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Home My WebLink About13745-z FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANC' Instructions A. This application must be filled in typewriter OR ink, and submitted m jJJa~Jae 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 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 pZoperty 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. es: ~(,~ Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15o00 $15.00 Date ..... .~../~..~ ..~.. ........ New Cons tr'uc tion ...... / Q?..o.OId or Pre-existing Buildingc~..~ ............ ~..~.~'~'~ ~.~# ~.~Vacant ?and ............ Location of Property ............ ~ ........................................... House No. -- ~ Stree~ _ / Hamlet Owner or Owners of Property .... ¢~. J~..'.~.....~.....~.~ .... .~..~(.~.~.~ ............. County Tax Map No. 1000 Section ...... .~...0 ..... Block ..... /..~.. ..... Lot .... .~/...~. ....... Subdivision ................................ Filed Map No ........... Lot No .............. Permit No ..... Date of Permit ......... Applicant .................................. Health Dept, Approval ........................ Labor Dept. Approval ...................... U ,derwriters ApprovalB¥....~...~...J~ ....... Planning Board Approval .................. ~equost for Temporarg C,rtificate ..................... Final Cortificate ...................... Fee Submitted $.. ~. ~ .~.~ X ....... Construction on above described building ~ ~it[ ~)~ ~ m~.~ applicable codes and regulations. ..... ................................. Rev. 10-10-78 [ELD~ INSPECTION FOUNDATION COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION FERN. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION [ ] FRAMING ~-]/FiNAL REMARKS: DATE (~?~C iNSPECTOR/~,~_ (~ THE NEW YORK BOARD OF FIRE UNDERWRITERS 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~Oa,o May 17,1985 /~ppliea,ion~Vo.o.file 331774/85 N 6922:[6 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant namedon the above application number in the premises of Andrew Stype, Crittens Lane, Parkway~ Southold, New Yokk in thefollowinglocation; [] Basement [] ~.t Fl. [] ~nd Fl. outside Seetlon Block rot wasexao~inedon~ay 1~ t~9~5 andfoundtobelncompliancewiththerequlrementsofthisBoard. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT VAPOR DRYERS 1 FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET RVICE DISCONNECT OTHER APPARATUS: G.F.C~I0- 1 (Swimming Pool) S E C NO* O~ECR~,COND OFAWG AWG. NO. OF NEU~RA A.W.G CC, CONO O~ HI-LEG OF NEUTRAL NO, OF HI-LEG This certificate covers compliance at the date of inspection only because of unusual environments ~t is advisable to have frequent test and/or repairs made by a qualified person. Jody Pumillo Pat Lane Mattituck, N.Yo, 11952 Per_ 11 certificate must not be altered in any manner; return fo the office of the Board if incorrect. Inspectors may be identified by their credentials. CO BI IT. THI E ALTERED IN ANY MANNER ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~,OUTHOLD, N.Y. 11971 TEL.: 765-1802 xamined .,.~ 9¢~&..~ .... , 19~./. pproved...~.. 9~..~....~.., 19~. .~. Permit No.I..~.~ .~ .~..:~.. BLDG. DEPT. TOWN OF SOUTHOLD Received ........... ~19... isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely tilled 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- lion. 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 ' ail 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 all 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 [ilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dt authorized inspectors on premises and in building for necessary inspeclions. ..... · ..... (Signature of applicant, or name, if a corporation) ~ailing address of applicant) ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ... ~.,~/.e~,,~.~. .~..~.. T-~./~c.'~.--~.,~.. arne of owner of premises ...~V~ ..... ~... ~a ~... 2'~7{~ ........................ (as on the tax roll or latest deed) ~ app:~~si~duly.~_.~uthorized officer. Builder's License No ........ ~.Q ............... Plumber's License No ......................... Electrician's License No.. ~./~ ~..~'/~...W-,~..~. (el L> Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. .......... !.o. 20. £.e., :. D. ............ House Number Street Hamlet County Tax Map No. 1000 Section ........ ?. (~ ....... Block .../.& ............ Lot...{J.*...~.~. ......... Subdivision ..................................... 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 ..................................................... b. Intended use and occupancy .................................................................. 5. 6. 7. 10. ll. 12. 13. 14. Nature of work (check which applicable): New Building .......... 'Addition. i ........ Alteration .......... Repair ............. .. Removal .............. Demolition ........... Other Work ~/.~9/(O.q.. ~. .//. ~/.~ ~ ,' ~jz-,~C21/ (Desc_riptio,n)~ Estimated Cost ...... .O~). ,...c~. .... ............. Fee ......... i .... :~-~/~ (to bei paid on filing this application) If dwelling, number of dwelling units ............... Number o f dwelling unlts on each floor ....... , ....... If garage, number of cars ........................................... i .......................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... Dimensions of existing structures, if any: Front ............... Rear ...... i ....... Depth ............. Height ............... Number of Stories ........................... ~ .......................... Dimensions of same structure with alterations or additions: Front ........... i ..... Rear . .' .............. Depth ...................... Height ...................... Number of Stories ............. ' ....... Dimensions of entire new construction: Front ............... Rear ....... i ....... Depth ...... i ....... Height ............... Number of Stories ........................... i .......................... Size of lot: Front ...................... Rear ...................... i Depth ..................... Date of Purchase . ................. , ............ Name of Former Owner i .......................... . Zone or use district in which pr~inise~ ar'o situated . . . ' Does proposed congtruct~on violate any zoning law, ordinance or regulation: ... i ........................ Will lot be regraded ...... ~,~ ...... ; ......... Will excess fill be remove, d from premises: Yes' '"~' Name of Owner of premises t~/.,. .~-. ~.,..-~..q~..~-'7. Address..J'~r*qT-/~?-Z2. ! .... Phone No ............... .... Name of Architect .......................... Address ...., ........... ~ ....Phone No ............... Name of Contractor..~.:.~ .~. -~. ;~c'~9~ .~.... Address .~7-~. ?~.. Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, an& indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show .street names and indicate whether interior or corner lot. STATE OF NEW YDRK~ COUNTY OF .... h'O.l~&C.l( .... s.s ....... ~t0 ~ff.~./~... I~. ;.. ~./~?.4./'.~. .....~..: ...... being duly sworn, depgses and says that he is the applicant (Name of individual signing contract) above named. .e is the ............ ............................... ............................ (Contractor, agent, corporate officer, etc.! 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 contained in this application are true to the best of hi~ 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 ................ 4.' .~..,,,,~ .day of.. j~. ~.~..~.. ...... ,19..~.~-- . ' . // ,,s- .... / .......... t -'