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Home My WebLink About11496-z FO~M NO~ 2 · ~ T~H OI BUILDING TOWN ~HALL· , SOUTHOLD, N~. Y. No. 1:1496 Z (THIS PERMIT MUST BE KEPT ON THE PI~E/~IS~S UNTIL I~ULL COMPLET ON OF THE WORK AUTHORIZED) :: Per ;missiod is hereby granted to: at p~-emJse~Jocated at C0uflW 108 Map No 1000 Sect on ' : Block . ..~ ~Lot No. 4 ........... pu~s¢*nt ~o ~pplicohon d~ted ..... ..... :..:~. ........ ~....~..._, ~ ., ond 9ppr~ by the Bu ding nspector. R~v. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD ~ui~ding Dapar~men~ Town Hall SOddlOld, N.Y, 11971 APPLICAT)O;,J FOR CERT)¢ICATE OF OCCUPANCY JNStFUCt~ORS Th~2 csDlication must be filled [n typewriter OR nK, and sub~l~a iR duplicate to the Bu)lding I~spec- ~or ,.vhm ~me io)~owimg; for new buildings or new use: 1. F{mal sur,'ey of propertv wJ;h accurate location of all buildings, property lines, streets, and unu~al 2. Final 2cato'ye1 o~ Heaith Dem~. of water supoiv and sewerage disposaI--(S-9 form or equ¢l). 3. Agcrc','al of electrical installation from 8oa~d'of Fire Undep, Nriters. 4. Commercial buildings, Industrial buildinos, Multiple Residences and similar build[ngJ and imstalla- t~o.ns..~ cerdf.icate of Code compliance fFom the Archi~e'c't 'or Engineer responsible for the buiid/ng. 5. Sucre), Pia~mng Board approval OT comple(ed si~e plan reGuirements where For exis:ing buildings (prior to April 1957), Nonconforming us~s, or buildimcs and "pre-exlstmg" la~d uses: ~ ' ' 1. Accurate sNmyey of peoperty showing a(( prouerty lines, ~reets, buildings and unusual natural or loco~roph~c ¢ea[urrs. ' 2. Sv..or~ s~3~cmen[ of owner or previous owner 8s ~o usa, ocsupsncy 8nd condition of 3 ¢a~e ¢" housing code or sa~eW mspec:]on o¢ buildings or premises, or o~her perdnen~informa. tic2 rcqu~rgd to prepare a ce~if~cate. / - Fees: 1. C¢~Jf;cate of occupancy 2. C.r,.,': ..... of occupancy on =-¢ ' *~ pr; ~x~s,,ng cwelhng or land us~ SS.CO 3. Cos'/of c~rt¢ficate of occupancy $I.00 ........... ~' .......... Old or Pre-exis:ing 8uiidlng(Z} ' · . ........ = /Vacant Land ......... Ccunp/Tax ~,1~o NO..1000 Section ~¢~ ~.. Subdivision P=rmi~ No ..... Date of Permit ,&¢pfics~t ,~ ...... ¢, Health De2:. Approval ' '~'-' ' ........................ Labor DapL Approval ...... Unda¢.'/ri:ars Approval ........................ Planning Board Approval .................. ~ . . ~ Reques~ for Temporary Certificate .................... Final Certificate' Fee 5ubmh~ed S .... .* .~ ................. above described budding and perm¢~ mee~s all apoficab ~od*s and raauladons , ~.=...... , Oo. -. COMMENTS FIELD INSf'ECTI~ON 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: TOWN OFFICE OF BUILDING INSPECTOR_ · P.O. BOX 728 TOWN HALL SOUTHOLD. N.Y. I I971 TEL. 765-1802 - Applicant This is to advise vo ...... · Permit ~o. ~,a~. ~o.i~u~-=~ ~e 3o~ unaer Building ......... ao /____/ aas noz /~f~ been done. com~_~e ~hzs file, it is necessary '~- ~ -~s .... ?lease fill out the ~ o~d or..(s), re~urn same to ~= o.~_c~ th a c.~c~ for $5.00 payaole to the Town of Southo!d. ~n--~=oe to whom the Ce- ~ificate of Occuoancy is to be ~=~e~, and arrange with ~' ~ ' ' ,..~-. on.s office for an inspecgion date. Thank you for your prompt attention. Very truly yours~ Victor Lessard Adminis tr~ ~or VL:ec Enclosures FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, r,l.Y. 11971 TEL.: 765-1802 Disapproved a/c ....... ; ..... - ...................... './. - . - APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled iu by typewriter or in ink and submitted in triplicate to the Build 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 stre or areas, and giving n detailed description of layout of property must be drawn 0il tile diagram which is part of this cation. c. Tile work covered by this application may uot be commenced before issuance of Building Permit. d. Upon appro.'aI of this applicatiop, the Building Inspector will issue a Building Permit to the applicant. Such pen shall be kept on the prcmises available for inspection throughout the work. e. No buildJag shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupar shall bare been granted by tile Building Inspector. APPLICATION 1S HEREBY MADE to the Building Department for the issuance cfa Building Permit pnrsuant tot Building Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for tile construction of buildings, additions or alterations, or for removal or demolition, as herein describ~ The applicant agrees to comply with alt applicable laws, ordinances, building code, housing code, and regulations, and admit authorized iuspectors on premises and in buildings for necess~.