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Home My WebLink About10424-z l~OP~I NO. ~ TOWN 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? 1042~ Z Permission is hereby granted to:/~ ~· / ..~.~,...~..~..:.~.~,,.,.** .............. · ................... .(......., ............ ........... '.. ...... z:::::::::::::.:',. Building Inspector. Budding lnspecto FOP,~ NO. 6 TOWN OF SOUTHOLD Building Department Town Hell 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 w~th 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 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. 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 Bu,, '-M4~t.(..'~..'..O-~..q~. Old or Pre-existing Building(Z). _. ~ = "Vacant Land ............ Location of Property '/'~¢~ ~/~¢/M~?~-~/~"g ~.~.~. -~.~ ~, //~/. Hou~ No. Street Ham/et Owner or Owners of Property ...... ~ ~- . .... / ~. .................... County Tax Map No. 1000Section .... ~.'~ .... Block. ~ Lot ~ ~' ~'~ Subdivision ...... ~ ......................... Filed Map No... ~ ...... Lot No..~ ........... Permit No.d¢~ ~ Date of Permit d~iT~..Applicant ........ E, ~& Health Dept. Approval ........................ Labor Dept. Approval ......................... Underwriters Approval ............... Planning Board Approval .................. ~ ~. ~ Request for Temporary Certificate ..................... Final Certificate ...... L .......... - Fee Submitted $ .... ~.. 5 .'L~.~.,..~v:~,- ......... Construction on above described building and permitbmee~s all aDp4i, cable~c~o_ des and regulations. PP · ......,,¢"...~¢'.Y,C(.'¢"<~¢, .-'. /.~.~..~-~. ~'~.._o .............. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC~IT~ 8§ JOHN STREET, NEW YORK. NEVi./'YORK 1OO31~ THIS CERTIFIES THAT ' only the electrical equipment as described below. ~nd introduced by the.appllc~?nt ~zn~'d.on t.h.e.a.'oove application number itt the premises of De,told C. Aldric_h, 1620 ttia~at/ae~ Par. n, ~ouctl~ta, ~.¥. in the following location; [] Basement [] Is, FI. ~ 2nd Fl. Section Block Lot w.se~.,.iuedon April 12, 1982 : ~ FIXTURE OUT£ETS 13 ~ECEPTACLES SWITCHES 29 FIXTURES NCANDESCENT FLUORESCENT DRYERS OTHER APPARATUS 1 -Srao~e Detector SYSTEMS NO OF FEET E R V I C E AWG OF NEUTRAL 1620 Hia~at'has Path Sour:bold, N.Y. 11971 GENERAL MANA~,~R ii ~ ~ Per ~ Th s certificate must not be altered m any manner; return to the office of the Board if ~nco~rect. Inspectors may be identified by thmr credenhals. ~'i t~.t A t FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 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 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 this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Build~ng 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 Bmlding 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 w~th all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary in~p~ections. (Signature of applicant, or name, if a corporation) .//.;.o. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises. <~. O'q./.~.Z..~. .~"~./'~"~A~/ ' ' '~t'e~f4/~'"~ ''~'. ~. '~?/'~' '/'(' ~~ ~ ........ (as on the tax roll or latest deed) If applicant is a corporation, signature of drily authorized officer. (Nmne and title of corporate officer) Builder's License No .... ~..'~..~..~,~f..~..~ .t'~.E Plumbers License No ..... ~{ ~ .......... Electrician's,License No ....... ~ ........... Other Trade s L~cense No ......... ~ ....... I. Location of land on which proposed work will be done.. ~...~~. ~ ........... ..................... .................... ........... I}ousi ~er -/d~ Street ~~ ~Hamlet ~~// County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision .................................... 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 ~~,d~Z... T... ~ .~ ................................ . ..... ................................ 3. Nature ofwork (check which applicable): New Building .......... Addition .......... Alteration .....~-:ff~.... Repair .............. Remoyal .............. Demolition .............. Other Work ............... ~.~.l.~....~O~ ~,/c~.T~,~ (Description) 4. Estimated Cost ................................ Fee ...................................... (to be paid on filing this application) 5. If dweliing, number of dwelling ~inits .... ~..,'~..~. .... 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 strnctureS, ~f any: Front... 3.,4." ........ Rear J.,g ..................... /' . Height .... c~.~ ........ NumBer of Stones ....... ~ ..................... Dimensions of same structure with alterations or additions: Front ' i i 2 '..-~.~.' .,~ ~.' .' i i i i i 'l~;ir' i ~.'~..F~ .~L'.. ....... Depth .... ~..~'~.. ~ ........ i.. Height .....---~..~...~. .......... Number of Stories .... ~.~. ~...'~. .......... 8. Dimensions of entire new constraction: Front ..... .~-... ....... Rear -'- Depth Height ............... Number of Stones ....... w-:. ...... . ............................ ~ ........... 9. Size of lot: Front .... ~../~..~., ..... ,,,._.._Rear...././~..~..~. ............ Depth ... ,4'. f.,.O. .'. ...... , .... 10. Date of Purchase ........ ,~4~4~t.../.~.'~..J'~. ...... Name of Former Owner ,e~.~¢,Ot'.,~,,¢4)...&~'/'~.,,~.4~.... 11. Zone or use district in which premises are situated ...... ~ ............................................... 12. Does proposed construction vlola~;e any zomng law ordinance or regulation: . .,ff~/O. .......................... 13. Will lot be regraded ....... ,,~.~ .................. Will excess fill be re. moved f,ro~a premises: Yes No 14. Name 6f Owner of premises . .~..'~'.4~E~.. ~..*".~.,~.~'.. Addressff~.~/~.~..~,~:.."~h'~.. ~('. Phone No.. ~...~?..-~.o~....~./... ~ Address Phone No . Name of Architect , ~" Name of Contractor .-'~. i Address '-- Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& 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, :~ ~ ,-~ COUNT¥... _ --OF" ,e..___ ..//.//.// .... ~.' ..~..O..,,~..,~..~.,~ .d',. d~..~'~.~~. .,~. ~..C. ,~.~g duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................. ' ............................................................... ~-'¢'r~(Contractor, age't, 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 all statements cont¢ined 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 me this ......... d"~ ....... day o!... ~,.~.~i~ .... , 19 .,~,~ ota yPubli ,, ............... ; .... County