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Home My WebLink About13750-z FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in wpewriter OR ink, and submitted i ~ to the Building inspec- tor with the following; for new buildings or new use: 1. Final survey of properW 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 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 prepare 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... ~... ~.: .~.L~. ........... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~.~,'~ ....... .~.~/17.~.,./~.,~.. ~./~.~. ........... ~?~:)..~../P~ . House No. Street Hamlet Owner or Owners of Property ~. 0 ~-~/7./~,~. .... ~ .............................. County Tax Map No. 1000 Section . . .~.~. ....... Block .... .0.¥ ........ Lot.../~. .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ...... ~7 Date of Permit ~..-./L?~.J. .Applicant ... ~' ·. · Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...~.'-,d,'T~,. ,V/,, .~., .C?~ ........... Construction on above described buitding~,ermit meets ali app~ ~od~esxand regu lati.ons. C,O,:~-:t 5-7-7 I Applicant ~L~.~ .~ ............ Rev. 10-10-78 FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) COMMENTS ROUGH FRAME & PLUMBING INSULATION FER N. Y. STATE ENERGY ODE FINAL ADDITIONAL COMMENTS: /THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 .ate ~U~.,'~ O~, 1~ -'p,,llc.tion No. o.S"e 338~'~/S~' N 7 0 3 4 i 8 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant ~amed on the above application number in the premlses of in the follotving location; [] Base,nent JUly ~9, 1985 [] lstFI. FIXTURE OUTLETS RECEPTACLES SWITCHES 7 2 DRYERS FURNACE [] 2nd FI. Section Block Lot and found to be in compliance with the requirements of this Board. FIXTURES RANGES FLUORESCENT FUTURE APPLIANCE FEEDER: OVENS DISH WASHERS EXHAUST MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I C NO, O E COND' OF CC, COND. OF HI-LEG NO, OF NEUTRALS A W.G. OF NEUTRAL certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identifi their credentials. 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 ~pproved ...~ .¢4-. f~. !/ ..... 19~. ~.'. Permit No./. .~. 7.A..-D. .~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF SOUTHOLD Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 :ets 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 >r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 hall 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 hall 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 dmit authorized inspectors on premises and in building for necessaryj/lspections. _ - . .......... (Signature of applicant, or fidme, if a corporation) .e/ ....... (Mailing ad:dress of applican¢)' ' grate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. d! C. ................................................................ lame of owner of premises ..,~ ..0 .~.C .,~.. ~.)--.../~. ,.. t ~.~.).->. ~. ~*~ ..................................... (as on the tax roll or latest deed) if 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 ...................... Location of land on which proposed work will be done .................................................. ..... , c,,. . . , ,: . ................... '. ,., ;/_2. o.x . ................ House Number Street HamI~t County Tax Map No. 1000 Section ...... .C.)..~.."~.. ..... Block .... .O..~ .......... Lot.. ;¢~...C)..~ ..~.. .... Subdivision .~. &...~....¢~... '.['~...ON .~... Filed Map No../~ ~9.q ....... Lot...\.q .......... (Name) k3 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... /.~ .;..~/..)..~ ..... ~. Z4.dL z(f. ~.,5~ .................................. b. Intended use and occupancy . . . /~ ~z./e. ~. ~. ~5...: ..... l..~(~ .... .~.~ ...... 3. Nature of work (check ~vhich applicable): New Building .. ' .. Addition .. v// Alteration ... Repair .............. Removal .............. Demolition .............. Other Work ............... (~:~j~] [ "~ '. , i , (Description) 4. Estimated Cost ........ ' ........................ Fee : I *-' (to be paid on filing this application) 5. If dwelling~, ........ number of dwelling units ..... /. ......... Number o f dwelling units on each floor ................ If garage number of cars 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existihg stmctm'es, if any: Front... f~.~." . ..... Rear ...Sf.~. ( ...... Depth .. ,~,~.F). / ............ Number of Stones ....................................................... Dimensions of same s~tructure with alterations or additions: Front ... ~9.-~..' ........ Rear .... ~/~.'~..( ........ Depth ..... r~,.~/~. ......... i.. · Height ................... Number of Stories ...... /. .............. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 11. Zone or use d~strlct in which premises are s~tuated ...... ~.~....~.". ~ ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~.~.c~ ....................... 13. Will lot be regraded ...... .':~-~%~.., ............. Will excess fill be removed from premises: Yes 14. Name of Owner of premises2'~.Z2 f/~: .g.~.. Z,..~.~?,6g. ce~k~F~ess ~L~..~.z,U?ff~O. J-z.i .,. Phone No.'??.7. 7/. ?.[CLdC~ .... Name of Architect ....... .~4~J~' ............ Address ................... Phone No ................ Name of Contractor ...... ~.f~? ~ ........... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly a~l 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 show street names and indicate whether interior or comer lot. STATE OF NEW YORK .... ·.....~.fir)O~ ~RJ'¢~. · ~ ....... . ................. ~... being duly sworn, deposes and says that he is the applicant (Name of individual si~ning contract) above named· He is the ......................................................................................... of said owner or owners, and is daly authorized to peri )rm or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth in the apphcahon filed therewith. Sworn to before me this ........................ day f .............. ~ ......19 Notaw eublic~%~;. ~ .... ~unty ~ . No. ~22563, Suffolk Cobnt~, ; j ~ Term Expires March 30, 19~ NOT~=Y ?' 765-! 302 ~'-, ,,*'~. TO ~. PM FOR ~H~ 1. FC'JN-'-'~' -~g~,O REQUI~ FOR P .....x' :'. CO~CRETE 2. RC" ~G=. c~* *~,x,~.,~,, ~ ,, _ :° PLUMB'I~ 3. IK?UL ALL C3NF THE R'-QL"-r":? ? STATE CONCTqUC~C~d-~ ~'-'Y~ ':.RGY CODES. NqT R DESIGN OR