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HomeMy WebLinkAbout43722-Z FOtlr Town of Southold 5/24/2019 y P.O.Box 1179 0 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40415 Date: 5/24/2019 THIS CERTIFIES that the building GENERATOR Location of Property: 22495 Route 25, Orient SCTM#: 473889 Sec/Block/Lot: 18.4-14 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/1/2019 pursuant to which Building Permit No. 43722 dated 5/8/2019 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: "AS BUILT"GENERATOR AS APPLIED FOR The certificate is issued to Blesch Jr,Edwin of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43722 05-21-2019 PLUMBERS CERTIFICATION DATED uthorized Signature �pS�FFocK TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE o . SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 43722 Date: 5/8/2019 Permission is hereby granted to: Blesch Jr, Edwin PO BOX 430 Orient, NY 11957 To: legalize "as built" generator installation as applied for. At premises located at: 22495 Route 25, Orient SCTM # 473889 Sec/Block/Lot# 18.-1-14 Pursuant to application dated 5/1/2019 and approved by the Building Inspector. To expire on 11/6/2020. Fees: AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $200.00 ELECTRIC $170.00 CO -RESIDENTIAL $50.00 Total: $420.00 Building Inspector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN FALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and"pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the_reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00- Date. 15.00Date. Lr(��e�ze r> — New Construction: Old or Pre-existing Building: (check one) Location of Property: Z745- �-5 House No. ^ Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Block Lot Subdivision 'y- Filed Map. Lot: Permit No. O Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: ✓ (check one) Fee Submitted: $ r,; EV1( Applicant S gnature pv SOU��®�® Town Hall Annex Telephone(631)765-1802 54375 Main Road a� Fax(631)765-9502 P.O.Box 1179 ®C Southold,NY 11971-0959 ,c® ® �® roger. richertCaD-town.southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Edwin Blesch Address: 22495 Route 25 City: Orient St: New York Zip: 11957 Building Permit#- 43722 Section: 1$ Block: 1 Lot. 14 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor. AS BUILT DBA: License No: SITE DETAILS Office Use Only Residential X Indoor X Basement X Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches Twist Lock Exit Fixtures �j TVSS Other Equipment: "AS BUILT" "ELECTRICAL SURVEY' "NO VISUAL DEFECTS" Notes. "STANDBY GENERATOR"with 8 place transfer switch Inspector Signature: Date: May 21 2019 81-Cert Electrical Compliance Form.xls SOUTyO� * TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION - I FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION' [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: a DATE 1 INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(1ST) O ) -------------------------.....-------- 'FOUNDATION (2ND) N � ROUGH FRAMING& PLUMBING �y q INSULATION PER N.Y,. y STATE ENERGY CODE FINAL ADDITIONAL COMMENTS z m z ' • V ,H TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey South oldtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application �j Flood Permit Examined 20 Single&Separate Truss Identification Form Stone-Water Assessment Form Contact: Approved 20_6 Mail to: Disapproved a/c Phone: Expiration '20 Building nspector' DPLICATIONAPR 3 0 2019 FOR BUILDING PERMIT Date 14 30 , 20_AJ_ 7:5€�"� zi "0 INSTRUCTIONS TOWN®k'sO11J71 o a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 waterways. 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 issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months. Thereafter,a new permit shall be required. 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 inspections. (Signature of applicant or name,ifV corporation) ,�°tl AJx q3 D k r— 0 � (Mailing address of applicant) I( G_�7 State whether applicant isDowner, l`ss�seee,, agent, architect, engineer, general contractor, electrician,plumber or builder Name of owner of premises E—D W!n! �� 'l� L _ESe!