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Home My WebLink About7528-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-6160 DateMAy 27, 1994 THIS CERTIFIES that the building ADDITION Location of Property 400 (P~T RD ~20) MAJORS PATH House No. Street Hamlet County Tax Map No. 1000 Section 54 Block 2 Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 9w 1974 pursuant to which Building Permit NOo 7528-Z dated SEPTEMBER 9, 1974 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is A DECK ADDITION TO A ONE FAMILY DWELLING The certificate is issued to EUGENE L. FISCHER JR. (owner, lessee or tenant) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A '-~ ~ // BuiIding Inspec=or Rev. 1/81 1~01~ ~0~ ~ TOWN OF sOuTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOL~, N~. Y. N°. BUILDING ~ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: at premises located at ..t,~;~O~S..~..~t,~3. ......................... ~ ..................................................................... ................. ~; ............................................ o~t~t~ 0~¢I, ........ ~ ..................................................................... pursuant/to application doted ............................. ~O1~.~ ....... ~ ....... , 19.~.~,.., and approved by the Bu Iding / Inspector. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ............... ~. ........... Street conforms substantially to t~e Application f~uilding~Per~t heretofore filed in this office dated .............. ~.,~ 19~ pursu~o w~h Building Permit No. '~ dated ............. ~..~.~., 19 ~, was i~u~fand conforms to all of the reqmre- ments the provisions ~he law. The occupancy for which this certificate is applicable The certificate is issued to ~&'~F~Z~ ~. F/.~ (own , ot the aforesaid building. Suffolk County Department ot Health Approval ..... ~: .~ ......................... UNDERWRI~RS-'~FICATE No ]uilding Inspector FOK?~I NO. ~ TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instruetlons A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil 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 installations, 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 p~'evious owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buddings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date . ../..~...T .~...~..?...~.. ........................ New Building ................ Addition ..~. ......... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .....~-~...~......../~....~...~.~.~......~..~'(.......~..~..(--~..~.~........~.'...~......./../..~.ZZ ..................... Owner Or Owners Of Property ............................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~.,J.~...~..~....... Date Of Permit ..~..T.~:..~.~..,Applicant ....~.~.,~./~.....~...:......~../..~..~l(/..~..~..~. .......... Health Dept. Approval ............................................ Labor Dept. Approval .............. ~C.': .............................. Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary-¢eJ:J~i-ficate ........................................ Final Certificate Fee Submitted $ .................................... Construction on above described building and p,~rnit mee~ts,all appl~cable code~d re~lulations, Applicant ...... ~ .............................................................................................. Sworn t~before m~?.h~ ? ./ /,-~/ ................ d~f ............................... ~..~:;,~,~,- (stamp or seal) ~ ~/~;J~' Notary P ',..~~t3 Jugm~ T. BO~N :-- '~2 1~011~ NO. 1 BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application N '.o~....Sf.. ~ .~..~ .............. Disopproved~ ............ ~" - APPLICATION FOR BUILDING PERMIT -~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and subm tted ntr p icate to the BuiJdin~l inspector, with 3 sets 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 prem sas or pub c streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port of this application. 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 issue a Building Permit to the applicant. Such perm t~ shall 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 Occupa,~,%,' shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to tl~e Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and Other applic~able Laws, Ordinances or Regulations, for the construction of buildings additions or alterations, or for removal or demo t on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections (Signature of applicant, or name, if a corporation) ........ (Address of applica~'~i .................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ................................................................................................................................... Name of owner of premises ....~...~..~...d'...,~....~.......~...........~.../.f:..~.../~..~....' ..~..x/_~ ........................................................................... applicant is a corporate, signature of duJy 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 ............................................... 4 1. Location of and on wh ch proposed work w be done Map No ' ~- L,,o_t No Municipality 2. State existing use and occupancy of premises and intended use and,~]:~_c~,_~p~sed construction: a. Exisiting use and occupancy .~...' ............. ::..~.~../.~...~/..~. ....... ~ ............... ~...%. ................................. b. Intended use and occupancy ....... ~..~.~.t~ ....... ~.c...~...~. .......................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition ....X.. .......... Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) (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 of existing structures, ir any: front ............................................. Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ~/L'.( ... Rear Depth ~1~ ' Height ......~.~ ......... Number of Stories ~ 8. , Dimensions of entire new construction: Front ......... ( .......................... Rear ....... I..(? .................. Depth ........................ Height .....; ............. Number of Stories .............. '~......: ................................................................................................. 9. Size of lot: Front ......... .~.~..~.. ..................................... Rear. ~ / 11. Zone or use district in which premises are situated ....... ..~..~..~;.L...Cg.. ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~ ............................................. 13. W~II* lot be regraded' .Z~....~. ................. Will* excess fill' be removed from prem~ses:-¢--)--)~* · " ~' 'J 'Name of Architect ...........~ ......... ', .............................. Address ' " ..... ~ ..................... Phone No. '- Name 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 and indicate ............... ~ ......... .~:..: ................................................................ being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 ti,at the work will be performed in tl'je manner set forth in the application filed therewith. Sworn to~b~./~e me this ,~' ~ -- - -- ///' (Signature of applicant)