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Home My WebLink About13763-z FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,~:~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submittecl~;~lul:Hcct-" 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. Approvat 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 peoperty showing alt 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 bu ildings. 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 $5.00 / 2. Certificate of occupancy on pre-existing dwelling / 3. Copy of certificate of occupancy $1.00 landuse--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 New Building ............. Old or Pre-existing Building ....~. ...... Vacant Land ............. Location of Property .. W;I~....~..~'~.'~. '. ..... F,.~t:'./'~.~¢..-/~'.[-.~. · · .;. ~...~..~.~.?.. House No, Street Hamlet Owner or Owners of Property . ~.'./~.~.~./.'.~/. o .~.': .~.~.~. · · .~.~.~..~.)}~. ,.~-/??~.. ~.. ~ol .~'. ~.~/~ ,,~7 County Tax Map No. 1000 Section ...... /. '~, ...... Block .. ~ .......... Lot .... ~... :'~: .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.J~...'Z~.~.,~-~Date of Permit ~.~.~..~..Applicant .~..~.... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval //~ .~. ~..~. ~.. ,,~. ~/ ........ Planning Board Approval ...................... Request for Tempo,r~y, Certificate ..................... Final Certificate ..................... Fee Submitted $ .................. Construction on above described building and permit meets all applicable codes and regulations. Apphcant ............................... FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~=uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte~cpl[cct"- 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 peoperty 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. of occupancy $5.00 / Certificate 2. Certificate of occupancy on pre-existing dwelling/ land use --?re-]~× ±s t, ±n~ C.O. $15,00 3. Copy of certificate of occupancy $1.00 ~ Vacaot, land C.O. $ 5.00 Date .~/,~1.. ! ~/./,~ ,~,'~, ..... New Building ............. Old or Pre-existing Building ,. ~ ........ Vacant Land ............. Location of Property.. ?..~..~...~/?~...%~....~'/,~'J~C~ .~....~......~.~'...u~..~.~ ..... House No. Street Ham/et County Tax Map No. 1000 Section .... ].~, ........ Block ... ~ ......... Lot ..~, Subdivision ............................... .~J=iled Map No ........... Lot No .............. Permit No. ~ ~../. ~,J/.-Date of Permit .......... Applicant · Labor Dept Approval Health Dept, Approval .......... ,~ ...................................... Underwriters ApprovalA( ~J~..~.~,~. 6 Planning Board Approval ~ Request for Temporary Certificate ..................... Final Certificate ...... · .~... · · · ...... Fee Submitted $.~.~. .~ ~...~'~. .................. Applicant ~4~.."/.'¢/P;~ ......... //¢/-y:~?! ........................ Rev. 10-10-78 FIELD INSFECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY 0DE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- O1 8-5 JOHN STREET, NEW YORK, NEW YORK 10038 ~,,,,~.,o.~o.o.~,,~ N 705336 THIS CERTIFIES THAT only the el~trlcal equipment ~ described below and int~duc~ by the applicant named on the above application number in the premises of ~n Gl~ P~'lvate ~, F~ers Isla~ N Y i. ~,~ foUo~i.~ ~o~.tlo,. ~ ~...,.~., ~ ~ rt. ~ ~.d rt. S~;tlo,, ~to~ Lot wasexaminedon ~]J~ J,,3~ ~ attdfoundtobeincompliancewiehtherequirernentsofthlsBoard. FIXTURE FIXTURES RANGES :OOKING DECKS OVENS DISH WASHER EXHAUST FAN OUTLETS SWITCHES FLUORESCENT VAPOR 9 8 9 9 DRYERS FURNACE MOTORS FEEDERS TIME CLOCKS UNIT HEATERS DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I NO, 0 E COND. OF '~C, COND. 1.4~t~e Detector Heater ~1.2~ C OF HI-LEG NO OF NEUTRALS OF NEUTRAL Lic 2455 E GENEI~AL certificate must not be altered in any manner; return t~ the office of the Board if incorrect. Inspectors may be identified by their credentials. 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1809~ ~roved ...~2,~-_~..a~, ?...i 19~ .~-~ermit No.. ~pproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Ttfis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 se ~ of. plans, accurat, e plot pl~ to. scale. Fee adcordin~ to s~chedgle. ', b. Plot plan showing lo.catior} of lot and of buildmgs bn pr. emises, relationship to adjoining premises or public streets areas, and giving a detailed descriptioh of layout of property must be drawn on the diagram which is part of this appli- ion. 