� ^� (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: House Number Street // Hamlet County Tax Map No. 1000 Sectiofhu Block, l Lot y Subdivision 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 b. Intended use and occupancy 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed 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:., f� Depth Height Number pf'Sto(ies I S C •- , 8. Dimensions of entire new construction: Front Rear ~' Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO Will excess fill be removed from premises?YES NO 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? *;YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF� 2>1 e ScA,h being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the Ouol(l A (Contractor,Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained 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 b9fore me this , day of 1 20� X , otary PublicNOTARY PUBLIC,STATE OF NEW YORK Signature of Applicant NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2D(9, BUILDING DEPARTMENT- Electrical Inspector X0`9 TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 roger.richert(aD_town.southold.ny.us APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Date: Company Name: Name: License No.: email: Address: j— CJ/t��S ��_ Phone No.: JOB SITE INFORMATION: (Ali Information Required) Name: C ' - Address: � Cross'Street: Phone No.: `�7-S7� Bldg.Permit#: �j� �`� email; �vkC f- ,Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK(Please Print Clearly) Circle all That Apply: Is job ready for inspection?: YE !NO Rough In Final Do you need a Temp Certificate?: YE Issued On Temp Information: (All information required) Service Size 117h 3 Ph Size: A # Meters Old Meter# New Service- Fire Reconnect- Flood Reconnect- Service Reconnected - Underground -Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION a 82-Request for Inspection FormAs F� APP011VED AS NOTED DATE. 5 B.P.# 2 FEE: 09, 19, BY: NOTIFY BUILDING DEPART ENT AT OCCUPANCY OR 765-1802 8 AM TO 4 PM FOR THE USE IS UNLAWFUL INSPECTIONS: l.-FOUNDATION - FOR POURED CONCRETE ETEEUIRED WITHOUT CERTIFIC47- ► 2. ROUGH - FRAMING & PLUMBING OF OCCUPANCY 3. INSULATION 4'. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF ELECTRICAL. NEW YORK STATE & TOWN CODES INSPECTION REQUIRED AS REQUIRED AND CONDITIONS OF @L-8�81�Zp SOUTHOL� O S OLD TOWN SEES f ' / V GENERAC Mr66,L., bc) SIT --57b O w n.e r s. Manual v:;r 2sx.•r^+cap.. ,. -..- ....? 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'f; .'a aif� .:',+r::+ ria`,' x''•J"fit"" .Y'" = i.„.+�,e - ' _ li- J. k - -- _ ��d:-:.�,;'..�IX..x)'�,,•.'i...��c- �F.�-'}�' ,,f�tr..✓ ^«'i'i°"t'f'..:. f, _ -r,i ifz.r,a- '•'?^,»:?r•.. /tie' ye •'t'� � is '.i`' i-€-,�_ -- - - C.i' '7`:Y� �rfi k ..at, - - v;e ?, w�'ar s,.t'=.T'>- 4, .. ='!�_�' 1..-'2' - "'i`•x 'a�• .'t a-r - t• „>`^;:�c, .tiff:::.==:a,%'�M :2. ?br - rr. - 'J "J manual 1 1 remain with.the unit. 12/19/13 Generac Power Sy terry-Product Activation GENERAC English I Espanol Investors About Us News&Events Service Careers Contact Us Date: 12/1912013 INSTALLER OWNER Purchase date: 1 210 912 01 3 Name: Timothy P Smulian Address: PO Box 430 Orient NY 11957-0430 USA Phone: (631)3233858 E-mail: tsmulian@optimum.net GENERATOR SITE ADDRESS Serial Number 8544785 Address: 45 Youngs Rd Model Number. 0058370 Orient NY 11 957-1 02 6 USA Description: 71<W LV432 GEN+8C 50ATISW Thank you for registering your product By registering,you can now stay up to date with production information and enjoy quick and easywarrantyservice. NYSE-GNRC$54 44 12119,12013 11 21 am EST QUICK LINKS PRO( (0 2013 Generac Pow er Systems me All ngnts reserved Find a Dealer Builder Sitemp Activate your product Pow er Privacy Register your product Becorr Terns 8 Conditions Mobile Link GEWc RV Generators GENSL R omotional store Dealer Government Suppliers Y 3 FOLLOW US ON: -it mm.gerterac.corWProductActivatiorVActivate! 