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Home My WebLink About9818-z FOR~Y~ NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and 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 all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(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 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: ]. 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New BLlilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........................................ /~. ...................... ~ ....... ~,...~.:.~... ............................... p ............................................................... Owner Or Owners Of Prope.y .....~...~. ............... : ........... ./....~:. ............ Subdivision .~. '.J'~ I, ?...i~.. ~/ ~ ~. ~ ,.~:~..~1~. Lot No .... ..~,.. ................................................................ Btj~E No...~...?. Z .~. House No....?...~...~. Permit No. ~iY Z Date Of Permit ..7../~'/?...~....Applicant' '-- , .~...~..~..~....~./..~.~.~.., Health Dept. Approval ...~,.:.~,.P..~..?..-.~... .............. Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building_cLn_ql.permit meets all applicable codes and regulations, I;I1ENBltl/Ill ltOM Applicant/~"~ .........../~/~..j.~q' .............. ~ ~Z~.~' ................. ~l_~ ............................................ ................ day of ............................................ (stamp or seal) Notary Pub,c .................................... Coun TOWN OF SOUTHDLD I-IFF~OE rlF PlUILDING ~NSPEOTI:]~ TnWN I~-LERK'~ I-IFFIrtE SOUTHnLD, N. Y. TEL. TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Ye .................. .... ........... Approved ................ · .~../~.....~....., IgZ..~.. Perm,t No...?....~...(..~.....~.::.~. ........ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............ ~.~..... ...................... , ] 9..' .~..?..... 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 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 o 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 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 ~'~f~[t~,~l~ ........ ~' ' (Signature of applicant, or home, ira corporation) .... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................. If applicanl////is a corporate. ~6na~ure~,~// of du~authorized officer. ....... (Nome and title of corporate~fficer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No. 1. Otherkocotion ofTrade's License NO.c.~:~~.~../N.: ............................................... ~/~-'~ Lot No ~ ~dm~; w.h..i ' . .: ................................................................. Street and r ....~.....~.. Municipality 2. State existing use and occupancy of premises and intended use~pancy of proposed construction: o. Ex s tng use and occupancy ............ .~.~,,~/./~,.~..,~....~ .............................................................. b. Intended use and occupancy 6~'~ 4/~ ~'/'~ ~' . .~...~...(..~... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ , .... ~q" ~'~ (Description) Estimoted Cost ............................................................ . ................................ ,- ..................................................... (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 ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. DimensieJ~s of entire new construction: Front ......... .~..,.,.~T.,, ................ Rear .......~....~;T... .............. Depth ,.~3 y 3~ Height .................... Number of Stories ~)fd~ ..................................................................................... 9. Size of lot: Front. ......... ~.../...~..~...'~...~.. ....... iiiiiiiiiiiiii'.iiiii ~eo; iiiii.....i'.~.'.'...~...,....~..~i ............ ;2pth ..~.....~...~.......~....~...~. 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: ...... ,,,~,,,,~,, .......................................... 13. Will lot be regraded' . ........ .~....