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Home My WebLink About12770-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 12770Z Dote ........ ~ ........................... , 19.~.~ Permission is hereby granted to: .~,~..~..~..~.~,~t~L...~.~ .............. ,~..~.~.......~,~.:~.~,...~:~:.....t.,~..~.~ ..... ,o ............ ~~.......~.. ~.~...~.~'~ ....c..~...~ ~....~.~..~ ..~. ot premises I~ocoted et ..... !.:..~..~,..~, ........ ...~.....~.~...,.,C~,~ ....... t~.~t.~... ....................... County Tax Mop No. lO00 Section ....~......~...~.-~.. ........ Block ........ ,~, .......... Lot No ...... ,~ .............. pursuant to application dated ...~.~.~.....t...~. ............. , 19..~..~., and opprovecl by the Building Inspector. Building Inspector Rev. 6130/80 ~o~o~z THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY C.,~O]C~_~ ~ ],.~z~ 85 JOHN STREET. NEW YORK, NEW YORK 10038 ~ ~,~.,~. ~. o~s,,~ ~ N 662131 THIS CE~IFIE~ THAT only the elect~cal equ~men~ ~ ~sc~d be~ ~ int~uc~ by t~ appli~nt ~d on ~he able applicatio~ number in the premises of ~r~ Fries~ w/s ~ple ~e, ~ & ~ ~, was examir~d on ~ ~ ~ ~ and found to be in compliartce with the requirements of th~ Board. RXTURE OUTLETS DRYERS FIXTURES RANGES OVENS DIEH WASHERS TIME CLOCKS SYSTEMS NO. OE FEET OTHER APPARATUS: I~e ~'c~or E e V I C NO' O~_~ CC COND'I A' W. G ER ~' OF CC. COND -- OF HI-LEG NO. OF NEUTRALS A W.G. OF N~UTRAL ~ ~.u. ~ ~ ~ / ~1tl ~ ~ ~v~h~, ~.~. ~I LIc.~3 ~ ~~i ~ ~is certificate must not be oJtered in any manner; return to the office of the Board if incorrect, inspectors may be identified by their creden?a~. ~Jj J . COPY FOR BUlLDI.G DEPA.TME.T. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANy~,_E. .... IJ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS 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 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 buitdings (prior to Apri~ 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of p~operty 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. C. F 'ees: ' ' 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building ....,........~ Old or Pre-existing Building $15.00 Date .. / ............ Vacant Land ............. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo, ~r)~o DateofPermit/I/2'.?/.~-~ .Applicant ].~.~ .~-~.~.~..~ C-OtJ3~--~, ' ~ Labor Dept Approval Health Dept. Approval ................................................. Underwriters Approval ........ · .~", · ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .,~,; ,0. ,~. ..................... Construction on above described building anti.permit meets all.applit~able cod)~s and regulations. Applicant ............................ R~v. 10-10-?S ~ =/¢- d,.<"~5"/ ~,O,~Z /3/~ · '(3 Examined ~...I~....[~....~.~.., 19 .~..~ Approvedl). ~ .~....~..~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Received .......... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 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 issued 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, bu~ri~pg code, housjag code,, and regulations, and to admit authorized inspectors on premises and in building for necessary in~~....~ ~ -- .................... .......... (Signature of ap~li~ant,'or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... . .......... ........ .......... ................................................... Name of owner of premises.. ~7.~..~ '~[1..~.I~-"IT~'! .~..~..~...~... (as on the tax roll or latest deed) ]~f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~.1~..'~1~.1~1...~.O. ~..~.."~.14.~;~V~ ON Plumber's License No. ~lgTr:...~.. !t. {~ .~ ~' .1~..~ Electrician's License No.~.~'~k"~-AI~...~. ~.~v.: Other Trade's License No...~.~.~...17~... 1. Location of land on which proposed work will be done ................ ~_~.~'~--~kg-~'m~' ............... ...... ........... {e. k., ............ ............... House Number Street County Tax Map No. 1000 Section ... ~.~.. ........ Block ..... ~ .......... Lot... ............. Subdivision.."J~4..~....~.~..~..~..~..'~.., .~.."JT. .............Filed Map No.~..~..~..~ ........ Lot . ..~ .~ .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......................................................... b. Intended use and occupancy ...[.....~.~.~...~ h.-~ .... .~.~.~.1..~...~. ......................... 3. Nature of work (check which applicable): New Building ....~.. .... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost .(,~)~.I~..~1..(Z). ........................ Fee ...................................... : (to be paid on filing this application) 5. If dwelling, number of dwelling '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 ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front Rear ~ Depth Height Number of Stories ~ Dimensions of entire construction: Front Rear Depth ;~i 8. new ......... , ............................... ~ tteight ............... Number of Stories ................................................... ( J' .'i. 9. Size of lot: Front ...................... Rear ...................... Depth .................... :... 10 Date of Purchase Name of Former Owner 11 Zone or use district in which premises are situated :~ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................ ................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes~ No 14. Name of Owner of premisesO~Q'~-~.{~ .......... Address .~..'~..{~...~.~$.~'~... Phone No ................ Name of Architect .O~.~..~5- .............. a~l~s 1~.. ll~[~lt'~,Oig .~l.~t.. Phone No ................ Name of Contractor ~l~l, ga~.64...~-. :~17~.. ......... ! t1~.~. ..... Phone No.~][.~..~.I ! .~.. 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,¥~IC, /,~ S S COUNTY . ' ' ' ". (~ /~ .-"7'-~. ....... ~.'.~ .~.~.'., .......... ~~ being duly sworn, deposes ~d says that he is the applicant (Name ofindiwdual signing ~tract) above named. He is the ..................... ~ ............... ; ....... [ ............................ ~~t, corporate officer, etc.) of said owner or owners, ~d is duly authbfized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ~ ~0 0