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HomeMy WebLinkAbout11177-z FOFAV/ NO. ~ TOWN OF i~OU3'HOi~D~ BUILDING DEPART/~tI~N'I TOWN HALL SOUTHOLD, N~ Y. BUILDING~ P, ERA~IT (THIS PERMIT MUST BE KEPT ON THE P1~EMIS~S COMPLETION OF THE WORK AUTH6RIZED), N? 11177 UNTIL ~ULL Permission is hereby granted to: .... . ..~.~....~. at premises located at. County Tax Map No. I{)00 Section ....~..~.~..,...~,. Block i..[ '~-~. .......... }Lot No....~.../...~.. .......... pursuant to application dated B~ilding Inspector. Fee $ ...... ~ ............. 1~...~..., and 'approved by the · Building Inspector 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 featu res. 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 applicable. 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 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 or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ............. O~d or Pre-existing l~uilding_ ............ Vacant Land ............. Location of Property. ~. Z~.~. (~.. ~.~../~... ,~. ?. ~. ..... ~0~(~.. ~ ........ Houee No. ~ ~ree~~ ~ / Hamlet Owner or Owners of Property ..~~ ~ ~~ County Tax Map No. 1000 Section ............... ~loak ..... - .......... Lot .......... Subdivision ................................. Filad Map No ........... Lot No .............. Permit No. ///Z~ ~ Date of Perm,t~ ~ ........... Apphcant ............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Bequost for Temporarg Certificate .............. Final Certificate ....................... lee SuBmitted $.. ~ ................... Construction on above described building and permit meets all applicable codes apd'~lations. Applicant ........................ R,v. o- o-7a O. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Application No.. f. ~ )Yf/7.. .... Disapproved a/c ................................... ....~..-..:._. '~:: '~'.' ~ . ... .......... (Building Insuector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 drawn on the diagram which is part of this apl; cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of tins application, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspectmn througimut 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, additmns or alterations, or for removal or demolition, as herein describe The appncant 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 inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State xvhether applicant is own_re', lessee, ggent, architect, engineer, general contractor, electrician, plumber or build. .,-9-/,'5/.9 ......... Name of owner of premises .. ~/~/.z'..-r'~.~../~'..~CF?Z'.-~ F,v'.fi'., .~ .~. ,/.~7. < ....... './~/.t.~f': .......... TT'. ............ (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~...? .............. Plumber's License No ......................... Electrician's License No ....................... House Number Street Hamlet County Tax Map No. I000 Section .................. Block ............ Lot ............ · Map No Lot SubdMsion Filed (Name) 2. State exlsting use and occupancy of premises and in~ndcd t~se and occupancy of prdposed construction: b. Intended use and occupancy ...... '. .:~ ............... 3. Nature of work (check which applicable): New Building .................. Alteration .......... Repair .............. RemoVal .............. Demolition ..... Other Work ............... (Description) !, Estimated Cost ' Fee ' I (to be paid on f'fling this application) i. If dwelling, number of dwelling traits ............... Number of dwelling units on each floor.....-'LT-.... ........ If garage, number of cars ............. :.., '. ..................................................... '). If business, commercial or mixed]oceupancy, specffy nature and extent of each type of use .................... ?. Dimensions of existing structurei, if any: Front ........... ¥... Rear .............. Depth .............. Height ............... Number of Stories ....................................................... Dimensions of same structure wiih alterations or additions: Front ................. Rear ................. Depth .................... ;. Height ...................... Numbar of Stories ..................... ~. Dimensions of. entire new construction: Front ......... ~.,:2,-... Rear ...~.~ ......... Depth ...oc~.Q ........ Height ...... ,//..6. ....Number of Stories ........... ./. .......................................... ~ Size of lot: Front i '"-~-.' Rear Depth ). Date of Purchase ................. ~ ......... Name of Former Owner ............................ i. Zone or use district in which pre~nises are situated .................................................... L Does proposed construction violate any zoning law, o~.dinance or regulation: ............................... I. Will lot be regraded ............................ Will excess fill, jg_e removed fi'om premises: ' Y,e~ ~ No ~. Name of Owner of premises ... ~. ~'-'~'. ~-~. ........ Address .... .~...c:..o..,~/..c-:.... Phone No..,~.-~.~...~. ..... Name of Architect ......................... Address ................... Phone No ................ Name of Contractor ........................ Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all .buildings, whether existing or proposed, and. indicate all set-back dimensions from :operty lines. Give street tu~d block ~umber or description according to deed, and slmw street names and indicate whethe~ ~terior or corner lot. rATE OF NEW Y~,/Z/,~J e e OUNTY OF .. ~... .............~ ~ _///.'.~l~.Ct'~'.~. .............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) e is the..' ............................................. (Contractor, agent, corporate officer, etc.) f said owner or owne~, ~d is duly autho~zed to perform or have performed th'e said work and to m~e and file ~is 9plication; that all statements contained ~ this application are true to the best of his Bmwledge and belief; ~d that the ,ork will be performed in the m~nir set forth in the application flied therewith. .................... day o ....... , 1 :Ot~~ . ~... Coun ................. ~RY PU~ Stat0 of ~ow York ~ ,ff /([i~at~e of applicant) ~o. ~2-8125850, Suffolk Cou~ . Term Fxmr0s ~rcb ~O. lt~ ' _ THE NEW YORK BOARD OF FIRE UNDERWRITERS T~ BUREAU OF ELECTRICITY THIS CERTIFIES THAT only the electrical equipment as described bel~ and i~troduced by tlw applicant na~ned on the above applicatton number tn tfle premises of in the follotving Iocatiott; ~ Basement ~ 1st FL ~ 2nd Fl. Section BIo,'k Lot wasexamlnedot~ J~]L~~ ~ ~9~ attdfoundtobeiacoml, llaflcewithtberequ~rementsofthtsBoard. FIXTURE OUTLETS IECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS FtUORESCENT VAPOR DRYERS FEEDERS TIME CLOCKS LJNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF EEET SERVICE DISCONNECT S E R V I C PER ff OTHER APPARATUS 4/0 NO OF HI-LEG OF HI LEG AWG OF NEUTRAL TNs certificate must not be altered m a~y manner, return fo the office of the Board if }ncoTrect, Co~,~.m. ~U?mNe O~.A"!Mmz. mm ,c0mr 0~ may be ,denhhed, their ANY MANNER. ,[000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY~ ~ ~'~ ,~ 19~1 85 JOHN STREET, NEW YORK, NEW ~RK 10038 THIS CERTIFIES THAT only th~ electrical equipment as described bel~ a~d ~tttroduced by t~ ~can~ ~d on ~he above ~pplica~ou number i~,~t~ premises of ,n tae>llowln~Iocatton; ~ Basement ~ 1st FL ~ 2,d FI. Section alock Lot was examined on Daca~r 7~ Z98~ and found to &e ia ~o,np~ance w,ta tae requirements of ta~s aoard. FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FIXTURE 17 3 9 12 5 DRYERS FURNACE MOTORS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS NO O E CC]ND OF ~:C COND NO OF HI-LEG AWG OF HI LEG ~0 OF NEUTRALS AWG NEUTRAL P.O. Box :t,43 tiattit.~k, RY. 11952 Thru cerhflcate must not be altered in any manner; return to the office of th Board if GENERAL MANAGER may be identified by their credentials. COPY FOR BU~LDING DEPAR~rMENTo THIS COpy OF IN ANY MANNER.