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Home My WebLink About12998-zFORE{ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, Cerfi{icate Of Occupancy No. ~ !.3.1.6. 5. .......... Date .... .d.a.n.u..a ?.y..2..2_ ................. 19,8.5. ']['HIS CERTIFIES that the building .. g.d.d. J, ~ .i9. q .................................... Location of Property ...2 ] 05..C, a~nlo, ,i~,iv,e.o, Ll,~. B.d, ............... M.~ ¢~;L.~.~tq:¢ .......... House No. Stroot /t~mlot County Tax Map No. 1000 Section . . .1.2..~3 ...... Block ..... ~ ......... Lot . .5.,.2; ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms stlbstantially to the Application for Building Permit heretof'or~ filed in tl~is office dated ·, .~pF.i.]. 5 .......... 19 ~b. pursmmt to which Building Pem~it No. 1 dated . . .fi P ¥.J-.]~. J P ................ 19 $ (L, was issued, and conforms to all of'the rcquirememts of the applicable provisions of the law. The occtipancy for which this cottifica ~e, is issued is ......... .1;0..e.x:~.t,~.ng. ~.rl~. f ~.t~:i,,]. y. The certificate is issued to THOMAS S, & BARB~RA P. MAC ..................... ...................... of the aforesaid building. Suffolk County Deparhnent of llealth Approval ....... ~./.~ ............................... UNDERWRITERS CERTIFICATE NO ............... {)fl.~ ~ J 9.~.~ ......................... Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12998 Z Date ............ ~, .................... , 19 ...... Permission is hereby granted to: ......................... .~.:..~.~.....:o..~.~..'.~.~.~ ........... ,o .~,~.... ~.~.~.-.., .~.o...~ ..... ~.~,~.. ' ,~...1~.. ' at premises located *t ...~.../..°...~.....,.L<~6....-Y...7~...~-..~?..C-~.~/.; ...... ~..~../..~F~.. County Tax Map No. 1000 Section .../..~..~. ......... Block ....... .~. ............ Lot No......'~....:....~. ......... (~_2~'~ ,~ 19.~.~.., and approved by the pursuant to application dated ........ T ....................................... ' Building Inspector. Fee $ .,~:~'~ ............... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~' ~outhold, 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 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 topographic featu res. 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/, land use --]~re-E×±s t,±ng C. 0. $15,00 3. Copy of certificate of occupancy $1.00 '¢aca~f. 3. and C.0, $ 5.00 Date . ,~..,~,.,~,. c~ ~ / ~'L/~: . New Bp~ding ~-'~-~''~-yL~ ~- ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~.~. O~- ~,¢~/~,~/~) /,~(~./~..~.0~,o~ /~o,,~ 'N'o: ................... Owner or Owners of Property . J~.~,7( .......... .~, ........................ County Tax Map No. 1000 Section .... /.'.~'..~. .....Block ....... .~. ...... Lot .... Subdivision ................................. Filed Map No ........... Lot No .............. ......... Permit No./~ .~.. ?.?... Date of Permit .... ,,.. j..Applicant..:~-----------------~ · Health Dept. Approval ........................ Labor Dept. Approval ........................ · Underwriters Approval.......°~.................PlanningBoardApproval .......... ............ Request for Temporary Certificate ............. Final Certificate ~'~ Fee Submitted $ .... .c~.. ~ .~. ................. Construction on above described building and permit meets all applicable codes and regulations. Applicant .~...~...q.~. ~¥~. ~,/..~. · .~. .~. ~o-~e-78 ~ -~ ~ .~-~- ¢ ~ looo(~63 THE NEW YORK BOARD OF FIRE UNDERWRITERS n8 BUREAU OF ELECTRICITY 23,°"" ST.EET,. V YOR,<, o.ly the electrical equlp~e.t as described below and tnt~duced by the applicant named om the ab~ application ~utnber in the premises of Tom Hac Cloud, Camp Ninola in the foltowing location; ~ Bazement ~ 1st ~7. ~ 2nd Fl. Section Block Lot was exa~nined on January ~6, ~9~,~} "nd found ~o be ln compllanee with the r~quiremeats of this Board. OUTLETS ~ECEPTACLES SWITCHES FLUORESCENT DISH WASHERS EXHAUST FANS DRYERS OTHER APPARATUS: RCC~ W, G, r NO. OF HI-LEG NO O1~E COND OF '~C COND' C E A, W. G NO, OF NEUTRALS OF HI-LEG OF NEUTRAL 2: J.l : Per · This certificate must not be altered in any manner; return to the office of the Board if nco~rect Ins-ect0~ ma be identifie ..... ' ~ ' ~r~re~r~e~evv~/v~~ ~,'.~i"~?.~,~, y . a ay me,r creapnt,als. ~1~ COPY FOR BUILDING DEPARTMENT TH S COPYOFC~Wmzo~e ~.,,~,~ ...... ~.