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HomeMy WebLinkAbout10976-z FOEM NO. ~ TOWN OF $OU~THOI~ BUILDING DEPXRT~i~'N~ TOWN HALL $OUTHOLD, N~. Y. r BUILDING P, ER/v~IT (THIS PERMIT MUST BE KEPT ON THE PREh COMPLETION OF THE WORK AUTHORIZED) IS~S UNTIL ~ULL N°. 10976 Z Dc~te ..,Z'J~.~-./~./~'t~..(~.~.~...~....~......., 19- Permissio~ is hereby ~ranted t .~ ,~ ~.~ ~ ................. ....... . --/ ~ ~ ~ - ~ ~ ~ . ~ .L ~ ~.~.~.~z......~.~../~.a ......... ~..- .[~, x~x.~...~JZx~G .... ........... ~. ::: . ~ ..................................... ............ ot ~o.,~.~L.~.,..~.~ / by Building It~spector'. ]nspecto? 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 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 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 New Building .... ~ ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... .~.. ~ .~. .............. .~..~..~.~./,J/.~'~ .... ,¢~ ~ ....... ~. '~. ~'. ~/-~;:). · · House No,~ 4~ / Z~, Street Hamlet Owner or Owners of Property ... ~.,. ~///~Z~',z~, ,~, .~, .~',,~. <, ,~.~, ',~d., ,/~,,, ................... County Tax M ap N o. 1000 Section .... .~. '.~'~. ......B lock ..... ~).~'. ...... Lot,. ~) .'~.~-,~ ~ ¢?/. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.../?. ?..7.~.. Date of Permit ~./~P//~¢)..Applicant .~."~.//x~.. z~..~..~--4¢,2/. ~e~. ~ Health Dept. Approval ..... ~ ............... Labor Dept. Approval ..... ~ ............... Unde~riters Approval . .'...~ ~ ........ Planning Board Approval .. ~ ............... Request for Temporary Certificate ..................... Final Certificate .... ~ .............. Fee Submitted $. , .~ ~ ................... , I Construction on above describe~:~da~.a~.~.ll~~s' ~d. ~..~. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW Y~RK 10038 THIS CERTIFIES THAT only the elec trical equipo~ent as described belo*v and introduced by the applicant named on the above application nu.~ber in the premises of ~rl R. ~sl~, 820 ~1~. ~., S~old, N.Y. in the following loca~ion; ~ Basement ~ 1st ~7. ~ 2nd ~. Section Block Lot ~.~,~.~do. Fe~ ~, 1981 FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES 2 7 2 2 FLUORESCENT DRYERS FURNACE FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E NO, O~E~,COND, AW.G. OF CC. COND. I C E NO. OF Hi LEG A W.G. [NO OF NEUTRALS A W,G OF HI-LEG / OF NEUTRAL Paul 1{. Burns, Towa Harbor Lane, Souchold, N.Y. 11971 1 ~e. 282 -E This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by THIS NOT IN ANY MANNER. FIELD ~NSPECTION FOUNDATION COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined ,~..d.7/~ Z ~ 19 c~ Approved ('c/.o...l~....~.. .... , 19.~.~. remit No../...~.~. ~.~..~'/~' Disapproved a/c ......... ~ ~ ........... ~f~ ......... / (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.../~. ~.. ~.( ....... Date ...... //./[. f ...... , 19~2~. 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 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. o. . f . . . .< .c.d c-,¢. . ; . . . (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. ..... cbz .................................................... Name of owner of premises . .~.. ~.~..~...~. ~../.~.~.~.~.~-f.~ .... ,..~. ,~. ~'.2r.~..~.'..*~..'-./.'(..e: .~.~./.~. (as on the tax roll or latest deed) If applica~orporation, signature of dui; authorized officer. (Name and title of corporate officer) Builder's License No .... .~.~ .O .................. Plumber's License No .... ~; .......... .~fl .~. ..... Other Trade's License No ...................... Location of land on which proposed work will be d.o_n_e. ....... ...... House Number Street Hamlet County Tax Map No. 1000 Section ....~. 7.~ .......... Block ....~..~. ........... Lot. Subdivision ........... --7 ......................... Filed Map No. .. >. ........... Lot .............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.. ~)~. -... -.~.~-ff:a'~./. ~... ~. ~d~.~a-~5~'.,,4~;~ ................................. b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building .......... Addition ...... Alteration .......... Repair .............. RemoVal .............. Demolition ............ Other Work ............... ~4. Estimated Cost . .//-~/...~.. ................... 5. If dwelling, number of dwelling ~nits ............. (Description) ..... tee ........................... (to be paid on filing this application) Number of dwelling units on each floor ................ [ If garage, number of cars ..... ~ .................................................................. 6. If busir~ess, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height i ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ?. Height ...................... Number of Stories ............ , ......... 8. Dimensions of eptire new constrUction: Front ..... ,~..~. ...... Rear ....,r~. q ......... Depth ./. P~.. ......... Height . .. ~ ......... Numbter of Stories .../...~../~A~.~... ? ........................... ~ ............. 9. Size of lot: Front ....... 1.'7. ~.'. .......... Rear .... /7._,,~ .............. Depth . . . .2~...~. ............. 10. Date of Purchase ........... i .................. 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: .... r:V~.z?. ........................ 13. Will lotbe regraded ...... /9{?.., ................ Will exce~s fill be removed from premises: Yes ,,~ No 14. Name of Owner of premises //ffl~..~.~.-~',..., ...... Address ................... PhoneNo ................ Name of Architect ...... x~.~5..../f'f.~.4~..¢.. Address ................... Phone No. Name of Contractor . .=f//~... d~./~5~.~/'-/~/.--..~.~.rfPF~. Address ~C0~,4,~-. ~. ..... Phone No..~f.' .°~.'~i-~?i~'~ i i property lines. Give street and block interior or corner lot. PLOT DIAGRAM Locate clearly and distinctly all ,buildings, whether existing or proposed, and. indicate all set-back dimensions from tumber or description according to deed, and show street names and indicate whether STATE OF NEW YORK coumvy OF... .............~--~.)./f'~. ·'~,~,~t'~?.' · ................... being duly sworn, deposes and says that he is the applicant . (Name of individual sighing contract) above named. He is the ..................... i ............ <9~: ./.~'~:~ ................................. (Contract' or, 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 all 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 me this · /.ff. dayoi /c/of 19 ,CD Notary Public ......