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Home My WebLink About10746-z FOP~I~ NO. 2 TOWH OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) / 10746 Z Dote .... ~./.C,~.~. ....... Z-.~. ................. , Permission is hereby granted to: ...... ....~.~......~. ........ ~_~...~.~.~ .... ~o. ~ .~.~.~_~_z. ...... .~.~.~. ~£...;./.~.~... ~. ~.~ .~.z...~..~.~. ~ ............ ..... ~.~.~.~z,.~......c..~ ......... ~ z.,.~ ....... ~ ~ ~.~... .6;;~...~ II~.~ at premises located Z..~.?,...~....~.~. ........... .~'L~ ...... pursuant to application dated ......... ~L~.,...~,.~.. ............... , 19.~..~.., and approved by the Building Inspector. Fee ................. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hail Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application mus[ be filled in typewriter OR [nk, 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 instal[a- tions, a certificate of Code compliance from the Architect o? Engineer responsible for the building. 5. Submtt 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 hnes, 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. Dale 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 : ........... Owner or Ow~ers of Property ...~ ........ , ..... Subdivision ........ ~ ........................ Filed Map No. ~' .Lot No. Permit No. {.O~. ~Date ofPermi, k[~l~.Applicant Health Dept. Approval .... ¢/~ .............. Labor Dept. Approva[ ...~/~__ ........... Unde~riters Approval ...................... anning Board Approval Request for Temporary Certificate ..................... Final Certificate ..... Fee Submitted S ......................... Construction on above described building and p,~it~meets all app~cable~co.des and regulations. Applicant ...... ¢~.-......~ ........~./ ............................ ,~,.,o-,o-7~ ' ' .C~~. ~/~[~G' ' . THE NEW YORK BOARD OF FIRE UNDERWRITERS [J~[ BUREAU OF ELECTRICITY -- 85 JOHN STREET, NEW YORK, NEW YE)RK 10038< Date THIS CERTIFIES THAT only the electrical equipment ~ described belo~ and i~trod~c~ b~ the applicant ~amed on the above opplicatio~ number ~n the premises of in thefollowinglocation; [] Basement [~ 1st Fl. [] 2nd Fl. Section Block Lot wasexarnlnedon~[ ~¢~O~ ~ ~980 .nd.foundtobeincom. llaneewlththerequlrementso/thlsBoard. OUTLETS 5 rECEPTACLES SWITCHES RXTURES RANGES OVENS NCANDESCENT FLUOEESCENT EXHAUST FANS DRYERS DIMMERS SYSTEMS E OTHER APPARATUS B R V I ¢ NO OF CC CONO A W G NO OF Hi4EG A W O NO OF NEUTRALSJ~/A[ (~ W O pER ~' OF CC COND OF HI LEG OF NEUTRAL I z/0 1 ~ This certificate must not be altered ;n any manner; return to the office of the Board if ipcorrect Inspectors may be identified by thmr ~- COPy FOR BUILDING DEPAR~ENT. THIS COPY OF ~ER~IFICAT~.~UjT.~OT BB~LTERED IN ANY MANNER. ~IEL~ INSPECTION COMMENTS FOUNDATION (~s~) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CO~E FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved .~.~../~..~.....~-. 5.., ]c~..0Permit No.../..~.7...~.'-''~ Disapproved a/ ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT ~ Date ,~Cll.~..~..~..~ . INSTRUCTIONS Application No../.~...7..~.. ...... 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 properW 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 ~nspection 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 et.her 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. .T. .%. ......... (Signature of applicant, or name, ifa corporation) ...... (Mailing address of applicant) ~ t--5~-J ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .C.~'.~.~Lk.C-Z...~r.~4~{~.X..~..[.~--~.~. ................................... (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 .................................................. ............................ 5 ................ ..................... House Number Street Hamlet County Tax Map No. lO00 Section ... f. .~. . ~. . ....... 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 use and occupancy ~.~1 .~--. :~.... ' b. Intended use and occupancy ...~'~2:~-C>~.J~ ~... ~. ~. ~.'~. ~ ........................ 10. 11. 12. 13. 14. Nature ofwork (check which applicable): New Building .......... Addition..Z'~ ...... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... Estimated Cost ~[~ J.Z. tO.O..O. Fee ].~ ~ (Description) ~ (to be paid on filing this application) If dwelling, number of dwelling iunits .............. Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front..~2.~.(,*.' .--..~. .... Rear . .~.~,.-7 .t~. .... Depth...'~..~. ':'.Cl... Height .../. ~7-.C~. ..... Number of Stories ....... I ................................................ Dimensions of same structure with alterations or ~tdditions: Front .. ~ .~. C> ...... Rear .... ~..~2~-...C>.. ..... Depth ..... .~.~ .............. Height ..... I..G~.7.a~>.. ........ Number of Stories ........ I .............. Dimensions of entire new construction: Front .... 2,.~.7..~.... Rear ...~:.4 .~..C~..... Depth ...[(~.-..~.... Height .... ]~..'Z .CC. .... Number of Stories ........................................................ / Size of lot: Front ...................... Rear ...................... Depth ...................... [)ate of Purchase ' Name of Former Owner Zone or use district in which prSmises are situated .......... :' ./~.. 7. ..................................... Does p'roposed construction vioiate any zoning law, ordinance or regulation: .. j.J.d .......................... Will lot be regraded ......... ~ ................... Will excess fill be removed from premises: Yes No Name of Owner of premises ...' ........ . ......... Address ................... Phone No ................ Name of Architect ' Address Phone No Name Of Contractor ' Address Phone No PLOT DIAGRAM Locate clearly and distinctly all' buildings, 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 Iot. STATE OF NEW..YORK, /- ' COUNTY OF..O.C/.~. ~. 19.. ).~.... iS'S ..... .~'ff...~.~.G/./).~. ~.. f)-..:/~.~?../~. .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing 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 be performed in the manne~ set forth in the application filed therewith. Sworn to before me this . o~3 .dayof... C .,19.0~. (Signature of applicant) Qual~fred m Suffoll{ County Commission Expires March 30, 198~ ~OF 1