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Home My WebLink About10521-zFOI~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22293 Date APRIL 28, 1993 ADDITION THIS CERTIFIES that the building Location of Property RESERVOIR ROAD House No. Street County Tabx Map No. 1000 Section 9 Block 8 Subdivision Filed Map No. FISHERS ISL~, N.Y. Hamlet Lot 3.3 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 8~ 1979 pursuant to which Building Permit No. 10521-Z dated DECEMBER 17, 1979 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued ms DECK ADDITION TO DWELLING "A" AS APPLIED FOR. The certificate is issued to ROUNSEVELLE SCHAUM (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 Bu'ilding Inspec~ 1~01~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHO~D, N. Y. BUILDIHG P,ERk~IT (THIS PERMIT MUST BE KEPT ON THE P~EM~SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10521 Z Building Inspector. Fee $./~... ............ ./ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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 tile 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~Coperty 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 occupency New Dwelling,S25.00, Accessory '$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5. Updated C.O. $ 5 0.0 0 Date .... A.p,r.i.1., ./.~.,..],9. 9.3 ...... NewCons truc t ion..X,... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ....................... ,R,e.s,e,~. ¥,o.~,~,, ,R,o,~,d, ......... House No, Street Ham/et Owner or Owners of Property . . .~, ,o ,u.~, s, e, y,e.~,~,e,, .S.qh, 9~,m' ................................... County Tax Map No. 1000 Section . .0.0,9,: ,0,0 ....... Block ... ,0.8...0,0, ...... Lot.. ,09.3,;9.0,3 ...... Minor Subdivision Plan of W: .B.r.op.ks Filed Map No Lot No 2 Subdivision. ,Rg.b~. ,'F~c. ............................................... Permit No..~. 0..5.2.~.... Date of Permit/,~//7/2.~.Applica~t. ~ ..... ~.~ .......... Health Dept. Approval .................. Labor Dept. Approval ............ Underwriters Approval ........................ Planning Board Approval., ,E,u~.~, ,2,8/.. ~ ,9.8,0.,,.. Request for Temporary Certificate ..................... Final Certificate ...... ~, ................ Fee Submitted $ ,2. ,5: ,0,0. ...................... Construction on above described building and permit meets all applicable codes and regulations. Appli ..... cant ;; ..................... Rounsevel le Schaum Rev. 10-10.78 ~IELD INSPF~CTION COMMENTS FOUNDATIOM (Ist) FOUNDATION 2. ROUGH FRAME& PLUMBING (aha) INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..~7.-7. ................. k./? ........ / APPLICATION FOR BUILDING PERMIT Application No. /~(~5~t~/ Date fl.o.v.: .8., ............ 197.~.. - INSTRUCTIONS ~ 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 apphcant. 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 1S 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 inspections. (Signature of applicant, or name, if a corporation) .oed. .............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ?,O,6..~. ,~J.../?.~fl, q~ .......................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Z~ ~ .... Plumber's License No ..... ./V./.~ ................. Electrician's License No ...... /~/./] ............. Other Trade's License No .... /Y./.~. ............... ,UrVl¢.C tt~t/ 1. Location of land on which proposed work will be done. /~/~..coAr~'~.~-,~O~ ]~oad and.gJdr~]utop ]'~oad, ..... House Number Street Hamlet County Tax Map No. 1000 Section ~ ............... Block . ~ ............... Lot..OQ.J ............... Subdivision..~..e~..~.~y.et/' ~..~. ................. Filed Map No ............ .~.. Lot ,,~. ............. (Name) 2. State existing use and occupancy of premises and intended use and occulJancy of proposed 9onstructiorfi- a. Existing use and occupancy .~..' .~-&.....a~... ~dd-~. ..,.. b. Intended use and occupancy 5'/~ ~'am/~ ]~ 3. Nature of work (check which applicable): New Building .......... Addition .. Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4 Estimated Cost $1~000,00 Fee ~.15.,.0~. ' (to be paid on filing this application) 5. If dwelling, number of dwe~g units ............... Number of dwelling units on each floor ................ If garage, number of cars ..... i .............................................. Atz~t ................. If business, commercial or mixed occupancy, spec/Iv nature and extent of each type o£ use ..................... 7. Dimensions of existing structure~, if any: Front..t(2. ........... Rear . .0.2 .......... ~. Depth..23' ............ Height ................ Number of Stories . .2. ..................................................... Dimensit3~ of same structure with alterations or additions: Front .[..c~. .............. Rear . .~ .q~. ............. Depth. ~ ................... Height . .~..a~.. ................ Number, of Stories..~..aCt,~. ................. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ........... ' ........... Rear ...................... Depth ...................... 10. Date of Purchase /1/or../5}7~. :... Name of Former Owner .(]~....C~.v.e,,~ 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed c'ons'truction violate any zoning law, ordinance or regulation: ./YO .......................... 13. Will lot' be regraded .f~-~ ...... i ................... Will excess fill be removed from premises:~, Yes ' (No.} 14. Name of Owner of premises . ....... Address ..... Phone No. ~,~.~P, JT. ....... 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 ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF !S.S COUNTY OF ................. Roboct , (Name of individual sig~ing contract) above named. ., ,' ,. He is the.. ........................................................................................ . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy authorized to perform or have 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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... ?.~. ........... day of... · ./~., ............... 197.~.. ry Public, /l/Ca/J, ~r/dqr~ ..... ~..,._.: .............. County · ' I NOTAP'Y PUBLIC (Signature of applicant) being duly sworn, deposes and says that he is~ ,/