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Home My WebLink About13881-z FOIL~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT CrHIS PEP-J~IT MUST BE KEPT ON THE PREMISES UNTIL FULL CGMPLETION OF THE WORK AUTHORIZED) 13881 .. ' .......... /.? ............ , ,,...~..~ Permission is hereby granted to: ....'.~..~..s:....~.......~.....: .................. ~..~.t..o. ..~.~ ~,~-~ ~'~, ot premises located at .............. ~ ...... i .............................. ~ ...... ...~....~.. .......................... County Tax Map No 1000 Secton .~...~. ~ Bock ....................................... Lot No....L~. ............... ..... · ~-~.....~..~. ...................... , 19~...~.~., and approved by the pursuant to application dated Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~ ~-~ _'~1', u% 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: 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. Approva~ 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~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. 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. :V.(,.L~ J.,.. '1' .'i[0-.~ ..... ,/ , New Building ............. Old or Pre-existing Building Vacant Land ............. ' ,L Location of Property , ~ ................... House No, Street () \ ~, Ham/et Owner or Owners of Property . .(~.~.~.,.~C..c~....C.~Q.~....~_._.c'~...'~( .~.q.,.;.~..~....~.,. '~t ........... County Tax Map No. 1000 Section ...(~.('.[..~ ....... Block ... ~ .......... Lot ~ g' ~ Subdivision ................................. Filed MaP No ........... Lot No .............. ' Permit No..[~..~.l..~. Date of Permit ... 4.Applicant . .~.'.~.h~'). Health Dept. Approval / Labor De reval ................. ......................... pt. App ....... Underwriters Approval ........................ Planning Board Approval .......... · ............ Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ....... .~-..~. ................. Construction on above described building and pe,~mit meets all applicable codes and regu latio~s. Rev. 10-10-78 al.o? .too~to?,t THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY , ]' 85 JOHN STREET, NEW YORK, NEW YORK 10038 .3,- .. 8 .~" ~pplic.tionNo. o. file v.,s caav,~,as v.~. N 727772 only the electrical equi~men~as des~r~d below an~ introduced ~y the applicant ~m~ on the ab~ agplication number in the premises of R%t¢l~ara Rea..~J.y~ ~nalan Neo~ ~ane(~er~ani gob), ~econic,~ w~examinedon~(~ ],~,98~ andfoundtobelncompliancewlththerequirementsofthisBoard, FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES INCANDESCE~ FLUORESCENT MEKCORY AMT. VA~R K. W AMT. K W. AMT. K W. ~T. K. W AMT. H.P. 22 41 24 22 1 10.4 1 u~ FURNACE MOTORS FUTURE APPLIANCE FEEDER: SPECIALREC'P? TIMECLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS 3 F [ 30 SERVICE DISCONNECT: ND. OF S E R V I C E i 100 cb X 1 4 1 4 ~.F.C.I.- 1 Smoke Detecto~~- 1 G ~ S Electric BOX 215 SoUthold ~ N,Y., 11971 GENERAL ~his certificate must not be ohered n any moaners, return to the office of the Board ff incorrect. Inspectors may be identified by their crede~tiol~ HENRY J. SMITH & SON, PLUI~B~NG, HEATtNG& FUEL O~L MAIN ROAD 80UTHOLD, N,Y, 11971 (516) 765--3690 Inc. CERTIFICATION D a t e _.J..~ z~:~ ~ my_ _6.~._19..~ 6 _ Building Permit No._~lZ ....... Owner_~_~_~Z~_~l~Z~_~R~_NY 11958 Plumber Henri. J. Smith & I certify that system contains less than the solder used in the water supply 2/10 of 1~ lead. Sworn to before me this 6th day of __~__, Notary Public, Suffolk County State of New York, Commission Expires March 30, 1986 COMMENTS FOUNDATION FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: BUILDING DEPT. INSP~ECTiON ~ FOUNDATION'S, ST ~[ ] ROUGH PLBG.' FOUNDATION~ 2ND '~' INSULATION, FRAMING [ ].~ · "FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y, 11971 TEL.: 765-1802 ~..~ .~.., 19~.'.~. Permit No. [ .~.~...~] ..~.. kpproved )isapproved a/c ..................................... .............................. APPLICATION FOR'BUiLDING PERMIT INSTRUCTIONS Received ........... ,19... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ts of plans, accurate plot plan to scale. Fee according to schedule; b. Plot plan showing location of lot and of buildings on premises, relationship td adjoining premises or public streets · areas, and giving a detailed description of layout of property mast be drown on the diagram which is part of this appli- tion. 