~~ ~7/r~d , (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Nmne of owner of premises ...~.. ................. (as on the tax roll or latest deed/)' tf applicant is a corporation, signature of duly authorized officer. ~ (Name and t~tk: of corporate officer) · . Builder s L cense No .... . ................ o Plumber's License No ......................... Electrician's License No.' ...................... Other Trade's License No ...................... 1. Location ofland on whicb proposed workwiilbedone./-7.....~..~ .'../~..~~ ......... House Number Street Hamlet County Tax Map No. iO00 Section ................. Block .................. Lot ............ Subdivision ..................................... Filea Ma9 No ............... Lot .............. (Name) 2. Stateexistinguseandoccupancyo~esa~tended use and o~ncy of proposed consTction: a. Existing use and occupancy ....... ~.~~. ~~. ~~~ qir .............. Relnoval .............. ~ Demolkion . ~ (Description) (to be paid on filing this application) ;. If dwelling, number of dwelli;ig units ............... Number of dwelling units on each floor ............... Ifgarage, numberofcars ...! .................................................................... L If bu~mess, ¢or, mqercial or mixed occupancy, specify natnre ant) extent of each typ~ of/.lse ............. ! ....... /. Dimensions of existing structtires, if any: Front.._,., ./".~.., ..... Rear ..... l.j.~.. ......Depth.. Height ..... ~a ........ Ntimber el'Stories . .<:9: ............................................ Dimensions of same structure ;with alterations or additions: Front ................. Rear ................. Depth .................. ~ ....Height ...................... Number. of Stories ..................... Dimensions of,cfi, tire ne>v. 9~n~truetion: Front ..... .~.~/[ ...... Rear ..... ~.. ,W, .r' ..... Depth .../.:-r~. ........ [ Heiaht .. ,,).'~'~./. · Ntimber,of Stories .......................... ' ...................... iz;o Iot: F,ont .C./ ..... >.y... Rear.. ........ >.2 ....... Date~6f Purchase ........ ~..7 ............... Name of Fenner Owner ... iff". ,,~,~.~h~'.,~. ........... Zon~ or use district in which ~remises are situated... 2 ............................... :./. ............. Does proposed construction '~ [olate any zoning law, ordiaance or regulation: ..... ~ ~. .................... Will lot be regraded ...... ~_. ,'(~. ................. Will excess ,ei, ll be removed f~)~.~es: Yes Name or Owner of premlses 7,,~./~-~..C-f~. A, ddress .~/.~. ~ ~.'Ph~one-~o. 3.2~.~oO,.~, ~.~.... Nmne of Architect ................... >2,'//: · "' · Address ......... Phone No ............... Name of Contractor ....... i..~ ....... Address ................... Phone No ............... ). ). I. L PLOT DIAGRAM Locate clearly and distinctly all m iklings, whether existing or proposed, and, indicate all set-back dimensions fron roperty 1/nes. Give street and block number or description according to deed, and show street names and indicate ',vhethe .letter or corner lot. rATE OF NEW YORK, ~, , ,, ,, . · OUNTY OF .... , ........z. ~ .,~ ~ ?/,.~ l ~/-~ [ (Nanie ofindM " ' ' being duly sworn, deposes and says that he is tile applican. e is the .................... (Contractor, agent, corporate officer, etc.) f said owner or owners, m~d is duly authorized to perform or have performed the said work and to make and file th.~ )plication; that all statements cohtained in this application are tree to the best of his knowledge and belief; and that tk 'ark will be performed in the manher set forth h~ the application filed therewith. worn to before me this .................. day'of .............. ,19 eta, Pub ic~;~ ~ ~ ~;. C ' (Tel. 515-~74 -Z~) : * ' ~t ~ I ' '~ t,?.~ ~... , ~ M~~~ -~.: I: ',>7 ' ' ...... ~/~ /. ' *~. ,, /~)~1~c$4 . / ~ EDUCATION LAW. , N .Y. : '- SUFF, CO. DEPT, OFHULTH~[I~ ,,~ ,, , ~ TE~ TOFIHTE T .... APPROVAL OF CON~U~ON ON~ D~L ~Y~TEM9 FOR THI~ RE~I. ; ' '"'' ~