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Home My WebLink About10831-z TOWN OF ~OuT~D~ TOWN ~HALL ' ! SOUTH'OLD, N~ Y. (THIS PERMIT MUST BE KEPT ON THE PRE~ COMPLETION OF THE WORK AUTHORIZED) N? 10831 'Z D~..~ INTIL ~ULL Permission is hereby granted to: ...~.' .K.z~.~...~. ..... i.../~ ..... ../E..-...~..: ........... L.~.~..r, ......... /.,.~,.~ .............. . ../.~.~'~.~.,~..: ... ,~. .............. :~ tO at premises located at ~.~....~...... p~Ursuant to application dated ..... , 190~ ~.., approved by the Building Inspector. i $ Rey. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD F:CU ilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Th~s apphcatlon must be fltled m typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; fog new buddings or new use: 1. Final survey of property with accuratJ location of all buildings, property lines, streets, and unu~Jal natural or topographic features. 2. Fhqal 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 buddings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certffmate o! Code comphance flora the Architect or Engineer responsible for the building. 5. Submit Pldnrung [3omc approval of completed site plan requirements where applicable, For existing buddings (prior to April 195)'), Non-conforming uses, or buildings and "pre-existing" (and uses' 1, Accurate snrvey of peope~ty showm9 all property lines, streets, buildings and unusual natural or topographm features. 2. Sworn statement of owne~ or p~evious owner as to use, occupancy and condition of buildings. 3. Date of 'any housln(.J code or safety inspection of buildings oF premises, or other pertinent informa- hen lequHed to prepare a certlfmat¢,. C, Fees: 1 Certdlcate of occupdncy $5.00 2 CertJfmate of occupancy on pre existing dwel ~g or and use .e,5 00 3. Copy of certlficate of occupancy '$1.00 ' ~ "~ ....... New f~uild~nq~ ~ '. ...... O~d or Pre-ex.sting Building ........... Vacant Land ............. Locat'onofPropert;7. ¢~..~ ........... Hou~ No ............. ~ ............... OwnerorOwnersofPropmty .~~ ~treet H~m/et CountyTax Map No 1000Section ~} ~ :" ' ...... '> ....... Block .. ,~), / ......... Lot, .(,¢,, ,~uhdw~sion .... ~ ................ Filed Map N~ ........ Lot No. (7' ............ ? .t Health BepL Approval . .......... Labor Dept. ApprovBI . ..:lj~?~;; .......... Underwriters App¢ov~l . ~ ...... Planning Board Approval equest for Temporary Certdmate ......... ~ ..... Final Certificate .. , :ee Submitted $...1%-.'. ?~ :~..¢ ....... ~ _~// ~ ~.~/ .......... lev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NI~0~7}.~.~YORK~ lg~38 theJollowing locatlon; ~ U,,s~.,~.t ~ ~t Ft. ~ ~,,d FL C~ttni.da ~ ~L Section Block Lot ~t~ ~ ~9~ ~. and found to he m compliance with the reqalrements ~g this Board. ~ECEPTACLES SWITCHES ' FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT VAPOR DRYERS FURNACE MOTORS FUTURE AEELIANCE F[=EDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT S E R OTHER APPARATUS. AWG OF CC COND .. NO OF HI-LEG E .Vz(iLc,.ltu'ci% N.'~. ]195X This certificate must not be altered in any manner, return to the office of the Board if {ncorrect Inspector, s may be identified by thmr cred~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF IN ANY MANNER. I' 0 Ioo,0 FORM NO. 1 TOWN oF SOUT,OLO BUILDING DEPARTMENT TOWN HALL ................ ....... (Bu~dh~ [~sp~cto~) 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 ames, 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 Bmlding 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 m 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 theisst trace of a Building Permit pursuant to the Building Zone Ordinance of th, e Town of Southold, Suffolk County, New Yorl ~a~,d other applicable Laws, Ordinances or Regulations, for the construct]on of buildings, additions or alteratiori~,~ br~l~ rtl}oval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bulling,i~,,~, ~e, housing ~9o~e, an~)egulations, and to admit authorized inspectors on premises and in buildings for necessa, rg. ....in~gpect~,~.[.~. ~.~-s'~~o (Signature of ap rporation) (Mailing address of applicant) State whether apphcant is owner, lessee, chitect, engineer, general contractor, electrician, plumber or builder. Builder's License No .......................... Plumber's License No ...... '~~(.~t~ ....... No .... ; ..... Electrician's,LicenSeOther Trade s License No ....... ~/J .......... 1. LocatJ.on of land on which proposed work will be done .................................................. . . o. . . .,. . /. . . . . /. . . . ............ . , . . . . :. ............. : Ham]et County Tax Map No. 1000 Section ...~ ........ Block . .~..~ ............ Lot..O~.~ ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of prclnises and intended use and ocg~pancy of prol~osed construction: b. Intended u,e and occupancy ....fO..O~J. ,,, ~., ,~.....~~.,, ./ ......... ! .................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal ..... I ......... Demolition .............. Other Work ............... 4. Estimated Cost ................... Fee ........... ~ (to be paid on filing this application) $. If dwelling, number of dwelling units.... ~ .... ~ ...... Number of dwelling units on each floor ................ lfg t ............. arage, number of cars ........................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........ .~,., ........ 7. Dimensions of existing structures, if any: Front... ~ .'~, ....... Rear .. ,~'~..'~ ...... Depth. ~:~' ....... Height ............... Number of Stories ........ ,/ ............................................. Dimensions of same structure with altera,~ions or additions: Front ................. Rear ................. Depth ...................... Height ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front .... .~. ,~., Rear~ ..... , .......... Depth .............. Height .......... ,/~,.. Number of Stories ...(i~. i ~L., ~..~....f~.t~., ,O?....~.. t~-:~-~.~, , ¥ .......... 9. Size of lot: Front . .[.~..~. ........ ' ..... Rear...~..~.~..~.i .3 ....... Depth . ,/~, · .~..~. · ......... t 1. Zone or,use district in which premises a?e situated... 4~.~. ~. · .................. . ...................... 12. Does proposed construction violate an~ zoning law, ordinance or regulation: ...... ~.~ ................. 13. Will lot be regraded ..... ]l~.~O .... :..,, .......... Will excess ~11 be r~noved from premises:. 14, Name of Owner of premise~ .'~[gt, Pb~. ,~. ~J{~..T_.., .... Address,,yf:~. ,~?../~....t,..~..~ ..... Phone No.C~./. ~, · .~.~.~..t?.. , Name of Architect , .~,. ~ ........ ~.. ~..~,'T!.~<..r~. Address . .~,.~j,, .,~ ......... Phone No. ,,~ Name of Contractor .~'/~l~... ~l?../r,~. ........ Address .~/F~. ........ Phone No. ~..Td, ,O..,-f./..c~.. PLOT DIAGRAM Locate clearly and distinctly all Nfildings, whether existing or proposed, and, 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. "" '/%.. u s /oo,. ,. STATE OF NEW~K~t~ ~ ~ .~.~ ......... being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contrac~ above named. He is the .............................................. , ............................... (Contractor, agent, corporate officer, etc.) of s~d o~ner or ownem, ~d is d~y author~ed to perform or have perfo~ed the said work and to m~e ~d file ~is application; that all statements cofitained ~ this application are true to the test of his ~owledge and belief; ~d that the work will be perfo~ed in the m~ner set forth in the application filed thereMth. Sworn to befo~ me this ...... ...... ........ .... ( ' / NO, 52-8125850, Sufidk Cou~ / 1elm Exp~es ~a~ch 30,