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Home My WebLink About11354-z FORH NO. 2' TOWN ~OF BUILDIN~ TOWN'HALL SOUTH'OLD, N,., Y. BUILDING P,ERJ~IT! (THIS PERMIT MUST BE KEPT 9N: THE PR£MIS~$ UNTIL EULL COMPL.I:TIOIq OF THE WORK ACTHORIZ£D) N? ~1354 Z Dato. ~. ...... 19. Permissior is hereby granted to: ......... .. ~c.~. ~.,....A.....~...., ................ ,o ..:.~.~-z~.....~?......~.~_~.~.~~.~..z~...~ .~cm.~.~......~.~Z/~ ........... ~ ........... --....~.~.~.....~~ ...... .......................................................................... ~ ........... ~ ...... ~.,~....~ ................. ~ ".. · ..: ............. ~ ............................................................................ ~,.~..?~ ................ ~'. ............ ~ ................ ~ ......... - co,,~ T~ ~ ,o. ~o0o s.:,o.....~[..... ,~o:~ ~ ........... o, ,o.. ~ .... pursuant ~o opplicotion d~ted ........... ......... · ............ 19 ~nd ~pproved by the Bu Id~ng I~spector. ~e, ~../.~... ....... ;.. Rev. 6/30t80 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 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 app!icab!a. 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 tines, 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 inspecti,on 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 $5.00 3. Copy of certificate of occupancy $1.00 l~ew-B4~[4L[~-~ ............ - ' ' g ' ' g(X).. .......... ~ Vacant Land 'i ............ HouseNo.~ .,; ~__,¢~ ,/,,_ Street. Owner or Owners of Property , . .,. ::~.,;-~w~ ~-- .~L~._/,~.~_ ...... ............................... County Tax Map No t 000 Section .... -. ..... I .... Lot .... ; . Subdivision ............................. . ....Filed Map No...: ....... Lot No: ............. .... ........... ~ealth Dept. Approval ........................ Labor Dept. Approval ...................... ~.. Underwriters Approval ........................ Planning Board Approval ' .. ~ ,. ~ Request for Temporary Certificate ..................... Final Certificat~ .... ~ ......... - Fee Submitted $ ....................... This'certificate mvst nor FIELD INS ~ECT i~ON 1. FOUNDATION / 1st) COMMENTS FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: - FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date .......................... , ..... File No ........... O~"l'Pt~q .............. PLEASE TAKE NOTICE that your application dated for pe~t to ................... boc~uo~ o~ ~mp~tW ~s~ ~o ................. ~ ..... ~/e~i .... ~ ................. ~mlet ' ~ub~i~isio~ ................. Ei~a ~a~ No ................. Yot No .................. Building Inspector RV 1/80 100 37 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR[CITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment ~ described below and introduce~ by the applicant named on the ob~e gppHcatlon number itt the premises of ~. ~h~ fo~o~i.~ ~o~.~o.; ~ ~.~.~ ~ ~ r~. ~ Z.d r~. ~ S~tio~ mo~ rot was exami~ted on $~ 3, ~98~ and found to be in compliance witb the requirements of this Board. FIXTURE OUTLETS SWITCHES 3 4 DRYERS FIXTURES RANGES .'OOKING DECKS NCANDE$CENT ~LUORE$CENT 3 DISH WASHERS EXHAUST FANS SYSTEMS HO. OF FEET E R V I C OIHER APPARATUS: Panelboards: 1-4cir. 125~mps. 1-G,~ Dennis Claire P.O. ~sox 284 Laurel, N.Y., 11948 lac. ~2342 I~RNERA/ MANAGER This certificate must not be altered in any manner~ return to the office of the Board if incorrect, Ipspecto~s may be identified by their credentials. COPY,FO~ 9UIL~JDING DEPARTMENT. THIS COPY OF CERTIFI~AT~ ~FST~ NOT BE~ ~ER~D !~ ANY MANNER. - U' ,'-~ ~'~Y APPLICATION FOR BUILDING PERMIT TOWN O, SO.T.OLO --- TOWN HALL SOUTHOLD, N.Y. 11971 TEL: 765-1802 Application No ................ INSTRUCTIONS Date ... ¢ .......... 19.~-dt3 a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 a detailed description of layout of property must be drown on the diagram which is part of this ap[ 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 pen~ 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 Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describt The applicant agrees to comply with all applicable laws, ordinances,.