HomeMy WebLinkAbout13957-z FOBM NO. 0
TO~N OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PER,AlT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NO 13957' Z
Permission is hereby granted to:
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,o .....(~.~..~..Z~.~ ......... ~.~--~-_~.....,~./D...,Q.z~.z.~.~/.....~_.~..~ ...................
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ot prem,ses located at ........... ~/~¢r...~.....~.~... ............ ~--~.....~,~.~...,,~...~. ...................
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.................................................................. .~..~...~.. ......................... ~..,, ............................ ..o....~.~ ............
~urs,,o~, ,o app,t~a,,on ~o,~ ..~...~..~. ....... /.~... ................. , ,,..Z~,d ~ppro,~ b, ,L
Building Inspector.
Fee $....~..%~.. ...........
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
~outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
in duplicate ,~-
This application must be filled in typewriter OR ink, and submitted, · .'?¥; ?o~ lhe 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. Commemial 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.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p~coperty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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 preoare a certificate.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
$15.00
Date ..... ?~.//..Z/?..~j. .........
//
New Building " Old or Pre-existing Building ............ Vacant Land
Location of Property ............................................................
House No. Street Nam/et
Owner or Owners of Property ...... .~ ~../~zY'..~.~.~.*~. .... ~'..f-.~. ~..~..~-~'../~.../~.... ~ ~ ................
County Tax Map No. 1000 Section ..~ ...... BIock...~..¢~.'.... Lot....~¢~.../~.3:.~
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant ............ ~. .....................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ..... ~ ...............
Request for Temp~ficate ..................... Final Certificate .......................
Fee Submitted $ . . .~ ........... ,._.^., . . . ~-~-------~ /
Construction on above described building and perm'it meets all applicable codes and regulations.
Applicant . ./~.~.-~>. ~. ...................
FIELD I NS~ECT~ON
FOUNDATION (1st)
FOUND&TION (2nd)
NOUGH FRAME &
PLUMBING
iNSULATION FER N. Y.
STATE ENERGY
Q,ODE
FINAL
COMMENTS
ADDITI'ONAL' COMMENT~:~
)
TO~VN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
To Whom This May Concern,
A permit has been applied for 5/13/85
along with an application for a Certificate
of Occupancy on the same.
The permit is for a deck addition to
an existing dwelling.on a private road in
Orient owned by Kenneth Strachan.
Building Dept.
dsm
Memorandum from.. ·
BUILDING INSPECTORS OFFICE
TOWN O1:
'[OWN IIAI.I., L~)X 728, SOUTIlel I), N,Y, 11971
765-1802
July 19, 1985
?lea~'~e find enclosed your check f~109
mado out to the Southo]d Town Bul]ding
Dept. ~n the amount of $55.00. I am
returning this check at yo_~r request.
Memorandum from...
BUILDING INSPECTORS OFFICE
TOWN OFSOUTHOLD
TOWN HALL, BOX 728, SOUTHOLD, N.Y. I1971
765-1802
July 30, 1985
On July l~th I returned your check #109 to
you, at your request.
?lease send us a new check for $50 to cover
the cost of Buildin~ Fermit #13957Z. Upon
receipt of your c~eck we will mail your
permit to you. Thank you.
Yours truly,