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Home My WebLink About11215-zFORM NO, 4 TOWN OFSOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate 'Of Occupancy Z~4830 Date ' Aug.u?t. 2.2 198.6. Location of Property .... ~ ............................ House No. Street ttamle~ County Tax Map No. 1000 Section 022 .Block 0. 4. Lot 02 ~ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated J.u.n.e.. ~., ............... 198. ~.. pursuant to which Building permit No. 112.15 z . .. dated .d.u.n.e...29., ................... 19.8. ~., 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 ......... The certificate is issued to ..... Robert R. Sch?.oed,~.P.~ Sp .... of the aforesaid building. Suffolk County Department of Health Approval ................ .I.N/fi. ...................... N571076 UNDERWRITERS CERTIFICATE NO ................................................... Rev. 1181 InspeCtor .... Sou~HOi · BUILDINg! PERMITI' (THIS PERMIT /~UST BE KEP N H,[ I ILl COMPLETION OF THE WORK A H E : · Date at p~emise~ located at .......... JLL and ~approved by the FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instruotions ~-n dupl±cat:~ A. This application must be filled in typewriter OR ink, and submitted V :~:o she Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all bu Idmgs, 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 mstallat'on 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: I. 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 preoare 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 $15.00 .......... ~) ~) ,C~, g B New Building ~ ......... Old or Pre-existin uilding ............ Vacant Land ............. ......... ....... Location of Property .................... ' ...... Ham/et Hou~ No, ers of ProperW ' ' · Owner or Own ...... ~ ................................. County Tax Map No. 1000 Section . ~,~ ~..~... Block...~.~ ....... Lot...~.~. ~ ..... Subdi;~;on. ~.~ .~ .~ .~ ~ ~.~.~,~ ~.~. Filed Map' NO .......... '.~ot No.. ~.[ .~.,. ~.. ~/~/~ Date of Permit ~/[~. Applicant Permit No ..................... Health Dept Approval Labor Dept Approval · · Planning Board Approval ~ Underwriters Approval · Request for Temporar~rtificate ..................... Final Certificate ....................... Fee Submitted $ ............... Construction on above described braiding and permit meets all applic_abl9 codes end, regulations, Applicant .. ~ ................ Rev. IO.lO,7e 1001071 THE NEW YORK BOARD OF FiRE UNDERWRITERS BUREAU OF ELECTRI~IT~ 85 JOHN STREET, NEW YORK, NE~/~)_[~K 1003~B THIS CERTIFIES THAT / only the electr~i~ ~eq~i~ment ~0 ]~ ~ des~ibe~ be ~, ~and ~3~{~-l~~ ~.'~D~llc ~as~ ~t ~: pp ~,~: 'on number in t~ pre,iises of FIXTURE OUTLETS SWITCHES [] lstFl. FIXTURES FLUORESCENT [] 2nd FI. 0~'t1~ Section Brock and found to be in con/Pllahce with the requirements of this Board. RANGES OVENS Lot EXHAUST FANS UNIT HEATER SYSTEMS OTHER APPARATUS: C E FIELD INSPECTION ~ 1. FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINA~ ADDITIONAL COMMENTS: 76S-1802 BUILDING DEP'T, INSPECTION FOUNDATION '~ST [ ] ROUGH PWG. [ ] FOUNDATION 2ND [ '1 INSULATION [ ] FRAMING REMARKS: [~NAL FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL ~o.~ ...... ~ ......... ~ ......... ~.. ~~...~. ........... 1~ .~../.. co~.t~ ~x~v ~o, ~000 ~tio, ...~ ..... ~;o~ ...~ ....... ~o~ ~0 ~ ........ RV 1/80 FOI~M NO. 1 , TOWN OFSOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTNOLD, N.Y. 11971 TEL.: 765-1B02 E amln d .... ........ , Disapproved a/c , ,~.[ ................................ FOR BUILDING PF_.,~M IT APPLICATION Application INSTRUCTIONS a. This application nmst be completely fiiled'~in by typewriter or in ink and submitted in triplicate to the BuildJ 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 stre{ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap[ cation. c. The work covered by this application may not be commenced before issuance of Building Perm. it. