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Home My WebLink About13752-zTV~/~- 1-0 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 I Immmmma to the Building Inspec- tor with the following; for new buildings or new use: 1. Fina~ survey of property with accurate ~ocation of al~ buildings, property ~ines, 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~:operty showing all propertv 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. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ~$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 c.o. oo Dat . ............ NewCons bruc t. ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~.(~ ~.~ /~J .~.~ .Sk.~., I k, ~ .... House No. Street F/am/et Owner or Owners of Property . .~.~?. · .~.C~<~. .......................... CountyTax Map No. ,000Section ..... I('.~. ...... Block... ~:) .......... Lot .... · ........................... F,,ed MepNo... ..4 ..... Lot No. ......... Permit No../.~.. f.~..~.. Date ofPermit .~ ~//~ ~-~.~Applicant ...~...[?~.'~..C/?~.~..~.~....C~ Health Dept. Approval ........ ~ ~ ............ Labor Dept. Approval ..... g,.~ ............... Underwriters Approval ...... ~..~ ............. Planning Board Approval.. ~, ~. ................ Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...~. ~.~,..0~.. ................ Rev. 10-10-78 ~EL~ INSFECTION COMMENTS FOUNDATION (Ist) ~FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION FER N. Y. STATE ENERGY ~ODE ADDI/ NAL 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 building permit no. 13752Z issued to Tom Christianson on _3~L~85 for Addition is completed a final inspection has ( ) has not ( X ) been done. and In order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for $25.00 payable to the Town of Southold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or use is unlawful without a Certificate of Occupancy. Please help us to clea~ up this matter so that legal action does not have to be taken. Thank you for your prompt attention. Very truly y~, Victor Lessard Executive Administrator VL:gar e, ncl. .¥ .i 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION FRAMING [~FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING REMARKS: lOOO, 78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY f ['~gV'..~ '1 ¢*~"~85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS GERTIFIE~ THAT ~ ~,. C~istimmon, N~ S~io~ Ave., C~o~, N.Y. in the/olto~ing toc. tion; ~ B.se,nen~ ~ 1st FI. ~ 2nd Fl. Section Block Lot was ~.,.i.~d on ~er 10 , 1983 and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS RECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS INCANDESCENT FLUORESCENT VAPOR DRYERS FURNACE APPLIANCE FEEDER: TIME CLOCKS UNIT HEATERS MULTI-OUTLE SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT R V I C E A W.G. NO OF HI-LEG A. W G NO. OF NEUTRAl A.W. G, CC. COND. OF HI-LEG OF NEUTRAL 3 I 5 Charles M. Hall Elect. 760Lon~greekDr. Southold, N.Y., 11971 L[C.#657 must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be ]~R BUI ) IN ANY MANNER. f ' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N,Y. 11971 TEL.: 765-1802 [pproved ....~.o4~IA .... , 19~..~. Permit No..I..~.~..~..~. ~ )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS 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, 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. tAPPLICATION 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· e 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 inS~rP~ections. ._/__ . ..... ...... (Signature of a/Jtbplicant, or name, if a o p rat·on) .... ..... (Mailing address of applicant) ;tare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 4ame of owner of premises .. '. ].'~..(9 FF144.5.. ~. .... .*f...~.~.V.C..~...~.]9..~'] ~.'j./..6'6 p¢.~..;...g}. ................ (as on the thx roll or latest deed) fapplicantisac°rp°rati°n'signature °fdulyauth°rized °fficer't~[l~"~*I['~UU~u[~;~}!.!" !.;': )(i:i~ [1 ~ (Name and title of corporate officer) ~I~'~:':''' '~'. "~'~'i ~.,~'~F~ 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 ........ '.~.~ . .o%.. . ...'7.0. ........... ff'.o. .............. .............. House Number Street Hamlet County Tax Map No. 1000 Section ~ [ t'7 Block .(O. Lot ..... ~. 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 . .p ~'J y/,'rv~...,..~.~B'], t. [~. ¢~,.I. ~.J ..... ~o~ ~ ~,~ ;.~t.(~,~,./, ......... b. Intended use and occupancy ...~'~)v.T(3.¢....~..l'..q'~%.... ~.OO.[.."~.....~,~,,~i( ~o::::~?~.*?i,¢2'. ?'~'] 3. Nature of work (check which applicable): New Building ..... ' ..... Addition ..... Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ...................................... Fee ...................................... i *" (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 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ......... . ............ 7. Dimensions ofex~sttng structures, ffany: Front ................ Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new consiruction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ..................... ' .................................. 9. Size oflot: Front ..... Rear .... [ .... Depth ).~12 .. , , 10. Date of Purchase .......... .1 .~rJ3 .............. Name of Former Owner . . .C..R.~.. [.¢ 5. [{,rC..L~07~X ....... 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction viglate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ! ............ : ....... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .'~m .°~.~6~. ~lri. S{i'tZtl~ Address .70~,.~).5'.%~!~ ~,.... Phone No..11..{/'f: ff.~0.7.... Name of Architect ......... .. ................. Address ...~?.'.~.~.~i~[K-, ./~..Y... Phone No ................ Nmne 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 show street names interior or corner lot. STATE OF NEW YORK, i S.S COI, J)NATY OF.., ..... ;... ,...,... ... ~..~.~..~.F. [~.. Oh..~.l,.~. '.~.' .~f e..~.O.~. ............... being duly (Na~e of individual signing contract) abow~ named. and indicate whether ~-~0~ 9 A~ TO 4 P~ FOR THE F~U~mp'TIOM - T~O REQUIR~O ~w pO qFn CONCRETE ~UC~J - FRAMING & PL.UMB[NG FIN) I. CQ~ ','% R: ',," 'FION MUST BE (i~F~P''''TF FOR C.O. ALI- C''''t''lq'x'r''~C FION SIIAI_L MEET TIqE R':c''t lu*r*&E¢$15 OF THE N.Y. STAFF CONq-IRLJCTION & ENERGY COPEq. NqT RESPONSIBLE FOR sworn, dep~ He is the ..................... I .................................................................... i (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 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 ........................ day or. a4~pe ........ 19~:). T*r~ ~ M.~a aO. 1~ (Signature of applicant)