~. ........... Will excess fill be removed from premises: ( ) Yes ()~') No 14. Name of Owner of premises ....~...~..?,.....,~.#..~..~:,./......~..~..~..,~...~..'"" Address .~..,/~...~.:.~...~.../.?,...../~.'.~.", Phone No...~.....~..Z./...~.....G. Name of Architect .............................................................. Address ................ "'1 ............ Phone No ....................... Name of Contractor ..GI]£[~I~I~.,i{0M[~..I~, ................ AddressZ~.~..~..~....~.L.,~..~.~..,..~, Phone No.~..,~...Z../...~.....~. PLOT DIAGRAM Locate clearly and distinctly oil buildings, whetk;er,,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 nterior or corner lot. STATE OF NEW YORK, COUNTY OF ...... ~ .~'. · .~..~.~.~. ·, ./~.. ........ ~~: ~r,,.~.~.~....~ .............................. being duly sworn, deposes add says that he is the applicam (Name of individual signing contract) above named. He is the ....... .~~.~ .......................................................................................................................................... (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 contaim~ in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the appllcatipn filed therewith. Sworn to before me this / .... ~ ................. day of ............................................ , 19 ........ .......................... ............................ ~0~ TITLE NO 0792577 ADDRESS TEL .: · -'MONUMENT FOUND O= PIPE FOUND SUBDIVISION MAP FILED IN THE OFFIC~ OF THE CLERK OF SUFFOLK COUNTY ON DE~ 27~ 1966AS~APNO 4??0 D,~STAKE PLACED "R'THE LOCATION OJ= WELL (W),$EI~rlc TANK(ST)IBDE~SPOOLS [CP)SNOWN HEREON ARE FROM FIELD OBSERVATIONS AN D OR DATA OBTAINED F ROM OTHE RS, SURVEY FOR UOHAI KRI£G ~ ELLEN KRIEG LOT NO. 9, "SMITHFIELD PARK " AI SOUTHOLD TOWN OV SOUTHOLD SUFFOLK COUNTY, NEW YORK ~UNAUTHORIZED ALTERAT'JON OR ADDtTtON TO THIS SURVEY iS A VIOLATION OF SECTION 7209 OF THE NEW'YORK ~TATE EDUCATION LAW ~' COPIES OF THIS SURVEY NOT REARING THE LAND SURVEYOR'S iNKED SEAL OR EMBOSSED SEAL SHALL NOT RE CONSIDERED TO REA VALID TRUE DOPY ~GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY iS PREPARED, AND ON HiS ~IEHALF TO THE TITLE COMPANY, GOVERN- MENTAL AGENCYAND LENDING INSTITUTION LISTED HEREON,AND:TO THE ASSIGNEES OF THE LENDING INSTITUTION. GUARANTEES' ARE NOT TRANSFERABLE TO ADDITIONAL iNSTITUTIONS OR SUBSEQUENT OWNERS, ~DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURE~ ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO RE USED TO ESTABLISH PROPERTY LINES OR FOR THE ERECTION OF FENCES OCT /~/ 1978 dUNE 22, 1978 DA~E , JU/VE 9,/978 SCALE: /"--40' NO. 78 -324 ? CO YOUNG e, YOUNG ALDEN W. YOUNG,PROFESSIONAL ENGINEER AND ~AND SURVEYOR NXCS. LICENSE N0.12845 HOWARD W. YOUNG, LAND SURVEYOR N.~S. LICENSE NO, 4589.3 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK EXCAVATION INSPECTION REQUIRED COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY OTHER THAN THOSE SHOWN HEREON. WILL CONFORM TOTHESTANDARDgOFTHE SUFFOLK COUNTYDEP~TMENT POUND SUBDIVISION MAP ~ILED IN THE OFFIC~ OF THE CLERK OF ~FFOL~ COUNTY ON DE~ 2~ 19G6 ASMAP NO ~ =S~AK~ PLAC~D SURVEY FOR JOHN Ht~EIG ~ ELLEN I<REIG LOT IVO. 9, "SMITHFIE.LD PAt~t( " AT SOUTNOLD , TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK ~UNAUTHORfZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF, SECTION 7209 OF THE NEW'fORK STATE EDUCAT](~NLAW, ~COPJES OF THIS SURVEY NOT BEARING THE LAND SURVEYOR*S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE'A VALID TRUE COPY ~GUARANTEES INDICATED ~EREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, ANO ON HIS BEHALF TO TNI~ TITLE COMPANY, GOVERN- MENTAL AG~[NCYAND LENDING INSTITUTION LISTED HEREON,AN[~ TO THE ASSlSNEES OF THE LENDING YOUNG a YOUNG ALDEN W. YOUNG, PROFESSIONAL ENGINEER AND I~AND SURVEYOR N.Y~S. LICENSE NO 12845 HOWARD W. YOUNG, LAND SURVEYOR N.Y.S. LICENSE N0.45895 .( DATE SCALE: .' NO JUNE' 9, 1~7~ 1'~ 40' 78 -32~ \"ko 400 OSTRANDER AVENUE RIVERHEAD ~ NEW YORK