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Home My WebLink About10754-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, ~q. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 10754 Z Permission is hereby granted to: .... Z/~..~....~//....~.~.(...~..../'~.~.~...~ z~,~r Co. ..~.~.T~.~.,~..***z .............................. ............................ ~.~... ..~.. to ...... .~.~..~.~.z~,~/. C~~ ,ef~..~..zz z~. z~. . .. ........ ~-~.z~-~...z~¢-~ ....... ~.,~.,'-~ ,~..~.~..... ~..~.'-~'J'.~,~ .......... = ................................. at premises located at .7~.~.......~...~..(. ,~.."~/.C.../~.'~'~.'..~...-~'r- ../.4~..~./.(~........~b,¢~'(~....~.~-.),.. ........................................................... z~..~.../..-Z..,~...~...c.,f,. =......~.:..~ ..... pursuant to application dated . .~..~..~. .................................... , 19 ., and approved by the Building Inspector. ....... 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: 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 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 $5.00 2, Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ..April. _12, 1982 New Building ............. Old or Pre-existing Building(Z) ....... =/Vacant Land ............ Location of Property . (~r'.r~',,q~ .S, qu. rJ.d..Av¢~.u.e..&..P~.c.~ .f.~ .c..S¢~'~ ........~ .~a.t,~i.t.u.g.k .......... House No. Street Ham/et Owner or Owners of Property ~o.~h..F.q~.k Bank_ .&..T?.~.s.%..Comp.a.ny .............................. County Tax Map No. 1000 Section . 1,41 Block 04 Lot 024 Subdivision .... ~( ............................ Filed Map No ........... Lot No .............. Permit No.. [075.4. Z.. Date of Permit 6./.26/.8.q...Applicant .Npy'.~.h..F.0.F.k.B.a.n.k..&..T.F.u.s.~ .C.0.m.p.a.n,v .... Health Dept. Approval . .. [J/A .................. Labor Dept. Approval . .N./.A. ................. ,.. Underwriters Approval . . . [~z~9~522 .............. Planning Board Approval . .N./.A. ............. ~ . . ~ Request for Temporary Certificate ..................... Final Certificate . ~ ...... - ......... - Fee Submitted $... [~, D0.. '..' ................... Construction on above described building and permit~meets all app~cable_.co.des and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRIC~iTY~ V 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as describ~ below and introduced ~y the~plicant nam~d~n the~bove appl[cptlon~um~er itt~t~g premises of in the following location; [] Basement [] 1st FI. ~ 2nd Fl. Section Block Lot was examined onOC~O~ ~6 ~ ~98~ and/ound to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS 7 ~ 1 7 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SERVIC~ DISCONNI~CT S E R OTHER APPARATUS: TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS NO OF. EC~C~.CONDr t(,~r J A w ~ NO O~H~-L~ A W ~ NO O~ NEUTRALS AWG OF NEUTRAL ~a2L~Lq)LUcl. ec Sy~ 14'-0 Plug $~vii~ 17 R~cp~s. ~land Elac. Co. ILO. ~ [43 ~a~:ituck, N.Yo 11,952 Lie. 242 E This ce~tific¢ate must not be (~hered in uny ~manner, return to the office of the Board if , CG THIS COPY GENERAl may Jpe Menhfled by their c ~__ F___ISLD ~NSPECTION COMMENTS FO~ATIO~ (~)) FOUNDATION (2nd) 2. ROUGH F~E & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;~ Application NO..~..~.ff.~?. ~ ...... A pproved~ .... : .c~.~ .... ,19~ Permit No../(..7.~..c7/ ~ / Disapproveda/c. .............. ...... (Building I ,ector) ~ 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 issu~ 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. · J~l.q6'T../,~....~q~ ?....g.,8. ~. ~..,L.T.;.:%.?-...d.q,.. (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 . ~.O./?'.~.~.... '.F.'?.~. '.~. ~-~./.0.t?..