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HomeMy WebLinkAbout13325-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13131 Date Jan. 15 198.5. THIS CERTIFIES that the building ....... .G.r.e.e..n..H.o.u..s.e..A.c..c.y.. .... ?.3. .............. Location of Property ..3. 6. .4.0.q .............. .c.o.u.n..ty..R.d. :..~.4. 8. ...... .Pg.c.o..n.i.c. ......... House No. Street Ham/et County Tax Map No. 1000 Section . . . Q 6. .9 ...... Block . . .0. 4. .......... Lot . . .0..0.7 ........... Subdivision ..... .X ......................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... .J.u. 1. y ..... .1.9 ......19 .8.4. pursuant to which Building Permit No .... .1.3.3.2..57 ........... dated .......... .~.u.q.u..s.t ........ 6... 19.8.4., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Farm Building The certificate is issued to .................. .G. qI..Lp.,, fi..~.Y. ?.. q.Eb?' .................... (owner, of the aforesaid building. Suffolk County Department of Health Approval .......... IXJ../.~ ............................. N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z13132 D Jan. 15 198.53 No ............. ate ................... THIS CERTIFIES that the building ....... .G.r.e.e..n, .I~o.u..s.e..A.c..cy.. .... ,~.4 ............... Location of Property 36..400 Count, y ,Rd. #48 ....P,e.c.o..n.i.c. ......... hid ....................... ....... County Tax Map No. 1000 Section 069 .Block 04 .Lot ,. 0.(.17 Subdivision ..... .X ......................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore f/led in this office dated .... .J.u. 1. y ..... .1.9 ......19 .8.4. pursuant to which Building Permit No.. 13325Z dated .......... .A.u.g.u..s,t ........ 6... 19 .8.4, , was issued, and conforms to all of the requirements of the applicable provisions of the law. "lhe occupancy hr which this certificate is issued is ......... Green [louse A~cessor~ Farm Building The certificate is issued to GUILD, JAY & JEAN. (owner, of the aforesaid building. Suffolk County Department of Health Approval .......... N, ./,A ............................. UNDERWlhilTERS CERTIFICATE NO ................. .N./b ............................. Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N,Y. Certificate Of Occupancy No. Z13133 Date Jan, 15 198.5. THIS CERTIFIES that the building .......... · ..................... Location of Property 3, 6. 40 0 ..... .cp.u.n.g¥. Rd..# 48., P~coni,c ........ County Tax Map No. 1000 Section ...0.6..9 ...... Block ...0.¢ .......... Lot 007 Subdivision ..... .X ......................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~.u,1.,y ......1 ? ......19.8?. pursuant to which Building Permit No .... :L 3.3.25 g dated .......... .~.u.g,g ,s ~ ........ 6... 19.8?., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Green House Accessory Farm Buildin~ . 'II~e certificate is issued to .................. .G.U.~ .l/p.,. ~q .,¢.~. ?.. ~A.~. .................... (owner, le~¢~not~O of the aforesaid building. Suffolk County Department of Health Approval ......... .N../.A ............................. UNDERWRITERS CERTIFICATE NO . N/.A Building Inspector Rev. 1/81 FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy .Z.1.313.4 Date Jan. 15 198.5. THIS CERTIFIES that the building ....... .G.r.e.e..n..H.o.u~ .s.e. Accy, #6 36400 County Rd. #48. Peconic Location of Property .............................................................. House No. Street Ham/et County'rax Map No. 1000 Section ...0..67 ...... Block ...0.~. .......... Lot. 007 Subdivision ..... .X ......................... Filed Map No ......... Lot No .............. conforms substantially to thc Application for Building Permit heretofore fried in this office dated .... .Ju.l.y ..... .1.9 ......19 .8.4. pursuant to which Building Permit No. 13325 Z dated .......... .A.u.g.u..s.t ........ 6... 19 .8.4,, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .Green House Accessory. Farm .Building The certificate is issued to GUILD, JAY & JEAN (owner, ~e ~-te~t¢ of the aforesaid building. Suffolk County Department of Health Approval .......... N../.A ............................. N665440. UNDERWRITERS CERTIFICATE NO ................................................. Buildmg Inspector Rev. 1/81 FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13135 Date Jan. 15 198.9 THIS CERTIFIES that the building ,., Green House Accy, . ~7 Location of Property 36400 C9.unty Rd. #48 , Peconi.c House No. Street Hem/et County Tax Map No. 1000 Section ...0..6.9 ...... Block ...0.4. .......... Lot 007 Subdivision ..... .X ......................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in tlfis office dated .... ~.u.i. ¥ ..... ~....9 ...... 19.8.4. pursuant to which Building Permit No, . 133.25g dated .......... .~.u~.?.t ........ 6... 19 .8.4., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Green Itouse Accessory. Farm Buildin~ The certificate is issued to ................ of the aforesaid building. Suffolk CoUnty Department of Health Approval GUILD, JAY & JEAN ~wne~ N665440 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13136 Date Jan. 15 1985 TI-lIS CERTIFIES that the building ....... ~?.o.e..n..H.o.u..s?..A.~.c~'.,. ...... ~.8. ............ Location of Property 36400 Cou. nty Rd.. ~4B Peconic House No. Street Hamlet County Tax Map No. 1000 Section . . .0..67 ...... Block 04 .Lot 007 Subdivision X Filed Map No. .Lot No. confm'ms substantially to the Application for Building Permit heretofore filed in this office dated · July· 19 19 .84. pursuant to which Building Permit No. 13325Z dated .......... .A.u.g..~..?~ ........ 6. .. 19 .8.4., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Green House Accessory Farm B.u.:~l.d.i.n.g The certificate is issued to .................. .G.U.I..Lp/..q'.A.Y. fi...5~.A.N. .................... (owner, le~ee.ot~te~t~ of the aforesaid building. Suffolk County Department of }{ealth Approval .......... N../~ ............................. UNDERWRITERS CERTIFICATE NO .................. N.~ .6.5.4.4. .0 ........................ Building Inspector 1/81 I~O~-M NO. ~ TOWN OP SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJVilT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13325 Z Permission is hereby granted to; _ ...~...~..~...~......~..~ ....... ...................... .~...~ to ............... ~ .......... a ............ at premises located ot...~..~..,~.....~....~ ~ ..~....~.. i~.'~~ ..~...~..~, .;. Building Inspector. ond approved by the Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY J/ l I I 1985 B DEPT: L OW. OFSO OL Instructions 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 approvat 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 si~nilar 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 p~L"operty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land CoO. $5.00 $15.00 Date New Building . X Old or Pre-existing Building Vacant Land .... Location of Property ................................... t ............................... House No, Street Nam/et Owner or Owners of Property . . ~ ............. Cot, nty Tax M ap No. 1000 Section .... (~ .~ .~. ..... B lock .... .(~ .~. ....... Lot ..... .(~.C?..~ ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No,'/..~. ~ .~. Date of Permit .~..~/.2. ~/, .Applicant. ,~. ~ .... ~..~..~. ~ .ti ............. Health Dept. Approval~ .......... Labor Dept. Approval ........................ Underwriters Approval/¥..L~?..~,/..~..%...~..(~....Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~.' ...................... ~ . ~, Applicant ..... ~.~: ~.~J ............................. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG. DEPT. TOWN OF SOUTHOLD Instructions 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 si~nilar 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 property 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, 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date S ! New Building ~ Old or Pre-existing Building Vacant Land Location of Property .................................. ~ .~,~i~ ............... House No. Street Ham/et Owner or Owners of Property . ,'~,i~, ...................................................... County Tax M~p No. 1000 Section .... ~ .~ .~.. ..... Block .... .C~ .~) ....... Lot ..... .O.~..~ ..... Subdivision..~'i .............................. Filed Map No ........... Lot No Permit N,o.).~.&,~, .,~:l' ,:~. Date of Permit ,~/6,/,~ ~..Applicant...~, ~,~, ,~ .... ~. ,t/. ,~. ~ ?] ............. Health Dept. Approval %. '!i :: ~', ........... Labor Dept. Approval ........................ Underwriters Approval...~'O.-...,o.Planning Board Approval .........,...... Request for Temporary Certificate ..................... Final Certificate ....................... Submitt d $ ~.~ Fee e ............ Construction on above described building and per eet~f~ll Ii codes and regulations, ~k~-C- 3~.'% .'~ lib Applicant ...... R~. 10'10-78 p ~ r~ h ~ ~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY ~nstrucfions 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 sit, ilar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Su bm it Planning Board approval of completed site plan requirements where applicab For existing buildings (prior to April 1957), Nomconforming uses, or buildings and "pre-existing" rand uses: 1. Accurate survey of pz"operty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land CoO. $5.00 $15.00 New Building . ~ Old or Pre-existing Building Vacant Land of Property ~o ~ c~ Location ................................... ~ ............................... House No. Street Ham/et Owner or Owners of Property ..... c~- ~ County Tax Map No. 1000 Section .... ~").~..~ ..... Block .... .(~.~ ....... Lot ..... .(~?)..