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HomeMy WebLinkAbout10905-z FORM N0. ~ ~' TOWN OF BUILDING' TOWN HAL£ SOUTHOLD, N~ Y. ~: N? BuILDING~ P, ERt~IT (THIS PERMIT MUST BE KEPT ON THE PI~,E~IS~S UNT L LL COMPLET C~N OF THE WORK AUTHORIZED) Permission is hereby grar{ted to: ......... .... .,~.~.Z.,.c,~,,...=..~ **~..*.~.., .......... ~0 ................. ....... ~: ...... ~ ' ' , -: Building Inspector. Fe~ ,.../..~.~... Rey. 6/30/80 // FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~nstructions 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 electrmal 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 Aprd 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 ............. Location of Property ~'2'~f~l .*~..~'./.. ? .Z,~.,~'./?.~..~¢¢-.~.~...~?.Z~.,~,~-..~..~,..~. ff .zT.-/.~'..,~'.~..,~.~ House No. Street Hamlet Owner or Owners of Property .Z~.-¢.~,..G~C~-~./..~:. .... .~..'~../~/.~.~../~..~'t ........................ County Tax Map No, 1000 Section , ./.~.~,'. ........ Block .... ~. ......... Lot ..... /. .......... Health Dept. Approval ........................ Labor Dept. Approval ............. ~.. ~ ~/..~/~ ~\ ~/~ Underwriters Approval .................... Planning Board Approval ........... ~).~..~...~.\.. Request for Temporary Certificate ..................... Final Certificate..'~'~-~ .... ~..~... ,H.~./. Fee Submitted $..%-') ......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant... ' .~. ,~.~ .~..~ .................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS i~j BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW MORK 10038 AppHcat,o,~ No. on file N 5 , THIS CERTIFIES THAT only the e~ctrical equiprnent es described belo~ and i~ttroduced by t~ appJlcartt ~d on the above application number in the premises of in the followittg Iocatio,H ~ Base,tent ~ 1st FI. [] 2nd FI. Section Block Lot and found to be in compltance w~th tke requireinettts of this Board. P,XTURE ~ 2 [ 2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDER! RANGES OVENS EXHAUST FANS SPECIAL REC'PT TIMECLOCKS UNIT HEATERS SYSTEMS NO. OF FEET E DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E NO OF CC COND PER ,~' AWG, OF CC COND C NO OF HI LEG I A W G NO OF NEUTRALS OF HI LEG AWG OF NEUTRAL This certificat not be :l ~n ,y manner; return to the office FOR IILDING THIS Board if lic, 1529-E OENE~AL MANAOER Inspecto may be identified by their credentials. IN ANY MANNER~ FIELD INSPECTIONs. I. FOUNDATION ( 1 st ) COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY CO E FINAL ADDITIONAL COMMENTS: AT - TWO REQUIRED ~ONCRE-FE - FRA~INGi& PLUMBING MUST SHALL MEET N: Y. ENERGY FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved .~.~. ~.-.C~ .~. ...... 19~.~ Permit No..4.~.' Disapproved a/c -~----~ Application No. / .(~.('~..~<?.~ ...... APPLICATION FOR BUILDING PERMIT7d Date ................. , 19.~,©. 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 Penmt. 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, or 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 d", . .~./.~ .~ .~.//y~ ./5{..~.' ............................................. (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.. ,,~',~.'.~..If.L~.~.-D.....//,~./.~/,~,~.., Plumber's License No ......................... Electrician's License No. Other Trade's License No ...................... Location of land on which proposed work will be done...~..~. ~'.~'../.~./.~../~..7~.~. ..... ~.~ ~'~(~ ~ ........ hgb d ..... ......... ...................... ..... ........... County Tax Map No. 1000 Section ............... Block .~ .......... Lot, Subdivision .................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing us~ and occupancy ................................................................... b. Intended use aha occupancy ... ~?~/~.~-/f ...... (~((~. .................................... 3. Nature of work (check which applicable): New Building .......... Addition ~'~' ~ ' Alteration Repair .............. Removal .............. Dem/)lition .............. Other Work ............... (4~ ~O ( ~ (Description) 4. Estimated Cost ..................................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................ I f garage, number of cars . 6. If business, commercial or mixe:d occupancy, specify nature and extent of each type of useOfq.~L~. ·~. . ,..~.~.'gr~. · .~-. 7. l)~nens~ons of existing structures, if any: Front../..~..~ .........Rear ./..g. P ......... Depth../. [ ........... Height ./~./.4 ?. ........ Number of Stories ~/Y~' ..................... . ......... Dimensions of same structure with alterations or additions: Front ./.~...o ........... Rear .../..~. ............ Depth .... ~i~f.o..~'. .......;..Height... °t ~' ' .. . /... ~. ~ ............ Number of Stories ~ '~' ' ,7 ' ' 8. Dimensions of entire new construction: Front .... ~,. ......... ~ear ... ~ .......... : ' Iteight .../.q ........ Number of Stories .... ~. ?{.~ .............................................. ~' pth 9. raze of lot: Front ...................... Rear ...................... De ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. I 1.Zone or use district in which premises are situated .................................... ',,k~ ............. 12. Does proposed construction violate any zoning law ordinance or regulation: ................................ 13. Will lot be regraded ... fif.~., i ................... Will excess fill be removed from premises: Y~/' No 14. Name of Owner of premises .(~g$..-.~.(/l~.tyO~.l~, ....Address .~?.F((~'(z.~..,~.~./#~F/.z/'.~cy.~Phone No. ~?.~: f/.~. g.ff. .... Name of Architect ' Address Phone No Name of Contractor Fr/~..ff.~f~.. './f~.~.~./f..ef.,~. ....... Address ~..oF?p~'.~.,../~p~../~.~.,q..P~'Phone No..,7.~..~..~'. ~"~. ?... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, ihdicate all set-back dimensions frbm property lines. Give street and blocki number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWcA'~K:/., ,~ S S COUNTY OF..7~_~~I.....c~,/~_' ' ¢ (Name of individual mgriing contract) above named. t,--L ~agent, corporate officer, etc.) of said owner or owners, and is duly"au~horized 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 mann?r set forth in the application filed therewith. Sworu to before me this ....... ~L--~7]~ .......... dayoi~'.__rf_).. / .... 19.~. ........ ~ fJ N 0iaR¥ ~ ~[~C~Na~eN E0fV~E ¥0rk ~ ............... (Signaf(u;e of applicant) , No, 5~ 8125850, Suffolk Cou~.Y.~ '