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Home My WebLink About10983-z ~o~ NO. e TOWN OF SO~HOL~ TOWN HALL $OUTHOLD, N,. Y. BUILDING PERMIT (TI{IS PERMIT MUST BE KEPT ON THE pi~E/V I$~S COMPLETION OF THE WORK AUTHORJZED) ~ UNTIL FULL Building~ Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 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. B. Submit Planning Board approva~ of completed site plan requirements where applicab)e, 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. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Co 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 -~5/'f', .,~'~'. .. i New Building z~¢z>.I~:.IQF... ~J or~Pre-existing Building(X) ........ ~/Vacant Land ..... Location of PropertyHous~/~)' ....................... Ne. Street * ........ * ' ' ' '?Fl;m/et* Owner or Owners of Property~.~ ~ .... .......................... / County Tax Map No. 1000 Section ....... t .... Block ............... Lot ....... Subdivision · . . }~/~},~..Filed Map No ........... Lot No .............. Perm't No.~.'~.'~:~.' iii ;;t~;;;n~i;./.../..... .Applicant .................................. Health Dept. Approval ........................ Labor Dept. ~,pproval ......................... Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate ........ - ......... Construction on above described building and per~i~meets ail ap~cabl~des and regulations· FIELD I,NSP. F_~TION !' ~oowo~o~ (~) COMtV[ENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CO~E FINAL ADDITIONAL COMMENTS: C 765-1802 9 AM TO .~ P,M FOR THE FOLLOWING IN?ECTIONS: ~1. FOUNDATION - TWO REQUIRED FOR POUR~:D CONCRETE 2. ROUGH - FRAMING & PLUMBING 3~ INSULAT[ON 4~ FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCI'ION ERP~OR[}, ,~ q. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Application No../?.>~..ffz..~. ........ APPLICATION FOR BUILDING PERMIT Date..~.~. ?~..¢ ..... , 19 ~. INSTRUCTIONS a. This application must be completely filled in by typewriter or 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 of property must be drown on the diagram which is part of this appli~ cation. 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 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. .......... iI~'aili~g ~d~ress of applicant) ~ ~ q~"l ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ................................................................... Name of owner of premises ....... '.'~..~.~ .~.1..~'... ~ .~ .U..~.c./....~....~..~...~-.5~ .~.~.~. ..................... (as on the tax roll or latest deed) ~ If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~ e 0 &.~.~..~. c'.}¥7-~ ~t.c>...~... t~ Plumber's License No ......................... Electrician's License No .... v .................. Other Trade's License No .............. ~ ........ 1. Location of land on which proposed work will be done..~f...~i~.~.~.. ~.O. ft. ¥."~... ............................. !'-&~House .... Number' .~..~.-. ~ ~..~. .... ~..~..~ .1'7...~. ......................' ~' '~' ~'T" {~ ~'[' 4Hamlet ...................... ~/~ ....... >-~treet k~i/-'/~' ' ~:~' ~' County Tax Map No. 1000 Secti ~.~.~__~ .......... Blo ........... .__ . J .~..~. ~.,~.]... Subdivision ..................................... Filed Map No ............... L~t ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...[. ~.k,.~.k .I .,-~ .... ~'? .D.~. e~. { .I/~.~. b. Intended use and occupancy .......,*-/~'~' .[~.C .~. 3. Nature-oj~ '~ fwork (check which applicable): New Building .......... Addition . Alteratioff .......... Repai~ .............. Removal .............. Demolition .............. Other Work ............... 4. Est~atedCost... ~ ~ 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 of cars .... ~ ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each twe of use .................... 7. I)~ensions of existing structures, if any: Front... ~. t. ....... Rear .. ~. ~.~ ~. Depth .... Tq. ~ ...... Height ............... Number of Stories ........................................................ D~ensions of same structure with alterations or additions: Front ................. Rear .................. Depth. .................. ~.. HeiSt ..................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .... '~ 0.~ ...... Rear .... ~.~ ~ ...... Depth ...~ ~ .......... Height ............... _ ~Number of Stories ............................................ ~.~.~9 Size of lot: Front ....... (P~ .......... Rear ...... /.q~~ ............ Depth . .~.. 9. 10. Date of Purchase .......... ~ .................. Name of Former Owner ............................. 11. Zone or use dist~ct in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~.O .................. ~ .... Will lot be regraded ........ ~ ................... Will excess fill be removed from premises: . Ye~ No 14. Nme 0f Owner of premises .~q~ ~... ~. ~.~.~.... Address .~ ~'7'' ~.~u.~. Phone No. ~. ~ ~/.~... Name of Architect ......... j ................. Address ................... Phone No ................ Nme of Contractor .~'~O. ~o~(~(g.O .... Address ~cl ~¢~ q ~ Phone No. · ......... .................... PLOT DIAGRAM Locate clearly ~d distinctly ~t bufld~gs, whether existing or proposed, and, indicate all set-back dimensions from prope~y lines. Give street and block interior or corner lot. number or description according to deed, and show street names and indicate whether ! STATE OF NEW YORK, :" S ..... i ..... Y.~.t'~Al...~.-.../~..~/~.' .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the.. ................... 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 cont¢ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Not ary Public, (/J/'r,~. ~¢/. ,~i'~ ..... ~ LINDA F. KOWALS~i ~ ..~... re of a hcant No. 52'4,q24771 ~/ual~hed rn SUffolk Cotmt¥ C0mmmion Expires March 30,