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Home My WebLink About12277-z TOW~ oF soumOgD BUILDIHG D~PARTM*H~ TOWN'HALL' SOUTHOLD, N. Y: BUILDIHG ~E~IT ~HIS PE~IT MUST BE KEPT ON THE'PRE~IS~S C~PL~ION OF THE WORK AUTHORIZED) ~? ~2277 Z permissiori is hereby granted to: to at premises located at UN~L'~ULL Date ..~} Z:....~ ............... , Cou0ty To~( Mop No. 1000 Section ...... ?.., BI~ .~.~ Z..,?,..AL: No. ~ ... BUilding Inspector. Rev, 6/30/80 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, 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 featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and c~ondition 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 ~ 3.IS 2. Certificate of occupancy on pre-existing dwelling land use ~! 5.00 ~ew Buildino ............. Old or Pro-~xistin~ Buil~in~ ............ Vacant Land ............. kocation of Propertg ...'~ .... ~ ............... ~< Hou~ No. Street ~ ~ Hamlet County Tax Map ~o. 1000 Soction ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Request for Temporary Certificate .......... .7 "~ .... Final Certificate .... ~ ................ FeeSubmitted, ....................... ~.. / J~ 0 R~, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS t~ BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 -.re ~y lz, lgs~ ~,plica"onNo. on~i,e 213970-83 N 602490 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above appl cation number in the premises of ~ki~u%y Dip Pools, Main Rd. Route 25 FacCoz~ff Ave, & Bray Ave., Mattitc~k~ N.Y'. in the following location; [] Basement [] 1st FI. ~ 2nd FI. Outside Section Block Lot was exan~ined on ~y 9 ~ 1~ and found to be in compliance with ~he requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS 1 1 3 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C E ~CCA AW~ NO O E COND OF CC, COND OFA W C- HI-LEG OTHER APPARATUS: 1-G.F.I. NO O~ ~EUTRALS A W G, OF NEUTRAL Glenn R. Bradley RFD 169 l~brtc~ Mag~itux.~k, N.Y., 11952 This certificate must not be altered in any manner; return to the office of the Boar, LIE. J/1227 ~ i GENERAI~ MANAGER ~Pe~ ! , mo¥ b~ their credentials. FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 .. (Building Inspector) , APPLICATION FOR BUILDING PERMITDate ~j../~. .... 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 ptan showing location of tot and of buildings on premises, relationslxip to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part crffthis ap[ cation. c. The work covered by this application may not be commenced before issuanc~ of Building Permit. d. Upon apprc.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such porn shall be kept on the premises available for inspection throughout the work. e. No buiklJng shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan s!,.all have been granted by the Building Inspector. APPLICATION IS HEREBY blADE to the Building Department for th~ issuance ora Building Permit pursuant to t Building Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction or' bnildings, additions or alterations, or/f-mI removal or demol~on, as herein describt' The applicant agrees t~ comply with .a, ll applicable laws, ordinances, bui3dingJcode, housing co{]e,jand regulations, and (Signatnre of applicant, or name, if..,a cor,poflltion) , .. ...... (~ailin~ address of applicant) State whether applicant is owner, lessee,(agenJ~, architect, engineer, general contractor, electrician, plumber or bnild / / . (as on the tax roll or latest deed) If appli s a c rporation, silnatur,~tf.n~f duly attthori ed officer. . Builder's License No .......................... Plumber's License N.-_. Electrician's License No.' ...................... Other Trade s Lice ~se No ...................... 1. Location of land on whichvroposed work will be done ................................................ ..... ..... .................. ............. House Number Street Hamlet County Tax Map No. I000 Section .... ./rid ......... Block... ~'.7 .......... Lot. ~,~.,..O~.: ..... / i Subdivis on ............................... Filed Map No ............... Lot .............. (Name) remiscs an.d intended use,, an,d occupancy of proposed construction: 2. State existing use and occupancy Nature of work (check whlcl, iapplicable): New Building .......... Addition . Repair .............. Re[novel,....,.. ...,. D0molition . ........ . Estimated Cost ............ If dwelling, number of dwelling units ....... roperty hnes. Give street and blodk number or .terior or corner lot. ........ AlteratL~n .... . .'>:w/... · .. Other Work ?,~[/ ...... (Description) ............. Fee ........................ ,. ~- .......... (to be paid on filing this application) Number of dwelling units on each floor If garage number of cars ~ ....................................................... If business, commercial or mixed occupancy, specify hature and extent of each tXpe of use~/,~''. ~q~. ~ ~.o~/[~.' . Dimensions of existing structures, if any: Front...~ ;~Cca ..... Rear . .O~-..;~.~.... Depth . .~....'~. ....... Height ~ Number of Stories ]. Dimensions of same structurejwith alterations or additions: Front ""-' Rear Depfh ' I~lei~t Number of Stories Dmlens~ons el entire new constructton: Front ............... Rear ............... Depth ............ Height Ni:mber of Stories Size of lot: Front ' '. '.. Rear Depth Date 6f Purchase ' Name of Fomrer Owner Zone or use district in which premises are situated :' Does proposed construction violate any zoning law, ordinance or regulation: ........................ V~il otberegraded ....... ...' ........ Will excess fill be r~rOoved from premises: ' Yes - Nc Name of Owner of premises ~././.h'Rl't~. :(~k-~. Address/r~'iC]. j(~../~.]:']:. Phone No.,;~-..~....~.~.7. ~.. Name o, Arcbm. ct .......... .,-:, ...... ~ ..... '.. Address ....... ............ Phone No ............... Name of Contractor : . · .... Address .................. Phone No · i PLOT DIAGRAM ~" Locate clearly and distinctly all et 'ldings, whether existing or proposed, and. indicate all set-back dimensions fro~. description according to deed, and show street names and indicate whethe TATE OF NEV~I'O ~ ~. ,,,.~, ,.t I., '..-. OUNq'Y OF./~..(L.~[~.I.'~,, .', .o~ff~/j. ' " (N~'~'~al signing contract) ~ ...... being duly sworn, deposes and says that he is the applicgn, ~ove named. e is the ................. : td~;o;p;~ i (Contrac r officer, etc.) f said bwner or mvn'ers, m~d is d{dy authorized to perform or have performed the said work and to m~e and file ~plication; t]mt all statements contained in this application are true to the best of his knowledge and belief; and that th: 'ork will be performed in the man~er sot Forth h~ the application filed therewith. worn to before me this .... g.t ..............