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Home My WebLink About13618-z J'OI~M HO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERN~IT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N_° 13618 Z Permission is hereby granted to: ~..~..~.~Z~,~_~..~....~: .......................... ..... ~z~..,~,,~...-...~......~ ....... /L.~.7./ ,o ...~~~.~..~~ ~..~~....~ ............ ................................................................... ~....,~ .......... /~...~~...~~ ...... at p~mtses I~ated at ..?/~,~ ....... ~./~.~ ........ ~ ................................... co~.~ T~ ~p .o. ~ooo ~.o...L~ ......... ~ ..~.~Z ....... ~o~ .o. ~:..~ Building Inspector. dlding Inspector FORM NO. 6 TOWN OF $OUTHOLD 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 ~m ~am.m.~m to the Building Inspec- tor with the foliowing; 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 applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property 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 $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date .................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property / / ~ ~' ' ~/~//~y~ ~z House No, Street Hamlet County Tax Map No. 1000 Section .... /.. ~ ? ....... Block .... ~ ......... Lot... / .z~., .~. (? ...... Subdivision.. '~.' ./q. 7.~..~.~.1.~.../~,.~.)'?.~..~ ........... Filed Map No...~.~.~...Lot No...~.D. ......... PermitNo. /~/f~ Date of Permit / .Applicant ~T~/~,~ Health Deot. Approval ....~. ................... Lak~or Dept. Approval ~/~, .~ 3.~. ......................... Underwriters Approval .... ~.v/.'. ................. Planr~ing Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... Fee Submitted $ ~ .~.~'~...~..1~:2 ...... Construction on above described building and_permit meets all applica~ codes and regulat ons ~2'~: ~--~-Iqq~;~ App cant ~ ~' ..~.~ .................. ........................... Rev. 10-10-78 -.% THE NEW YORK BOARD OF FIRE UNDERWRITERS ~00*}~07J[' BUREAU OF ELECTRICITY ~ BE JOHN STREET, NEW YORK, NEW YORK tOO~B THIS CERTIFIES THAT DRYERS SYSTEMS NO. OF FEET E OTHER APPARATUS: E R ¥ C , . ...... GENERA~MANAGER ~ This certificate must not be ,I,ered in any manner, return to the office of t~ Board if i,,orrec*. Inspectors. may be identified b; ,hei5 credentials. ~[ COPY FOR BUILDiNG DEPARTMENT. THiS COPY OF CEeTiFi~T~S~NO~BE~LT~RE~IN ANY MANNER. TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date /~/~/~ ~ Building Permit No. Owner (please Plu~er ~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plUmber' s signature sworn to before me this Notary Public ~~ / ' ~otary Public R~INA ~. MATTHE%q~ County NOTARy PUBLIC, Sta,e of New York coNn~2'46~_6665, Suffolk Coun~ '~s~on Ex~trc3 March 30, FIELD INgPECTION COMMENTS , , FOUNDATION (1st} FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS . .-,,-,., ~:_~. ___ ~.~.~ 765-1~0;Z ~ .~ ,~,_~~-~BUILDING DEPT. ~ INSPECTION~ FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: [ ] FINAL ~' ,, 765-~,802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND/ INSULATION [ ] FRAMING [ ] FINAL REMARKS: INSPE~rOR ~- "FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL · ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined . ./..~.//..G. ..... , 19 .~.. / , Approved ....... Disapproved a~ ....................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. This application must be completely filled in by typewriter or in ink and submitted to the Building 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 streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 issued a Building Permit to the applicant. Such permit 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 Occupancy 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described· The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signatu[e of applicant, or n~l~oration) · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.....~....~... ~....~. ~ff~.~ ............................ (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 ..... ./.~Z'. ................. Plumber s License No ......................... Electrician's License No ....................... Other Trade s License No ...................... Location of land on which proposed work will be done .................................................. House Number County Tax Map No. 1000 Section .... /..d). ~/'7. ........ Block 5~ Lot Subdivision.. :~z~../Z~..,~.~..(~q.a.~.~.,~..~______ .......... Filed Map No .... ~.~.~.~... Lot... 2~.~3.... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .<:~ r!~-d.--' " ............................ ~' ~,~.~'I · · ~. · *,.- · ,':. ...... ' .......... b. Intended use and occupancy ...... : ...... . 3. Nature of work (check which applicable): New Building ...... 'Addition .......... Alteration .......... Repair .............. Rem6val .............. Demolition .............. Other Work ............... 4. Estimated Cost ...... ] ................... Fee .................... ~'. (to be paid on filing this application) 5. If dwelling, number of dwelling pnits ............... Number of dwelling units on each floor ................ ' number of cars If garage, · .... ................................................................... 6. If business, commercial or mixed occupancy, specffynatureandextentofeachtypeofuse ...' .................. 7~ Dimensions of existing structur6s, ifany:Front ............... Rear .............. Depth ............... Number of Stories tleight............... '......... ............................................... r)imensions of same structure with alterations or additions: Front ................. Rear .................. ' Height Number of Stories Depth 8. Dimensions of entire new construction: Front .... t1..~./' .. Rear .... /./. 7. ...... Depth.... ~.,~-.." ...... tteight ....... ~.... Number of Stories ...... ~'..~l~r-. ........................................ ,,' . ........... 9. ~ze of lot: Front ..... 1~---~"~'I ........... Rear ...... '2,-.~. O. Depth ...... 10 Date of Purchase ~ Name of Former Owner ................. 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction vie!ate any zoning law, ordinance or regulation: ............................ ~... 13. Will lot be regraded ....... ,:fi/. ?.. ;. ....... ~ ...... Will excess fi, Il be remqved from premises: Yes ~/No 14. Name of Owner of premises/,'/~'t~,~..c"~.~./4~ddress ./~q.)~4~,q'(~ .~..~ .~.. Phone No ................ Name of Architect ......... i ............. t.. Address .~..~.O.. ?.~.~{.~. ,f~Phone No ................ Name of Contractor -~.~.t~. t~ ~-~'./~(~. ~/~... Address ~gF~ .~.~ ...... Phone No. ~/_,~.'r/.~"~'(,~... 'Locate 'clearly and distinctly all property hnes. Give street and block interior or coruer lot. PLOT DIAGRAM buildings, whether existing or proposed, and~ indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF NEW Y, ORK~ ........ ~ ....... '~ '~(~' d ~"/'/~' ' ' ........ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................................... of said owner or owners, ~d is duly authorized to perfom or have perfomed the said work and to m~e and file this application; that all statements con~ned ~ this application are true to the best of his ~owledge and belief; and that the work will be perfo~ed in the m~n~r set forth ~ the application filed therewith. Sworn to before me'this ............... Nota~ Pu~~~L . County ~ Commission ~lr~ ~r~ ~, ~Z~ (Signature of applicant) 0 _J ?, nd 8