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Home My WebLink About10386-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 10386 Z Dote .... .~........, 19..Z./~ pursuont to opplicotion doted ...... ~....,,~.~.~-~) .......... 19.Z~.., ond opproved by the Building Inspector. Fee $.../.~.. ........... . //Building Inspector THE NEW YORK BOARD OF FI~RE UNDERWRITERS BUREAU OF ELECTRIOIT'f ~' 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 ~..~.,,o. ~o. o.~,,~ N 670240 THI$ CERTIFIES THAT only the electrical equipment as described belo~ and intr~uc~ by the applican~ named on the able application number n the premises of in the followlng locatlon; ~ Basement ~ 1st Ft. ~ 2nd FL Section Block Lot was examined on ~)~lJ~ ~ ~ 1] 1~84 and ~ound to be in compliance with the requiren~ents of thts Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT MERCURY DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS T!ME(~LOCKS [JNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT S E R V I C E NO OF CC COND PER ,~ AWG OF CC CQND NO OF HI-LEG A W G NO OF NEUTRAL~ OF HI LEG AWG OF NEUTRAL OTHER APPARATUS David t~. DeFrie.,~ 55 Oakwood This certificate must not be a tered in any manner; return to the office of the Board',f iinco'rrect. Inspectdrs may be identified by their credentials CQ~ FOR BUILDING DEPARTMENT. THIS COPY O~ CER~TIFICAI~E~MI~ST_~IOT I~E ALTERED N ANY MANNER 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 at~ property lines, streets, buildings and unusua~ 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 $5.00 Date . .~?..~-.. ?.-~.,.../..~?~..~. ....... New Building ............. Old or Pre-existing Building ..~.. ........ Vacant Land ............. Location of Property ........... ¢( ~'~/~ ~ House No, Street Hamlet Owner or Owners of Property . . .~.~, .vi~c.~,, .~-.:..,',~.~.....~.~. ~.,.~ .~....'~,~-,, .'.~.~-..~.~*." ¢?. ?. ............ County Tax Map No. 1000 Section .... .~.?. ....... Block ... ~ .......... Lot .... /.?. ......... Subdivision ................................. Map No ............... Lot No ............... Permit No./.~.?.~'.~. ?... DatT, I ~x,°f Permit ?/~/'/?'..~...Applicant, ,~?. ?.'.~.. ,~.'./.~.~..~.~':~.¢?.'.~, .......... Health Dept. Approval../.M/:~ ................ Labor Dept. Approval . ~.. ................... Underwriters Approval ........................ Planning Board Approval . ~ .......... :: Request for Temporary Certificate ..................... Final Certificate ................. Fee Submittad $..~ [~.. ...................... Construction on above described building and permit meets all applicable codes and regulations, Rev. /kD DIT/Ot,,JAL ' I r' ~.I~FORMA~ION FOR ?UILDING DEPARTMENT WE ARE IN TItE PROCESS OF ISSUING A CERTIFICATE OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION AS COVERED IN AN APPLICATION FILED W/TH OUR DISTRICT OFFICE. ~-~FHl~ NEW YORK BOARD OF ~FIRE UNDERWRITERS /" v I~ INS~fOR - ~' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 /_/~ TEL.: 765-1803 ExammeO,~., .~. .... ,19 ~..~ Approve ".~.~ ~.~-. , 197. TeermitNo /(~.~...~..~ Disapproved a/c ...... ~_i '--' ' ' ' '~_-~ ' ........... ~'~ ........ APPLICATION FOR BUILDING PERMIT Application No./..~.~7. ?_ ...... 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 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 th~s application may not be commenced before issuance of Building Permit. d. Upon approval of this apphcation, 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. ,,, ................ (Signature of applicant, 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 ~),~ .~! {.~....~:..~'...~.~-..t.~ ~ .L: ~. ..... .~..~... ~.'