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Home My WebLink About11403-zTOWN O~ TOWN HALL SOUTHOLD, No Y. BUI,DING pERMIT! ~ (THIS PERMIT MUST BE KEPT ON THE PREglS~S UNTIL dULL COMPLETION OF THE WORK AUTHORIZED) ,,~- ..:.r.&~.¥~/¢. N°. :1:1403 Z Date ...... ,.~..: ........................ _ 19...~.../ Permission is hereby granted to: ...... ~o ........ ~ ................ Ad ............................. ~.~....-...~ .......................................................... -t ~,em..-~ ............................................ ~.* ....... r....? .......... , i ........ f .......................... co,;~ ,~ ~o~ ~o. ~000 s~,,o, ...Z~ ....... ~k ....~'..,.~ ~o.~ ............... purs~ont ~o ,pplic~t[on dot*d 1 , *nd ~pprov~ by th~ Buil{~lng, II~!pector.. ........... R~y: 6/3oz8o 'Building ~spector ' FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted mm,,,-~.~, 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 e~ectrica~ 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing alt 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date....~. ?,~,~..~..?..~. .......... New Building .... ~,~,~ ......Old or Pre-existing Building ............ Vacant Land ............. Location of Property ./.l..~. ~.P .... !~,..~....L¢.~., ./~.~.~-~.&~".~C ../.~ ............................. House No. Street Ham/et Owner or Owners of Property ......... ~.~. cY ................................. County Tax Map No. 1000 Section . /.O..~. Block . .~. ,~_ .......... Lot. · .O .~.. Z' ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit ~,~..~/'2~..~ .Applicant .. _~./.~¢ P. ~.~< .c.c_. ~ .......... Health Dept. Appraval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building an~it,, meets al~able codes and regulations. Applicant , .5. ~/2/~2,~'~:.~ ~j.~.~.~z..~'.~. ~ .................... FIELD INSPE~I~ FOUNDATION (1st) FOUNDATION (gnd) ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY G,ODE FINAL COMMENTS ADD~ITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Approvedc~./'~. fiT(cl. 1 ~..~'. Permit No ~/,~. .~..-~ Disapproved a/c .... 77.T~'. ~ i .., .................. ~ · ,. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application NO.././~.~. ~.. ....... 2:/ 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 tc 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 drawn on the dia~am which is part of this apl: cation. c. The work covered by this application may not be commenced before issuance of Buildiug Permit. d. Upon appro.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such porn shall be kept on the premises available for inspection tt'.roughout the work. e. No building sbalI 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 IIEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of tile Town of Southold, SufIblk County, New York, and other applicable Laws, Ordinances Regulations, for thc construction of buildings, additions or alte~ations~ or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary~spections. ~ ../. ~/¢zz.~:~,;.). ~ . .~. ~~_7 .......... (Signature of applicant, or name, if a corporation) ff'3.?..7.., d .2 . p/<, '*: .... State whether applicant is owner, lessee, agent,, architect, engineer, general contractor, electrician, plumber or bnild~ ................. y'..e'..5 .... ~...~..~..¢&. ...................................................... Nmne of owner of premises ....... g. ........................................... (as on the tax roll or latest deed) If applicant is a corporalion, signature of duly authorized officer. (Name and title of corporate officer) Bnilder's License No ...... .~. : ............ Plumber's License No ......................... ~J Electriciau's License No ....................... ', · //7~ Other Trade s L~xe lse No ...................... I. Location ofland ou which proposed work will be done .... ~.q.~/ ..... ~., ~d, .~..~....('. ff., .~?....~..~., . ,.~ ,ff'.2'J5 o -ta- .... o. Z,, ............................. 7. ........... House Number Street Hamlet County Tax Map No. 1000 Section ...Z/...~.ff. ........ Block ...~...'~.. ......... Lot..,.~.....~. ....... Subdivision ..................................... Flied Map No ............... Lot ...... (Name) State existing use and occupancy of premises and inteuded us.c-and occupancy of proposed construction: b , d d d cup y ~/~ ~?~O Nature of work (check whict, applicable Repair .............. Removal ... Estimated Cost ........ ~'~. {Q. . .~, , . ;. If dwelling, number of dwelling units . If garage, number of cars .... , ...... ;. If business, contmercial or mixed occul: L. Dimefisions of existing structures, if an lleight .,. :~'..~'..~/:. ...... Number of Dimensions of same structure w, ith alter Depth ...... :~ ...... ...... ....,I-leis,_._ ~. Dimensions ofvntire new' consmlct~ua: Height ............... Number of ,~ New Building ..........ddition .......... Alteration .......... Demolition Other Work (Description). (to be paid on filing this application) · ../. ......... Number of dwelling units on each floor ................ ncy, specify nature and extent of each type of use ............... "'-7: ' ' Front .... ./~'. ~.."~. .... Rear ... ?.~ ./~ .~.... Depth .... /. e~-...'~:... cries .... ./ ................................................. tions or additions: Front Rear t ...................... Nmnber of Stories ..................... *rent ............... Rear ............... Depth ............. :cries ....................................................... ). Size o~flot: Front .......... ........ II .....Rear ............... · ....... Depth ..................... ). Date of Purchase .......... ....... ~., ........... Name of Former Owner l. Zone or use district in which priemises a · situated .......~.~.,i[/~...~,~}'~te. ~i~_. ......... i'. ................ 2. Does proposed construction vic. late any ;oning law, ordinance or regulation: ........ ~.t? ..................... t. WiIJ lot be regraded ........... Wil! excess ill! be removed from premises: Yes No i. 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 buildin s, whether existing or proposed, and,indicate all set-back dimensions from roperty lines. Give street and block: number according to deed, and show street names and indicate whather .terior or corner lot. TATE ,O,F NEW YORK, (Name of indMdual sigifing cent act) )eve named. e is the . .i ................... ~ ...... f said owner or owners, and is duly )plicationl that all statements contained in 'ork will be performed in the manner worn to before me this ' ....................... day of .... otary Pubtic, ( Comrr being cluly sworn, deposes and says that he is tile applicant Contractor, agent, corporate officer, etc.) /zed" to per/btm or/lave performed tile said work and to make and file this this application are true to the best of his knowledge and behef; and th,t the in the application filed therewith. KOWALSKI PUBLIC, State of New York '{. No. 52.4524771 ........ hfied in Sulfo/k County '.. (Signature of applicant) :h 30,