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Home My WebLink About10417-z ~OP~N~ NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT OKI THE P]~EMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) ~1~? ~_J)z~JL7 Z Date~~,~.~ j~,~ , 19~.~. Permission is hereby granted to: / ....... ,o ..~....~~L~~....,~..~~... pursuant to opplicotion d~ted ...~ .... 19. ~nd ~pproved by the Bu}ldin~ Inspector. FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in Wpewriter OR ink, and submitted ! ~ 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 and uses, or buildings "pre-existing" land uses: I. Accurate survey of property 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 New Dwelling $25.Q0, Accessory ,$10,00 Business $50.00 2. Certificate or-occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewCons truct ion..[..//~.. Old or Pre-existing Budding ,._~ .......... Vacant LAnd ..... ./ ........ Ham/et Owner or Owners of Property~'.,'~ .~., .~.. .... ..~..,...~.~..~..'.,~.~~ .... County Tax Map No. 1000 Section ........ D.. .. Block ..... ~. ........ Lot...~. ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 1.0.~l..-).. Date of Permit .t~../~..~..Applicant .................................. Health Dept. A0proval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ........................... Constructio~ on above described building and p~rmit me?s all applicable co~es and regulations. ......... Rev. 10-10-78 THE NEW YORK BOARD OF FiRE UNDERWRITERS 100]"09'~ BUREAU OF ELECTRI~IT~ ~£ 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 THIS CERTIFIES THAT ~ the el~t~[c~[ e~ipmeht ~ ~er~e~ heJo~ ~ i~t~ce~ ~ the eppJiee~t ~e~ o~ the a~e eppHee~Jo~ ~m~e~ ~ the pre~es o~ ~. Carnagie, Soun~vi~w Av~nuc~ ~-~i~ko~ Lane~ Sou~ol~ N.Y, ~n the following location; ~ Bas~.,ent ~ Ist FI, ~ 2nd FL Section Bilk Lot ~sexa~nlnedon l~a~Ctl 12t .~7 andfoundtobe~ncom~llancew~ththerequire.~entso~thlsBoard. FIXTURE OUTLETS FIXTURES RANGES OVENS EXHAUST FANS DRYERS SYSTEMS NO Of FEET OTHER APPARATUS. E ~ ~V I c NO OF CC COND AWG OF HI LEG NO OF NEUTRALS AWG OF N~UTRAL Gary Doros}~i 11935 This certificate must not be altered in any~manner return to the ~office Per ~. be identified by their credenhct(s. CO~ ~=OR BUILDING DEPAR 'ME~T. THIS COPY EDWIN ANY MANNER. .'5 I 1,-I I (.; L,~.'T- i 0 t-;! 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ZST [ ] ROUGH FLBG. FOUNDATION ;ZND [ ] ~NSULATIDN FRAMING [ ~ FINAL REMARKS: TOWN OF SOUT'flOLD OFFICE OF BUILDING INSPECI'OR TOWN HALL SOUTHOLD, N. Y 11971 TEL. 765-1802 January 11, 1980 Mr. Vincent Carnagie 4l; Earl Drive North Merrick, New York Re: BP 10417Z Issued: September 25, 1979 ~lioant: Wm. Jo Jacobs Dear MK. Carnagie: Mr. Jacobs informed us he has completed his part of the construction under this permit. The framing has been inspected and app£oved as of January 8, 1980. Ail further work will require inspections. Before you can cover any plumbing or insulation, call this office £o~ %he Inspector. The wiring, also, must be inspected before it can be covered,by the N.Y. Board of Fire Un6erwriter. Call 765-5l+l+.~ between 8:00 and 8:&5 A.M. to contact the Inspector. Feel free to call us if you have any further questions. · 1 Your permit will expire September 25~ 198 unless you write to request a six (6) month extension. Yours truly, GEORGE H. FIS}~R Sr. Building Inspector / 1) '~'~'--.--. ~"29'20" ~'~.~.~._ 1~.07 f~et; and FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 E amin / Disapprove~( t lc ..... : 7~ ........ -/ .......... ............................... (B~ilding inspector) / APPLICATION FOR BUILDING PERMIT Application No../(.O.. ~./.~.;~ ....... Date ......... 19 '.~,~· INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building In~spector, 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 g,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 m 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 applican6~O'r n~e, 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 ... ~.4'/.~.~.--.~. T. · . .C.~..~..A'~..~..~· .]..~..- ....................................... (as off the tax roll or latest deed) If applicant ~s a corporation, signature of duly authorized officer. (Name and title of corporate officer) Buitder's License No ......... 0~.~.. . . i ....... Plumber's License No.. ~...~.~?...~. · .~. · · · .~: Electrician's License No ....................... Other Trade's L~cense No ...................... '~'-~ ,, ,-' House Number Street Hamlet County Tax Map No. 1000 Section 0[~rQ~Q~5 .~.. Block .................. Lot ................... 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 .............. Removal .............. Demolition .............. Other Work ............... .{~.'.~,~...'.i~.. ' ~.~f ~-- (Description) 4. Estimated Cost ............................... 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 structure~, if any: Front.. ~J'~. ........ Rear ...~.. ....... 'I~;~;t~ ii.~iiiiiiii ii Height.. .............. Num:ber 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 ...... ................................................... d> . h 2,~ _ ~O? 9. Size oflot: Front ..,~. ..... : ........... Rear .... ~..~. ............ Dept .~ ~I~. .............. 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises 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 premises . l~'.~.O:lwr'...~P'~'.t)~/..~. Address J~ .~"/'~ .~,~t?~(..~-... Phone No ................ Name of Architect .......... 1 ................. Address ...... ~ .......... Phone No ............ Name of Contractor . ~5.~...~. ~.~.~-~-~..,,~q'. ....... Address .~.. ~?.' .~c ....Phone No. ~. ~. Y...3.-~'.l $. 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 humber or description according to deed, and show street names d indicate whether interior or corner lot. f ~ . I STATE OF NEW Y~RIC , ~ COUNTY OF ,l¢~/.,~f~. .... '~'~ .......,-- ~ ,-,--~- ,x ~..(/J,~.~'ff~..-' :'~t .~~---- ~-- ......... berg duly sworn, deposes and says that he is the applic~t (Name of individual sign:lng contract) above named. He is the . ?..". ............ ~/. . ~ ...................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e ~d file this application; that all statements contgined ~ this application are true to the best of his ~owledge and belief; and that the work w~l be perfomed in the manner set forth ~ the application filed therewith. Sworn to before me this ........ ~ ~ ....... day of.. Nota~.Pub?, ................~0~}I ~ .~ .~ f~.. County ....... ~e ~.8125850, $uf~oJ~ County