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Home My WebLink About12896-z FO~ NO. ~ TOWN OF SOUTHOLD B~IJILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT Cf'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NV 12896 Date .......... ~(~ ...................... Permission is hereby granted to: .~,~..~.~.....~.:....~..~. .............. ~.~ ....... ~..~.~..~ ....................................... ,o...g~.~ ...... .~A~..~.....~~ ........ :~ ........ ~'~ .... :-:": ..... r ,~~ ~ ~ ~'~-'~ .......... ;'":'~'"'~'"~-'~ · 0 ~-~, ~ at prem,ses I~ated at ..~.~.~. .......... ~..~.. ~.~ ...... ~ .................. ~ .............. c~..w ~x ~.~ No~o00 s,~,o. ...... L!..~ .......... ,,~k ....... ~ ........... ~o, No....~..~....: ......... pursuant to application dated .~~....~.~ ................. , 19 ....., and approv~ by Building Insp~tot. Building Inspector Rev, 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall P~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted--iccduF~cct; 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 electrica~ 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 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 ~remises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --Fre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date...~. J ~.[~ ................ New Building ............. Id or Pre-existing Building ............ Vacant Land ............. Location of Property . .~ .~).(~.. House No, Street Ham/et ,z/C ]c o/c/ ................... Owner or Owners of Property ................... '.~ ..... -~, ...... ~ ..... ........ .. P B,ock ..... .q ..... County Tax Map No. I000 Section /]'7- ' ~ .... Lot ...... Subdivision ................................. Filed Map No ......... ~ .Lot No .............. Permit No../'.~..~q.G..~. Da of Permit '~,/~/~/Ann o~ t ~' ~/~"~ ~'~//~*~ ...~..~*~.~.~. · ',-' · ./' 'r . .,.~...~_n ........................... Health Dept. Approval .. ~. ~ ................. Labor Dept. Approval ........................ Underwriters Approval ~ .~.~..~.~..~.? .~..Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. ,~.. ~.~-4~ ..................... Lt_.lFonstruction on above described building.a~.d per~it me, sCs all applic~l~ codes and regulations. ¢ ~\~ Applicant . ./,x~f y: r. ~ r.'<.~..'¢.o'¢..'~.~.~.%; ......................... Rev. 10-10-78 1oo1o93 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premlses of Danny Lyon~ NewSuffolk Rd. ¢.~6340, Cutchogue, New Suf~o~k,NoYo in tkefollo~ving location; X [] Basemen£ ~ 1st FI. ~ 2nd Fl. Section Block Lot was examined on 5une ~1~ ~98~ andfoundtobeincomplia'ncewiththerequlrementsof~hisBoard. FIXTURE FIXTURES RANGES OVENS DISH OUTLETS SWITCHES FLUORESCENT VAPO~ EXHAUST FANS DRYERS FURNACE FUTURE APPLIANCE FEEDERS TIME CLOCX~ MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: - - IGFC I - ,- S E R V I C NO, OF CC COND. A,W.G. NO, OF Hi. LEG A,W O, NO, OFNEUTRA[$ A,W,G, PER ,~' OF CC. COND OF Hr*LEO OF NEUTRAL Gary Doroski 420Monsell La. Cutchogue~Noy. 11935 lic. 2941-g this certificate must not be altere~ in any manner; return to the.office of the Board if incorrect. Inspector,s COPY FOR RI JILDING DEPARTMENT. THI,~ GENERAl. MANAGER Per may be identified by their credentiaJs. ~IER. 76.5-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION XST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION []FRAMING [/~INAL ~ .... FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMME FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c: ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ............ 19... INSTRUCTIONS 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. e. 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 gpplicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. .... .~.,¢5.~...z~.~. D.. U.~..,. ~.r......27.,v.e.: ......... (Signature of applicant, or name, if a corporation) .~.~./..5.9.q ~ .... .cg..~..~..~.~..~.~.o~.e-....~.:~.,... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... ~).q.,~....Z..~..o..~/. .... '-7.../~.*[xfl....~'.c/..~.~..[..~..'7....A/.~..-~.qt/..d~..~. ·A/. .......... (as on the tax roll or latest deed) I~ is ~ure of duly authorized officer. ' .... (Name and title oq..~rporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... I. Location of land on which proposed work will be done ........ ./~.. ~..~4:/ .~'~ ............................. g/~.~...57~ f..c-e. ! K-.....~p.~D .................................... House Number Street Hamlet County Tax Map No. 1000 Section //?~ ~..- ~Z Block Lot Subdivision ............... ~ ................... Filed Map No. ..~. .......... Lot . ~ ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building .......... Addition ..... Alteration .......... Repair . ............. RemOval .............. Demolition .............. Other Work ............... fl? i (Description) 4. Estimated Cost ........... j ........................ Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwellingjunits ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nunlber of Stories.. ....................................................... D~mensmns of same structure w,lth alterations or addnmns: Front ...':qi~~. Rear . ...~..~. D pth f.-~/~f~{'. Hight N tuber of Stories e ..... i.. e . . .-~.t u .. '~- 8. Dimensions of entire new c.onstructinn: Front ..... .'.'.'~..C2... ' Rear ....,'~-.?. ....... Depth .../..~..~¢. ?. .... Iteight ..... '7~. I. ....... Number of Stories ......... ~.. .............................................. 9. Size of lot: Front ...... .f. cTv.~ f .......... Rear ..... (~.o.: .2[/. ......... Depth XdrT.: I0. Date of Purchase ' . Name of Former Owner 11. Zone or use district in which pr6mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... .~.?. ........................ 13. Will lot be regraded ....... ./~.Q ................. Will excess fill be removed from premises: ~ No 14. Name of Owner of premises . .~3,/..4~o.'.~. ....... Address ./~rh:.~..Sff?..~./.~. Phone No ............. ..... Name 'of Architect " Address Phone No Name of Contractor ........ i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW/YORK, { .. ....................... [ ..................... being duly sworn, deposes and says that he is the applicant above named. He is the ............................................................ ~ ........... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is du,~ly authorized to perform or have p'erfo~ed the said work and to m~e ~d file application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will he perfomed in the m~n~r set forth in the application filed therewith. Sworn to before me this Nota, eublic~'. ~.-~ ........... Count~ ~ 'i'()1 :'ilL[_ I0 m 'd I -- 7 .1 Z