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HomeMy WebLinkAbout13882-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-° 13882 7_. Permission is hereby granted to: ....... ~.z<... Z?.z...~~/.~. .............. ...... k.~.~.~...J...~. ..... /Z...~ to ................. ~; ................ ~... ................. ot premises located at ...~../'.~..~........~...~_~.~..~/~..~../~........~.~.....~,~..~r.~..~C~ County Tax Map No. 1000 Section ..~.0~..~.. ......... Block ...Q~.. .........Lot No..~../..~.. ........... pursuant to application dated ......................................................... 19 ......... and approved by the Building Inspector. Fee $ ....................... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building 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: 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 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. 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 ~..~..~-. ~...Z~.. 2. ~ .~.~;... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Locat,on of Property.2..~ .... ~?~;........ ~L./ ............ ,.. ~ .... ~ ................. House No. / Stree~_ Hamlet Owner or Owner~ of Property .¥.~'~-~¢..~...~. ~.~ ~.~-/.~.· .~... :~ '~.. ~...-~././.~..~.~../.~:~.'~ ............ County Tax Map No. 1000 Section .~?..~.'7~-;-.f. ~.. Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. .?~ Date of Permit pplicant t.. /. . ~ ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval~0~.~'...~ '/~' ~.~.~..~. .... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... .~-/~/ .............. Fee Submitted $ ..... ',:. ...................... Construction on above described building and permit meets all appli~caJ~i;e codes and regulations. Applicant . . ? ..................... Rev, 10-10.7e )00s THE NEW YORK BOARD OF FIRE UNDERWRITERS I~UREAU OF ELECTRICITY "~ SS JOHN STREET. NEW YORK NEW YORK 10038 N 778480 o~ the electrical equipmen~ ~ ~scribed be~w a~ int~uced by t~applica~ ~e~.on theatre a~pli~t~n number in the prem~es of ,J~ DiGio~io, Pe~nic ~ ~ulev~, Birch ~ ia the fol~owlng Iocat~on~ ~ B~e~ent ~ I,~t FI, ~ 2nd FI. Section Bilk Lot ~se~umlnedo~ ~ ~ 1~ and~oundtobe ncomplanceu'iththerequlre.~entsQfthisBoard. FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST EANS FIXTURE OUTLETS SW~TCHES FLUORESCENT ~ 9 5 5 DRYRRS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO, OF FEET DIMMERS SERVICE DISCONNECT S E R V I C OTHER APPARATUS: NO, OF NEUTRALS OF NEUTRAL J~ck DiGiorgio 15 Howes Street Hunting~on Station, N.Y. 11746 GENERAL MANAGER This certificate must notbe altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUlL.DING DEPARTMENT. THIS COPY OF CERT F CATE MUST J'IOT BE~ALTERED N ANY MANNER. 'IELD INSPECTIONs_ COMMENTS FOUNDATION (~st) (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE ADDITIONAL COMMENTS: 7GS.IS02 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: ~) '~ FINAL ,,INSPECTOR 7GS-180~ ~BUILDING DEPT, INSPECTION~ FOUNDATION XST~ [ ] ROUGH PLBG. FOUNDATION 2ND ~] INSULATION FRAMING [ '1 FINAL REMARKS: ©/~ DATE INSPECTOR 765-1802 BUILDING DEPT. rlNSPECTION [ ] FOUNDATION IST [ ] ROUGH *PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [/~//FRAMING [ ] FINAL REMARKS: DATE NORM NO. 3 TOWN OF SOUTItOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Subdivision .................~ Filed Map No ..... · ............................ . .~~.N.o~ is returned hel~with and disapproved on the following grounds .... ', ,~ gu~ng Inspector RV 1/80 ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-18011 ~amined ~i~f~.../.~., 19~..~-- pprove f ../. 7..., Pe it? APPLICATION FOR BUI LDING PERM IT BLDG. DEPT, Received ........... ,19... \ INSTRUCTIONS [ a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 se~s 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 o~areas, and giving a detailed description of. layout of property must be drawn on the diagram which is part of this appli- 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 until a Certificate of Occupancy all 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 filding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ,'gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. te applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations, and to mit authorized inspectors on premises and in building for necessar~inspectio~./) .~ . . " - . · //(Signature of applicant, &"name, if a corporation) (Mailing address of applicant) [te whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,, plumber or builder. role of owner of premises 't~,~.~. 74.~... J~.U fi. {~:... ~. J.. ~. ~ ~ ~.~./ .............................. (as on the tax roll orZatest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... .,~'~.~.F?. ............ Plumber's LicenseNo ......................... Electrician'sLicenseNo.~.~.../~..~.~.~4~'~ Other Trade's License No ................... '. · · Location of land on which proposed work will be done .................................................. .o.'7/. ~...o~ .... ~.~.,.& .G,~7. .~./.. d......-..-....~.~?.,~/ .................................. _... House Number Street , Hamle. t County Tax Map No. 1000 Section . .~.."-. ~ .... 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 .......... ~. ~. ~--'. ~ ."~. .... ~t~..7~.t.. O... ~..~0 .~.4~. '~. ~-. .................. b. Intended use and occupancy ......... ': . · .l: Q. ' .. . :~,... ./.AZ.5..~ .............. :Y. Iq~ture ofv~)~ri~ (check!~yi~ch apphcable): New Building .......... Addition .......... Alteration ........ ~..... Rep~r~ [[.~ .......... ~ Rem?al .............. Demolition .............. Other Work ............... (Description) /to be paid on filing thi? application) 5. If dwelling, number of dwelling pnits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... I ................................................................... 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i' · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height . .............. Number of Stories ........................................................ Sizeoflot: Front .... ;.~.q.~.~.,,~., .,~ .... Rear ....... l.O. 9.(. . Depth ./. ?. ?~ ~. .......... Date of Purchase, ~[~..~.. I. 7,..J. [? .~. :7. .......... Name of Former Owner ....~.o..,~...,:~..~. ~ .'~'. .......... Zone or use district in which pr~mises are situated ....... Does proposed construction violat~ any zoning law, ordinance or regulation: ..... .,,~....~. .................... Will lot be regraded ....... ~ ~.(~. ............. Will excess fill be removed from premises' Yes ,..No Name of Owner of premises ~3,). ! .(_¢/.0 [2.f I.i?..~.~..:. Address/.d~'~.o.t .~a~. s5.'~, .,~2~:~.,Phone No.' .4~ .'~4',-~0. .-J .... Name of Architect .. /- '; ,~ ...... ~ ........ Name of Contractor. ~ ~t.~.l. i~ ............... Address ~:-~.~>?..~.,-~..~(,~?.~. ~.~. Phone No.4.2:.~...'~,.?.d. ~ ! ~'~ 'fi' ! ~ . Address ................ .... Phone No ........ :. ....... PLOT DIAGRAM 10. 11. 12. 13. 14. Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF 'NEW YORK, !S.S COUNTY OF ................. I ' being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...................... : ................................................ . .................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is cluly authorized to perform or have performed the said work and to make and file this application l that all statements cont~dned 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 .................. day o ............... ~ ~ ~' .~..~...County Notary Public, . ............... NOTARY PUBLI ;, ,)taie of ~ew Y0r~ .../,,,;~ JF .... ~. % ~.~ ........... i ~ No. 4707818,Marcl~Suiiotk ~'erm Expires '!