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Home My WebLink About14107-z FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEIU~IT FI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 14107, Z ..... ~o ...~..~.a~.~.~.~..~.c ~.....~/..~-,~ou_~.~......~.z ~./.~..c~... ..~..~..~ .................... / ot p,,,~,,.s ,~o,ed ot .Z.~.~. ....... ~.~.'/..... .x...~.~./~./...,. ........ ~....~ .......................... ........ ~.........~.~...~....../~., ....... _ ................................. : ..................................... co.,~, Tax Map No. ,000 S.~,,o, ..O...7.~ ........ ,,,~k ....~7. ........... Lot No..../.~..,.~.. ........ pursuant to application dated ...... ~...~....~.....~.. ....... /. ...................... , 19~...~..'~., and approved by the Building Inspector. Fee $...2 ................. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bui)dlng Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ to the Building Inspec- tor with the following; for new buildings or new use: I. 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 disposai-(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. 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date .......................... NewConstruction......OIdorPre,existingBuilding ... ..... ... . Vacant Land .... ........ . Location of PropertyHou,e' I! .O.No. ..... '~" '~' '¥] ~ ....... '~ ¥.Q. .~:.L. p,~ .... ~. ......... ~.~.~Hamlet Street Owner or Owners of Property . .~.~...~. ~.~.~ ~ .... ~ ~ ................. County Tax Map No. 1000 Section . O.V. ~ ...... Block ....0.~ ........ Lot ....... ~..O.l~ Subdivision...~)~-~ .... ~ ......... Filed Map No. ~.~...Lot No ..... ~ ........ PermitNo. /.~.'.Q.?~DateofPermit .~/'l~:AppJicant ...?~.~.~:..~ .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building an~)2~pplicable codes and regulations. Applicant . ./-~E'~ V-Cd~..~ .~,~. .'7; ;T .............................. R~v. 10-10-78 30553 co ,FIELD I~SPECTION FOUNDATION FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING IKISULATION PER N. Y. STATE ENERGY C.,ODE COMMENTS lo~so;~3 THE NEW YORK5UREAuBOARDor E'ECT.,CITyOF FIRE UNDERWRITERS ~g 85 JOHN STREET, NEW YORK, NEW YORK 10038 o.t~ Augus~ 06, 1.9~5 ~47081/85 ..,,¥,,ic,,t,o,, No. o,,.r,,,, N 703616 THIS CERTIFIES THAT ~[OB~i~[' ~0~, Sloe~y Hollow Lane~ C/O Willow [~on(~ Lao$outhol(l, ~ [] Base,nent [] Ist Fl. [~ 2nd FI. Ott~Si(~e Section Block Lot in location; ~.%'t~J%t~lt 0~, ~ ],9~5 and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS OUTLETS SWITCHES EXHAUST FANS SYSTEMS NO. OF FEE This certificate must not ~e altered in an . . . . -" - /~ ' /. ~ ~ 7~ ' - PY FOR ~ ILDING DEPARTMENT. THIS COPy, OFCERT[F!G TEM "~N ~ E ~LTE ED IN A~y~ANNER. ~Jj BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION []FRAMING []FINAL REMARKS: ~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL 'FORM NO. 1 ToWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 BLDG. DEPT. ~OWN OF SOUTHOLB Approved. ~/G./.q....~. .... , 1 . Permit No./~./. ·~ .... Disapproved a/c ............ '..~7--.. Y~'~.~ ........ (.]. ...... N (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. 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 regulations, and to admit authorized inspectors on premises and in building for necessary jpsj~ections. ~ ...... / f ... (Signature of applicant, ~Frm~ if a corpo at' (Mailing address of applicant) /v State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. .~-~ ~.c_) .77. Nalne of owner of premises ~..0 ~.~.7.~. · · .~..0../:J.~) ...................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~t- Z[ G oq .. Plumber's License No ......................... Electrician's License No .... ~ .ce../..~ ............ Other Trade's License No ...................... / [~) ~oc.c~ c~3 t-?..~.e7 I. Location of land on~l~ch proposed work will be done~..~]q-~ .............................. ................. r'~... ~ ~ ..... ~': ......... itouse Number Street Hamlet County Tax MapNo. 1000 Section ........ 2~ ...... Block .... [ ............. Lot..........~ ~';~.. Subdivision ................ (~'a~) ................ Filed Map No ............... Lot ..... ~] .... ~.. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy / ~/q ~ ~cC . b. lntendeduse~doccupancy ~S/~C~ .9Q/ ~.~ /~6~M~' ~W/~ ~.,. ' ~ ~/q~ ~C~7 ,.~o.: Co.o~ ',. 10. [)ate of Purchase .......... : .................. Name of Former 1 I. Zone or use district in which pr~mises are situated 7; ............... 12. Does proposed construction violate any zoning law, ordinance or regulati 13. Will lot be regraded ........ ~ ................... Will excess fill 14. Name of Owner of premises .,~.o.~.~.. ~oA6O ..... Address ~g).. Name of Architect ........................... Address ...~.~...c~., Name of Contractor ,.Y~/.~o. ~:2~ ~. ~ .o~s.' ......... Address ~.7./.. Nature of work (check which applicable): New Building ..... ' ..... A dition .......... Alterationz7 ......... Repairs' .... ~ ...... _,RemO4al .............. Demolition .. "l .......... Other Work..../.0.~A ........ , : II~ ~/,~ -!' ,_ _---.- ~- (Description) Estimated Cost...'~..f~/..~..~..~. ....................... Fee ~. ~'.~. ............................... ' ~ i ". (to be paid on filing this application) · If dwelling, number of dwelling units ............... Number of dy If garage, number of cars ..... l ............................... If business, commercial or mixed occupancy, specify nature and extent e Dimensions of existing structures, if any: Front ............... Rear Height: ............... Nunlber of Stories .................... DimenSions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... !.. Height ..................... N amber of Stories ...................... .... F /6' ¥.3(e R pth Dtmenmons of entire new construchon rent ........... ear ............. De ............... Height ............... Nunlber of Stories ..................................................... S~ze of lot: Front .~.-~. {..'¢.15/. ......... Rear ...~.~'.,~..,Y.~. ~ .......... Depth · ...~..4 ..... PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or propose property lines. Give street and block number or description according to deed interior or corner lot. STATE OF'NEW YORK, S.S COUNTY OF ................. ...... ~4; ................... being duly sv (Name of individual sigfiing contract) above named. ! lie is the ~ i , (Contractor, agent, corporate of of said owner or owners, and is du!y authoriZed to perform or have perfor applicationl that all statements contained in this application are true to the work will beperformed in the manner set forth in the application filed thereu Sworn to. before m.e this i ling units on each floor ................ each type of use ..................... ............. Depth ............... Owner .............................. ~n: . ..~.o. ............................ e removed from premises: Yes No ~ ....... Phone No. :/.~.,., .,~.-,././{ ~'-- ..... ·. ,'-ff. .... Phone No. ..._. _ ?-.17-~ ...... Phone No..'7...~.V...ff./.~.~ .... t, and, indicate all set-back dimensions from and show street names and indicate whether ,rn, deposes and says that he is the applicant !icer, etc.) ned the said work and to make and ~e this ~est of his knowledge and belief; and that the ith. ......... ,/{. ............ day o~.. ~Z. . Notary Public, ............ ,19 ~..4'~ ........... ........... ~ot*ry Ptlblico St~. of New York ~ Commission Exp ra~ Marc / 30 19~ ............. ~ ' Um of app.c~t)