112 12/7/13 The Home Depot-Order Confirmation GET IT,IN TIME F04 OVER. I I 11 ! PROSite Tool&Truck Rental Installation Services and Repair 1 GiftCards ' Help Cart Your Store: Lima dolr4 Riverhead#1222(Change) Store Finder �' Local Ad Credit Center Savings Center Shop By HelloTimothyP, Department Search All What can the help you find? Vn Project:How-To Your Account Chat with Thank You for Your Order Customer Service ;1 sEcuREo f p—fA;6 try Y¢rl$Ign Thank you for shopping with homedepotcom.You will,receive an email confirmation shortly. You can check the status of your order byvisiting the Order'Status page.If you have anyquestions about your order,call Online Customer Care at 1-800-430-3376. Order Summary W244959490 Billing&Payment Details Quick Links Merchandise Subtotal $1,a31.00 Timothy P Smulian Print This Page Shipping FREE PO Box430 Rebate Center 4 Sales Tax $160.51 ORIENT,NY 11957 Order Status 1 item(s) Total $2,021.51 Visa*'*"'*-*—5407$2,021.51 Continue Shopping 'Ship to Home Timothy PSnuhan Estimated Arrive]: 45 Youngs Road DEC 16-DEC 20 SIT,W 11957, (631)323-3858 Item Description Unit Price Qty Item Total 7,000-Watt Automatic Standby Generator with 50-Amp Transfer Switch $1,861.00 1 $1,361.00 Model#5837 Store SKU#1000021553 Intemet/Catalog SKU 202214401 -- - -- - - - --- - -- -- ------ ....... _V 9 ¢- Discounts&Coupons _ Free Shipping on Most Orders over$45(see details) 9gZ Free Shipping on Most Orders over$45(see details) Questions?We can help. /��M 4c Zs3e S bt°tal $1,a61.e0 Shipping FREE See our online FAQs or phone us: Sales Tax $16051 Online Customer Support: 1-800-430-3376 ! / tai $2,021.51 Mayor Appliances: 1-800-455-3869 Call 7 days a ek-6 a m.to 2 .m T 2 . Credit Center ' Get It I stalled Moving Services Tool&Truck Rental Mobile Apps Kcqancing Avaitabte The hbme Depot tome Fuld everything you need for The Home Depot offers afford- Ntore saving.Nbre dong On the corJvwebappM�slstores/s vlet1OrderO�eW7largW-%catalogW100538,storeld=10051&kWo=LSDDnLAHgOF7BbHNITtrnyC6... 1/2 12/5/2013 Generac 7,000-Watt Automate Standby Generator with 50-Amp Transfer Switch-5837 at The Home Depot Fill Hill 1 11 111 PRO Site 4 Tool&Truck Rental Installation Services and Repair Gift Cards Help More savin Your Store, h Moredoln7 Riverhead 41222(ci,ange) Generac 7,0004MAL&mitic Standby Generator with 50 TransferSm&h • •'� �,.. 'lA �',i..�ry �.r✓�` Model#5837 Internet#202214401 Store SO SKU#1000010550 ^k $1, 1. �.tj L*o> VV ".\�h•.-^�("^.=fN{�Y IA'f�, R"�zry#«��•4"�JIf' 00 f Qa � t, , `,yam t•': AW,. Wit'„t',°=!"i': �,R: f$„;T� 1N G':=r;��i, of 'r"�.ti`}•.'+,�'- ., .�•'Y,�,,,,• ,g,.'„ :5�.� �;i.¢�I�try:.. ^ � .. , `S < .. i. Free Shipping Buy Online,Ship to Store PRODUCT OVERVIEW --- - . Run this Generec Core Power 7,000-Watt Home Standby Generator i onei.hernatural gas orliquid propane for versatile fueling options. Info & Guides This generator offers a di9dal controller with LED status lights and fault indicators for easy monitoring of the operational status.The Included composite mounting pad eliminates the need to pour a Energy Guide concrete bass for installation convenience Comes with Generator. Installation Guide 50ATransfer SVdtch,and Load Center to Back Up 8 Circuits. Specification • Want to learn about Standby generators and find the right one ! for you?Click here for our generator selector tool Use and Care Manual • 432 cc Generac OHV engine runs on liquid propane or natural gas Warranty • Includes a 50-amp transfer switch and load center with 8 circuit breakersYou will need Adobe@ AcrobatO Reader to view t - - - - -- ---- --- - -- - ----- - • Digital controller with LED status and fault in makes it PDF documents.Download a free copy from the 1 easy to monitor generator status Adobe Web site. • External LED status indicator lights for quick check of system status • Programmable weekly self-test cycle helps keep the generator in top running condition • External breaker connection to allow fire marshal access • Lightweight and compact design accommodates placement in tight spaces • Easy-to-remove sides allow accessibility without tools for installation and ongoing maintenance • Included composite mounting pad eliminates the need to pour a concrete base • All-weather composite enclosure withstands harsh r environments including coastal areas • All-weather