~4td~ng code~-pufii~ c.~ode, and regulations, and admit authorized inspectors on premises and in buildings for · ~.? s':...~.'F.~..z~. ~.~.~...&.. ~..~. ....... (Mailing address of applica ,.1~_ ~ _ State whether applicant is owner, lessee, agent, architect, engineer~ electrician, plumber or build, ........................... ...... ...... ?:_ .... ............................ Name of owner of premises ..... Z.<:y...v?e~....L~... 0. ~/..~...~ ......................................... (as on latfe 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 Plumber's License No ......................... Electrician's License No .... '.b.~... ~__~/o-.,x_,, . Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ ...... ~ .~ ~ ................ . .~. . . ¥'. .~. . . . . . ~, ............. ~. .~-~. . . ~ ~.~ ..... House Number Street Hamlet /,1L5 { County Tax Map No. 1000 Section .. (Se-~..D- 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 occupancy ........... .C..--.~.. ~ .~: .c~ .~...v~, .~..-~ .................................... b. Intended use and occupancy ......... 3. Nature of work (check which applicable) Repair .......... .... Removal .... 'L Estimated Cost ...... '~.)(~.!.(2¢...~2>o.: 5. If dwelling, number of dwelling Units... If garage, number of cars ............ 5. If business, commercial or mixed occupa 1. Dimensions of existing structures, if any: Height ... ?~..~. ....... Number of S1 Dimensions of same structure with aitera New Building .......... Addition .......... Alteration .......... ......... - Demolition .............. Other Work . .3~:~ .u0...o~. ~, ..%'7'7. ............. ....................... ¢ ........... (to be paid on filing this application) . ......... Number of dwelling units on each floor ................ :y, specify nature and extent of each type of use ................... Front...~.(~. ....... Rear . .7 .% ........ Depth...<~.~ ...... eries ...... ~ ...................... .~.: ............ :ions or additions: Front ii'.i ~ .~. ....... Rear ....... .~. ......... Depth .... ?~.C~ .............. Heig~ ! . ....~. ~..~ ............. Number of Stories ..... ~ ............. 3. Dimensions of entire new constrUction: l,ront ..... ./.~. ...... Rear .... /..~. ....... Depth...~ .~.~.. Height ....~ ....... Number of S' eries ......... ~.~r~.'-/-.- ...................................... '"" -- ). Sizeoflot: Front ..... /.6..q.~ ............ Rear ...... .e'.~..¢) ........... Depth .... ~.~.. C.~ ........... ). [)ate of Purchase ...... ~ .~.. ~.. ............ Name of Former Omner ............................ I. Zone or use district in which premises ay: situated ....... .~'....'~: .% .,~ .~q-e~...'~-~..~ ....................... Does proposed construction violate any Will lot be regraded ......... ...... Name of Owner of premises .~. *. ,~-~T.o. Name of Architect .............. Name of Contractor...~....~. q~.~.'~.~ Locate clearly and distinctly ail buildin~ :operty lines. Give street and block number, terior or corner lot. oning law, ordinance or regulation: ..... ~., ................. ............. Will excess fill be rendered from premises: -~, ].~.~. .... Address. ~¢.~~ .~. Phone No...~ .:3. . i.. :-;? .... Address ..... ,~.. ,or~... ~hone No ................ PLOT DIAGRAM s, whether existing or proposed, and, indicate all set-back dimensions from >r description according to deed, and show street names and indicate whether TATE OF hove named. *e is the ................... f said owner or owners, and is duly pplication; that all statements cont~ained ,ork will be performed in the manner worn to before me this ................. day of ..... iota:ry Public, ·.. being duly sworn, deposes and says that he is the applicant agent, corporate officer, etc.) -- perform or have performed the said work and to make and file this this application are true to the best of his knowledge and belief; and that the in the application filed therewith. 'Z 0 U 0