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Home My WebLink About10987-z FOEM TOWN OF [ooTHO!~ BuiLDING O~P.~e*~i TOWN SOUTHOLD, BUILDING P, ERARITi'~ > (THIS PERMIT MUST BE KEPT ON TH,E PRE~IS~S UNTIL ~JLL COMPLETION OF THE WORK ^U'mOR~ · ' ~ ~~......Z .......... 1~..~) Permission is hereby granted to: at premises located ' ' i; ',: ' ! ...~..~..Q ....... County T~x Map No 1000 Secton /..J.../. Boc~ t '['~/" .........Lot No. pursiuan, to application dated .~..../~.~-~-~..k~-~/~;.;~..,'19-. and approved by the Builaing I?pector. ; ;ee ~$..~.~....~.~ . 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- lion 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 ....~..~).f?.t?~..~¢., ............ ~. ...................... House No, Hamlet Owner or Owners of Property . .~.~g~.~.uO....~...~...~..~.~..r~......~..~_..~.. ......................... County Tax Map No. lO00Section ..].[.1 ......... Block..!! ........... Lot...~.O .......... Subdivision ~..~.~...~.~.~ .~...~...~\.0.~...~.- .~..~.Filed Map No. !.~. !~.8...Lot No .............. Permit No. tO.°[~.~... Date of Permit ).~-. 1" ~'[' .Applicant .~.~.\.~.~... ~. ~,~.~. Health Dept. Approval .I.~. T ~ .C), .-.~ .~. ........... Labor Dept. Approval ........................ Underwriters Approval..~./.~.~. ~ ~ ............ Planning Board Approval ..... ~/... Request for Temporary Certificate ..................... Final Certificate ................. Fee Submitted $.. k.~,i-i .~-;~.~. ................... Construction o n above described bu lid ing~,er. ~r~,, m~ee~s a~app[li%le ~o~ a nd regu lat'o n s. Applicant Rev. 10-10-78 THE NEW YORK BOARD OF FiRE UNDERWRITERS BUREAU OF ELECTRI(~ITY ~- ~,y 1~,~ .~1 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,at~ ,~ppli¢.tion ~o.o,,y,~ 107711 -- ~1 only the e~ctrical equipment as described below and introduced by t~ applicant ~amed on the ab~ application number in the premises of in the following location; ~ Basement was examined on ]~¥my 7, 1981 ~ 1st FI. ~] 2nd FI, Section Block and found to be in compliance with the requirements of this Board. Lot OUTLETSFIXTURE SWITCHES FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS o~ 60 37 38 FLUORESCENT DRYERS FURNACE FUTURE APPLIANCE FEEDERS TiME CLOCKS UNIT HEATER MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E V I C E OTHER APPARATUS: 2-G.~ .C.I. .! -b'kw~ke Detector 2~,10,0 Kw. Elec. Fur~-mces R NO, OFpERCCgCOND OF A, WGcc, COND ~ NO, OF HI-LEG 1 2/0 AW, G, OF HI-LEG NO ~ NEUTRALS AWG, OF NEUTRAL 2/0 Gal Electric, 103 Br~d L~e, P],~i3,%view, N.Y. 1180[} lie. 149~E This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be COPY DEPAETMENT. OF ANY MANNER. FIELD~ IMS~ECTiON COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY COQE FINAL ADDITIONAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2N'D []INSULATION FRAMING []FINAL DATE INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803- Examine~.../. ...... ,19~.. Approved/~.~%., .1 ........ 19~. Permit No./{.0. 72t/~ ~ Disapproved a/c .............. -~--~'::..~7~:77... ............. ~~. ~~ APPLICATION FOR BUILDING PERMIT Application No. ~0~ .c~...c~. ........ 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 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~br 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 .~'-..~.'4'~.~.. tic...~..~.q~.$~..~?.....~.~2~ .~X .~. .................................... ~ (as on the tax roi?or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No...i.~ Electrician's License No...?. Other Trade's License No ...................... 1. Locatio~,n of land on which proposed work will be donq. ................................................. .... ............. 5d. .......................................... House Number Street Hamlet County Tax Map No. 1000 Section ...././.X. ........... Block .../.F.: ............ Lot Sub division .~.~.,~. ~.~.¢~q)~...~? .~ .~.~..C~ ~..w.~.. ~?...~*'~iled M ap No. ~0~:> Lot . .7~ ~5~... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .Q~.X-3~. ..... ~..~.~?..~..,~..X._?/I ....~.,~..~;q .x?...~ ........................... b. Intended use and occupancy . .~.. ' ............................................ 3. Nature of work (check which apblicable): New Building .. .:. Addition .......... Alteration .......... Repair .............. Removal ............. Demolition .............. Other Work ............... ' ~ ~/ ~ (Description) 4. Estimated Cost ................................ Fee ./..W.%r'..~..~ .......................... (to be paid on filing this application) $. If dwel!ing, number of dwelling Units ..... ~ .......... Number of dwelling units on each floor ................ If garage, number of cars .... 22 ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing stmcture~, if any: Front ~ Rear ~ Depth - ..:: .... Height ~ Number of Stories ~- ~ Dimensions of same structure with alterations or additions: Front ... .... .~-..' ...... Rear ...~. .............. Depth ........... ~. ......... Height ....... ~..~ ............. Number of Stones ......... } .......... 8. Dimensions o~f ~ntire new construction Front . . .~.~. ........ Rear . .~'.~.'. ......... Depth .~) eiCt . ..... Number of Stories..... . .... i .................. -,.. .......... 9. Sizeoflot:Front...~.~ ...... i ........... Rear .... %-?.~ ....... i ..... Depth .~.t~.~....'.iiiiiiiiiiil. 10. Date of Purchase .............................. Name of Former Owner .......... ; .................. 11. Zone o~ use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... ,~^A.. --' .................... -_~ Will excess fill be removed from premises: Yes No 14. of Owner of premises II.I .~.~..g~. g.~..g~9.°..~?.~./.~. Address ~q.%~q~)c,~..~. ........Phone No ................ Name Name of Architect .......... ~ ................. Address ....... ~ .......... Phone No ................ Name of Contractor .xm~\.~5~ttr;,,~.~ .wg ......... Address 2,5 5¢.~¢~. .... ~,..~.... Phone No..td.~.~J. I.C'4-~ ...... PLOT DIAGRAM Locate clearly and distinctly all' buildings, whether existing or proposed, and, indicate all set-back dimensions from property lir~es. Give street and block aumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Yf~K/ ? , ,~ COUNTY ;' s.s ..... I '.~*rq-~'~--L~,. ~.~ · ................... being duly sworn, deposes and says that he isthe applicant (Name of individual sighing 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 all statements contained in this application are true to the best of his knowledge and belief; and that the work will b6 performed in the mann{r set forth in the application filed therewith. Sworn to b~fore me this ............ .... Notaw Public, ~ .,,~../''-:...':x~..~~.. Notary Public, State of New york .... '~,'.'*'; ·; ,"~-;-.",-<". · .' .... ,"w~, · ,'-~,~D ................ , No 52-0344-963 Suffolk County~¥ / (~l~natnre, i ] Cor~misaion Expires March $0~