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Home My WebLink About20395-z?OUNDATION ( 1 s t) FOUNDATION (Pnd) 2. ROUGH FRAME & -FLUMBING INSULATION PER N. STATE ENERGY CODE FIliAL ADDITIO~;A'L COMMENTS: I~)~'M* ~0. ~ TWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT frills PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 20395 Z Permission is hereby granted to: ....... ~.~.....~....~u~:... ............... ..... ~..~,~.~.....~.:.~.,__ ~ ...... /.~..t~.~. ....... , _ at p~ises ~o~oted ot....~.~.~......~a...~.... ~.~..................... · ..... ..... County Tax Map No. 1000 Section ....0...~.~...~':. ....... Block ...... .~..(~. ....... Lot No ...... L..;; ............ pursuant to application dated ..... ..~~ .......... ./....~ ........ , 19.~....'~., and approved by the Building Inspector. Fee $.~."...~.. Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTNENT TOWN I/ALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6.Submit Planning Board Approval of completed site plan requirements. ;3. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1.Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees l. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Building - $100.00 3.Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Coramercial $15.00 .,ew Construction ........... Old Or P, re-existing Building ..... . House No. Street Hamlet O · nwer or Owners of Property .... . ........................ County Tax Map No 1000, Section.. .~.~"' Bloc . .. '-;ubdivision ......... ........................... Filed Map.. . Lot .... Permit No ................ Date Of Permit ................ Applicant ............. Health Dept. Approval ...................... .... Underwriters Approval ..................... Planning Board Approw]l ........... .',equcst for: TempOrary Certificate ........... Final Certicate ..... ['ee Submitted: $ ............................. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~...o~..~.1.., 19~ ~ Approved .~t°"~u-~ ~J~.....~.l.., 19 ~.2~. Permit No..~...~.~ .~...~. Disapproved a/c ........................... . . ....//~ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CllECK .................... SEPTIC FORH .............. CALL . - MAIL TO: 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 cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ,hail 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or legulations, 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, housin~code, and regulations, and to tdmit authorized inspectors on premises and in building for necessa .ry~ ~ · . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ~...~.~.~...y...: .... .~...~ .... ~..~.~- ............. . ........................ rem ~ t~/~// .~.~ ..... /~'~./~.. Name of owner of p ises ............. (as on the t,~(x 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 ...................... Locat on of land on which proposed work will be done ....................... · .. . .... .... .... i.,...:.i'.iiiii.ii.iiiiiiii..iiii.i House Number Street Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises aml inte. nded use and occupancy of pro/posed construction: a. i tin usea doccupancy .... ....... ..... b Intended use and occupancy 3. Nature of work (cheek which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost .............. ........................ Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling u~its ............... Number of dwelling units on each floor ................ · If garage, number of cars ...... i ........................................ ~ ................. ~ ........ 6. If business, commercial or mixed ~ccupancy, specify nature and extent of each type of use ..... '. ....... ; ....... 7. Dimensions of existing structuresi if any: Front ......... ". .... -. Rear ....... .. ...... Depth ................ Height ............... Number of Stories .................................... ............. i ...... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... i' Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ......................................................... 9. Sizeoflot: Front ............ ~ .......... Rear ...................... Depth ...................... 10. Date of Purchase ............ I ................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate 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 ..................... Address ................... Phone No ................ Name of Architect ........... i ................ Address ................... Phone No ................ Name of Contractor .......... ................ Address ................... Phone No ................ 15. Is this property within 3Q0 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southoid Tqwn Trustees Permit may be required. PLOT DIAGRA~ Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nfimber or descriptioh according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, COUNTY OF ................. NOTIFY i3LI]L.O~NG DEPARTMENT 765-1802 9 ~qt TO ~ PM FOF~ FOLLOWING 1. FOUNDATION I'WO ~:QLJt~ FOR POURED CONCRETE 2, ROUGH FRAMING & 3. INSU[ 4 FINAL CONSIRUGTION MUST BE' COMPLETE FOR C,O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE STAT~ CONSTRUCTION ~ ENERGY COD~$, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS S.S ............................... i .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) tbove named· : % is the (Contractor, agent, corporate officer, etc.) if said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~pplication; that all statements, contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner s4t forth in the application filed therewith· ;worn to before me this ' N ;'; ' '"'" ~ .............. · 6, Suffolk ~6~6~ (Signature of applicant) Term Exptree June 12, 1 ~'