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Home My WebLink About10716-z FOI~M NO. 2 TOWN OF SOUTHOLD ~UILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH*OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 107~6 Z Permission is hereby granted to' ...... ~>.~.~. ~.. (X~./~--.-- ,~...,~:. ~ ....... ~,~..~.~.~.. ~......--....../~.....~...-- ......... ~o ../~/~.~....~.~:..~...~ ~.-...~.'~./~.. l.~.....~.... ...~:~.~..~/j/~ ~ .......................................... ~ .................................................... -- - ...... /~ ./_~ ~ ........................................ ~. .~.~ .................... pursuant to application dated ...... ~.~.. ~ ................... , ~9~, ~nd opproved by the Building Inspector. Fee $../.,~.-...~.~..~.- .... '~ f Buitdl'l~g Inspector ~'~ 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 disposa[-(S-9 form or equal), 3o 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 s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1o Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 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 Date .. New Budding ............. Old or Pre*existing Building(Z) . _. ~ .... =/Vacant Land Location of Property .. ......... , House No. Street Hem/et Owner or Owners of Property ~ ...... .].~. ~ ...... .~.~. ....................... County Tax Map No, 1000 Section ..... ~,[ ~'~ ...... Block ..... ?J ........ Lot .... .~. ......... Bubd~v~s~o,.. ;.~..O.Z~..~. ~' ............ F,ed M~p No..! .?.S. ~..'or No..C~. Permit No. [~.).J;~... Date of Permit .~.:~.O?.~?.Applicant ,-~ 0 Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. , Request for Temporary Certificate ..................... Final Certificate ................. ~ Fee Submitted $. ,~,,4 .%~, ..................... Construction on above described building and permit meets^all ap~cable~cg,de~ and reg~lat!,ons. ..... , ....... .............. Bev. 10-10-78 FORM NO. 6 TOWN OF $OUTHOLD Building Depar~men~ Town Hall Southold, N.Y, 1197~ APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicauon must be filled in typewriter OR ink, and submitted in duplicate to the Building lnspec- tor,,v~th the followin;; for new buddings or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or tooograohlo fe3tures. 2. Final approval of Heaith Dept. of water supply and sewerage disoosal--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrlal buildings, IVlultiple Residences and similar buildings and installa- tions, a certtficate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Ptanning Board approval of completed site plan requirements where applicab e B. For existing buildings (prior to April 1957), Non-conforming uses, or buildines and "pre-existing" land uses: - 1. Accurate su~ey of peoperty showing alt property fines, streets, buildin§s end unusual natural or topographic features. 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 occuoency on pre-existing dwelling ocr land use ¢;/~/~5.00 3. CoDy of certificate of occupancy 81.00 New Building ............. Old or Pre-existing Bullding{,'~} ......... ~/Vacant Land Location of Property .... . .................. ~ou~ /VD. S(ree~ Hamlet County Tax Map No 1000 Section //~ Block ~ Lot ~ Subdiv,sion..~A~.~.q.~.~ .Filed MapNo. ~Z.~...Lot No.~/ Health Dept. Approval ~ ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate .... ~-. ........ Fee SubmittedS.. ¢~ ¢¢ Construction on above described budding a~it'meets all app~bl~odes and regulations. 5'J ............. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographm features, 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical ~nstallation 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 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 features. 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 SB.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 Buildlng(:~). _.._~__ _. = ZVacant Land '- Location of Property . ~ t ~_~ ~ House No. Street Ham/et Owner or Owners of Property '~ ~ ' - County Tax Map No. 1000 Section .............. Block ............... Lot ................ Subdivision ..... LL .. ?.., & .......... L).J .... Lot :S:: !. Permit No,.....~O'~ t,~. , , Date of Permit ~, .'~'!(?,~.~,~,Applicant ..... ,~, ,~. ,~ ,/~,..-~ C.(.~.~ ..........~' Health Dept. Approval ........................ Labor Dept. ~,pproval ......................... Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate .,, ~....- ......... Fee Submitted $...-~.f .~.