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Home My WebLink About11769-zFORM NO. 4 iWI£DiNG D EPA~I~'~NT Town HaH South,old, N.Y. ~IS CERT~IES t~t the ~..9~9~ .......................................... ~on of~o~., ~ .... ~Vp~.~ ~. ~. ~p~ Na~uck M~ ~o. ~ NM ~ T. Map No. 1~ ~on .. ~ .1~. ...... Bl~ .... ).1 ......... ~t ................. Su~on .... ~ .......................... FHed ~ No. ~ ....... ~ No. X ............. c~f~ s~t~y to ~e ~pH~n for B~d~ P~t ~tofo~ ~ ~ ~ ~ ~ ...4gO9..~ ........... ,l~,p~t~h~~. ..t1~{9.. ..~ ........... ~t~ .... 4~..a ................. ]~., w~ ~, ~ ~ m d ~ ~ of ~ ~b~ ~m of ~ hw. ~ ~y f~ w~ ~ ~ ~ ~ b ......... ,an lna~ound lvimaing pool. gdva~d Hanus of ~ ~ ~. ~o~ ~ty ~mt of ~ Ap~ ... P.L! ................................... ~awx~ ~R~m~ nO ........... ~.. } ~) Y.!~ ............................. ,, 11769 Z is hereby granted to: BUli~DI~ H~LL ~ COMPLETION OF THE WORK AUTH~RIZED~){ b0te a~t p~remis~s located at ........... ~,(.. County Tax Map No 1000 Secton ..... p~r.~luant ~0 app ication doted FORM NO. 6 TOWN OF SOUTHOLD Building 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 featu res. 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: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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. C, 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 $5.09 Date 7~ .~./~. ~' New Building ............. Old or Pre-existing Building .... ~ ..... Vacant Land ............. Location of Property .... .~i .~'¢~i J ~'.~. ~n", .~.f~ /V~ ~L,~ ~¢ Hou,e NO, ' ................... /' ~;r;;t ........................ ~;;;t Owner or Owners of Property . ~ .~:,.~...~. ~. ~.~.. ~ .~ ¢.~.~ .............. County Tax Map No. 1000 Section ............. Block .............. Lot..~.~ ......... Subdivision ................... ~ .....f+A ...... ,~xr .Map No ..... .......... Lot No~ .............. Permit No.l./."~.~. ~-... Date of Permit .~.~'~.~..~..~.Applicant...~. r.~.~r'..~.~; .~.~. ~-Jcl~r_J, Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval . ..~.. ................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ~ .................. Fee Submitted $.. 5~..~..~....~. .............. Construction on above described building an~m~t. ~e~t~all applicab~od.e~ and regulations. Applicant.....'~--~--~...~,..~-~¢~..... ~.. ( ./.~ ................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS [l~ BUREAU OF ELECTRI~IT~ ~ only the elect~cal equipment ~ ~scrlbed be~w and introduced by t~ apphcant ~a~ed on the above appl*cat~on nu m~er *n the prem*ses of ~d ~, 035 L~n's ~t, ~$~i'~, N~Y. in the followlng location; ~ Basement [] 1st Fl. FIXTURE FIXTURES OUTLETS SWITCHES FLUORESCENT 0~ts~de [] 2nd Fl. Section Block Lot andfot~¢l to be in co.tj~llti~ce with the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS SYSTEMS NO. OF FEET E ~ v 1 C BeCause of unusual environments it is advisable to ~v~ frequent; test and/o~ re~airm made by a qualified person. N.Y. 11952 GENEEAL ~ANAGER !This certificate must not be altered in any ma..er~ return to the office of t~e Board if ~inc~r~ct. I.spect~rs may be identified b/their credentials. ~ cqP;~Fpp B~l~alNG DEpARTmENt- THIS C~PY;~F ~C~Ka~ ~F]~ZE;~U~J~,~I~R. Ea~N ANy MANNER. AD t i r:~. DWA ~. D :/ B. FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ..., 19/~,-Permit No../.g.'.~.~. F Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT 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 ~ving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. A~.x..'