The URL can be used to link to this page

Home My WebLink About10755-z ~OI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTt-IORIZED) N? 10755 Z Permission is hereby granted to: ....... ~~.....~..~.~.~.~.~.~..~:/ ...... ~...: ....... .z.~._~ ....... .z..~.:¢~.... ...... ~.~..r.~.z~z.~....-.....~:.../' ..~.~ ...... C~z~,.~..~.~.~.c~.......z~..~.~. ....... ~z~.~.z ' ......~.~...~.~. ........ · ~._l.....~'~..c~. ...... ~..c~.~.~..,~r~. ....... ~ ........................ ~ .......................... at premises located at ..7~.~... ....... ~__~..~.'..~.~,~,~C~...~.~..~.,~ ...... ,,~..~r..'~-~.~.~ .~:....~.) ~;;/, ..~..~.~.~.~.o,~. .......... ~.....z...,....v...:. ............... .:..:::....~.~....~7.. .......................... pursuant to application dated .. · .~.~............~....~... ................. , 19...~..., and approved by the Building Inspector. Pee *..I~Z ...... FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. Th~s apphcation must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: ~. Final survey of property with accurate location of all buiIdlngs, 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, Industria~ buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect o~ Engineer responsible for the building. 5.Submit 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 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 prem/isas, 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 Building ............. Old or Pre-existing Building(X) .. ....... =/Vacant Land ............ Locat,on o, Property. ...... : ...... ......... House Ho, Street Ham/et Owner or Owners of Property . ~,,~/~, D. ~ .~¢.-~, ./0~..'/: .0¢,~.l;~ ./~f{~,..c~..'.~ ..... -,¢f<'£ '...k~. ~ .... .. CountyTax Map No. 1000Section ...¢~..~ ...... Block ...// ......... Lot...(~..0..~.//. ...... Subd.vision . .. ~?~E~..E4'.¢~. ~,~.O.O. ~)._~ ............ Filed Map No..~../...~,/.Lot No....~/...~. ...... Permit No. /0 ~,~-2 Date of Permit ~J .Applicant .,~,/~¢¢¢. ,'~r./(~ .~,.~J.,,~,Z,,~/.~(~..~.E.. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval../~..z_/,~-. ~,. (¢..~/.~. ...... Planning Board Approval .................. Request for Temporary Certifi~.~te ..................... Final Certificate ................. Fee .... buDm ttea ~ ........................... Construction on above described building and permit'meets all appJ~cable~codes and regulations. , , '-~ ~D0~ THE NEW YORK BOARD OF FIRE UNDERWR. ITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW yORK 10038 N ..t~ 3uty z~, 19BO ~pplicat,o.~Vo o,~Si~ 081922 THIS CERTIFIES THAT only the electrical equipotent as described belo~v and introduced by the applicant na~ned on the above application number in the premises of ~,~c. Wisniewski~ 725 C~'it~r~; I~tne, SO~t~l~, in tke followlt~g I~ation; ~ Basement [] 1st l"l. .,.~o~...~,,,~d,,,, July 17, 1,980 FIXTURE OUTLETS 1 DRYERS [ECEPTACLES SWITCHES FIXTURES NCANDESCENT FLUORESCENT 1 1 [~ 2nd FI. 01~8~,~ Section Block and found to be itt compliance wtth the requtrements of thts Board. RANGES OVENS DISH WASHERS SYSTEMS NO. OF FEET Lot OTHER APPARATUS: S E NO O~ERCC~COND AWG OF CC COND AWG OF HI LEG NO OF NEUTRALS AWG OF NEUTRAL e must not be in 11767 , manner; return to the off;ce of the Boar, ~ Copy OF ANY MANNER. F~EL,~i~iNSPECTiON COMMENTS FOUNDATION 2. ROUGH FRAME PLUMBING (aha) INSULATION P~R N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: ~n. ,~.r,~,~-,-/ '"~'"~ "' :-- ,Y .... / FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .... ,19 . ^pplication ....... .... ........... ....... // .......... :~ ,~ ................... APPLICATION FOR BUILDING PERMIT 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 drown 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 premises and in buildings for necessary inspections. (Signature of applicant, or name, if I/corp ration) . . a . . ¢. . /4.57. 2o. . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ................................................................................. Name of owner of premises . .~..~.f~../~, .~..'~....~.,: .~/.D..~.... '.f~.. f'~ ./~./.~.~..6Q..~./.~-/. i ............................... (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..C.'.,~/~ .~· .~..~.~..~ '.~ .'77..d.O.t.~. Plmnber's License No ......................... Electrician's LicenseNo ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section .~7~ ......... Block .... ~( ............ Lot . .~ ~.~ ...... Subdivtsion ~. ~o~. ~'~a~ .................. 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 occupancy . . . /~ ~~ b. Intended use :and occupancy ...~~. ~ ~...~ ~.. ~.. ~{~ .................... 3. Nature of work (check whtch apphcable). New Bml&ng .......... Addmon ..... Alteration .......... Repair .............. Removal ............. Demolition ........ ~.~... Other Work/~(g~(//~. · ~3~.*C (Description) ....... 4. Estimated Cost ................... Fee ...................................... (to be paid on filing this application) 5. If dwdl~g, number of dwelling un~ts ............... Number of dwelling units on each floor ................ If garage, number of c~s .......................................................................... 6. If business, commerci~ or mixed dccupancy, specify nature and pxtent of each type of use ..................... 7. D~ensi0ns of existing structures, ~f any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... t HeiSt ...................... Number of Stories ...................... 8. D~ensions of entire new constru¢ion: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................ .~'~ ~ . ~ i~ ~ ~,~''r./~2~ 9. Size ofl6t: Front ...[.~'.~.¢ .......... Rear..~ ~.. ~ ~;~ 10. Date of Purchase ............ 1 ................. Name of Fomer Owner ............................. 11. Zone or use district in which premises are situated .......................... ~]~.- ....................... ............... 1 2. Does proposed construction violal e any zoning law, ordinance or re~lation: ..... t ~. ·. 13, Will lot be regraded ....... ~...; ............... Will excess fill be removed from premises: ~ ~. ~ No ' . Address .~g~ ~?~( .~. Phone No.. ~]~. ~0. 14. Name of Owner of premises ~. 4 ~B~/~.~F~'. ' ' ' Name of Architect . .~ ·..~ ..... Address ................... Phone No.. Name of Contractor .~.t ~ ~ ~2~ }. Address .] 7.O9..OT~o .~Phone No ~ ~ PLOT DIAG~M Locate cle~ly ~d distinctly ~1 build~gs, whether existing or proposed, ~d~ indicate ~1 set-back dimensions from prope~y lines. Give street and block [~umber or description according to deed, and show street nines and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF .-~u'/E'../ff.~.~. ~ .... './/d4. .a. . .ad./. .................. (Name of individual sigging contract) above named. being duly sworn, deposes and says that he is the applicant 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 con!airier in this application are true to the best of his knowledge and belief; and that the work will be performed in the man,er set forth in the application filed therewith. Sworn to before me .this ~ i ......... ~ ........ Say al.. ~ ......... , 19~//)'' \ LINDA F. XOW,~'A% NOTARY PUBLI6, ~ .~J, .~~, ............ No s~-~24m (Slt~ture of applicant) Qualified m Suffolk County ' i Commission Expires March 30~ 198~,