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HomeMy WebLinkAbout12747-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z.1.2. ? .5.8 ......... Date ...S.e.p.t: :..7 ...................... , 198.6.. THIS CERTIFIES that tile building .... 2. n..d..~.~ o. r.,y..d.c..c}¢ ............................ LnnntlnnnfPrnnartv 205 Cedar Beach Drive West Southold House No. Street .............. ~l~/e~ County Tax Map No. 1000 Section '..~ 0 ........ Block ...2. ........... Lot .... 2. .5 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .S.e.p .~....1.2. ........19 .~.3. pursuant to which Building Permit No ...... 12747Z dated .S e p.t.... 22 .................. 19 .8.3., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tttis certificate is issued is ......... ..... ~..2.n.d..s..~ p?.y...d.e.c.k...~p..e.x..i.s.~.i.n. ¢..qn. e...t.a.m..i .~.y..d.¥?.~.~.i.n..~.. ................. The certificate is issued to Lothar Hertel (owner, lex,~ g~tttt~,~ X X of the aforesaid building. Suffolk County Department of Health Approval iq/A UNDERWRITERS CERTIFICATE NO ...................... N./..g ......................... Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) 12747 Z Date ....,)~!~ ...... ./..~.. ......... , Permission is hereby granted to: · ,,~ .~..~..~..~ ...... ~.~.~ .............. ' ...~.~...L.~..~..~. ...... ~. ................................ · ~~ ~..,.~.. ~,~.:. ~/~. ~'... ,o~...~ ........................... ~.~ ....... ...... ~ .................... ..~ ............... .... ~.~.~.~.~.~.. ....%L~...c..~...~...~..~q..,....~ ....... ~...~.... ..~ .~ ~ .................... ~ ~ ~ .j ,~. ~ ~ ~'r'~"~' ~-~"-";"~ .... at premises located at ....~..0....~..,....~?..[.~.......~...~..~...~/l.....~......~,)..~~.. ........ ~'":~'::::"'"'"~'~: ....................................... : ............. i'i":': ....... :i::::: .......... :": ................ County Tax Map No. 1000 Section ..... ..~.,..°1....~. ....... Block ....... ..~... ......... Lot No ..... .~....~..C ......... pursuant to application dated ..... ~ ............. - ..................... 19.~..~., and approved by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of ali buildings, property lines, streets, and unusual natural or topographic featu res. 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 instatla- 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 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. Certificate of occupancy $5.00 / ~_/$ 2. Certificate of occupancy on pre-existing dwelling ~/r land use $/ 5.00 3. Copy of certificate of occupancy $1.00 Date ......................... New Building ............. Old or Pre-existing Building "/' Vacant Land ............. House No, ~(~ ,, Str,,eet Ham/et County Tax Map No. 1000 Section . ..? ?. ......... Block ...~. ........... Lot ..... ~?~...~. ...... Subdivision ..... Filed Map ............................ No ....... ....Lot No .............. PermJtNo. /.,~..~,~J.~...;~, Date of Permit J'/.i?-/?~.AppJJcant .~.~.~,...~.~., .i _., .;~ ~..~..~.'.~.~.. , Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... ~' ............ Fee Submitted $ r~.. ~.~'. ...................... Construction on above described building and.permit, meres all appticab, le cocLes and regulations. Applicant .... ~.. ~. ~'. ~.//~.'-~.~.. ~.--;;....~."..~ ~ TOWN OF SOUTHOLD FIELD'INb?~CTION FOUNDATION (~st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING Ye INSULATION PER N. STATE ENERGY ~ C,~DE FINAL COMMENTS ADDITIONAL COMMENTS: I ,I DATE: NO'I:IFY BI 7~,,5 ] P0c' 1. f-OUN m,, E©R, 2. ROI DEPARTMENT AT AM 'FO 4 PM FOP. TIdE !NF?EC TIONS: qON -iTWO REQUIRED ~:-'D CQNC:RETE FRAM!~!C-', 8, PLUMBING ,' r!'x,,^~ ('"~IqT'RI~JCIION MUST pr ~- '""l "rE PiOR C O. /L[ ('nN';TIt';rt~IqN F, HAM MEET E"-AFF CqNF'-~.~UCTIOH & ENFRGY ( ODES h,l¢~{' RFSPONSIBI_E FOR ITM SiGN r~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Approved.....~..4...~..~...., 19'~ .'~,. Permit No. ] .~.?. Disapproved a/c ..................................... Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INST RUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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 premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 permit 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 Occupancy shall have been granted by the Buildilag Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable 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 in buildings for necessary i~tspections. ~. , (Signature of a~licafi~, or name, if a corporat'on') (Mailing address of applicant) / / ~ ~ .'~- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... ...................... ................................. Name of owner of premises ,~lj]~ .~..~..,~.. ....... fi.~, .~,, . .~'~..~. ....... ~20...'~T .~,.../~.~..~-11,~ ........ (as on the tax 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. ' ..................... 1. Location ofland on which proposed work will be done. . .~. .°.d?'{ . .Ji ?. ./. .,~. . . 6.~.z~. .~?. . .~°.'~.' -r. .~. . .~.'. . . .~.~.~.~ House Number Street Hamlet ' C;unty Tax Map No. t000 Section '..O .~.'. ~. ......... Block .... ~. ........... Lot. ~-~,~.~.. ...... ~ Subdivision..C~0.~. [3~..~. !P. .... ~..~./.~. ~. ...... Filed Map No...?..L) ......... Lot...4.~.~. ..... .~. / (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · . / C..,m., '. . a. Existing use and occupancy ............................... b. Intended use and occupancy ,~.' ' 3. Nature of work (check which applicable): New Building .......... Addition...~... .... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ! .. ,,~. (Description) dted C st ? Fee 4 Estim o ............ ~ ...................... (to be paid on filing this application) 1 5. If dwelling, number of dwel ing units ............... Number o f 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. r)imensions~of~i~.ting structures,- if any: Front .... ~.Z~. ........ Rear . ,~ ~ ....... Depth....~.~ ........ Height .. ~ .......... Number of Stories .../.~. ........................................ , .......... r)imensions.o.f ~ame structure with alterations or additions: Front .. 2 .~.6... .......... Rear ...~..O. ........... Depth:....~'/.~'. .............. Height ...... ~ ....... Number of Stories ........ 8. Dimensions of entire new construction: Front .... ~.,. ........ Rear . ./.~.'.~ ....... Depth [.~./. t~. * ight /. ? mb ' He . ............ Nu er of Stories ........................................................ 9. Size oflot: Front ../.a.~ .... j.' .......... Rear...//,ff~-.. ......... ... Depth .~.t~'~.~./,~'.~''. ........ 10. ~ate of Purchase ............................. Nejd} of~ormer Owner ............................. 11. Zone/)r use district in which pr~mises are situated .... ...~..~.~/~.-~... ;.~.... ........................ 12. Does proposed construction violate any zoning law, ord~nance or regulation: ....~-~..~. ........................ 1 3. Will lot be regraded ....! ................... . Will excess fill be removed from premises: . Yes 14. Name of Owner of premises .~..~.~../~.... ~'~ .~. Address ................... Phone No. Y.g.~'~?..9'.4..Y' ..... Name of Architect ..... t~',' ' '! ................. Address ................... Phone No ..... · ........... Name of Contractor ~..- . ~ ............ Address ./~o,,~... ~xxe-~ ..... Phone No. ~).y'.-..i~,/.~j... PLOT DIAGRAM Locate clearly and distinctly all; buildings, whether existing or proposed, and, indicate all set-back dknensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. sz^z OF ,( S S COUNT~(IF...~. , · , · .......... ~div~dal signing contract) .... being duly sworn, deposes and says that he is the applicant (Name above named. ~ of said owner or owners, ~d is du~y authorized to perform or have perfumed the said work and to m~e and file this application; that ~1 statements cont¢ined ~ this application are true to the best of his knowledge and belief; and that the work will be perfumed in the manner set forth in the application filed therewith. Swum to before me this .....