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Home My WebLink About13747-z 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 m mmmmmmm 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 p~perty 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 cede 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 $10,00 2. Certificate of 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 .~/./.D/.~.'"'/'~/'"~ 5.Updated C.O. $ 50.00 Date .................. NewC ons truc ~,ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... ~.~./?......~.o..~.q .~ q ./.e..~....~ ...... .~...m~... Q!?./.../~,: .~/ ....... House No. Street Ham/et Owner or Owners of Property County Tax Map No. 1000 Section .............. Block ............... Lot ............... Subdivision ~'.'.T.E~Cfp..~ rO~%'~-- .Filed Map No. .Lot No. ' Permit No..~,~7 ~... Date of Permit ...il .~'.~....Applicant . ~..r~?. ,C~... ......................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....... ~ ............ Fee Submitted $.., ,~.~,~.,..(?. J.9.~.. ........ Construction on above described building and permit meets all applicabl~c.-codes ~nd regulations, 9.O-t PP ' " ' ' Rev, 10-10-78 TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because.of the following reasons. /~An application for Certificate of Occupancy is not on file. (E~c~d) _~/--/ No Underwriters Certificate on file. /~he check ls(outdated/qot on fi~.)~L~b /5~No Health Dept. Approval on fi~e. (~/ ~/5°/~ /~/ NO final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. .-Building Permit # ~ ~ ~ ~ Z Building Dept. ***/_~/No Plumber Solder Certificate on file.~L~c/ox~'~) ( all permits involving plumbing being issued after April 1,1984 ) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. /'J~TY~ ~' Owner ~'~{A/A//'$ ~-'-~/I,I/~S Plumber (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this ·/~ day of. ~ . Notary Public, ~/J~ County Notary Public HELEN IL DE VOE Yolk NOTARY PUBI, IC. State ef New _ Ne. 4707878. Suffolk Ceenty ~ 9' Term Expires Msmh ~, 19--~ / FIE[~ I~PECTION FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION FERN. STATE ENERGY ODE COMMENTS FINAL ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under the building permit no. 13747Z for New Dwelling is completed. A final inspection made on 3/11/85 showed that the Cellar needs door. fitting energy requirements Railings on deck and cellar steps Since you building permit expired on 9/11/86 it is necessary that you obtain your CO. If the problem has been corrected, please contact this office to set up a time for re-inspection A check of $25.00 is also required along with an Underwriters Certificate. Occupancy or use is ~lawfu~-~thout-~-~'~d~tific~'~ of Occupancy. Please help us to clear up this matter so ghat legal action does not have to be taken. Thank you for your prompt attentign. Very truly yours, Victor Lessard Executive Administrator VL:lmr 76S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ~ ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION /~FRAMING [, ] FINAL DATE~ INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 o.t,. April 14.:] 987 378491/86 ~pp,,c.,,o.~o.o,,Z,,e N 803623 THIS GERTIFIES THAT o~y the electrical equipment ~ ~scribed below and i~roduced by t~ applicant ~med on the above application number i~ the premises of Dennis A Davis, Soundview A~n~, (Sterling Forest Road~ Mill La. Kenneys Rd. Southold, N.Y. .~sexa,nlnedon Apr~b, ~ .%~,~o. m~ to, and found to be in co.tpllance u'ith the reqt~irements qf this Board FIXTURE FIXTURES RANGES C~KINGDECKS OVENS DISH WASHERS EXHAUST 49 39 ~"~"~ 1 1.2 1~/2W 1~'3W 3~'3W 3.e' 4w NO'O~ERC~'CONDOF AWGcc. CONO NO. OF HI-LEG 2/0 OTHER APPARATUS: 6--0° F. C.I. ]..-~Smoke Detector Track Lighting 8'0" 4 Lites ¢ E AW, G OF Hi-LEG NO OF NEUTRA[S A.W G OF NEUTRAL 2/0 Dennis A. Davis ~C~J~'~~ 471 47th. Street Linde~hurst, N.Y. 11757 GENERAL MAN; ER Per ~.~ This certificate must not be altered in any manner; return to the office of the 8oard if incorrect. Inspectors may be identified by t credentials. :OPY I BUi THIS COPY OERTll ~UST ' ! ALYE'RED IN ANY MANNER. Memorandum from... · BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN H^rL, Sovxaoro, N. Y. 11971 765-1802 'FORM NO. 1 .TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 [sapproved a/c ........................... ~ .......... ............................. ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT FEB 261985 BLDG. DEPT. TOWN OF SOUTHOLD INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 s 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 areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- tion. 