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Home My WebLink About16540-z FOU'M' NO. ft TOVtN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PE~VUT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: '~ ...... X-UR'~ ........................... ti~ ............. ,.~.~.~..x....~,.~ ................................................ ..... ...... ...... r)_ to, ~'"b- - ~-'- ' ': " :" " ............ ot premises located at .~,~-.~..~...,..~.~..~........~,.....,.~ ....... [~.-).~.~.... ........... County Tox Map No. lO00 Section ....... ~..mj..~. ....... Block ...... ..¢~.l ......... Lot No ..... ~..J~. .............. pursuant 'o application dated ...0..1~.~...!...~.. ...................... 19:.~...~..., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department, Town Hail ~ $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE O Instructions A. This application must be filled in typewriter OR ink, and submitted aa ~ 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 p=operty 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 $1 5.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~ /~/~ 5.Updated C.O. $15.00 Date '7 7 New C on s t thc t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property -~ 3 ~'.~. ~o o/L~ D ?/~ b~...~ ~ ~ .~. ~/.~U ~/~ ~ ~ Hou~ No, Street NataNt Owner or Owners of Prope~y .... ~ .~. ~ ~ .~J. ........................................ County Tax Map No. 1000 Section . ~.~ ........ Block ..... ~ [ ........ Lot .... ].~.' ....... Subdivision ................................. Filed Map No ............ Lot No .............. Permit No./~. ~ Date of Permit (~/.,~./~.~Appl.cant~.'~...... . ~.................~X~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval . . .~./../~ ............. Planning Board Approval :~ ............... Request for Temporary Certificate ............... Final Certificate . ~ ..................... Fee Submitted $ ............ - .... ~ ~. Con,ruction on above described building and permit meets all applicable c~s a~ r~ulations~ ..... R~. 10-10-78 TOWN OF $OUTPIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner //~//7~5. ~(---7 (please print) Plu~er ~,/' ~o~ _~o~~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (pluraber ' s Sworn to before me this ,~ day o~ 3~/,, , 19 ~. Notary Public Notary Public Oo County c-, ~ ~ ~ ~ OFFICE OF BUILDING INSPECTOR ~s~ ;~. ~ ,~J SOU I'IIOLD, N.~. 11971 To Whom This Hay Concern, TEL. 765-1802 We are unable to complete your Certificate of Occupancy because .of the following reasons. /~'~/ An application is not on fil~. / No Underwriters /? The check /? /? for Certificate of Occupancy ertlflcate on file. is (outdate'.u~.t ou ~:o Health Dept. Approval on file. No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation.- Building Dept. '~**/-//No Plumber Solder Certificate on file. ( all permits involving plumbing being .[s:;ued after April 1,1984 ) 765-1802 BUILDING DEPT. INSPECTION FOUNDATION IST ~- ] ROUGH PLBG. FOUNDATION 2ND [~"NSULATION FRAMING FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION :)ND [ ] INSULATION ./ DATE INSPECTO BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ;ZND [ ] INSULATION [~/~RAMING ~r ] FINAL INSPECTO 765-1802 BUILDING DEPT. INSPECTION F.,~D~A?ON 1ST [ ] ROUGH PLBG. 'FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL // FOUliDATION (1st) FOUNDATION (2nd) !!DATE COMMgNTE INSULATION PER N. STATE ENEROY CODE FINAL ADDITIONAL COMMENTS: 7G5-'~802 BUILDING DEl)T, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION / FRAMING ~r/~'~INAL THE NEW YORK BOARD OF FIRE UNDERWRITERS 100~ 381 EUREAU OF ELECTRICITY r-- Es JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT ~ exami~ on a~f~nd to be in compliance with the ~ui~menf. of th~ ~rd. RXTUItE RXTUIIE$ lANCES OVENS OUTLETS SWITCHES 7 t9 19 7 DRYERS PUBNACl 'I~MI CMX:KS UNIT HEATERS MULTI-OU~I~I' DIMMERS SIRVIrI D~SCONNICT S i I V I ~;hEC. ROOM I{~:ATERS:I-2.0 K.W.,2-]..25 ELEC. ROOM HFJTERS:2-.5 K.W. PANF, LBOARDS:]-8 CIR. 100 .g HOR t~'1 I)'~JT}iCTOR: - 1, JODY PUMIt,I,O PAT LANE MATTITUCK, NY, 1.1952 blCENSg NO. 2300 ~ This certificate must not be altered in , manner; return to ~e effice of the Board if incorrect. Inspectors may be identified BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MM4NER, EP, C_TY C ODE CALC .X £-,,/4 !) HEATING EQUIPMENT ~0 MEET 7813.23 - 75% EFF. '2_) FW. ATTNG C~.ROL5 TO MEET 7813.15 .RANGE 45 TO 75 DEG~ FA~IT. 3) WATER HEATING PER 7813..31 THRU .38. 4) PIPE INSULATION 7813.19 5 ) ~SNDOWS - DOUBLE GLASS. 6) C'ONSTRUCTION TO MEET N.Y.S. EI{ERGY CODE. /? .3° /9 O. IF 0.0~ 0.5~ 0.~0 0.03 O. 0.