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Buildh~g Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations; or for removal or demolition, as herein describr The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. ~( %V .... : .......... (Signature of applicant, or name, if a corporation) (Mailing address of applic~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~ Name of ow .................... ncr r es .................... i ....... , ............. (as on/he tax roll or latest deed) If applicant is a co;potation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............. · Plumber's License No ......................... Electrician s L~cense No ....................... Other Trade's License No ...................... L' o'~w' ~\ ~, ["~,t - ~.mq~.~v-e~ ¢]o0~6 J I. Location of land on which proposed work will be done ............ , ........ ~ ......................... ~%0 ~ . ....~ .... ~(~X~.~.' ............ House Number Street ' Hamlet County Tax Map No. 1000 Section '7 ...... % . Block .................. Lot ................. ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, [xisting use and occupaucy ............. : ............. ~ ................................ b. Intended use and occupancy CO~. }:~ ..... ~ .[ '~-' {~ ~... , ~: Nature of work (check which applicable): New Building 'Additi~on Alteratiot~ Repair ............... Removal ,., .' .......... Demolition .............. Other Work..../~', q9 .t~,. 0 ~ , (Description) ~ Estimated Cost Fee ....... (to be paid on filing this application) i. If dwelling, number of dwelling units ,i .... .......... Nmnber of dwelling units on each floor .............. If garage, number of cars .......... i ............................................................ 5. If business, commercial or mixed occupancy, specify nature and extent of eacll type of use ................... ? D~mensions of exmtmg stractures, if any: Front ........................... Depth ............. Height Number of Stories .......... Dimensions of same structure with alterations or additions: Front ................. Rear ............... Depth ...................... H~ight ...................... Number of Stories ................... ~. Dimensions of, entire new construction: Front ............... Rear .............. Depth ............. Height ............... Number ot' Stories .................... ". ................................ ~, Size of lot: Front ..../,o. ~.: ...... ; ....... Rear .... .~.o. ?.: ............ Depth ................... · 1. Date of Purchase .... ' ........... ! .............. Name of Former Owner .......................... l. Zone or use district in which premises are' situated .................................................. "!. Does proposed construction violate any zoning law, ordinance or regulation: ............................. L Will lot be regraded ............ ~ ............... Will excess fill be removed from premises: Yes . L Name of Owner of premises ~.~?..~!~., .~.?~?,~.~. ~.~.'~Address .~:./.&"~'., ~ ......... Phone No.. ~7,~,-;./~?.q .... Name of Architect ............. i ...... ' ....... Address ................... Phone No ................ Nmne of Contractor ............ ~ ....... ~ .......Address ........ ~ .......... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from :operty lines. Give street and block number or description according to deed, and show street names and indicate whether .;.terior or corner lot. ........ ~--~ .~: ~. ~...~ ~.~ F~ ~. being duly sworn, deposes and says that he i, thg applicant (Name of individual si~ing contract) 5eve named. : ; (Contractor, agent, corporate officer, etc.) said owner or ownem, ~d is d~ly authorized to perform or have performed th'e sqid work and to m~e and file ~is pplication; that all statements contained ~ this application are tru~ to th~ best of his ~owledg~ and belief; ~d that the ,ork will b~ performed in thc manet set forth in th~ application filed therewith· worn to before mc this ~ ~ ~OT~Y PUBlIC, ~ato of NOw Y~ ''' ~ '" ..................................... ac, 5l-ala~a~O, ~.o~ c~ (Signature of applicant ~ Term Fxp[fes Mar~h' 30, 19~, 10 ~3 ~,ClAL LINER REQUEST 1979 LINER & EXCAVATION LAYOUT _~ECIFY FOR: :,IAi~ONAL CORNER RADIUS 'J T SIZE A B C D E F (3 H J K 12'X 24' 12' 24' 3'6" 6' 2'6' 6' "6" 8' 7' !'6" 14' X 26' 14' 26' 3'6" 6' 2'6' 6' 7'6" tO' 9' 2'6" 16' X 32' 16' 32' 3'6" 8' 4' 6' 13~"8'6" 8' 16' X 36' 16' 36' 3'6'~ 8' 4' 6' 13'6" 12'6" 8' 4' 18' X 36' 18' 36' 13'6'" 8' 4' 6' 13'6" 12"~' 10' 4' 20' x 40' 20' I 40' 3'S" 8' 4' 8' 13'6" 14'~" I