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 ill be kept on the premises available for inspection throughout the work. e. No buikting shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy 11 Liave beeu granted by the Building Inspector. APPLICATION IS HEREBY MADE to (he Building Department for the issuance of a Building Permit pursuant to the Iding 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 inspections. --~ ,-, ?b. D,6 ..... · t :,~"~ ~' 'U ' ' · · (Signature of applicant, or name, ~f a corporation) z z-zs.Z& ...... (Mailing address of applicant) ~ ~ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or.builder. 'A4 ............... ..: . .,et. A .................................... ....................... (as on the tax roll. or latest deed) me of owner of premises L. Martin Gibbs ..................... ipplicant is a corporation, signature of du!y authorized officer. (Name and title of ecrporate officer) Builder's License No ........ .~.~.0.'. r/.... ...... i. Plumber's License No .... F~ ........ Electrician's License No ........................ Other Trade's License No ...................... of land on which proposed work will be done .. ................................................ Location · Wilderness Point Fishers Is}tn. ti, NY... House Number Street Hamlet Coun ax Map No. 1000 Section 12..7 ........... Block 2 ..... Lot 8 Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use aud bccqpancy · single Family Residence · Single' Family Residence Intended use and occupancy ....................... Repair .............. Removal, .. 4. Estimhted Cost .... .4.0:0.0.0...I ...... 5. If dwelling, number o f dwellin~ units . Nature of work (check which applicable): New Building ..... ' ..... Addition . X Alteration ........ Demolition .............. Other Work ........ , ....... ./ / ~ (Description) ............... Fee. ....... ..... .............. ~'.--(to be paid on filing this application) ........... 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 type of use ............. ~ -6" Depth ' " 7. Dimensions, of existingstructu~es, ifany'.Froht........44'-6".......Rear .4.4 .. , .... ,[15.71Q,, Height 17J Number of Stories on, e Di with It ti dditi 44'-0" Rea 4.4.'7§~! mensions of same structure a era ons or a ons: Front r .... Depth 49'?7" ] Height 17' Nu be of Stories one Di sion of enti ~ructio F R D pth 8. men s re new cons n: 'rent .............. ear .... ....- ....... e ........ [-leight ............... Nmnber of Stories ........................................................ 9. Size oflot: Front 18694 2 Rear 167'86~ De-th 30.3:31' ................................ ' ......... 10. Date of Purchase .. Name of Former Owner dh m ..Lo I 1. Zone or use.district in which premises are situated .... .~ ............................................... t2. Does propos~,d ~onstrtlction vi61ate any zoning law, ordinance or regulation: . ....Nq ........................ I3. Will lot be regraded . N.q .... ! .................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises .L.?..M. qr.tin' .G.i.b.b.s ......Address ~ .}YPO01atqc] ~Y..][t,.Y.e.,N.~hone No/:'.~.//f..'~,.~',~'Y?)~ ~ Name of Architect l~U'~trJgg.!Sbii;q .~ ~B.u,r.tis. ...... Address3.1.1..W: .4.3v.d..S.t: .N.Y. ,1~..Y. Phone No.(.2.1.2} .2.4.07p.2pp... Nmne of Contractor A1 .Plan'.hoB.. Patnfmld ~ t~,~Z ' PLOT DIAGRAM ~ 6 ~,~ ~]' ~ ' ~cate. clearly and distinctly a buildings, whether existing or proposed, andAndicate all set-back dimensions from property lines. Give street and blocl number or description according to deed, and show street names and indicate whether interior or corner lot. U. STATE OF NE~/YORK "S ' ..... 4 .'~' r~. ~..~r~ · .~· . .- · I: .~ ~r f.['(.~. .~.~. .)'fl. . · · being duly sworn, deposes and says that he is the applicant (Name .... ~ ' ofmd~wdual s~gmng contract) i (Contractor, agent, corporate officer, etc. . , of said owner or owners, and is dgly authorized to perform or have performed the said work and to make and file this ~pplication; that all statements cogtained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manaer set forth in the application filed therewith. Sworn to before me this