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Home My WebLink About15795-zTOWN OF $OUTHOLD BUILDIHG DEPARTJ~AENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ $5795 Z Date Permission is hereby granted ~: ....~...~.~..~...t ..................................................... ............ ~....~..~ ...... u..~ ................ ~ at premises located at .....~...~.......~L.~.....~<.....':'~-~c .......... : ............................ County Tax Map No. 1000 Section ....... (~1.'~....O. ...... Block ....... ..~....~:... .... Lot No....J..~.:..~. ......... ..~. ~ 197...'].., approved by the pursuant to application dated .... ~ ......... .~. ............... , and Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted mlammm~ 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. 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 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $]0.00 2. Certificate or-occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... ~ew 0 OhS t~ruc t~ion ...... Id or Pre-existing Building ............ Vacant Land ............. Location of Property .., l~)''~ f- .~..~ ~ ~ ~ .... House No. Street Nam/et Owner or Owners___o, Property _:. ~...~.%..~_.....~-~-. !..~. ~..0~..~....~..... ~....~....~... ..... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo ........... L~"~...~.~"~_. Date of Permit ....... 3/~.Z Applicant ....................... ........... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building a~nd per~m~ iJ~J~eets all ap.plicable codes and regulations. C .O . 'z I $'- OUNDATION (1st) OUNDATION (2nd) OUGH FRAME & PLUMBING iNSULATION PER N. Y. STATE ENERGY CODE FI~JAL ADDITIONAL COMMENTS: BOARD OF HEALTH ...... 3 SETS OF PLANS ...... 'FORM ~O. 1 SURVEY ......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALL ................ TEL.: 765-1B02 MAIL TO: Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 detaile,d description of hlyout of p~operty must be drawn on the diagram which is par~ of this appli- cation. c. The work covered by this applicatio~ m~Y not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued 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 ~ 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 building for necessary ' ~"~+' . (Signature of applicant, or name, if a corporation) '7.'71., .... ........... iI lailin address of applicant) State whether applicant ix. gwner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................. ' ............................. t ................. (as on the tax roll or latest deed) 1[ applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) · , ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED ~llm-iYd eY's~mense ~; .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ltouse Number Street Hamlet (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: I Nature of work (check which applicable): New Building'./.. ' Addition Alte/ation Repair Removal ' Demolition Other Work ~ ,"~, ' ' , ' (Description) Estimated Cost ' Fee ~ (to be paid on fihng this application) If dwelling, number of dwelling units ............. Number of dwelling units!on each floor ............... If garage, number of cars ....................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... Dimenslons of existing structures, ifany: Front ............... Rear ........ ! ...... Depth .............. Height ' Number of Stories Dimensions'of same structure with alterations or additions: Front Rear Depth ...................... Height ..................... Number of Stories ..................... Dimensions of entire new construction: Front ' Rear ~ Depth Height ............... Number of Stories ..... Size of lot: Front ...................... Rear .................. Depth ..................... Date of Purchase Name of Former Owner Zone or uso4tistficMn-whiclvpremisos-are situated .............. ~ ........... ~ ........................... Does proposed construction violate any zoning law ordinahce or re ulation Will lot be regraded ............................ Will exbess fill be removed 'from premises: Yes No Nmne of Architect " Address Phone No Name of Contractor Address ' ; ' Phone No Is th±s property located with±n 300 feet of a tidal wetland? *Yesi ..... No *If yes, Southold Town Trustees Permit may be reoutred. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from perty lines. Give street and block number or description according to deed, and show .street names and indicate whether :flor or corner lot. ,.;,,:t,,, ,, 07. USE iS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY %PPROVED AS NOTED NOTIFY BUILDING OEPARTM~T AT 7~.1~ ~R THE FOLLOWING INSP[~CTtONS: FOOJ~DA'r~oN '1~0 liTE OF NEW YORK, UNTY OF ................. S.S ROUGH FRAMING ~ PLUMBING FINAL CO~TRIJCTh ~N MUST AL~ CO~S"raHCrtON ~MACt. MEET THF RK~LJlf~Ft4'fS (Jr' t"HE N.Y ST~ TI CONS rRtJc*to;v ~ ~NERGY being duly sworn deposes and says that he is the applicant (Name of individual signing contract) ve named. is the . (Contractor, agent, corporate officer, etc.) ;aid owner or owners, and is duly authorized to perform or have performed the said work and to make and file this lication; that all statemehts contained'in this applic/iti0r/ilfq, true to the best of his knowledge and belief; and that the 'k will be performed in the manner set forth in the application filed therewith. .)m to before me this. ? ~ ' ' .......... ol of ..... ..... ,19f7.. .. ...................... .% ~--. ounty HELEN IL DE VOE NOTRRY PUI~LIC, State of New York . Ne..47.0787.% Suffolk coufl~' P leon ~p~res ~rch 30,19- ' (Signature of applicant)