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Home My WebLink About11059-z FOKI~ NO. ~ TOWN OF sOuTHOLD BUILDING DE~p,~RTME~IT TOWN HALL SOUTH'OLD, N~ Y. BUILDING P,ERMIT (THIS PERMIT MUST BE KEPT ON THE PP, I~M,ISES UNTIL F~LL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: Building I~spector. Re~.~ 6/30~80 InSPector ~ORM 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 ail buildings, property lines, streets, and unusual natural or topographic features. 2, Final approval of Health Dept. of water supply and sewerage disposat--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters, 4, Commercia~ 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 peoperty showing all property lines, streets, buildings and unusual natural or topograph ic 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, o/r 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 ,. ,~/~./~'2.- New Building ............. Old or Pre-existing Building(:~). --X ...... ~./Vacant Land '~ ...... Location ofProperty ../~.c:. ~._.~/.¢· .~.~..~ .c~'. ~ ¢~_ _ House NO. ''' -- '/'S'tle;t ..................... Owner or Owners of Property -~.~.. /~..~..~...-.- ................................ '. ..... County Tax Map No. 1000 Section ...~.~',5 ......... Block .. [ .¢~5, ........ Lot,.. ¢).~. Subdivision ..... Z. ......................... Filed Map No ........... Lot No .............. Health Dept. Approval ........................ Labor Dept. Approval .. · ~ .................. ,.. Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate .. ~ .... - ......... Fee Submitted $ · .~. ;-? ....... ,,~, .............. Construction on above described building and p..ermit' meets all appf~cable~codes and regulations. App cant~ ~ ' ,.,.,e.,o.,a '/¢¢o ....... ' .... '~uoo7o8 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ ' ~) 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the e~ctdcal equipmer~t as ~scr~bed be~ and introductory the applicant ~d on the abo~e application nu tuber in the premises of in the following location; ~ Basement ~ 1st FI, ~ 2nd Fl, Section Block Lot ~.~ .x.mZ.~d o,,~~ ~5, 1982 ..~ yo..d to be in compliance with the requirements of this aD.rd, mxluas k / FIXTURES "ANGES COOKINGOECKS OVENs DISH WA$HEES EXHAUST FANS 33 19 18 SERVICE DISCONNECT NO. OF [ S E R V I C E I gOO ~ x 1 g/O 1 ~/0 ~1 ~ato EI~., Thru cerhfl¢ate ~u~t not ~e altered m any m~net; ~et~rn to the o~ice o{ the ~o~rd if in¢or~e¢L Inspectors mo~ be identified by COpY FO~ B~IL~!NG OEPAR?MENT~ T.I~ cOPY OF ANY MANNER. FIELD I~..$PEC_~T I0N COMMENTS FOUNDATION (fist) FOUNDATION 2. ROUGH FRAME& PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: C.,~. z7 FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ~xamined ?~,d'~(zT~:. (..*.~.., 19 ~ ~pproved .~.~4f¢.~... ( 7.., 19~. Permit No. ~/~ )isapproved a/c .................................. ~ APP[ICATIO~ FO~ BOILDING PERMIT Application No. t//.~.~ ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building nspector, 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 )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work covered by this application may not be commenced before issuance of Building Pe.rmit, d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit .hall 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 ;hall 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~.egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ?he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to zdmit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) !.0.9.9...c.¢;.~, ~.. ~.K ,. ~./..../5..,~../.~../~..~ ~ (Mailing address of applicant) Ctate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~qarne of owner of premises ~ /~ , /'~./~/'~ ¢/I ~ ~/~t~ (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.../..L{ ..~. ................. Plumber's License No.'-~:~--./d... ~--./~L~-..~t~og-~..~ . Elec~iciau's License No. e ~' ~/ Other Trade's License No.. ~. ~ .( ....... ~.~, ~o~ g;rT~ i~, ~&~ I. Location of la~d on which proposed work will be done .... ~.~ ..... g ~...~..~.~. ~Y~. ~... House Number Street Hamlet com~ t~x ~p No. 10oo S~tinn ..~ .~. ~ .'~ ...... mo~ ...... ~ ......... ~ot .... 5.. ~Z.~.? .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ~ e~ / j?. e,,~.~./q-/-- .... .~. ....~//3c (_ fir b. Intended use and occupancy ......... (( ............. J ......... .fX~./y. /..Z.~. ........................... 3. Nature of work (check which applicable): New ~;l~ .......... Addition .......... Alteration ..... ~ .... ~. . Repair .... ~ ..... RemoVal .... '.~..... Demolition ............. - Other Work (Description) (to be paid on filing this application) ~. If dwelling, number of dwelling finits ..... ~. ........ Number o f dwelling units on each floor ................ If garage, number of cars ..... ! ................................................................... ~. If business, commercial or mixed occupancy, specify oa, ture an~t extent of eaqh, tyl0e of use ................ /. · · 1. Dimensions of existing structure~, if any: Front ..... M..~....t... Rear...q/..O.../.... D~p. th.... I.(/ ...... Height .. 2. ~./. ...... Numlber of Stories ...... ~ ......................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth .................... i.. Height ...................... Number of Stories .................... ]. Dimensions of entire new construction: Front ............... Rear ............... Depth ............. Height ............... Number of Stones ......... ',';' '; · ~ .................... : b' ',4,: '? ......... ~. Size of.lot: Front ..... /.~...2~.I. . .t ........Rear .... J.q~..L ............ Depth ... ~/.."~ ............ ). Date of Purchase . . .~..~,~'...i.J. ~..~..(P. ........ Name of Former Owner . ~--./.~..~.~..~. ..... ~'.~.6./~..~,. L Zone or use district in which premises are situated ................................................... L Does proposed construction violhte any zoning law, ordinance or regulation: ............................. /. Will lot be regraded ...... y ~ .~. ....... ~ .... ~...... Will excess fill be. removed fro__m premises: Yes [. Name of Owner of premises A4.A:.~..~J.~(..../~ .A~..~..~. Address ( .,~.L~; TT..5~?.¢.~..G-,o./. Phone No ............... Name of Architect ....... ' .......... .... , ................. Address ......... Phone No ................ Name 0f Contractor J~.l.~.,. ~..-q~'-~'~.o.~.5.,q i .... Address -J~:.~ ZT.. 4/4,~-~/.q .'~.. Phone No.//22 :'..Z..~.~. PLOT DIAGRAM Locate clearly and distinctly alt buildings, whether existing or proposed, and, indicate all set-back dimensions from :operty lines. Give street and block ~umber or description according to deed, and show street names and indicate whether terior or corner lot. I ; AP P U C.R. ¢8 PR P, }'/[~4 ~e~v )-40 ct/,S~iJ being duly sworn, deposes and says that he is the applicant (Name of individual sig/~ing contract) ~ove named. e is the ..................... : .................................................................... ;~ (Contractor, agent, corporate officer, etc.) f said owner or owner~, and is dully authorized to perform or have performed the said work and to make and file this 0plication:; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ark will be performed in the manngr set forth in the application filed therewith. worn to before me this ....................... day of ......... , i No. 52.4524771 . ~r...~ (Signature of applicant) i Quahhed in Suffolk County ~opunission Exp~ras March 30,