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Home My WebLink About10523-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22295 Date APRIL 28, 1993 THIS CERTIFIES that the building Location of Property RESERVOIR ROAD House No. County Tax Map No. 1000 Section 9 Subdivision ADDITION FISHERS ISLAND~ N.Y. Street Hamlet Block 8 Lot 3.3 Filed Map No. Lot No. conforms substantially to the Application for Bumldlng Permit heretofore filed in this office dated NOVEMBER 8, 1979 pursuant to which Bumldin§ Permit No. 10523-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 is DECK ADDITION TO DWELLING "C" 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 Build].ng fn~pector FORI~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST [~E KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 105~3 Z Permission is hereby granted to: ....... ./~,~.... ~..,...m,,.~o4.~' ............. ..~...~..z..~.../...~/..> ................ Z,~....4~,,~ ....... ~-.:zc~'~:~ , , ~-o .d.~ ,,c,-~.~¢,.,.~... ,~,,~,::.,r,.,..~..~..."~.¢,. x...,....x~.. ~ .,: .1,'.~. ....... ~ ............. ........................................ ' .~. ot pre,-,,ses,ocated a,,~..~....~ ....... ~~""'4" ......... ' ...................................................................................... ~..~.~.,,,~P~_~.....~~..?...-.~ ..... Building Inspector. Fee $../..~....~...~... .... tor 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 l~ to the Building Inspec- tor with the foitowlng; for new bulldings 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-g 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 property 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 New Dwelling. $25.00, Accessory .$ IO.O0 Business $50.OO 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. $ 50.00 Date .... A. pT,i.1., ./~.,, ,1.~.3 ...... NewConstruc tion X. Old or Pre-existing Building Vacant Land Reservoir Road Fishers Island Location of Property ................................................................... House No. Street Ham/et Rounsevelle Schaum Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section . ,0.0,9.: pp ....... Block ....0.8...0.0. ...... Lot.. 9,0.3,; 99.3 ...... Minor Subdivision Plan of Subdivision . .Po..b?.r.t..Wt..B.r.o?.k.s ................ Filed Map No ........... Lot No ..... .2 ........ Heelth Dept. Approva~ ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval . . .~.u.l.~:..2.8/..1..9.8.0. .... Request for Temporary Certificate ..................... Final Certificate ....... X. ............ ... Fee Submitted$ 25.00 Construction on above described building.and permit meets all applic~]~le~codes and regulations. Applicant i~..~.~J.. ~.~.v~.-- ;~ ;.~...-.. ............ Rounsevel le Schaum R~. 10-10.78 FIELD IN~PEC~ION COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMEN~S: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c .......... 'i-}'~[~'~'' '~i i ' ' ~ ~ i ;i~/~ ................ .... ' " . i.. ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date A/°u' 8t 19 79 INSTRUCTIONS r. 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 BuildingPermit 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 Regulattons, 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) .......... (Mailing address of apphcant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises Robe.~ W. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate of~fic..~er) Builder's License No... ,/I/~,`,` ./~, .o'.~?. ~,, ,/47,~{.5 C-~ Plumber's License No...~/~. ................... Electricmn's License No../1//~.. .................. Other Trade's License No..A//.~ ................ 1. Location of land on which proposed work will be done. /1/~J/. co/trt~ .~ ~.-~t~O~.~ .~ ~/~o~./~otT~, ..... House Number Street Hamlet County Tax Map No. 1000 Section . .0~.. .............. Block ..0~. ............... Lot .0~..~ ................ Subdivision..~.~.t~v. eqg..~n..c_~..~ .................. Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of pxop~osed cof~struction: a. Existing use and occupancy ...... ' .......... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition .X. ........ Alteration .X... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4 d C ~.1 0190 00 . Fee ~[,q,00 ....................... . Estimate ost .~ , ..... . ................................. . i (to be paid on filing this application) 5. If dwelling, number of dwelling ,units ,/. ............. Number of dwelling units on each floor .g//fl. ............ If garage, number of cars ...A/~.. .................................................................. Height ............... Number of Stories .. ? .............. ~. ...................... ._ ............... Dimensions of same structure wi~h alterations or additions: Front .3..oxy. ............. Rear . .~5q4~. ............ Depth . .~.~. ................ !. Height ...S..az~. ................ Number of Stories..~.ar~ ................. 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ~o~,.,. [~?~.. i ................. Name of Former Owner . ~/~... ~ove~mrttar~ ............. 1 1. Zone or use district j~t which premises are situated ................................................... 12. ' ' ' ' ~ ' .1 ' ' ' ' : .......................... 14. Name of Architect .......... ~ ................ Address ................... Phone No ................ Name of Contractor ......... ? ................ Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all .bmldmgs, 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. Swtv £ CO/V#. STATE OF ~ ;S.S COUNTY OF ................. ........ ~a/~:~/~... ,~]~4 ....... ' .................... being duly sworn, deposes and says that he is the applicant (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 application are true to the best of his knowledge and belief; and that the work will be performed in the mannTr set forth in the application filed therewith. Sworn to before me this , ': :~ ~ . ...... ........... day ................. Notary_ Public, . ....... ...... : .... -- NCt I'AP, Y PUBL~(I , (Signature of applicant) MY C01~IMISSI0~r,~X~I~.S ^I~fllL ! 1{}82 2~ 2.80' ~e pole 2~0