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 all 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 un*il a Certificate of Occupancy tall 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 ailding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Imeoulationsfor the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~ applicaht agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to it authorized inspectors on premises and in building for necessary inspections. · ........ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) :ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................................................. [me of owner of premises . ~:~.,~/=l. ~'..~.. ~.~,~.J~.... ~a~ ..~....~.. ................................. (as on the tax roll or late~t deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corpo?ate officer) Builder's License No /~./~. Plumber's'License No. Electrician's License No ~.. ~.~. Other Trade's LiCense No..~.d~/~l ............... Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ............ Block . ~'-' ' Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use 5~'~d occupancy of premises and intended use and occupancy of pr0posed construction: a. Existing use and occupancy ...... /~I~7~. 7 ....................... ............................ b. Intended use and occupancy ..... C}A/I~' .... ..... . . · ~ . .,.. .......................... N ofw rk( k h' happl' ble) N Building . ,Additi Alteratio 3. ature o chec w lC ica : ew ... on , ...... n .. ........ Repair ~ Removal Demolition Other Work ', ', ' ' (Description) 4. Estimaied Cost .. ~4~ID.~ ........................... Fee ...................................... ' *' (t ' ' ' gth' ppi' ' ) · o be paid on fihn is a lcation ii. If dwelling, number of dwelling units ].[. ............ Numberofdweliingnni!soneachfloor ................ If garage, number of cars ~ ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... ? Dimensions of existing structures if any' Front Rear ~ Depth Height ; Number of Stories.. ..... ' Dimensions of same structure with alterations or additions: Front ' Rear Depth ...................... Height .; .................... Number o4 Stories ............... ~ ..... 8. Dtmanslons of elthre new construction. Front ...... ..~. ....... Rear . .~lt'~...,... Depth ... 2, (~. Height . .. ~.~ .~. ..... Number of Stories; ...... /. ~..~'. 9. Size of lot: Front ...... l~O.~. .......... Rear ...... /.I$! ............ iDepth . .~.~..~.. .............. !0 Date of Purchase ' Name of Former Owner ,1. Zone or use district in which premises are situated .............. ~.. '.. i ........ 2. Does proposed construction violate any ~onin law ordinance or regulation' .. '. ! .~..o ............... 3. Will lot be regraded ....... ~.~9 .................. Will excess fill beromov~d from premises: Yes ~'~ No 4. Name of Owner of premises ~.~.~.~..~..,~t~/~..~/~'. Address Z~' ~,~'~r~,~,.~.. Phone No. ~2, .--.~.~.~.... Name of Architect ......................... ' .. Address .~..~gO ~'~'~/~./i~ese'~hono No ................ Name of Contractor .~'~te ~'~. ~,s~...~-~1:.. Address . ~t.s,.~,~,~. ~i .... Phone No. ~.~ ~..'~.,~'~.'~'.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, i~idicate all set-back dimensions from ,roperty lines. Give street and block ~number or description according to deed,_~'35L~i10~w_ stre~na~e~s and indicat~ whether aterior or corner lot. . , - ~ '.~-*~-~/~ ./~.~ ...... $1 t rATE OF NEW YORK, OUNTY OF .... ,~o.h,.F..~. ,~.t~' . S.S · ................... (Name of individual signing contract) ~ove named. (Signature of applicant) otary Public~2.). ..... ~,~,fi:. t?O.~.. County ~ ..... UNDA J, COOER NOT~Y ~U~ ~ New Y~k ~ NO, ~22~ .......... ~ou~, ~ Term Expires Me~h 30, 19~~ ' r \ (Contractor, agent, corporate officer, etd.)' ' said owner or owners, and is dUlY authorized t6~: perform or h~ive performed thel said work and to make and file this ~plication; that all statements contained in this application am true to the best of tlis knowledge and belief; and that the ork will be i~erformed in the manner set forth in the application fil~d therewith. ~orn to before me.this ....... be. ing duly sworn, de ~oses and says that he is the applicant N.,,I RO~D~:RICI~ VAN TU~?~, P.C. LICENSED LAND SURVEY'oRs GREENPORT NEW YORK H.S. NO, _ STATEMENT Of INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO SUFFOLK CO. THE .K SER~VICES -- FOR CONSTRUCTION ONLY DATE: H. S. REF. NO., APPROVED: STANDARDS OF THE OF' HEALTH SERVICES. · ,~.RTANI Ionial Road DEPT. OF HEALTH APPROVAL OF CO. TAX MAP DESIGNATION: DIST, SECT. BLOCK PCL. OWNERS ADDRESS: TEST HOLE J STAMP 1 SEAL