-. , · ........ ~,.,uo u ?~n~n~ I~? MANNER FIELD I~SF ECTION 1. FOUNDATION ( 1 s t) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE COMMENTS FINAL IDD ,NAL COMMENTS: 765-180Z BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [/~ FINAL REMARKS: / DATE ~:~ / ~J ~ .. INSPECTOR / / 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ;xamined .~..~.../. 0 .... , 19~ . .(~. ~..I..D ..... 19~.lt. Penuit No. ( ..~.cl.~.~...~.... ~pproved )isapproved a/c ..................................... Received ........... ,19.,, (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date, .M... ........... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 .,ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relatiohship 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- ~tion. 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 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 tall have been granted by the Bl~ilding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding 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 dmit authorized inspectom on premises and in building for nece~ti~n~.~,~ ,~ (Signal}ure of applicant, or name, if a corporation) ~c ~-t. ~,~k .~ ~d.,~.. N..~J l/.~.c.~. Crate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... . ....... . .......................................... qame clowner ofpremises ...~/r o'71q~, ......... ~'~¢/,&~?.. ........ ~/ .... &./~..~.,~ ~ ........../Z?/t~, .e .~..~ ................ (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... 2,<~.r-, ~ .... ; ...... . Other Trade's License No .. · · Location of land on which proposed work will be done .............. ' .................................... House Number Street Hamlet County Tax Map No. 1000 Section ..... ~] .D. ~ Block ~ Lot ~'. 2- Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) State existing use and occupancy of prmnises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~1. b lntanded use and occupancy .~..~ 3. Nature of work (check which applicable) New Building ..... ' ..... Addition .... ~ .... Alteration Removal Demolition "~--. Other Work Repair ...................... · ....................... : (Description) 4. Estimated Cost ..... o.t:;:'.o. ............. Fee .................................... . ~o. (to be paid on filing this application) 5. If dwelling, number of dwelling tinits ............... Number of dwelling units on each floor ............... If garage, number of cars ..... ........................ · ........................................ 6. Ifbusiness, commercial or mixedloccupancy, specify nature and extent of each type of use. .................. 7 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 ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ....................................................... 9 Size of lot: Front ; Rear..'. Depth 0. Date of Purchase ........... ! .................. Name of Former Owner ............................. which premises are situated 1. Zone or use district in ..................................................... 2. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 3. Will lot be regraded ......... ~ ................... Will excess fill be removed from premises: Yes No 4. Name of Owner of premises ... ! ................. Address ................... Phone No ................ Name of Architect .......... i ................. Address ................... Phone No ................ Name of Contractor ! Address Phone No PLOT DIAGRAM Locate clearly and distinctly alllbuildings, whether existing or proposed, and. indicate all set-back dimensions from ,roperty lines. Give street and block ~umber or description according to deed, and show street names and indicate whether ~terior or corner lot. ;TATE OF NEW//~ORK, , ~ S ~,OUNTY OF~,.~R: o.; (Name of individual sigging contract) .bore named. te is the ..................... , ................................................................... [ (Contractor, agent, corporate' officer,, etc.) ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements con{ained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. being duly sworn, deposes and says that he is the applicant (Signature of applicant) ;worn to before me this .............. ..... :.. ......... .... Co un'ty -- qotary Public. . ......... (... .......... ~ rI