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Home My WebLink About14046-z FOBM NO. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 14046 Z Permission is hereby granted to: _.._,, ...... L .(. .t . .(. .. .... at ................... premises :'"":'"'"'":,ocatea a, ................ ...(~.~.~.....~.....i~~ ................ '~ ................. ................ '~i ....................... ~i.~~.' .................... ...... County Tax Map No. 1000 Section ..... ~...~.../. ......... Block ..... .0,..~, ......... Lot No....~./..:..~.,~...~.. pursuant to application dated .,. '~.~..x:~..~..~ ........ 19..~..~.~.,-- and approved by the Building Inspector. Fee $..I. .................... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department · Town Hall' Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF ocCUPANCY Instructions A. This application mbst be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the fol!ow[ng; for new buildings or new use: 1. Final survey of property with acculate 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. Approvat of ~lectrical 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 Planr~ing 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 features, 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Dale 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 etlin or land use 2. Certificate of occupancy on p - g g $5.00 3. Copy of certificate of occupancy $1.00 : Date ....... New Building ............. Old or Pre-existing Building(Z~.f'... - ~ rVacant Land .......... Location of Property ................. /~.~./.../~../~..~. House No, Strut Hamlet Owner or Owners of Property .~.. ~ ~]~/~ ~/~L/ ~0 ........ County Tax Map No. 1000 Section .../F./ ....... Block .'.'...~ Lot. Subdivision ~ .... ; ............. Filed Map No ........... Lot No .............. · . · ' ... ./.,. ...... ........... , ........ '. ............ ..... ....... .. ,,. a .~.~t ................ ~.. Unde~r ters Approva ~c c~¢. ~/~ Planmn Boar ~ ' · ....... ' , d App,o,,~ ..*~. % .......... Request for Temporary Certificate. ~ · .% ......... Final Ce~ificate . ¢ Construction on above describedApp c~~_ ~building and perm.~t meets all appl~cable~e~coda, s.a nd ~ .~..~ ~' ~"~'~re!ulati°ns' , .-, .- /-..:, ,~ ''7~'~V ....... ~. ..,~. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFtES THAT only ~he el~ trical equipment ~ described belo~ and introduc~ by t~ applicant ~med on the above appllcatio~ ~umber ~n the premises of ~J~tL~'ack,-Travel-~e~. ~ 95 Love L~ne~ i. the following Iocatlon~ ~ Basement ~ 1st Ft. ~ 2nd FI. Section Block Lot w~ examined on L~OV~ 2~ t ~9~ and found to be in compliance with the r~quirements of this Board. FIXTURE OUTLETS 1.!. DRYERS SERVICE DISCONNECT FURNACE MOTORS FUTURE APPLIANCE FEEDERS GAS H. P, AMT N0. A, W. G. RANGES SPECIAL REC'PT. OTHER APPARATUS: NO. OF METER EQUIP, TIMECLOCKS BELL~UNIT HEATERS MULTI*OUTLET A,~T. AMPS TRANS. H, P* SYSTEMS NO. OF FEET _ R V I C I.~2w I 3w 3~'3w 3.e'4w NO, O COND OF CC COND. OF HI-tEG EXHAUST NO, OF NEUTRALS DIMMERS OF NEUTRAL ~, ~agctlo~ue, ~Y 11772 Lic~2013 GENERAL MANAGER // This certificote must not be altere~ in ony m~nner; return to the office of the Boord if incorrect Inspectors m~y b~ i~entlfied by their credentials. ; COPY OF CERTi ~iEL~INSL~ECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qOD FINAL ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date O- o 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 ~.~ale. Fee according to schedule. b. Plot plan showing location 'bf 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~tl~ 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 premis, es 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 Zone Ordinance o]/ the Town of Regulations, for the construction of The applicant agrees to comply with all a admit authorized .~rs ~n premises and additions State whether applicant is owner, lessee, agent, N .e of owner of premises.../2. . If applicdnt is a corporation, signature of duly authorized of for the issuance of a Building Permit pursuant to the New York, and other applicable Laws, Ordinances or or for removal or demolition, as herein described. building code, housing code, and regulations, and to (Signature of applicant, or name, if a corporation) ......... U(Mailing address of applicant) general contractor, electrician, plumber or builder. roll or latest deed) (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No. ~L .o.. !?~. ....... Other Trade's License No ...................... 1. Location of land on which propose.d work will be done .... :...~ ......................................... ttouse Number (~5~75~ X~a~,~ fi/at Street Hamlet County Tax Map No. 1000 Section ..... ]..q./. ......... Block ~ Lot.. ~/' Subdivision ................. "Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: use and occupancy ..... ~. ~ .......................................... a. Existing b. Intended use and occupancy .................................................................... 9. 10. 13. Nature of work~heck which applicable): New Building ..... ' .....'Addition .......... Alteration .......... Repair .... ,'r ......... Removal .............. Demolition ............. Other Work ........ 'i'! ~ (Description) Estimated Cost... ' ...................... Fee ...................................... I ~ (to be paid on filing this application) If dwelling, number of dwelling units ............... Number o f dwelling units on each floor ................ If garage, number of cars .... ! .................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....... Dimensions of existing structures, if any: Front... ~4 o ' Rear qt .~ ,. Depth /.~. `~' ;t-r'i.. ! 5' t. Number of Stories Height............... ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ................... ... Height ....... ./~ ............. Number of Stories ..................... Dimensions of entire new consiruction: Front . ~7~--:-' · · Rear ............... Depth .............. Height .............. Nmnber of Stories ................................... · .q.?. ' ' ..... / ~ .......... Size of lot: Front .. ~,,.. ~ ............. Rear ....... . .,~'.¢. ........... Depth .... :/.. 7. ............ Date 6f Purchase ...1~..d,-~.:... !./.~...../.~.~..~. .......Name of Former Owner ...... .~. ~ ..... Zone or use district in which piemises are situated . Does proposed construction violate any zoning law, ordinance or regulation: ........ q]..t~~. .............. Will lqt be regraded ........ i...,~.. ............... Will excess fill be removed from prem'i~es: ' Yes Name of Owner of premises . .i .................. Address ................... Phone No ................ Name of Architect ......... I .................. Address ................... Phone No ................ Name of Contractor ........ i .................. Address ................... Phone No ................ Locate' clearly and distinctly a property lines. Give street and blocl inte,rior or'cor~er 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 YORK, COUNTY OF....4'. '(/.~.~.....Z.~ .... , S.S ~./~ L/d__ ~--~[ L/ti ~ t40 being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) abow, named. He is the ., .......... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dt ly authorized to perform or have performed the said work and to make and file this application; that all statements con :alned in this application are true to the best of his knowledge and belief and that the work will be performed in the mann ~r set forth in the application filed therewith. Sworn to before me this .... . ......~fl C~ ........ day o:f .... ,~..,~. ........... ,19~'.~. HFLEN K. DE VOE '""'i' . ......... .~, · ,~~ .......... NOTARY PUBLIC, State of New Y~rk (Signature 'of applicant) No 4707878, SLtffoJk Count~ ,-'- Term Explles Malch 30, 19~$ i