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Home My WebLink About9624-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z1~733 Date July 31, 86 THIS CERTIFIES that the building ..... one s tory addition 50550 Main Road Southold, New York Location of Property tt/3~sb k/d ....................... 's't/o3i ....................... $t3,hiet County Tax Map No. 1000 Section ...0.7. 0 ...... Block ...0.2 ........... Lot .... 0. q. 3. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .~ a. ?.c.h.. ] ~ ............ 19 .7.8. pursuant to which Building Permit No. 9 6 2 6 z dated ... ~ .a.r.c.h...q., ................ 19 7. 8.., 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 ......... One story addition to existing one-family dwelling. ~ William A. Rusch & Virginia Rusch The certificate is issued to ........................................................... (owner, 16~e~X ~g~x x of the aforesaid building. Suffolk County Department of Health Approval .......................................... N392000 UNDERWRITERS CERTIFICATE NO .................................................. Building inspector R~v. 1/81 TOWN oF BUILDING TOWN SOUTHOLD~ N~ Y. ' (THIS PERMIT MUST BE KEPT ON THE PREMISES ,UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 962~ Z Date ..... : ..... ./. ............... 19. pursuant to application dated ............. ~4¢~/. ,~..': .~....-.,~ ......... :....., 19..Z'.~.,' and approved by the Building Inspector. / Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTiFiCATE OF OCCUPANCY Instructions in duplvicate~o A. This application must be filled in typewriter OR ink, and submitted : ~he Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of properly with accurate location of all buildings, property lines, streets, and unusual n.atural or topograph c features. 2.Final approve 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 ail 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 bLJildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to preoare 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 4.Vacant Land C.O. $5.00 $15.00 Date .......................... Old 'or Pre existing Building Vacant Land New Building - Location of Property , ~.~o~ ~.~ ................................... ,' ...... Hou¢e No. Street Hemlet Owners of Property 4) ,L ~ ' ~ · ' . .............. Owner or ..... · .......... kt ................. County Tax Map No. 1000 Section ............... Block ............... Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ...... -,- Date of Permit .... cant ~ A,~A ,)~ (L ~-¢ .. Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ...................... Planning Board Approval ...................... Request for Tempor~rtif~a~e ................... Final Certificate ..... ~. .............. ...... Construction on abovo do~ribod ~uildin~ and p~rmit meet~ all ~plicablo eod*s and r~ulations. Applicant ~.~tf¢~ , , , THE Juno 26~ THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..,,,..,,..,,..o.o./,,,, N392000 Soufhol d~ L,,I. inthefollminglocation; [] Basement [] tatrt. [] 2nd Ft. Ou*sl de Section Block ~t ~exami~on JU~O ~a 1~7~ a~found~incomplia~e~iththerequi~ntsofth~. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES FLUO~IESCENT 7 9 8 7 ~WEES FURNACE MOTORS F~TURE APIqJANCE FIBERS SERVICE DISCONNL~"T S E R V I C *.w.o. ~o.~ H~-t :-~ ^. W.O. .0. O~ mm'uts ^.w.o. cc. COaD. Oe m.L~ O~ ~ur~t R~land Elec, Co. P.O. !~o× 143 ~,!a t"1' I l'u ck ~, N.Y. 11957 Llco242E This certificate must not be a~tered in ony manner;, return to the office of the Board if incorrect. THIS may be identified b~ BI ALTERtD IN N. Y. / 7k . Examined ...... ...'~,~ :~.......; ............ ~9~ ~ ~ ~plicati~ ................................. ,.. ......... ........................... ............. . .................................................................. ~ ......... rh"'h"~ .............. ................................ i~:~;~"i~g;i ............ APPLI~TI~ FOR BUILDING PE~IT ' ~r.'~ ~_ ~ o. This a~licotion m~ ~ c~plemly fill~ in by ~ewnter~:oe in ~ a~ s~mi~ in t~l~ate to ~e Buildi~ Insp~tor, with 3 ~ of p~, ~te pl~ plan ~ ~e. F~ ~o~i~ ~ ~ule. b. Plot plan shying I~ation of lot and of buildings ~ premiss, relationship to ~jo n ng prem ~s or public stree~ areas, and g v ~ a detoil~ description of I~ ofpr~ must ~ d~n c. ~e work c~ered ~ ~is a~lication ~ n~ ~ c~menc~ before issuance of Building Permit. d. Upon appr~al of this application, ~e Build~ Ins~tor will i~ue a Building Permit to the a~licant. Such permit shall be kept on the premiss ~ailable for Jn~l~ ~h~t ~ ~ e. No building shall be ~cupi~ or u~ in whole or in ~ for any pu~me wh~er until a Ce~ificate of ~cupancy shall have been granted by the Building Insp~tor. APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Build~ Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appl~able Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, 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 ir~ buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... o~,~ . . . Name of owner o'~ prem ses ~ ~ 0,.,. ~ ' If applicant is a corporate, signature of duly authorized~fficer.' ' '' ~ . ' ' Builder's License No ..................................................... Plumber's License No ......... .~.....~,._..:....._.f. ............... Electrician's License No ............ ; ................................ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .~c~:~.~.~.~..~..~.~..i~..~..~...q.~..~.~.~...~.~..L.j~.~j~:.~.~ ................................................ Municipalit~ State existing use and occupancy of premises and intended'use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~..~.[ ...... ,.~....-~..4~.~.,...O~;~'~'~J~.~.~s' ................... .... b. Intended use and occupancy ...... ~ ~,.~ ........ ~,~,/~... Z;~,~/,/. ~. ? 3. Nature of work (check which applicable): New Building.. ................. Addition L/ Alteration .............. Repair .................. Removal .................. Demolihor ..................... Other Work .................................................... ~,~, (Description) 4. Estimated Cost ............................................................ Fee .......................................................................................... (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 O~ ................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............. ? ............ 7. ~2~s.ony~f~g st~;Z~;;,~ ~,~o,~t ....... .~.~ .... Rear ...~::~:.~~, .............. Depth ~.~... Dimensions of sa~e structure with atterot~ns or additions: Front ......... ~Z.~.~ ......... Rear ..... ~....~..' .... Depth .....~~ Height .... Z.~. ......... Number of Stories ...... ~.~ ............... 8. Dimensions of entire new construction: Front ..... ~.~......~.~ ................. Rear ........................... Depth ,,~-~..,~.~,~, ........ ~.~,,,~ Height ~.~ .............Number of Stories .......... ............................................................................................. 9. Size of lot: Front ...... ~.~.: .......................................... Rear ......~.9.'. ............................ Depth ..~.~.'. .................. 10. Date of Purchase ...... ~..~......~.~.....~b. ................. N~e of Former Owner .~,~.~,..~ .............. 11. 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 ~.~..~..~hone No. ~Z.(¢~.~ ..... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate dearly 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 NEW~/'~'O, RI, f4, COUNTY O F,,,~- .//C-,,~.. ...... .................................................................................................~ being duly sworn, deposes and says that he is the applJcam (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 have performed the said work and to make and file this application; that all statements contained in this applicction ore true to the best of his knowledge and belief; and tha¥ the work wilt be performed in the manner set forth in the application filed therewith. Sworn to b~,~e me this ./..-~'-- day of ...~..~..~...~..../.. , 19 ~ (Signature of applicant) rs':~:,y Ft,'fi;o, :"o',-, o' l',le,,,; York APPROVED AS NOTED DA'rE: ~/f /7~ FEE://~-'" BY: NOTIFY EUII.~iNG DEPARTMENT AT~ 765-2~60 9AM ~o 4PM FO~ ~E~UIR, ED INSPE~ZiONS: 1. BEFORE ~AC~(FH,LING FOUNDA- 3. BEFORE COV:~[~:; F:i~S OF ANY 4. FINAL WHeN ~G.; C~ ZPLETED NOT RESPONg[~ FC,~( DESIGN "OR CONSTRUCTION J. ALL CONSTRUC:[I~N ~ST ~/,EET RETIREMENTS OF ~LY. STATE ['Xi~JTiNG L+