~.1 ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ) ~.~.@S" .~:~ Date of Permit Applicant Health Dept. Approval .t. · ~ · ~ · ~ ·. .......... Labor Dept, Approval ...................... ~.C~. Pla g B d Appro I Underwriters ApprovaVY..M?. ~ .: .~. ,%". . . nnin oar va .................. Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~,'..~..O.. .................. Construction on above described building and pe/mi (~LC~ ~.~<~'~ '~ 0 Applicant ..... .,~ meei~a~ ~ti des and regulations, Y FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY JAN I 119 b :,. BLDG. DEPT. TOWN OF SOUT=,H, OL~ 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 applicabie. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre:existing" land uses'. 1. Accurate survey of p~'~perty 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4oVacant Land C.O. $5.00 New Building Y' Old or Pre-existing Building Vacant Land Location of Property ........................ House No. Street Hamlet Owner or Owners of Property ..-~,,q.~.. J, .~, .~, ,~? G ~u~}~ County Tax Map No. 1000 Section .... (~.~..~ ..... Block .... .~).~ ....... Lot ..... .q~.q~...~ ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 1.~..~..~. · Date of Permit .~ ~..Applicant . Health Dept. Approval .t ...................... Labor Dept. Approval ........................ Unde~riters Approval..~ .~.~ ~ .......... Planning Board Approval ,. ................ Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..~.'..~..o. .................... Construction on above described building and ~/~mit m/e/~/a~pp~a~codas and regu ,ations. ~tqO~ FORM NO. $ TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 l\\l JAN I BLDG. DEPT. TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 unu~Jal natural or topographic features. 2. Final approvat 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 sk~ilar 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 s~rvey of property 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. 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1~00 4.Vacant Land C.O. $5.00 $15.00 Date New Building Y~ Old or Pre-existing Building Vacant Land Location of Property ~ ~ ¥0 D ~-/C)~_ 3~ ~ ~ ~'~-~z ~J .......................................... '.., %.~. ................... House No. Street Ham/et OwnerorOw rs of Property ..... .~. J .~.?.?; ............................. County Tax MJap No. 1000 Section .... (-~.~..~. ..... Block .... .C~?. ....... Lot ..... Subdivision..' ............................... Filed Map No ........... Lot No .............. Permit No. ).'.~.~.~..S': .:~.... Date of Permit .~J .b/.2..~..Applicant...~. :~. ~ ....~. ~.~.~ ~ ............. Health Dept. Approval 't ...................... Labor Dept. Approval ........................ ,/ Underwriters Approval/v ..................... ~~ Planning Board Approval .................. Request for Temporary Certifica[e ..................... Final Certif~ate ....................... II d , ~0 .. FeeSubmitte $..~ .................... A'' Construction on above de,ribed building and pet~~ me~a~,~ codes and regulations. Building Department Town Hall I- - ~ .... ~ o~1 :/i Southold, N.Y. 11971 I ..... ~,_DG, DEPT, --~ ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Bo 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, end unu~al 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 responsibie 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 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 buiMings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre~existJng dwelJJng 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5,00 $15.00 Date New Building ... ~ Old or Pre-existing Building Vacant Land Location of Property 0 ~ ~ c,~ ~J~ House No, Stree~ Hamlet Owner or Owners of Property . ¢-::: ~'P ~ ~-I c~ County Tax Map No. 1000 Section .... (~ .LC..(.~ .....Block .... ,C~).~ ....... Lot ..... ,(~.c~,. ,~ ..... Subdivision ................................. Filed Map No ........... Lot No Permit No. ~.~,5,~. ~ .~. Date Of Permit ,~ .~/?, ~/..Applicant...~, .~. ~ .... ~'. ~,,~. ~ .c~ ............. ~ Lab pt App Health Dept. Approvals/ ...................... or De , royal Underwriters ApprovaICv, ................. Planning Board Approval .................... Request for Temporary Certificate ..................... Final Certificate ....................... ee Submitted $. ~.~ .................... Construction on above described bu ilding and pe~r4it mee~f~l i~lj~,~e ~odes and regulations. Apphcant ....... ~'.'~ Y Memorandum from.. · BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD ToWN ItALI,, }3OX 728, SOUTIIOLD, N.Y. 1197 765-1802 FIEL~ IN~ECTION 1. COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMME~NTS: 10007?l THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~at~ October 29,1984 ~pp.~.tio.