(.~.l..~.~.' :~ ....................... (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. ~-~.~ Electrician's License No.. ~.~. .... ". ........ Other Trade's License No ...................... 1. Location of land on which proposed work will be done....C~.~.O. . './~../5/..~.-~ .{~.....17-.°. JTT. .... (.%?..~.s.t-7..8.t! o~ ........ o^ .... r-. c6 ........ House Number Street Hamlet County Tax Map No. 1000 Section . (~.'7.~. ......... Block .... (,-QO~. ......... Lot...O./..~ .......... Subdivision... ?.../'J .~?..C7..~.-.~. ............... Filed Map No....)(.....Y%. ...... Lot .. iK. V, ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy . ~....~/..~7... ~' ./5.../(.%.. [ .~.~. ...... .~...[~..~.--. :g .Lc..r../[~. ~ ................... b. Intended use and occupancy .. ~ff. '/~.m~.-~. .... ~ !..~. (~. .... ,~. ~'.~ ...... ~. ~...~..(..{.~].~. ~.. .......... 3. Nature of work (check which applicable): New Building .......... Addition .... . .t~f~.... Alteration . .~.'.. ~ . . Repair .............. Rembval .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ......... ~./ Fee ~ (to be paid on filing this application) 5. If dwelling, number of dwelling!units ... O. N~.~. ..... Number of dwelling units on each floor .... o..~..~. ...... If garage, number of cars .... ~ ................................................................... 6. If business, commerciai or mixed occupancy, specffynatureandextentofeachtypeofuse .~.¢-,~.~.P.~7-.~..W3..~..~... 7. Dunenslons of existing structures, if any: Front.. i.~. ~ .......... Rear . :-~ 7.. ~. ...... Depth ~.~. ~ ~ ~. ..... · ' ~ I . l-Ie~ght .... J .at/, ........ Number of Stones ... ~. ................................................. Dimensions of same structure with alterations or additions: Front ...~../..~ .......... Rear . .-:~',4..t ............ Depth,.. ~.~'.~. '. ~.~.5 ..... i.. Height .... /.~. '.' ~ .......... Number of Stories...~. !5/.c7.~ ........... 8. Dimensions of entire new construction: Front . ./.~..~ ......... Rear ... (..'C-.r. ....... Depth . .1~'..~ ......... Height .... L--?"...~-~. .... Num'>er of Stories .... ~. t~/.~.-- .... ; ......................................... '. 9. Sizeoflot: Front .l.'?.,s'.'.~.'/'./'..././.a.,.~ .... Rear ./.z-/f.: .~..'.~./?.~.*..7... Depth .~-~'.~.rh~..~-E 10. Date of Purchase .~. P, 6~ ././.q. ~'.~. .............. Name of'Former Owner tqt.~/.e.'~ . .../~..~'.~.{ ............ 11. Zone or use district in which pr~mises are situated. ~...r~.e.-&~ .1) ~/,,'2T. ~/~. ~ ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .... .~..~. ............. ~ ....... 13. Will 10t be regraded ../~.A..~..w~. ! A:..[-.~. ?tr. ........... Will excess fill be remgved from premises: ;~ No 14. Name of Owner of premises ~. !.v: .~...~.~.~.~..;¢.~.~... Address Op~.~..o.o¥..A~q~. ...... Phone No. ~.~..~2."..~..~. ;~. .... Name'of Architect ......... : .................. Address ................... Phone No ................ Name of Contractor .~.0.3..~e.~. J../~.~.~?.'[n~ ~*?. ..... Address ./~?.'.~...~'.~...."C.~.~..~.*/.M. Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ail buildh~gs, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF EW YORK, S.S COUNTY OF. .... ......... .~)..~.~../.~ ...../~'~.~../.~.~ .~.4/~...~. .......... being duly sworn, deposes and says that he is the applicant (Name of individual ' ~ ' signing contract) above named. He is the ..................... ~ .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ail statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before m?,this , ~ ~n.n~ ~ ~ n,~ ~ Notary Public, . .................... .~x~r~.~. County (Signature of applicant)