composite enclosure withstands harsh v environments including coastal areas 7tI I r • 7,000-watt running power Click on • Click on the"More Info”tab to download the specifications PDF to view the refer a fiend rebate for the$50 savings • MFG Model#:5837 • MFG Part#:5837 SPECIFICATIONS Assembled Depth(in.) 30.22 in Assembled Height(m.) 32,95 in Assembled Width(in.) 24,35 in Certifications and Listings 1-UL Listed,CSA Lasted Color Farnily Beige Color Family Beige/Cream http://v,mwhomedepot.conVp/Generac-7-000-Watt-Automatic-Standby Generator-vwtl-F50-Amp-Transfer-Switch-5837/202214401#.UgC)S[tDsrU 1/2 -124 ST New York State and Local Sales and Use Tax Cerfificate of Capital Improvement After this cert!ftcate is completed and signed bv bol;t the customer and the contractor performing the capilai ,improvement. it must be kept by the contractor. Read this form completely before making any entries. This certificate may not be used to purchase building materials. isime of customer'1p,,;,i;+r';`:?E') i $;tat of COrltfaCtOf'i'rtnt J%it)('% x . CdJ7v�� ���J L L—��-->`P_ - �` L, -------- ----��-G-,�. �.,1'-j �� �-- C•-C� �__-i�:-- k� �..` �t� � St ect add css Street aac%Tess �^ ZIPCoae ' Certificate of Authority numt;er{if any, C_eriifica to of Authcrity nt�mL ei (!f Eine/) To be completed by the customer: Describe capital improvement to be perfoi rned: - -�d�----�JET%_ �1`Tt� R�li�-?/�•_ �"i�,I��IJ.C�� ���'���09� .----- - -----itis--�------------------------1`� ��®�Q� ------- -------`---�:i1_fcj/--��-- �--.. . P:olcct nail;e Strclet add'-3Ss tviherc`;tt :','oEk vS to min performcd City--i State - - ZIP co%le State 1 certify that --i aIn the %- liner, tenant r,f tha regi prr?l�Prty,dvnitfl d Crl ibis ioi"rr; and —The,work described above w;ll 'esuit in a capital irnoro-ernent tc the real property'within ifle gu;cetines of this foitn,and This contract fcilcrr one; in^fudes, _ does not include the sale of tangible personal property that,when installed. letair.s .ts identl;v as tangible personal property anrj dogs i%at b+c,:Grne a permanent puri of the ie-al propertV I ui derstand that- I will be iesponsible for any sales tax.i,3terest anc;pepaity di,e cjri tike contiactoi's total charge t;,r tz:ngible peisonai luoperhr and int labor it it is determine(I that th's work Closes:ioi qualify as a capitol improvement,and -l vlill be ioquited to pay the contractor the appropriate Sides tax on fan ible. personal property(and any associated seivtces) transferrk:1 to Pie :',UISUani to this contiac'. .,.Jl.3 n the property installed by the contractor floes not become a permanent part of he teal property,and -- I will be lit jr'Lt tc ci.'-) .it criminal peraltie-i for t,othi widet in:- fax t_c W if I nsue a false of trc+-',1 Uh-ni certit`,cate. To be completed by the contractor: 1. t+.e conlra,tor,certify that I have entered into a conliaci to peffcrm the work described by the CUStOMer nc'arned above ,A copy of the taller c:ontrac, if any is wtacnccd.) ! u,l i istan +ha" m fathart� i�colic.., iay as a r,_,:alt o` acce 7t;n art improperly er c .)' l y _ ;rrpr-pet, sxirztl;(, rt: Ittf,r•=tic- ^.Ill make me pr_1s%;naliy I%[;tilt-for the tax otherrdise due, plus penalties and i;iteres.t. i^aturi o:;;S?r:it_iGt,.. Cr o'fl`.-e,' -)til^ - Date � t This certificate is not valid unless all entries are coveted. Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ' 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This,application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Swom statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead_ 5. Commercial building, industrial building,multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. ' B. For existing buildings (prior to April 9, 1957) non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property,lines, streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied;the Building Inspector shall state the reasons therefor in writing to the.app'licant. C. Fees 1_ Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: �S ��U��5 ©ffl <j7- P rtY� House No. Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applicant S gnature