................................................... Dimensions of same structure with alterations or additions; Froot ........ ~ ........................ Rear · Depth ~ z/ ~' ~ Height ............................ Numbei' of Stories .........~.~ ................... , 8, Dimensions of entire new construction: Front .......... ~ ....................... ear ........ ~ ................ Depth ........................ 10. Date of Purchase ....... v ...... ........................................ oma of Former Owner ........... ~ ............................................ 1 1. Zone or use district in which p~emises are situated ............... ~ ...................................... ............................................... 12, Does proposed construction vi'elate any zoning law, ordinance or regulation: ...... ,/...~,~.,~, ......................................... 13. Will lot be regraded. .......~...~ ............ Will excess fill be removed from premises; ()<'~ Yes ( ) I~o PLOT DIAGRAM . Locate clearly and distinctly all buildings, whether existing or proposed, and indicate a set-back dimen~ ons from property lines. Give street and bl6ck number or description according to deed and show street names and indicate whether inter or or corner lot. S.S [ ~ ............. being duly sworn, deposes and says that he is the[ applicam )lng cont,rac~ , above named. J He ~. the ............................... ~: ...... ~ .................................................................................................................. ~'- ~ (Contract~, agent, corporate officer, etc.) of said owner or owners, ~nd is duly a~zfl~,od~-'e~to perform or have performed the said work and to make and file this applicgtion; that all stotement~ contained in this application are true to the best of his knowledge and belief; and thor the wgrk will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ..~ay of ....... , ............................. ~ ELIZ~B~H ANN N~ILL~ ' NOTARY PUBLIC, State of New Yolk i No. 52-8125~50, Suffolk