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Home My WebLink About13756-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 Wpewriter OR ink, and submitted ~ ~.--.--~ 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 property 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: Additions $25.00 1. Certificate of occupancy New Dwe]Jing $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 5.Updated C.O. $ 50.00 Date ...... ;;~.~1 ........... NewCons tpuc t ion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .............. "' / ......... Str'e~t' ' '~1 Nam/er House No. Owner or Owners of Property ...~.~ .................................... County Tax Map No. 1000 Section ..... .20. ~ ..... Block .... /. .......... Lot...o~.. ;..~ ...... · Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..J ."~.~..~'.~,. ?"Date of Permit..~./'.~.j..~...Applicant...~.~...~.~ ............ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant... ~~.~ ................ Rev, 10-10-78 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. 13756Z issued to Douglas Cooper on 3/15/B5 for Acqessory 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 $10,00 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 clear up this matter so that legal action does not have to be taken. Thank you for your prompt attention. Very truly yo~, Victor Lessard Executive Administrator VL:gar encl. FiEL~ INdirECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER 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 THIS CERTIFIES THAT only the electrical equipment as described belo~v and introduced by th~ aot~licont named on the above.application number in the premises of Douglas Co,per, Bre~w~er Ro~d, Stanley R~. ~uth Rd. E/S, Mattz~, ~ N.¥~ in the fotlowlng location; [] Basement [] 1st FI. [] 2nd FI. Section Block Lot was examined on ~il l~ ~ l~ and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS 6 [ECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS NCANDESCENT FLUORESCENT 8 2 6 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLI SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R NO OFpE RC~,~CON D OF CC COND C NO OF HI-LEG OF HI-LEG NO. 0[" NEUTRALS AWG, OE NEUTRAL Gust ~u ~I~ar tra M~t~ituck~ N.Y. ll95E L~c, 1529 must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their c[,e~entlals. COPY FOR [.DII ~G DEPAI ANY MANNER, , v.,' ~* '~ ?';:'E'FORM NO. 1 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 pproved ..X'..Y'/.I ~.'~. ).~., 19 J.~. Permit No. (Building Inspector) APPLICATION FOR BUILDING PERMIT · BLDG. DEPT TOWN OF SOUTHOLD Received ........... ,19... Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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- 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 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 granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or 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 : auth°rized inspect°rs °n premises and in building f°r necesi~>~..~..//¢.....~..% ......... _(Signatu~f appl~ant, or name, if a corporation) whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises .. ~/ (as on the tax r~ll 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 ...................... Location of land on which proposed work will be done ......................... ~. · .~ ......... ....~. O..~ .'~..~. ..... ~)..~. .....,~......~. ~./.O.~, ./.~. .... ~..~/.-~ ............. ~H~/m. let~./: ¢./4t. .~./'( ............ House Number ~/ Street County Tax Map No. 1000 Section ./..~. ~ .......... Block ./ ............... Lot...d?.~..~ .~..~. ...... 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 . .W .~..C..d~l. ~..~. ..... /~/. [~. ...................................... b. Intended use and occupancy ~7 .~..~ JC/~7 ........ ~ ............... 3. Nature of work (check which applicable): New Building .... /~.... 'Addition . , ........ Alteration .......... Repair .............. Removal .............. Demolition .......... ~... Other Work ............... 4. Estimated Cost ........................... Fee ......... ~ ............................ (to beipaid 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's'nd extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ...... i ....... Depth ............... Height ....... ,... ..... '.: Number of Stories ........................... i ............................ Dimensions of same structure with alterations or additions: Front ........... i ..... Rear .................. Depth ...................... Height ................. Number of Stories ... ~, ...... 8. Dimensions of/entire new construction: Front ....... ~..~./... Rear... ..... Height ...~'. .......... Number ~f Stories ..... ~. ..... i ...... 9. Size of lot: Front ... ~...~ .O.0. ......... Rear ~..~.'~ / .......... ~"' ~'' ....................... 10. Date of Purchase ........... ,/~. ~7.. ~77. ........"Name' ................ of Former Owner .~! t~eprn F3.~..r,.. ............ .--..,~. ~.q/. ~/~.,.."*' '"~.~. f~, .... 11. Zone or use district in which premises are situated ......................... i ............. ' J 12. Does proposed construction violate any zoning law, ordinance or regulation: ... ~.a~.5 ........................ 13. Will lot be regraded ../~d~. ...... ~ ...... ~.~,~ ..... Will excess fill be removyd fr~m premises: Yes (~ 14. Name of Owner of premises ~.0 V,~/.~J.. ~Y... (,-~Address ..~O. ~.~9~....}~.! .... Phone No./~.~. T.~.~'.~/~. .... Name of Architect .......... .e ................ Address ............... i ....Phone No ................ Name of Contractor .......................... Address ............... i ....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 and indicate whether interior or corner lot. STATE OF N~r~RK~,/ above named. being duly sworn, He is the ............. ~-~o,er~x~e-~,~ ................................. ~ ........................... (Contractor, agent, corporate officer, of said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file this application; that all statements contained in this application are true to the best ofhislknowledge and belief; and that the work will be performed in the manner set forth in the applicatlon filed therewith. Sworn to before me this · ............ ..... day : · / Nota_~ry Public .... ~..,,-~ .. ~./Q ......... ~ County ,,'Q "< ..... .... '.:'".: · ~c/~ i~ ~.~r ~).~f~l~ y~]~ ~/ [~gnature oz appncant)