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Home My WebLink About14156-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ('I'HIS PERJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14156 Z Permission is hereby granted toj. ~-- _ /~ - t ~ .... k~..,~.../:/~.~......~......~ ~ ~,,~,,~ ...... A~..~.,.... ..~..~.~.~.~..c......~ ................ ......... .?.~.?..r.//c~z~..~...~..,..~ ........ /./..~ 7../. ~o ......... ~.a~ G~. .~ ~ c ~......~.. .~. .~... .~.-.~.. .~. z.~.~ ... .. .,~-.~.~.L~ ~....~. .......................... ZZ ........... ~i ....................... 7':- ......... ~'":~ ..................... :-'i .......................................... '/'''' iii'" _t ~._...ise, loc.ted at .....~..7.....A ................ ~,......y.~.....~.~.~ ...... .~....../ ............................. , ............................................................................................................... ...,L~.,.-~.~.~..~.~ County Tox Map No. 1000 Section ...~..4~.~... ....... Block ...~./. ........... Lot No. ~..~....~..q..?~.. ...... pursuant ,o application doted .......... ..~.L..~.. ...... ~ ................... . 19.~ and approved by the Building Inspector. Fee $ ....~.....?.....~......~...? Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~J~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions in duplicate ~, A. This application must be filled in typewriter OR ink, and submitted < %. :~o~ zhe 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 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 buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to preoare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant: Land C.O. $5.00 Date j~./~ .~.. ,...~./../. ~. ?.~. ~ew Buildin~ ............ Old or Pra-exi~in~ Build~n~ ............ Vacant kand ............. Location of Property 2 . Hou~ No. ~ . Street Hamlet Owner or Owners of Property ........ · · · County Tax Map No. lOOOSection . ~ Block ~ ~. Lot .~'.~ Permit No /~/~ Z Date of Permit Zl~/~pplicant ~ ~ ~ Health Dept. Approval ........................ Labor Dept. Approval ........................ U nderwriters Approva[ ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. Construction on above described building and permit meets all app,/cable codessnd regulations. ...,,.,o.,, .(,v' /:7 ....... TOWN OF SOLITHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date ~/~ Building Permit No. /~/~ Owner ~ ~ ~/~e~ /~/~, (please print) ~please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Swo~to before me this I~day of Notary Public, ~\~ (plumber's signature)v ',LD INsP~TIO~ ·DATE COMMENTS 'NDATION ( ls t } FRAME & IGH ~LUMBING -~ ~,ODE FIELD 1, FOUN FO 2o RO 3, 4. A,J~DITIONAL COMMENTS: 76S-XS02 BUILDING DEPT. FOUNDATION XST INSPECTION [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL REMARKS: DATE INSPECTOR /~' ~-~ ~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ~] ~J~ATION FRAMING [/.~'/I=INAL REMARKS.' o c/,~ ~ / 7GS-~802 BUILDING DEPT, INSPECTION []FRAMING [~] FINAL REMARKS: DATE INSPECTOR 'FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18013 2_,~ .., 19.~,.4" Approved. . .Z..~. ..... 19 .~.. Permit No.../. ....... Disapproved a/c ~ ~ . .................. ·(Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 tsets 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 ~ Certificate of Occupancy ~hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant 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 inspection.. , ,, m'c ................ c(~oignature of ~ppllcant, or name, if a corporation) ...... ,~..'-27.~ :~./.4&. ?.4~. ~..O. ' .0~..7../-./~.4 .~. (Mailing address of applicant) 'State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... a. ~.zu ~e ./. ~.~,a/~.~ .~....&..w..~.~.~..,~ ............................... Name of owner of premises ...... ~ ~ .'~'.. ~ .......................... (as on the tax roll or latest deed) t(Name'and title olTcorpor~e officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... l. Location of land on which proposed work will be done .................................................. ...... /.:/. .c. ..... .Te' . . ............................... &.=:. . . ....... House NumberStreet Hamlet / " County Tax Map_No._. -'3'" '""' ' ''"'1000 Section .. 0~.~. Block ...... / ........... Lot .... .~.o...~ .......... Subdivision . . .~i~.~-'_'_~ ~....~.~,{~ ~-q' ' ' ' ' ' ' ' ' 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 ..... k,,/~.~/%. FA..~. .................................................. b. Intended use and occupancy ..... ~)l'~-,.. ['~/~....~54..{~.,,x,~....~--~-~,[k4.~.. k~..} }~[.Cxx .................... Nature of work (check which applicable): Repair .............. Removal ............ Demolition . Estimated Cost ............ 1. ~ .............. Fee If dwelling, number of dwelling units ...... J. .... Number of d' If garage, number of cars .... 1 ....... .c~ ...... iii ............. If business commercial or mixed occupancy, specify nature and extent Dimensions of existing structures, if any: Front ............... Rem New Building ....~. .... A, [dition .......... Alteration .......... .......... Other Work ............... .~. '~7~' ~ (Description) · '<..'<. ¥... ~dW. ..................... (to be paid on filing this application) filing units on each floor ................ ff each type of use ................... Depth Height Number of Stories Dimensions of same structure w~th alterations or additions Front ................ Rear ................. ight J ' He ....... . ....... Number of Stones ................... 9 Size of lot: Front ' Rear Depth 10 fP ' N fF O · Da(co urchase .......... ~ ................... ameo onne~ wner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regular on: ................................ 13. Will lot be regraded ........ i .................... Will excess fill 1,e removed from premises: Yes , No 14. Name of Owner of premises . .l .................. Address ................... Phone No.7.~..g.~. ff~ .--q.'.~.... Name of Architect ' Address Phone No Name of Contractor ......... i .................. Address .................. Phone No ................ PLOT DIAGRAM Locate. clearly and distinctly all buildings, whether existing or propo: d, and~ indicate all set-back dimensions from property lines. Give street and bloc~ number or description according to dee~ and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. , ........ ~ ................... : ..................... being duly si rom, deposes and says that he is the applicant (Name of individual sig0ing contract) above named. He is the ' (Contractor, agent, corporate of ~icer, etc.) of said owner or owners, and is duly authorized to perform or have perfor ned the said work and to make and file this application; that all 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 therev ith. Sworn to before me this : NOTARY PNOLIC State of N~w York .......... [. 7½ .',./..'ri ........................ No, 4707878, Suff01k Co,lin(jo, I 1' ]/' (Signature of applicant) Term Expires btarcir 30, i9JL~ ~J l i--? ,4' Id ~z ~ ~< 0 < 0 U n -r