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Home My WebLink About8900-z FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 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 iocation 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 pz*t~perty 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 $15.00 3. Copy of certificate of occupancy $1.00 ."~f"l ,~ 4.Vacant Land C.O. $5.00 .. Date ..... New Building . .~. .......... Old or Pre-existing Building ............ vacant k~and ............ Location of Property ./'.~-~... '~'~l · .~.~.],.L.~'....~). ~..Aq~.. Ab.. ~/~ House No, Street Hamlet Owner or Owners of Property .~'.! [']~....~-,..~..~.0, .~....~ .'M.d./.~ ........................ County Tax Map No. 1000 Section .... ~. ~. ....... Block '~ Lot .... ././'..~, Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.g.~.¢0.C.). ,, Date ofPermit~'.O.~,).~.(~..Applicant ...... ~/,..l.' .T'~... ~',~. ,.~-.~. /,~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... ~..~.0~' ..... O .~.~.. ~ / ..... Con~struction on ab~v<<~clescribed building and permit mee, J~ all/a~p_j~[j~al~c,,od,~s and regui~ions. %~','~-J~,O~!'~'~ O( ?~ Applicant ......... .~.~./.~.../~?/l~.~ .......... Rev. 10-10-78 Memorandum from.., BUILDING INSPECTORS OFFICE TOWN OI: SOUTHOIA) TOWN |JALL, BOX 728, $OUT! fOLD, N.Y. 11971 765-1802 July 10, 1985 Dear Mr, Maggio: I am writing to you regarding your application for a Certificate of Occupancy, You filed for two C.O.'s 1) B.P.9692 4/24/78 this one does not need an Underwriter Certificate because no ad- ditional electric work was done. B.P. #8900 10/6/76 need~an Underwriters certificate as electric work was done. The electricians name was Frank Mineo. Please send us this so we can issue ybur C.O.'s. Thank you. Memorandum from, ·. BUILDING INSPECTORS OFFICE TOWN OF SOUTIfOLD TOWN HALL, BOX 728, SOUTHOLD, N,Y. 11971 765-1802 July 10, 1985 Dear Mr. Maggio: I am writing to'you regarding your application for a Certificate of Occupancy. You filed for two C.O.'s B.P.9692 4/24/78 this one does not an Underwriter Certificate because ditional electric work was done. need 1 ) no ad- 2) B.P. ~;8900 10/6/76 need~an Underwriters certificate as electric work was done. The electricians name was Frank Mineo. Please send us this so we can issue your C.O. 's. Thank you. TOWN OF souTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ................ ........ . ............... : ......... ........ .............. ~~i;;~ .............................. Application Nn APPLICATION FOR BUILDING PERMIT Dote ........ .O...CZ..~.....~ ................ INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate 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 o detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 wiJJ issue 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 Deportment 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 Lows, 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, buildings for necessary inspections. (Signature of app icant, or ~?((~rrle, ~T a corporation) ' trJ .......... ,j ~ , (~dAtresslre.'"g~f al~licant) ~ /~-I Store whether opplicant is ownor, lessee, o~ent, orchitect, en~[ eer, ~ener~l controctor~ electridon, plumber or builder.~ ............. ........... 2;....;;..... ......................... .............................................................. ~,~ o, o~ p ~ ~ .................. ~....~ ................... ~...~......~.~_.~.~2 .............................................................. If ~pplicont is o corporate, sion~ture of duly outhorized officor. (Name and title of corporate officer) Builder's License No. Plumber's License No ................................................. E,ectric,on's L,ce.se No ...... .¥~....:~ Other Trade's License No ............................................... 1. Location of land on which propg,sed ~work wi, Il be, done. Map, No.,;,, ................... ..................... Lot No ...... .~,,~.,: ........... Street and Number ............... ~).~......~...~-~)L.....(...JM~....~..~....~....~..~.....~..%L: .......... / ~unicipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and 3. Nature of work (check which applicable): New Building.. ................. Addition........~... Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 4. Estimated Cost .............. ~.C,)..~....b. ................................ 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 gf cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify_ ~,~na~LLJre and extent of_ r~--eacb type of use ........................... ___ ~ 7. Dimensions of existing structures, if any: Front ......... .J.g...'....'.... .... Rear .......... ,/..Q...~...'.. ......... Depth ..... [.~....~..~.. Height ........................ Number of Stories ........... .f~..,~J.J~, ....................................................................................... Dimensions of same structure with (3iterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................Na~e of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ........ /Z~ .............................................................. ---~, ~ ,~ , ~ --/t--- ,V'~-'~ ..... C' ]2. Does proposed construction violate any zoning law, ordinance or regulation: ..... ...J,4,,~.......~.~... 13. Will lot be regraded ........... .~.....g. .......... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YDRI~- -- COUNTY OF ....... ~..~.~.~..?.1....~. ........ Vito ~ggio ................................................................................................ being duly sworn, deposes omd says (Name of individual signing contract) above named. He is the ............................................................................................ .~ .............. :~ .............................................................. ~ .... , ~..,, ~ate o}~ ~.) of said owner or owners, cnd is du[y 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 tha~ the work will be performed in the manner set fo~h in the application filed therewith. Swam to before me this ...... '.~ ........... day of ............ Notaw Public, ~uffo].k Coun~ /. ~/..?~y .~.....~.,~'~ ' ................................................................... ' ........ ~'2 '~' ~ .......................... * L/ z (Signature of apph~6~t) ~m Expires ~a,ch