.7.. ~.~ - ',.x.x~,~./?.~ - .(.;.,.~,. ,~ .r.~.,.~. · d~,_~ v (Signature of applicant, or name, if a corporation) /-.4..~,.d~,'c..~.,~,..~!,.~.~.~. ~. ~.,-,.cx., .~ '7: ././?.~. ¢ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, encneer, general contractor, electrician, plumber or builder. ... ~,x..~.~.~.x...~..~'o.. db,.x'~.~.x:..c. :x,,.,,:e,,~... "',,"'~ ................ ~x,~:'~.~: '~'22>'~'¢' ........... Name of owner of premises ...7Y/~/.~fl~.-.~ ....... FEE,' .t~.~..~... BOo,, .[/-~.../~/...": ............. (as on the tm~--~-~-[tFJl~,~l)'r~7~-rM~-T~-~ ~5q8o2 9 AM TO 4 ~M ~OR THE If applicant ig,a corporation, signature of duly authorized officer. (Name and f~J~e of corporate officer) Builder's License No....L/..Lf~..~. :..p./.~..~. ......... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... IrOLLOW/NG INSPECT/ONJ. II. FOUNDATION - "i~WO FO"~ pr)[JRq',O COI'NICp, r'Tw 2. ROUGH - FRAMING ,5 PLUM~}NG 4. F/hr ¢~'~ CON'SmPl '~';' I 2 M ~ C,')xxa~ ~4-~ FEf2 C. d. ALL CONqrRUCTION SHALL MEET THE REO[P~EMENTS OF THE N,Y. STATE CONSTRMCTI~g~ & ENeRGy CODES. NOT RES¢ONSIBLE FOR DESIGN OR CONSTRUCTIO'g ~RRORS. Location of land on which proposed work will be done ...... ~.. ~..,,/~'... ................................. ..... /,...t,¢.t?..rn..,:. ~....?-t.: ............................. . :.m~.~..e.,f.: ................... House Number Street Hamlet County Tax Map No. 1000 Section . ./?../.J..~. ....... Block ..... /.l .......... Lot...ff.f..g~. ~ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ~, ....... .. Repair .............. Rem6val .......... Demolition Other Work..~' ......... ~,Orq~ 'L-n~roar~J ~voJmt~m~ foool {v,nyl) t,o~4X ,~Ce,~C_~ j (Description) E 'm _-- u, ~,, /'~' 4. ,st~ ated Cost ..... b. r.c].~C.5. ........................ Fee.../..., ............................... (to be paid on filing this application) 5. If dwelling, number of dwelling pnits ............... 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. D~rnenslons 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 ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ...................... Rear ...................... Depth ...................... [)ate of Purchase ........... .................. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ........................... Will exoess fill be removed from premises: Name of Owner of premises .~/iHg~..~..~.. Address .../,fi4j)'P0~* ~o~ nd-/LJ. Phone No ,;~e~],] o~No Name ' ~ ck~' ........................ of Architect .. ~ ........................ Address ................... Phone No. Name of Contractor t{ ~T/4-~. ~..-JT..~5.cp./t...~. Address .I.2~./~{OT[27../~ V~. Phone No. 10. 11. 12. i3. 14. 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 NEW YORK. t COUNTY OF....S~ ,~.~.~. .... ..... , (Name of individual above named. ne is the...~O ~'T.~!q'..~i .~..~. of said owner or owners, and is duly application; that all statements work will be performed in the manner s Sworn to before me this ......... !.~. ~ .day of.. Notary Public, ...~.~r..~: ....... ROSE H. DONNE Notary Public, State No. 52-4624196 Suffolk ............. being duly sworn, deposes and says that he is the applicant agent, corporate officer, etc.) ~erform or have performed the said work and to make and file this are true to the best of his knowledge and belief; and that the h in the application filed therewith. .~-n~ .......... 195.~ (,_,) (Signature of applicant) 40.