~o. on~ile 298377--84 N 665440 THIS CERTIFIES THAT only the eJec trical equipment as described bel~ and introduced by t~ applicant named on the able application number in the premises of Jey W. Guild, s/~ ~36400 ~o~t:h Rd. ~econic~ in the followlng. I~catlOn;UC C . Z~ Z ~ ~ B~nt ~ 1st FI. ~ 2nd ~7, Section Block Lot was exam nea on and found to be iu compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS OUTLETS SWITCHES INCANDESCENT FLUORESCENT DISH WASHERS EXHAUST FANS DRYERS OTHER APPARATUS= Patlels: 1-12, 200amps, E R V I C E NO. OF CC. COND A W, O, NO OF HI-LEG A W. G~ A W G, 1-12, 4-4, 100amps each- NO. OF NEUTRALS Rulend Elec ,Co. P.O. Box 143 Mattitua~, NoY~ 11952 COPY APPI~O~,rED AS I~OTED NOTIFY BUILDING DEPARTMENT AT ?65-'[802 9 AM TO ~, PM FOR THE FOLLOWING INSPECTIONS: '1~ FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INgULAT!ON 4. FI~4AL. CON'STRUCTION MUST BE C©MPLETE FOR C. O. ALL CONSTRUCTION SHALL MEET T~-~E RE©UIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .._~.t~..~. ~ .... , 19~.~. Approved~'~- ~ ., 19~.~t.. Permit No.]. .~.~..~...~..:~.. Disapproved a/c ..................................... Received...~ (Building Inspector) APPLICATION FOR BUILDING PERMIT 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. 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 permi.a 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 t~ave 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 o[ demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building co~t~, t)pu~ng code, and regulations, and to admit authorized inspectors on premises and in building for necessary~nspqq~c$o~ffJ .. ....... .................... ')//~g'n( ature of applicant, or name, if a~corporatio~) ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner ofpremises i~ft~r~e' f~'~~~e'~~e~t'~e'd') ......................... If applicant is a corporation, ~)gnathre o y authorized officer. (Name and title of corporate officer) Builder's License No.(.~3 ~ .O~ .~..,.~.~..k<&..~.~. ~.~. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed woIl~wil~e,done ................... ~ ............................. House Number Street Hamlet County Tax Map No. 1000 Section ..... (~ .~.~. ....... Block....(~.. ........... Lot..©.~...~. ........... Subdivision ...... : .................. ['J. ......... Filed Map Ncr;--:Z~YT~-TV~-:-:-.-Tx"-Izot (Name) 2. ?; ff[12?2cOiffi,y. ~f. premises a. ~/./~., .~,, .~. ~i.i~ii~d.~d. ~s.~ i~)d. ~ii~i~i~ ~i yroposed construction:... b. Intended use and, occupancy... · .~.~. ff~'//~.'//-' ~<,7/ '__ ....................................................... _ . . ; 'i' ' ' ' ' ' ' ' ...... ' ' ' ' ' ' ' 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ........ ~. .... Removal .............. Demolition 4. Estimated Cost ..... ~ · ........................ Fee . .'...--~. ............................. '" (to be paid on filing th!s application) 5. If dwelling, number of dwellin~ units ............... Number of dwelling units on each floor ................ If garage, number of cars .... i .................................................................... 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 ............... Number of Stories ........................................................ Dimensions of same structure kith alterations or additions: Front ................. Rear .................. Depth ................... i. · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... _ Height ............... Number of Stories ........................................................ 9.Size of lot: Front .......... i ............ Rear ...................... Depth ...................... 10. Date of Purchase .......... i ................... Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ! .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. .................. Address ................... Phone No ................ Name of Architect ......... i .................. Address ................... Phone No ................ Name of Contractor ........ i .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly arid distinctly ali buildings, whether existing or proposed, end, 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 ~interi'or or corner lot. STATE OF NEW YORK,/ ,, ,, COUNT~ Ol~... fi/. ~. ....... Ia'~ ..... ' ~/~.ff/~/~(,, .ff.~../~.. ¥-//---//Dm t~/r .......... .................... being duly sworn, deposes and says that he is the applicant //~/]~Name of in~vidu~ sign~ing contract) abov~a~e~ /// ~/ ~ He is the .~ ~'~ ~4~., of said o~er or owners, ~d is dul~ authorized to perform or have performed the said work and to m~e and file this application; that all statements contained ~ this application am true to the best of his ~owledge and belief; and that the work will be perfomed in the manei set forth in the application filed therewith. Sworn to before me this ' ~ ~ ............... ..... ..... ........ Nota~ Public .... ~.. ~] P~.~ County ~ ~//~ /