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HomeMy WebLinkAbout8901-z FOF, a3i NO. 6 TOWN OF SOUTHOLD , Building Depmtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY insfructlons A. This application must be filled in typewriter OR ink, <3nd submitted in DUPLICATE to the Building inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil 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 end similar buildings end installations, o 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), Nan-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 formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 3 January 1976 New Building .~.~.. .......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... ~s~?`~[~~d~:~`~a~.~}~ ................................. Owner Or Owners Of Property ~.~,~.rL.~....&....,B...e.~.~..~..s..k...a. ....................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No....~..O,~.,©. Permit No. $901Z Date Of Permit ~.0../..7./..,'7..b-..,Applicant Inland Homes, Inc. Health Dept. Approval D..?.~...~).~.~..~.7~.?.,~.~?.~.Labor Dept, Approval ...... ~....e.~ ................................... Underwriters Approval .............................................. Planning Boclrd ApprovolY.e.,.~. ................................... Request For Temporary Certificate no Fino~ Certificate xx Fee Submitted $ .5.....0....O. ........................... Construction on above described building an~~nd regulations. Sworn to before me/t~is App h c' ant ..... I Iii' ~~ "~'~'.' ~ n'~ /~,'-7Z''t~/~/ffT~uTD'~C~ ........... ................ . - ........... Examined Approved ................... ~.! ................. , 'TOWN OF SOUTHOLD EUILDING DEPARTMENT ~-~ TOWN CLERK'S OFFICE Disapproved a/c ............ ~ ................. .:;~.-.~.%=.-.-~x ............... :&:::~-*-.~.-.~ ......... ~.~-~.~.~ .... ;.. ~ .................................................................................. :&' '~/' .......................... ....... f" ..................... APPLICATION FOR BUILDING PIERMIT State whether 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 az areas, and giving a 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 will 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 Department for the issuance of a Building Permit pursuant to the Build ng Zone Ordinance of the Town of Southald, Suffolk County, New York, and other applicable Laws, Ordinances or Regu otions, 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 ragu arians, and to admit authorized inspectors on premises and in buildings for necessary inspections. INLAND HOMSS, INC. (Signature of applicant, or name, if a corporation) ...................... (Address of applicant) applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Con~ractor Eugene Miska Nome of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) (_o-So,- Builder's License No ..................................................... Plumber's License No. $17-P 2148-E Electrician's License No ............................................. Other Trade's License No ............................................... ~ .~'..~. ' 1. Location of land on which proposed work will be done. Mop No.: .................................. Lot No ..................... Street and Number ....... .i'~.a...~.r.~.o..q.~..~..~.e. ~ ..F.i~.!;..j,:~;.v..C.k ............................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Vacent a. Exisiting use and occupancy ................................................................................................................................ 1-Family b. Intended use and occupancy ..................................................................................................... 3. Nature of work (check which applicable): New BuiJd*ng~ ...~..~.. ........... Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... 4. Estimated" $25~000o00 ~ C'-- 0 (Description) (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. Dirnensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with afferations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....G..~. ............................. Rear ....6...~. .................... Dept~.O. ...................... Height 18 Number of Stories 1 9. Size of lot Front .......... .1...6..? ....................................... Rear .............. ,3:..6...9. ..................... Depth ..,2..3.6. ...................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................ ~...o.. ................................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ~ ) No 14. Nome of Owner of premises ..~..~..g..?...~-~.....~..".....~...J:.~..~...~. ............... Address ................................ Phone No ....................... Nome of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor Inl&nd I-lames, Inc .... Box 117, Ma~:titu. ok ............................................................ P, aaress ................................ k'hone No.2. gD..-. 9.(~ 9.~. .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from 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 NEVi. ~6:1k ~ c S COUNTY OF ................................ .~..f~ A/~/,~!j ~ 1~.~. ~ '~ be,rig' duly swo,'n, deposes and soys that he is the applicam (N6n%e 6f indiviaua s~gning contract)- abow~ nQmed. Contractor He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of soJd owner or owners, and is duly au%horized ¢o perform or have performed the said work and to make and file this application; thc[ ~1] s¢cCements contcJmed im this appl[cofion are true to the best of h~s knowledge and beJief; Cha~ the work will be performed Jn Che manner set forth in the application filed therewith. Sworn to before me this ........................ ~ay at ................ ~ ........................... , I ........ ,/ ~fl ~ ) // · 8~%~o1~ Nota~ Pubhc, . ................................................... Coun~ ...~ .................................................. ' x~ (Signature of applicant) Term Expires March 30.