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 issued a Building Permit to the applicant. Such permit all 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 M1 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 dlding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~gulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ti applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit authorized inspectors on premises and in building for necessary inspection~.~ (Signature of applicant, or name, if a corporation) .......... ¢,¢,. . , ~,~/gO? (Mailing address 6f applicant) :ate whether applicant i~ lessee, agent, architect, engineer, general con.tractor, electrician, plumber or builder. m e of owner o f premises ..... .~.e.¢.O~.~... ~.....~.4 q/5... ~. ~.fl...~'~.~.~. t.c .g...b..~... ~&tf/.g. ........................ (as on the tax roll or latest deed) applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No..'~.~..../.5.~...~.&..~.' .<_.~..~-..~9 Electrician s License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done...I¢..o.r~.~ .tO..C.S....(°.r.n.e.~... ~'~er'/tn ~ · b .4r. .... lA., 7. ................................... House Number Street Hamlet County Tax Map No. 1000 Section .~.~..9..~....~. ...... Block ...... ~. .......... Lot....~.--, .7 .......... Subdivision ..... R .r~..,?..~...F?..~...~. ............. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ./'/.~. (q;..~.~.~..d-7'..~..-...~..-~../..~./? - ~ ' b. Intended use and occupancy .... ..<~./..o.~,.~....~../~.../~.../f__..c?,. ........ .~-..d'./.'(./- ....................... ~ ~.. ' Additi Alt ati 3. Nature of work (check which applicable): New~ Build~ .... on . ...... ... er on .... .... I. Repair .............. Removal .............. Demolition .......... ~ ....Other Work ............. . .~. ~.~.1 PRo i (Description) 4 ti ated C F .' Es m est .............................. ee ......... : ............................. "" (to b~ paid on ~ing this application) 5. If dwelling, number of dwelling units ......... Number of dwelling unlts 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 ........................... i .......... , ................. Dimensions of same structure with alterations or additions: Front ........... ! ...... Rear ................. Depth ...................... Height ......... ,. · .,; .........Number of Stories ..................... 8. Dimensions of e..~ti.re new construction: Front . .O~?. ??. Rear ~2.'7.~'.'~ ........ Depth ~.~. Height .~.~. Number of Stones et .... o2/,e~ ........................................................... 10. Date of Purchase ....... ~. .......... Name of Former Owner :...~.n??..,¢'.~.¢.&~. ............... 11. Zone or use district in which premises are situated ........................ ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ... i .......................... 13. Will lot be regraded ............................ Will exc~s~fill b~.re~..ov~d from premises: Yes 14. Name of Owner of premises .................... Address . .~/."./....6.~ .~.....~ ..... Phone No..~0~6..-/~.O.~.. i. Name of Architect ........................... Address .............. i .....phone No ................ Name of Contractor .......................... Address .............. ; .... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and shdw street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. ' .......... /~...~ .'....~.~ .............. being duly (Name of individual signing contract) above named. sworn, deposes and says that he is the applicant He is the . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the s~aid work and to make and file this application; that all statements contained in this application are true to the best of hii 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 ...................... ...day of.....~.. ................ 19 ~...~ Notary Public ......... ~?...~.:...~,~, .~/..~... County ~ ...... I-I[[[N 1<~ r>[ vol: X~ I., . i/'~,,l'f~ .~ [~i '.~ ._.x,~,.), NOTARY PUBL[O, 3tale of New Yort( /x..l>..l~-'r..~.-~.~...-, SUFFOLK CO. HEALTH DEPT. APPROVAL H. $. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DIS~SAL SYSTEMS FOR THIS RESIDENCE WILL APPLICANT W370~o ~el) SUFFOLK COUNTY DEPT. OF HEaLtH APP~VAL OF CONSTRUCTION ONLY' DATE: I APPROVe: ~ SINGLE F4~. ,. .... SUFFOLK CO. TAX OWNERS ADDRESS: ~, DEED: L. P. ~mom~ .--. SUFFOLK CO.HEALTH DEPT SUFFOLK COUN~ H~LTH DEP NT ,, .: SINGLE FAMILY ~ELLING ~ . t .~ - ~_ ~ ~ -- C~4STRUCT ION ONLy: