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Home My WebLink About8993-z FOE~! NO. $ TOWN OF SOUTHOLD Building Dep~ffment Town Clerks Office Southold, H. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled ih typewriter OR ink, and submitted in trlpiicote to the Building Inspector 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 installations, a certificate of Code compliance from the Architect or Engineer responsible for the building, 5. Submit Planning Board opprovo~ 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 property showing oil property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o certificate. C. Fees: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 // Date ......... /~/~.,:?/..~, · ....................... ~ ...~.....~,~.~..~)ld or Pre-existing Building ............................ Vacant Land ............................ Loc~tion ~t ~roperry ........... ~ ..........~ ...... ¢ ................. ~ ............. / ........................................................... ~ner Or ~ners Of Prope~y .9.~./..t~ .... ~; .... .~C.;~.~. ................................... Subdivision ................................................................ Lot No ............. Block No.,. ........... House No..~.~ ~ · Permit Na, ~ .................... ~ ~ D Date O~ Permit .................... ~pplicant Health Dept. Approval ..... ~ ................................ Labor Dept. Approval ........~ ....................................... Underwriters Approval .............................................. Planning Board Approval .........---~ .............................. Request For Temporary Certificate .'---' Final Certificate ..~ ................................ Fee Submitted . ..~ .............................. Construction on above described building and permit rr~e, ts-all applicable codes and regulations. Sworn to before me this '/'or ................ day of ............................................ (stamp or seal} /3 // - .................................... ou.. , ,,, O FORM NO. 5 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION TO .......... ?..o...~, ~'... N. ,q ~.~...~...'g~.,...~./, .~....~..9..b, .~..~.~,....D..~.m a z' e st (owner or authorized agent of owner) ................. ......................... (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a violation of: Zoning Ordinance .... .A..~, .~ .:....~..~...~. ..................... Other Applicable Laws, Ordinances'or Regulations ~ at premises hereinafter described in that .......... .~.~.J:..~..~..~.g....2..e....z~...~..~....~....8.~.~.~ ............................. (state character of violation) d 1 2/3/76 h ,~' ~.e.q.~.~. d ~ ~P. Ply. ~.or. ~ date as e zred. You are e new permit. in violation of Sec. 100-1~1H (State section or paragraph of applicable Iow, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the Iow and to remedy the conditions above mentioned forthwith on or before the ...................... .1..,~.~.. ...................................... day of ............ .D..9..q,e.~.b..e..~ ....................... , 19..~.Q. ,/~The premises to which this ORDER TO REMEDY VIOLATION refers are situated at · ./f::.-"~,..~.~..*....~;~'~....Z~.~.~...~...~..~,./~'~....County of Suffolk, New York. Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law · . / may constitute an offense punishable by fine or imprisonment or both./ · Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............................. .......................... ~'"'"'"'"'"'"'"' ~*t~*~*i'i~l*i*r~'~ Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No .................................. 4~ 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 tot and of buildings on premises, relationship to adjoining premises or public streets oF 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 hove been granted by the Building Inspector. 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, buildings for necessary inspections. (Signat~e of applica~[i"~r 'name, if a ;~';l~oration) ...... (Address of' applicant) State whether applicant is a~ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... z...;.:~ .................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on whigb, proposed work wilLbe dorjG Map N~o.: .... :.~ ................ ~ ................ Lot h~o ....... :, ................. Street and Number ~.9~.'..~....~...-......~.../.~..~.......4~..~.'.~:...:..~...~...~*....~..'~.~ .~.. .............. 4~.-.~.~ ................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy .............. ..~r..:...~ .......................................................................................................... 3 Nature of work (check which applicable): New Building'. ................. Addition ~ Alter ion Repair .................. Removal .................. Demohtmr .................... al er Work .................................................. ~¢/ ~ cr'O (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 ............................ Height ...... .~..~'..../. ......... Number of Stories ........ / ....................................................................................................... Dimensions of same structure with alterations or additions: Front ....... ~...~..../ ................... Rear ...~....~.../. ............ 8. Dimensions of entire new construction: Front ....... / ~...f ..................... Rear .../...~..J. .............. Depth ....?Z..?.../. .......... Height ...,/..~,..f ....... Number of Stories ...... ./. ............................................................................................................. 10. Dote of Purchase ........................................................ N,~e~of Former Owner ........................................................ 11. Zone or u~ d~stnct m which premises ore s~tuated ..... ............................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: .~ ............................................ 13. Will lot be regraded ...... '~.~. ........... Will excess fill be removed from premises: ( ) Yes (,10 No Name of Architect .............................................................. Address ................... ~. ........... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propr;rty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot, %-A'I'~ OF NEW YORK, / c c COUN'i'Y OF ~.~.~..~.~.[~ ............ f'~"' ...................... 7,.~.,~...~......../~'..../J...,~.....~.,,~.,~...//_,<,.. ............................... being duly sworn, deposes and soys that he is the applicoal (Name of individual signing contracf) above named. He is the .......... ~(~ ..................................................................................................................... (Contractor, agent, corporate officer, etc.) o~ s~id owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that oH statements contained in this application ere true to the best of his knowledge ond belieF; tha~ the work will be performed in the manner set fo~h in the application filed therewith. Swam to before me this ...... ~ ........ day of ...... ~.~ ............................ , 19..~..~~ ~ '.~~.~...7.~.,.~ Notary Public,· ................... ~.~¢.4.~. ........... Coun~ .~~..~ ~..'.-. ........................ Notaw Public State of Now York No. 52-7267800 Suffolk County Term Expiros M~rch 30,