~ O. ~'ZTo 2.0 ol0 - /~'TO/-/ I TO THE BEST OF MY KNOWLEDGE, BELIEF, AND PRO?FESSIC~A! JL~ THESE PLANS APE IN COMPLIANCE WITH THE CODE. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 BOARD OF HEALTH 3 SETS OF PLANS Z~-'~~-~ SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY HAIL TO: Approved ,Q .e,~.,,, .O~.,., ,,/, ~, ,, 19~.. j, Permit No,/, ~ .~., .~., .~' Disapproved a/c ..................................... Iff I ~'-':2~ ~111 ................................... . ........ D.. .~ ~ ~.~...~ ......... (Bufldin~ ~spectoO APPLICATION FOR BUILDING PER~IT INSTRUCTIONS a. This application must be completely fiBed 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 r~guiations, and to admit authorized inspectors on premises and in building for necessary inspect~ns. ~.~ ...... (Si~nJture of applicant, Sr name, if a corporation) -- (Mailing address of applica/it) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. ............................................ Name of owner of premises.../~-~,~.~.'.~ ......... i~.?~..~/~/ ..................................... (as on the tax roil or latest deed) Il' applicant is a corporation, signature of duly authorized officer. · ' (Name and title of corporate officer) 2/ ALL COIqTRAgTOR'S 1,IIIST BII SIIFFOLK gOO'lqTY Builder's License No ...... '~ ~. ;.~n. ~.../. ...... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done~ ................................................. .3.3.5.-5 .................... ¢..~..~...~/.,...~... ,,q v'r4 .,~.4~.~./.~.?..c,/< lfouse Number Street Hahilet County Tax Map No. 1000 Section .7.¢.'~. ............ Block ...... ( ........... Lot...( .~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /gq / bcJ~.~ )'~/~ ....... i ~-,¢'~ /"; '/' ,4.).~e~ ~/,,-'~-' ' b. Intended use and occupancy ...........,~.. ..................... '7.., ..................... 3. Nature of work (check which applicable): New Building ' Addition .......... Alteration ~ ..... Repair .............. Removal .............. Demolition .............. Other Work .......... ' ~1~ (Descrip~tion) 4. Estimated Cost : ~ ? .o .o.O...?OFee ................. ~ " (to be paid on filing this application) 5. If dwelling, number of dwelling 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 o) use. .................... 7. D~menmons of exmtlng structures~ ff al~y: Front ......... . ...... Rear ............... Depth ............... Height ......... Numbe of:Stories .' ........... Dimensions of same ~h'~,Ure W~l~rt~alterations or additions: Front ................. Rear Depth ...................... Height ...................... Number of Stones ...................... '- 8 Dimensions of entire new conslr,uction! Front Rear ... Depth Height ............... Number of Stories ........................................... ............. . 9 f 1 ' pth Size o or: Front ...... , ...... ~. Rear ..... . De ..................... 10. Date of Purchase ............................. Name of Former Owner ..................... ~ ....... 1 1. Zone or use district in which premmes are situated ..................................................... 12. Does proposed construction vi01ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ~..o. ............... Will excess fill be removed from premises: _Y, es No 14. Name of Owner of premise~t2J~./~..o. ~/~. ~..eP .~. .... Address ................... Phone No. g~ff...4(..op..~ .... Name of Architect ......... 1 .................. Address ................... Phone No ........... ~ .... Name of Contractor . .~.:/~. 15. Is this property located wit[in 300 feet of a tid~ wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required. PLO'r DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all s~t-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, S.S COUNTY OF ................. ~ . ./~. ~..~...,r?~....~../~....,~f.,..,~?.../.~..~/. ............ being duly sworn, deposes and says that he is the applicant (Name of individual staging co{~tract) above named. lle is the .................... ~ .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file this appilcation; that ail statements con~ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................ 4 ...... day ~f ...... .(~...C~... ......... 19 . ._ . S0~f0lkCou ~C¢~ (Signatur0tof applicant) occUPANCY OR ' SOLDER UNLAWFUL · USE IS CERTiFiCATE ,~',., OF,OCCUPANCY: oN LEA~ cERTIFIC,~Ic ul AS 80T~ ~VED N~I~ ~ILDING DEPARTMENT AT ~tem; piping shall 76~1~2- 9 AM TO ~ ~ ~fl T~ ~ K or L onl[ F~[O~NG INSPECTIONS:' : FOUNDATION ~O, REQUIREQ ~R ~URED CONCRETE ~UGH ' FRAMING · pLUMBING ~ ~ r ' 3. INSU~TIO~Z ' C N~ ~/~O--TRU~-~'' MU~ '~ 4. FINAL ~L CONSTRUCTION SHALL ~E~ T~ REQUIREMENTS ~ ~E N.Y ~A~ CONST~UC~ ENERGY ~S, NOT ~l~E ~R CONS~gTION