-? ..................... Construction on above described building and p~rmiAmeets all app~c~ble_.codes and regulations. Applicant ,, ,; ...... , ......................... Rev. 10,10-78 TOWN OF $OUTEIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-lS02 Applicant This is to advise you that the job under Building Permit No. ~O?/~ issued to ~A_~I on ~[t~o for ~e~-~d ~ ~ ¢~. ~ xs completed and a finaI inspection has/-~ h~s ~ot~ been done. In order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form(s), return same to the above office with a check for $5.00 payable to the Town of Southold. Please indicate to whom the Certificate of Occupancy is to be and arrange with this office for an inspection date. Thank you for your prompt attention. Very truly yours, Victor Lessard Administrator VL:ec Enclosures mailed, FIELD I COMMENTS FOUNDATION (Ise) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY COpE FZNAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ..... ..~. ....19 Disapproved a/c~ . ,...-~-.~...--~'~ .". .. ........... i i ~: i ] .. · .~../~/ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .O..0..~..~.,,, .&. .... , 19 ~..0 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 iremisel and in buildings for necessary inspectiO~n ~2 j~- //(-,' ! ~] . , (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpremises ...~..%~'~J ,~u/~ ,C.~..~..~./~,~.' ~C*~" ' (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 ...... ~ ........ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. . .... ...... .4.*. .r.t ....................................... ~'"' House Number Street Hamlet County Tax Map No. 1000 Section ..... I. ! .~. ....... Block ........ .~ ........ Lot ubdivisio ~ ~ ~c~,~.~,-~"7""~'''~ tqFSiledManN° 175''~ 5'1, S ~ ........ ~ ....... .~ ............... = ............... 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 ....... .~ .~,S...~. ,~..~..~..~..~- ............................................ b. Intended use and occupancy ..... .~x, ~ ~..¢. ~..(' .t~..~..~, ........................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work :,,,~¢, ~.. ....... 4. Estimated Cost ~. ~.'.O...o..~..~..4...~..~. o..~...~...Pi..R-.T..~.,~/.~..4,Fee .................... I..c9. ............... i (to be paid on ~ing this application) 5. Ifdwe!ling, number of dwelling hnits ..... C)..~.~.... Number of dwelling units on each floor ................ If garage, number of cars . i ................................................................... 6. It' business, commercial or mixe~ occupancy, specify nature a_nd__extent of each type_of_.use ......... 7. Dimensions of existing structures, if any: Front... '~,.. O...F7 .T.,.. Rear ...~. O. ~../..'.. Depth . .. Height ............... Nun3ber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth: ......... I.. Height ................. Number of Sto_rie_s~ ....... Heigh( ............... Nurqber of Stories ........................................................ 9. Size of lot: Front ...........: ........... Rear ...................... _Depth ..: ..... ~ .... 2- ....... 10. Date of Purchase ...... I.q. ~.i '~' ................ Name of Former Owner ... (~. 9.0. 0. H.~.. ~ .......... 11. Zone or use district in which pr~mises are situated ......................... ~1 ........ i'" i ............. 12. Does proposed construction vi~ollate any zoning law, ordinance or regulation: .... ~,~. 0 .................. 13. Will lot be regraded ....... I~ .~ ................. Will excess fill be removed from premises: Yes N(~, 14. Name of Owner of premises ..: ................. Address ................... Phone No ................ Name of Architect ......... i ................. Address ................... Phone No ................ Name of Contractor ..~./'t~ ~. ~ .'~. ~. O.P~ .O ....... Address .~.~.~..b...~..U'. ,. ...... Phone No. ~'~h .cj ... ~.~.~.1~ Locate clearly and distinctly ar property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STA~E OF NEW y'~RK, [ ).,," ,~ '~'~' ~ ~l /~ being duly sworn, deposes ~d says that he is the applicant ~; ofindiv}~ng contract) above named. He is the ............... ~,~ ~ ............................................................ (Contractor, agent, corporate officer, e~.) of s~d owner or owners, ~d is drily authorized to perform or have perfomed the said work and to m~e ~d file this' applicafioa; that ail statements contained ~ this application are tree to the best of his knowledge and belief; and that the work will Be perfomed in the m~nbr set forth ~ the application filed therewith. Sworn to before me this ~~..day 0f ........ . ....... .... ............. i ELIZA~ETH ANN NEWL[[ % "~ ~ (S~nature of appUcant) NOT~Y PU6ttC,~ate of New~