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HomeMy WebLinkAbout11554-zBUILDING DEpARTM! N~i ToWN H~LL SOUTHOLD' N~ Y' i BUILDIN~ ' PERMIT! (THIS PERMIT MUST BE KEPT ON,HE PRE~I$~S UNTIL F JLL COMPLETION OF THE WORK AUTHORIZED),~: N©. 11554 Z Dote .: ..... ~'-', ....... Permission is hereby granted to: ~ ~ ~~ . ...... ~.~:.....z~.~ ,:.. : ot premise~ ~lo~at~l at pursOant ~o application doted .~,,~.,.,.~:-~ ...... ~'"!i'"" ]9~'~and ;pproved by the Build'lng I~spector. ~ !~ ! ~speCtot 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: 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, {ndustria~ 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 topo§raphic 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) .... ~,,. ~/Vacant Land '~ ............ Locatio n of Property ........ ~,OL..~. ~ ......... 'T,/~..~..,~.~...¢~..--~..../'~. ¢~-~( ........... ~.....~: .... House No, Street Hamlet Owner or Owners of Property /~. ~.. '.-~0~¢~. ~:~.~ .-.-~*r~)¢~ ~'~L(~'~ .......... ¥ ~ .................... ~, ~"te ~ , County Tax Map No. 1000 Section ...~. ,~/ ........ Block .. ~./.~ ....... Lot,. ~.0..~, ....... Subdivision ...... .~. ......................... Filed Map No ........... Lot No .............. Perm it N o. I.l.~. ~'./~. i.~... Date ofPermit--'¢/;~,/~,7-r...Applicant..~_,T0..¢.'¢-. ¢¢~(~-...,,.~-'~..~ .......... Health Dept. Approval ........................ Labor Dept, Approval ...................... ,.. Underwriters Approval . ,~'k~ ............ Planning Board Approval .................. ~ ,. ~ Request for Temporary Certificate ..................... Final Certificate ..... - ......... * Fee Submitted $ .... ,~'~., ~_~.(~, . .C..~. ........... Construction on above described building and permit'mee4s all app~cable~co,d~es and r~guAation,~. Rev 10-10-78 ~ --/ L' ' ' ...... FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS P~3ul atomy Bldg. 40, SUNY - Roc~ 219 Stony Brook, New York 11794 (516) 751-7900 r~DI~T F. FL~ C~m~ssioner As a result of your inquiry cc~cerniD~ the a~ove refe~-~-~ced parcel, this Depai hc~t has con~cted an on-site ' _anspection. ?~ have found the '~ or '~ Therefore, pursuant to Part 661, Official C~L~llat/on of (bdes, Rules and Regulations of the State of Ne~ York~ Section 661o4(b), no permit under Az~-le 25 (Tiaal Wetlands) of the Environm~ Conservatic~ Law is Very truly yours,I B~gional Permit Admin/strator FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-180:3 Examined ' .. .... APPLICATION FOR BUILDING PERMIT Application No .............. Date ,../~.t~,...~. ........ 19 INSTRUCTIONS a, This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 stree or areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part of this ap~: cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprcvat of this application, the Building Inspector wilt issue a Building Permit to the applicant· Such peru shall be kept on the premises available for inspection throughout the work. e. No bnilding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shafi have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) · f~,..~, a~../.~.: .~....¢7~.~:..~.~, .~...../4:, ~ .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, ....... .~.~..,e.*,...77 .... ~:~......~..~...~:.~:.~.. ............................................... Name of owner of premises , ~ ,~,,~ (~..c~,5.../¥,. ~.../,~.. M..~. (~. ~...tr., ..... .~.~,ff..~.z? ...................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... ./~.]¢ ,W.. ~..,~',~.*t~..r ~.~....~..~ 7~. Plmnber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ................................................ ....... /. 7. .¥~. . ........... .~.~. .o. .,~,. .~. .... ~. .~. ?:.~ ...... ~.~.~. .?A ~,. q~ .... ~. ..· ."r5 ........ House Nmnber Street Hamlet County Tax Map No. 1000 Section ..... tg>. ~.. ........ Block ... ! '~ Lot ~- Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and ~ccupanc~ ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstrncti~n: a. Existing use and occupancy .... . .~).44 .~.....~.4 .z~./.c.~..... ~?..-~'..z~.~..c./..'5~..~ ........................ b Intended use and occu ancv . . . .~...~..w~..~.--ww...-Y~../..c~...°'/~:~z/~'~s~ :;~..~.t:~ ~ . P. -. ......... : ..../. .............. ../ .......... ~..,,... 1. Nature 9f work (check which applicable): New Building .... 1~ .. .... Addition .)t. 7' ~ ' ' 'r WorkAlterati°n ......... ......... Repair .............. Remqval .............. Demo ~tmn .......... l: :J.. Othe ..... . .~., ', ,~, ./ 0 0 F_~) ~//,..~ ,~, :.~,. (Description). ' Estimated Cost .... Fee * .... (to be paid on filing this application) ;. If dwelling, number of dwelling units ....... .4..,~.~-. Number of dwelling units on each floor ................ If garage, number of cars ..... ' ................................................................... i. If business, commercial or mixed occupancy, specify ~ature and extent of each type of use ..................... ~. Dimensions of existing structurels, if any: Front ..... .~.~.: ...... Rear ..... ~..,-~.: ....Depth ............ Height ..... .~. ~..~. ....Nun~ber of Stories ...... [. tZ".~-, ............. 1. ............... i'..~ .7. ...... Dimensions of same structure with alterations or additions: Front ..... ~..J.; ..... Rear .... 3 ~. fl ....... Depth ........ ~. · .~.: ...... i.. Height ......... ~..~.'7.: ........ Number of Stories ..... I .~.z".~ ............. ~. Dimensions of entire new const[uction: Front ............... Rear ............... Depth ............... Height' . .............. Nuntrber of Stories ................. .~ ...................... , ....... ; ........ L Size of lot: Front ...... - ....., .... l ! .~. .... Rea~ ....... l ....... · ....... Depth .~Y..'P' .................. ). Date df Purchase ....... /. ~Y. ~..I ............... .. Na~e of Former Owner ...,~7~....i.i.i.i.i.i.i.i.i.~-.,g, AT'~..~..r~.- .......... I. Zone or use district in which promises are sitt~ated... ,4~... ff.,~.,~'.,*.~.' .~r'/~ .......... '. ................. !, Does proposed construction violate any zoning law, ordinance or reguIation: ...... ~',~:~. ..................... 1. Y~.~ll lot be regraded ..... /~ ..................... Will excess fill be rer0oved from premises: (~ No [. Name of Owner of premises ...'~._~'..~.'~..~.5 ........ ,~reoo,,,r,,~, ~,-~ ~,~- ....... · Address .~.-4~,~.. ~-.,a'.. .... Phone r~o. ,fi:./6.-..~.x~,: .*-.~,.. Name of Architect ,,~,,~ .r .~..!~. q:~..~r'...~.~?.~..o-.... Address .ff.~,.~.,( (4/.L ~..,'c,'t'f~.~.. Phone No..-.-.~(~.-. Name of Contractor ......... ~ ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. 'fATE OF NEW YORK, ........ ~ ,,~ ~.,~.~..27~... ~..; i..~. YT. '~' .4 4~. ~ ...... being duly sworn, deposes and says that he is the applicant ' (Name of individual signiug contract) )eve named· (Contractor, agent, corporate officer, etc.) £ said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this )plicationl that all statements contained in this application are true to the best 0fhis knowledge and belief; and that the · ork will be performed in the manner set forth h~ the application filed therewith. worn to before me this otary Public, ......................... ,I Uounty / ,. /; u ~ ~,~lgnarure oI appncant)