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Home My WebLink About11563-z TOWN OF BUILDING DEPARTMENT, TOWN HALL SOUTHOLD; N. Y, · BUILDING P,ERMI$! (THIS PERMIT MUST BE KEPT ON'THE PREMIS] S UNTIL FbLL' COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: g- .2 ,~ J , '")'- ! · .... :~ .......... y. ................. C: 'y '""~;~""'~ ") ............ ',/ . ~ ~,....?.. ................ ~~../...C.....~/..q_:.~.~.~ ........... ~ ........................ ~T'_Z"LiL~ LL..~. z.~'~ ~ .,~! ~.:.. i!.: ........... ................. '" · '"': ................................................ ~ .......... "",~"':"'":i .......... '~: ...... " ...... ? ....... ~' ' CountY TaX Mop No. 1000 Section ......... ?...~(~'...,.... Block .~....~..;.:~.,.....~.iL_ot No ........................ purs0ant tb application dated .~...~..... ........ .'.~..;,.. .......... ~...,i?-, 19"'"r,; and ~pproved by the eu!ldlng I~pector. Fee ? ........ ~ ............... Rev. 6/30/80 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 in duplicate to the Building Inspec- tor 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 featu res. 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 Enqineer 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 peoperty 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.tionDaterequired°f any housingto prepareC°de~ certificate.°r safety inspection of buildings or premises, or ot~er pertinent informa- 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 Date .. New Building ............. Old or Pre-existing Building(X) . ~X~ .... ~/Vacant Land Location of Property 0 t b--.o ~, House No. Street .................. Owner or Owners of Property - County Tax Map No. 1000 Section . O, Block Lot Subdivision .................................. Filed Map No ........... Lot No ............... Permit No.~. ~Dato of Permit )lJ~[*.~ .Appllcant .~ ............. Health Dept Approval Labor Dept Approval ' Unde~riters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ' Final Certificat~ Fee Submitted $ ........................ , ..... ~ Construction on above described building Pp~cabf~odes and regulations. Rev. 10.10-78 . ~ loq -I FIELD INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL MMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;2 ~xa,ninod P.%".~...~.¢. ..... l.~.~ ^pp,,catlon No.././.~.~¥~ ....... ................... ~ (Bfii~ctor) ~ Date .. .I.t .~., 19. INSTRUCTIONS a. This application must be completely filled iu by typewriter or in ink and submitted in triplicate to the Buildi 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 stre* or areas, and giving a detailed description of laybut of property must be drawn on the diagram which is part of this apl: cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc.'al o£ this application, the Building Inspector will issue a Building Pennit to the applicant. Such pen~ 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 unti/a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY mADE to the Building Department for the issuance of a Building Penuit pursuant to t Building Zone Ordinance of the Town 'of Southold, Suffolk County, New York, and/other apphcable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for ren~va~ or d~e~oJC'tion, as herein describe The applicant agrees !~ comply with ~11 applicable laws, ordinances, building co~e,fi/~usir~/e~e2,~nd regulations, ,~nd admit authorized inspectors on prenlises and in buildings for necessary ' ~c~igu-~e ~ppli~ or namE, i.f a_corporation) , .... ......... (mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Nmne of owner of premises .................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name aud title of corporate officer) Builder's License No ...... '.r~..~'...~. .............. Plmnber's License Ne ......................... Electrician's License No.' ...................... Other Trade's License No ...................... 1. Locatiou of land on which proposed workwill be done. ,..~...~./.~/~.%......~..~.lff. ......................... ............ ¢.s0 (¢~g~.~...~..~.~....C.O.d,- House Number Street Hamlet ~ounty~axmapNo.,00o.*~tion ..... ~?Z... ,,o~ ..... 7 ........... ~o, ................. Subdivision. ~J~.6g~.. al ............. Filed Map No. ~¢~ rot I 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~L/~/~- ' ' a. Existing use and occupancy ................................. 2. Nature of work (check whict, ~pplicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal .............. D~,molition ..., .... ; ..... Other Work .............. ' ~. / (Description) Estimated Cost . /.~,dS>D ............, ., Fee ./..~Z .. ............. , ......... :. (to be paid on filing this application) If dw~lling, number of dwelling units ..... ~ ..... Number of dwelling units on each floor,...~. 1~. ........ Ifg b f ' If business, commercml or m~xed occupancy, specify nature and extent of each type of use ............ Dimensions of existing structures, if any: Fron.t .... ,~."2. ....... Rear .... ~ .~ ...... Depth ~..~ ....... H~'"ht N' b' of Stor' Dimensions of same structure With alterations or additions: Front ................. Rear ......... Depth ...................... Height ...................... Num her of Stories ............. Dimensions of entire new cons/ruction: Front .... .%.'~ ....... Rear ..... ~-.~ ....... Depth . ~...q.'~'~. Height Nt nber of Stories .......... ' ..... Date df Purchase ....'.~ ./.Z:.]..'~..L; ............. ~ Name of Former Owner }'~. ~-'l~k~.. ~..u.~.% .... Zone or use district in which p,remises are situated }/--,-¢-~, ~ t>iYto'r,'~ Does proposed construction violate any zoning law, ordinance or regulation: /~..o.. ........................... g, lll lot be regraded .. ~ .O~.:. '....~'...',: ....... ... Will excess_ill[ be re¢oved from premises: Y~ N ......... ~ . ., .................. Addr,,sd . .. Pt~.q.'.. Phone No ......... Nam~ of Arclnrect . A ...... ............... ... Address .................. Phone No. ; .............. Name of Contractor ........ Address ........ PLOT DIAGRAM . Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty hnes. Give street and block number or description according to deed, and show street names and indicate whether ~terior or corner lot. 'FATE OF NEW,Y-O RI'~-,~ ..... (~'~ '~'/:,' ,', .: ./'.' ~ L~ .C'~Tk'.' "'at"' '~"~ .......... being duly sworn, deposes and says that he is the applicant ' (Nafiie of indMdual sig?~g contract) ~ove named. e is the .; ..... ./......,... , '~ 5' (C°~tmc~gent' c°rp°rate °fficer' etc') ~ said owner or owners, and is dt~theriz~perform or have performed tt~e said work and to m~e and file tiffs 3plication; flint all statements con~taiued in this application are true to the best of his knowledge and belief; and that the · ork will be performed in the manner set forth h~ the application filed therewith. ~orn to before me this ....... ........... 5.ota~ Public ' , . i u,, ~ ~lgnaru olapplican~