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HomeMy WebLinkAbout13749-z FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions FEB - 1198 ' This application must be filled in typewriter OR ink, and submitted m ~--,-~-- 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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 New Dwelling $25.00, 'Accessory ;$~0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50-. 00 3. Copy of certificate of occupancy $ 5.00, over 5 years $I0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewConstpuction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ./,'~. ~,,-7~, ~,.. House No, Street Ham/et Owner or Owners of Property ....... ~'. I~. .................................. County Tax Map No. 1000 Section . .~. ,~ .~ ...... Block... ,*/~. ...... Lot..~ ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.~. ~2./'/..~... Date of Permit Applicant .~.' ~.Z. ~: ...... Health Dept. Approval . 'Y" ' '" ................. Labor Dept. Approval ...................... Uderwriters Appn rova/,, ';//, !~.,;.. . .Planning Board Approval ................... Request for Temporary Certificate ..................... Final Certificate ..................... . . Fee Submitted $ ............................. Construction on above described buUding and permit _m.e~ts all applicable coders and regulations. Rev. 10-10-78 COMMENTS FIELD INS~EC'D{ON FOUNDATION (1st) FOUNDATION (2nd) OUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: 7&S-~.802 BUILDING DEPT. INSPECTION REMARKS / ,* THE NEW YORK BOARD OF FIRE UNDERWRITERS 10001'14 BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 .~,,.,,I,,,,,,on ~'o. on ~,ic N 707013 THIS CERTIFIES THAT only the electrical equipment az described below and introduced by the applicant named on the above application number in the premises of Pe~y k%~t.ll~ 12580 Main ~d, " in the fotlewlng location; []a.s~n~~ l't~I~'~ =nd FI. Section Block Lot was examined on AU~C~Z~C ~ t ]~ and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS EECEPTACLES SWITCHES 15 7 4 DRYERS FURNACE MOTORS FIXTURES RANGES FUTURE APPLIANCE FEEDERS OVENS DISH WASHERS EXHAUST FAN TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: 1-GoF.C.I S E R V I C E NO, O E COND' OF ~C. COND, OF HI-LEG OF NEUTRAL ~ Elu~tric Co~p. (Cliff C~rnell) 325 Willow Point Boad south)Id, N.Y. 11971 Per certificate must not be altered in an)' manner; return to the office of the Board if incorrect. Inspectors may be identifled by their credentials. ER. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 ~xamined..,~...¢v~..!1 ...... 19~. kpproved .~f~..o~....}) ..... 19~.(. Permit No..}..~. ~.~.c~ .~.. )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS OLDG. D . ToWN OF SOUTHOLD I~ece 1red ........... ,19... ¢,o ~ ~,e,~,, a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relafionship to adjoining premises or public streets r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- trion. 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 tall 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 tall 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 uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to trait authorized inspectors on premises and in buildhig for necessa .W~J..~,~... d;¢~/,<'-77~ · '~/~...~ - (Mailing address of applicant) ttate whether applicant is~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ' ~/' ..... (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 ......................... Electrician's License No ....................... Other Trade's License No ...................... Locatiosof 1}nd on which p~r.~gposed work will be done ................ : ................................. /..Z. ......... .................. ....... House Number Street Hamlet -- County Tax Map No. 1000 Section C) fao \ Block [ ~-t Lot t)O~:> 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../~.~d?/~_~..-4/f~.././~.,g,. .'~../. :~./~/~./.~. ~..~.~, .~.~./'~.6~/(.~.~.f.~.~.~.~' .~.x/q/.~/~) b. Intended use and occupancy ............. .~.~..'~ ./.~...~.-. ............................................ 3. Nature of work (check which applicable): New Building ..... ' .....'Addition ......... Alteration ......... Repair Rem'oval Demolition Other Work ~ .;,i '~ i (Description) 4. Estimated Cost ..... ~:).~. -? : ..................... Fee . .-. .................................. ,~ 4, (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 .... i ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each twe of use ........ 7. Dunen onsofex~stmg strnctur,es,~fany: Front....pR~.. Rear ~ ~ . Depth ...............'fig'~"v ...... Height Jilt. 2&'.. Number of Stories ..... ~. .... - ............................. ~, ...... D~ens~ons of same structure w~th alterations or additions: Front ~ .......... Rear ~ ~ ' t .. Depth . ~p~ ~ .I.. ~ ....... .,. HeiSt ...................... Number of Stories ......... ~./. ......... 8. Dimensions of entire new conslmction: Front ~ t t , ~ . .-, ...~.j ...... Rear .~. ~ ........ Depth .. J~'.. ~ .(.. Height .~g. I.~'.~... Number of Stories ....... [ ............................................... 9. Size of lot: Front ........... ~ ............ Rear ...................... Depth ...................... 10 Date of Purchase ' Name of Fomer Owner 11. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed, construction viqlate any zoning law, ordinance or regulation: ............................... . 13. Will lot be regraded ........ ; .................... Will excess fill be removed from premises: Yes No 14. Nme of Owner of premises .., .................. Address ... Phone No. Nme of Architect ......... ~ .................. Address ................... Phone No ................ Nme of Contractor ........ ~ .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al'l buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bock number or description according to deed, and show street names and indicate whether interior or corner lot. , TA~ E OF NEW YORK, (Name of/individual sigtfing contract) above named. He is the ....................................................................................... i ~' i~;ntractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~rned the said work and to make and file this application; that all statements contained 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 Qualified ill Sutf01k County ,, (Signature of applicant) C0mraJs~ioa £xpir~s March 30 l 0 AP?~©'TD ~.~ NOTED DA~: *Ih ]'2..¢ B.P...~ FEE: ~, '- BY: V- NOTFv au,L3 NG DEPARTMENT AT 7E~ ]302 9 AM TO a. PM FOR THE 1. FOUN~4-':OR TWO REQUIRED FOP ~'_'~:'~ CO~ 3. INSL~: ALL C ...... STATE CONST~Ud CODES. NOT DESIGN OR Iff" ~ t CLOSg~