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Home My WebLink About12144-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building accessory building ( gazebo ) 50550 Main Road, Southold~ New York Location of Property ............................................................... House Ho. Street Hamlet County Tax Map No. 1000 Section 0 7 0 .Block 02 .Lot 0 q 3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore ffled in this office dated January 26, 19 8.3pursuant to which Building Permit No. 12166z dated . . ?.e..b.r.u.a.r.y...7.~ ............. 19.8..3, 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 accessory building (gazebo) William A. Rusch & Virginia L. Rusch The certificate is issued to ........................................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ....... iq/A N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 Permission is hereby granted to: '~.:, BU I~lng Ilhspecto~. ~? ~ ........................ at premises located at ..:.,.....; .......................... a..: ,.,...,.. ~u~ty Tax Mop No. 1000 Sectior~.~.4..,~.:.:,. pu~:~anf tO a~ltcotlon ~and bpproved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Bo Instructions This application must be filled in typewriter OR ink, and submitted m ~ 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 p~operty showing all 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 buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. 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 5 .Updated C.O. $15.00 $15.00 Date ..................... , .... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .. ~ .~..~..~. ....... ~.~.' .~.t~. ~.0.A.D.....~.O.0.-~..C,,~?.~,...~J: .~/.,, I./.~.~ .[ ........... House No. Street Hamlet Owner or Owners of Property ~ .~ ?,L.\A. ~.,~., .~.. ,~.~.~, .qL£.~ J~ (~,. ,~, /~O& t,!~ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No, .[~.~j ,~!.. Date of Permit.~./.7/~ ..... 13...Applicant .~.{~.. ! .t..~; ~.~ .~¢~...~.. f~.$ .<.. JJ. .......... Health Dept. Approval ........................ Labor Dept. A~proval ........................ Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary CertiCppte ..................... Final Certificate ....................... Fee Submitted ~. ..... ~[.~.......~, ...... Construction on above described building and permit meets all applicable codes and regulations. Applicant .~-')~'~.-~:' ~,-~"~ Rev, 10-I0-78 co ;q735 FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & FLUMBING INSULATION FER N. STATE ENERGY G,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined.~'...: ..... ,197.,~ Approved. ~ ~.. Z ...... l~. me~mit No. ~,,~,~,o,~ ~ ........................ '7' "'/ .... ~~ /)/ ~ / ................................ (Building Inspector) APPLICATION FOR BUILDING PER~IT Application No...//.c.~./..5~..~. ....... INSTRUCTIONS a. This application must be completely filled/n by typewriter or in ink and submitted 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 build/rigs 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 issued 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 Building 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 building for necessary inspections. ~ / .... .,:. . . .x.¥ :¥//..( . (Mailing address o£ applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ' ............... ..x~.~:4~ ..... i .............................................................. Name of owner of premises.. ~.d.~.~'..~: .7....~.~..'¢~/.'~.X..4.'~?.X ~ ................................. (as on the tax roll or latest deed) if applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Bnilder's License No ....... .~..?.~. ............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ,?:,.:.,2. 1. Location of land on which proposed work will be done .................................. ...... .,C/?~?--T.~.. .... ..xy~?. ~.: ................. -__Z:.o,~-~,~,.~.~,. ~4'/. ................ House Number Street Hamlet County Tax Map No. 1000 Section ..... .~'/~. t~. ....... Block .... ~.~..~.. ....... Lot .... l.: ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) !. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~.. ,~..~:~..'"~/.'Q/../..~.Zt-( .~.. ................................... b. Intended use and occupancy ......................... ~ .......................... 3.. Nature of work (check which applicable): New Building .... ./. ·.. Addition .......... Alteration .......... Repair .............. Remov.al .............. Demolition .............. Other Work ............... ..................... Fee .AC .............................. 4. Estimated Cost ...: .(4.~ ~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling uflits..............."-'--' Number of dwelling units on each floor ................ If garage number of cars ~ ~' .... 6. If busin0ss, commercial or mixed bccupancy, specify nature and extent of each type of use .... ~ .............. 7. Dimensions of existing structures,i if any: Front....~r:~... ........ Rear .............. Depth Height ............... Number. of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Dept ....................... Height .............. . .......... Number of Stones ...................... 8. Dimensions ofl~nt~ ne~w construction: Front/~,E.,~¢O~..~:.ff./rf~Rear .............. Depth /.o. ,/(.,k/dZ,/ Height ,:,aq~ ,~.: Number of Stories / .... / ....... 9. Size of lot: Front ............ i .......... Rear ...................... Depth ...................... 10. Date of Purchase ..... i ........ Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated <Z~Od~/;/,)~.~.:9 . 12. Does PrOPosed construction violate any zoning law, ordinance't~r'regulation: i. ~.t~'.-47.~.~. ..................... 13. Will lot be regraded ........... ., ................. Will excess fill he r,e~oved from premises: Yes No 14. Name of Owner of premises -(.'-~././.~.' .~-. ~2.~-Y~.,,... Address . .~,,,q'./~.' ,~o.~7z~9,~'Phone No ................ 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, a_.~nd show street names and indicate whether interior or corner lot. -- , STATE OF NEwYo~-~K, (Name of individual signin~ contract) duly sworn, deposes and says that he is the applicant 1bore named. ' is the .................................... . .......................................... : (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and £iIe this ~pplication; that all statements contaified in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner ~et forth in the application filed therewith. iworn to before me this ........ ...... dayof. .... ~otary Public, ........ .~, .... ~ ~.~.... County ~"'--) i ,//c--~/// ~~-~>~':~ ~~ ....... :.-. :., :'. · / .4.'/.~:V~ ............... ~ : uO~*rv ~t.m, S~te 0?jr, ~or ~ / flSignature m applicant) NO. 52-8125850, Std[Ol~ uO~t~/ ~ /