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Home My WebLink About10995-z FOI~'~ NO. 2 TOWN OFSou~rHO'~ TOWN SOUTHOLD, N~ Y. ~ r 10995 Z Permission is hereby granted to: UNTIL FULL ~-~/...~. .................... ~ ....... atn~'emises,_., located , .? ................... ...... ~ ......... ~ ............... ../......~ ,~ ~~..~ Couhty TaX Map No. 1000 Section/c.~ 1~..~,~...~. ...... Block ~...~.~ ...... ?Lot No....~.~. ...... purscant to application dated ~ ....... ~ ............ ~...}~....~....., 1~ and approv~ by the BUilding Inspector. ~ .:~2 R~v.~ ~/30/80 ~ ~, ~ 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 disposel-(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. 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 ............. · ocat,on of Property. House No/ Street ' Owner or Owners of Property ...~.~¢'/~.,,~. .... ~. ¢/~ ~ ............................. County Tax IVlap No. 1000 Section .... ~..~. ....... Block .... (~. ~. ...... Lot ..... .~./..~. .... Subdivision ................................. Filed Map No ........... Lot NO .............. Permit No ........... Date of Permit .......... Applicant.. ~..,~'..~'~,~.~. ................... Health Dept. Approval ...~//-~ .............. Labor Dept. Approval . ~¢.,¢~¢~. ................ Underwriters Approval ........................ Planning Board Approval . ,~..~, .............. Request for Temporary Certificate... ~ ~ .............. Final Certificate .. ~ ................. Fee Submitted $ ...... ~.^ ?.?. ................ above described budd~ ' Construction on ' 'ng ano permit meets ~11 applicable codes and regulations. ~-~' Applicant ........ ~...~..~¢,~.~. ................. THE NEW YORK BOARD OF FI:RE UNDERWRITERS D~ BUREAU OF ELECTRICilTY' )-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 .~te ~4~il 9, 1981 ~p~lic. tion~o,o, fle 113162 ~ 81 THIS CERTIFIES THAT only tke e~ectric~l equipment ~ described ~elo~ ond int~duced by t~ applicant named on ~he able application nun~ber D~ the pretnlsez of P~nd ~ib~(k~ 2720 ~y'~s in the Jollowing location; [] Basement [] 1st FI. ,~.~ex.,,,i.edo,, April 6, 19~1 FIXTURE FIXTURES OUTLETS SWITCHES NCANDESCENT FLUORESCENT 3 4 I 3 [] 2nd FI. Section Block Lot and found to be in compliance with the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS iME CLOCKS L~NIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT NO, OF CC COND. A. W ~, NO OF HI-LEG A W G, NO OF NEUTRALS A W, G, PER ~' OF CC COND, OF HI-LEO OF NEUTRAL OTHER APPARATUS: Sal Praco Electrici~n, (~.ec~io~.r., ~.Y. 11944 lic, 1049-E Per_ This certificate must not be altered in any manner; return to the office of the Board if Inspectors may be identified by their credentials. co.~.~pa sU~Z~mNe m~t~mt, tins co.K o~ c~.%~A~!:H9% s~[~tj ~g~, ,N A~N~r ~^~N~.. FIELD INSPECTION DATE COMMENT'S, ~FO~ATION (2nd) _ ~ STATE EN~GY FINAL ~DITIONAL CO~TS: Examine .~d~...~.-..../.~. .... Approve/.~.~;r.-.. (.~ ...... Disapproved a/c FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 ., 19.~.2~. Permit No.../~J.~.~.'~. - Application No. /6~ cfi~.~ g 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 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, a corporation) ?. ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, on,neet, general contractor, electrician, plumber or builder. · .................................................................................. Name of owner of premises . ~ c~.~o.w~.~ .... ~ .~.~.~.~.o..~ o .... ~../,~.T~., ................................. (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.../..7. ~. ................. Plumber's ~icense No. Electrician s License No .... X~..~.~... Other Trade's License No .... .~..~. ¢ ., .g.~..r.~..oF., e 1. Loca[~ion ofland on which proposed work will be done. . ./~! y l . .~t.~..~.~?......... ... i ............. ............. ..... ......................... House Number Street Hamlet County Tax Map No. 1000 Section ..... ~. . .~-.~. ....... Block ....... .~. .~. . ......Lot...~../..~. ........... Subdivision ........... ~.~n'..~.~.. ............... 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 . .O.¥.~.~...'~.%.v~x'~ [ .~.. ~..c~..~.[i. ~.~ ................................... b. Intended use and occupancy ./~.. ~:../.~ ..... .~.x. ~.e.n.~: o..~....~.....r.e..cy.~....~, e..~.r.o.?..o~. ............... 3. Nature of work (cheek which applicable): New Building .......... Addition Alteration .......... Repair.. ............. RemOval .............. Demolition .............. Other'Work ............... : (Description) 4. Estimated Cost. . ' ............... Fe .............................. (to be paid on filing this application) 5. If dwelling, number of dwelling hnits .... [ ........... Number of dwelling units on each floor ................ If garage, number of cars ...... 7). o. ................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....-%.o. ............... 7. Dnnenmons of ex~stmg structures, ~f any: Front ..... ~ ......... Rear ...,~..~ ........ Depth.. ~.6 .' ......... Nu :be ofSto i 0.~..e~-. Height ........... m r r es ................................................... Dimensions of same structure with alterations or additions: Front .. ~..~ ........... Rear ... ~."~ ~ .......... Depth ................ i.. Height .... g.~..~ .............. Number of Stories ... or~..~, .............. 8. Dimensions of entire new construction: Front ....~.~.'. ........ Rear ...~...~/. ....... Depth ... ~3.~ ......... Height ..../ ........... Number of Stories .... ~ ~ ................................................ 9. Sizeoflot: Front ...~./.~.~...J ........... Rear .... ~/. ~.t Depth 10. Date of Purchase..../~.~..........o ! ....... ........ 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: . A/.6 ............................ 13. Will lot be regraded . .xzx ~ .... ................... Will excess fill be removed from premises: ~) No 14. Name of Owner of premises ]~im.on.d..~/']e.[.t~,~d~.. Address ./.~$'. ~?~[O*~f~../~l~.d. Phone No ............. ~... Name of Architect . 12~..'t[.~ ~-~:...~.~.r.~.~. ....... Address . ~.~.Q .~.~(. J~.~.' .... Phone No.. ~ C../..o. ~. ~... of Name Contractor . [O~ .~h .~.g .cs~.~ .~/~,.o...~.e~o~c..I~*.... Phone No.. '?.~J= ../..~.~. 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 ~umber or description according to deed, and show street names and indicate whether interior or corner lot. " .~ STATE OF NEW YtO~K, . corny OF .......... ..... above named. being duly sworn, deposes and says that he is the applicant ~__-~-- . 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 mannir set forth in the application filed therewith. Sworn to before me this .......... .?. ...... day of .... Notary .Public, ....... _. ...... ~ .~.~. County -- ~' ~'~ffZ.~l) ETH -AN N NEVILLE f; ......... NOI^~ ~'tlaLIO, Stat0 of Ne~ ¥0rl~ No, 52-8125850, Suffolk County_ Termi Expires Murch 30,