~. ............................................. y) (as on the tax roll or latest deed) ~ appl~ant is ~¢ co.d~oration_.k, si]nature of duly authorized officer. ...... ib'a~d 'ada 'titid gk ~;~r~;i 'o~/ii~ir') ......... Builder's License No.../.. ..................... ~ Plumber's License No .... Jt4./~: ............... Electrician's License No...~./.4 .~, ..~. &f .~. ...... Other Trade's License No .... '.)~../~. ............ 1. Location of land on which proposed work will be done ..... :~...~. '. ?..'~. ........................................................... .r:.r..,ur. ¢.c..?.- ............ House Number Street Hamlet County Tax Map No. 1000 Section ..../.~./. .......... Block ....~. ~. ........... Lot....~..~.?. .......... Subdivision .................................... 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 oc p Y ...... x ......... -'~'''/~4¢ V ....... : ............................. b. Intended use and occupancy ..... ' .....; ....~ .... d(7 ..... -. .. ': ......~ ......................... 3. Nature of work (check which applicable): New Building .......... Addition .........~.... Alteration .......... Repair .............. Removai .............. Demolition .............. Other Work ............... 4. Estimated os ............ q ........................ Fee ........................... i (to be paid on filing this application) 5.If dwelling, number of dwelling ~n)J~s ............... Number of dwelling units on each floor ................ If garage, number of cars ..... ~ ~ .............................................................. .6.. 'ff,,business, commercial or mixed! occupancy, specify_nature and extent of ea0;t I~pe of use ............ t ......... "':~. i:D~ensions of existing _structure~, if any: F}ont...~.~. ........ Rear ...~...~. ........ Depth...~..~. ........ ~ Height .. ........ ~ ~.... Number of Stories .... /. ............... 7' ~ ................. ~ '5? .......... Dimensions of same structure with alterations or additi/ons: Front .... ~ O .......... Rear .... 9..~ .......... Depth .... ~.~ ............ !. Height ..... ].~. ............. Number of Stories .... t ..... ; ........... 8. Dimensions of entire new construction: Front ...... ~ ¢~. ..... Rear .... .2..6 ....... Depth ... ~.~. ....... Height.....J.~.: ..... ~. Number of S~ories .... I'. .................................................. i ' Fro ~E £~/~ T 9. S ze of lot nt ................... Rear ..................... Depth ...... 10, Date of, Purchase ............................ Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction v,,iol4te any zoning law, ordinan, ce or regu. lation: .............. ... ,~c~: .......... ~ 13. Will lot be regraded ...... j~.~. ................. Will excess fill be removed from premises: ,,. ~,~ 14. Name of Owner of gr~mises ...,..~.. Address .................. PhoneNo. ' Name of Architect .D. OYJ/~t~.~,..~.'. ~>?'~.' ~' ' ........Address , ,~,' ,AO.... ,l~..~,. ........ Phone No. ~ .~i .~i-.' .~'.' .~'.' i~ Name of Contractor ' Address Phone No PLOT DIAGRAM Locate dearly 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 lot. STAT[. OF NEW ~/ORI~,~ a,g o o CouNr¥ OF .......... ~.~. v'~.(//e, tx....:..~.'."1 .,/. O. ~. ...... being duly sworn, deposes and says that he is the applicant / (Name of individual signing contract) above' named. (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 manne[ set forth in the application filed therewith. Sworn to before me this ~LIZABETH ~NN NEVILL~ · · · -- ......................... NOTARY PUBLiC,State of New York (Signature NO, 52.8125850, Suffolk~,~ul~ty T~rm Expires garch .. i, ]l~]~, . '4" ~, ?L~ ~/~- ~te. , w.w, ~. ~p. ~ ~,, '. , , ~*~E..~2~ ~.~.~ d ~ - t': ~'~'~' -'~ ~ -, ---- . ~ ~ L .... ~ i ~ : , EE~ ~~ ~Y:~._ .~ ~ ~__ /~ ~A,~<~ ~ : ~ - ~ , .,, ~ . ~ .~ ~.~,~- t,,.~,~*~ ,~ : . ~:~ .o~ .~.,,,~ ~,I// I~- '". 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