HomeMy WebLinkAbout12999-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z~ 3585 Date July 2 1985
THIS CERTIFIES that the building second story addition.
Location of Property 565 Bayview Avenue ' Southold
House No. Street Hamlet
County Tax Map No. 1000 Section ..... .~.2. .... Block .... .~ .......... Lot 22
Subdivision... x .Filed Map No ...... .x..Lot No. x
conforms substantially to the Application for Building Permit heretofore filed in this office dated
..... A.]~?.i.1..~. ........ , 19B~, pursuant to which Building Permit No ........ ~..2.9.9.~.Z. .......
dated ....A~?. 5:..1. ~.0. ............... 192.~.., 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 .........
Second stor~ addition to existing one-family dwelling.
The certificate is issued to HERBERT & UTE SCHIlVlKHS
..................... ......................
of the aforesaid building.
Suffolk County Department of Health Approval ........... .~/..A. ...........................
UNDERWRITERS CERTIFICATE NO ................. ;...-.-i... ~I~97~.6.3 ..............
/
Building Inspector
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y,
BUILDING PERMIT
CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
12999 Z
Permission is hereby granted to:
..~.~~...~.....~..~, .......
...G.~....~.,...~..,~..,.....u.~..~.~ .......
,o :~.~.........~..~....~......~....~..~...~.~ .....
.~.....~.~.~.~..~...~,.......~.~.~.....¢~ ................ ~.. ................... ~ ...... ...~ ....
at premises located at ..~..,~..~-~.......~....~.?,,~...~ ......... ,,~.~.,,,~. ,,~.. ...... .-.~--.:.,~..:..
County Tox Map No. 1000 Section ..... .~..~.~'...~.. .... Block ...... ..~....~.. ........ Lot No.......~...~.~.-~...
pursuant to application dated ....... ~...~. ......................... , 19.~..~..., and approved by the
Building Inspector.
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 Wpewdter OR (nk, and'~bmitted ~n duplicate to the Building
tor with the following; for new buildings or new use:
1. Final su~ey of property with accurate location of all buildings, property lines, streets, and unumal
natural or topographic features.
2. F~na~ approval of Health Dept. of water supply and sewerage d~sposal-{S-9 form or equal).
3. Approval of electrical installation from Board of Fire Unde~riters.
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 approva~ of completed site p~an 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,J: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.
C, 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
Date . .6./,2.7,/.~,5, .................
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property .5.6.5..~.~.~.u.~,~,~ ~u,C~,u,~.,.' .S,o.u,~,h,o.~,~,..NeJ~ .~.q~,~,,., .].1.9.7..1. ....................
House No, Street Ham/et
Owner or Owners of Property .~.~,6.~z~ ,( .~, .S.¢~b~l~,u~ ......................................
County Tax Map No. 1000 Section ...0.5.~ ......... Block .... ~5 ......... Lot... P~£ ..........
Subdivision ................................. Filed Map No ........... Lot No ..............
,~2999z Date of Permit ~ ./ .~ ,0. /. 8. .~ Applicant
Permit No ..............................................
Health Dept. Approval ........................ Labor Dept. Approval ......................
Underwriters Approval ........................ Planning Board Approval ....................
Request for Temporary Certificate ..................... Final Certificate ......................
Fee Submitted $ .~..0.0....~.~.. j .~ .--] .............
Construction on above described building and per/ni, t/mee~s all,~pl~a~le codes a~l regulations.
,'o.' ' i
~ou09~ THE EW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITy
~- O1 85 JOHN STREET, NEW YORK, NEW :YORK 10038
.ate a~.~ 2~, ~.985 ~ppiic.tlo. No.o,,S.e =7,268~./84 N 697963
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
· ',C',C',C',C',C',C~/m]c,~, 565 Bayvi~w Ave. off Colonial Dr., $outhold~ N Y
in the followlng location; [] Basement [~ 1st Fl. ~] 2nd Fl. Section Block Lot
FIXTURE
OUTLETS
June 20, 1985
and found to be in compliance with the requirements of this Board.
FIXTURES RANGES OVENS EXHAUST
VA~OR
FLUORESCENT
5 16 7 5
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS
TIME CLOCKS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT
S E
NO OF CC COND
OTHER APPARATUS:
R V I C E
OF CC. COND,
NO, OF HI.LEG
AW, G.
OF HI-LEG
NO, OF NEUTRALS A. W g
OE NEUTRAL
Bi-County Electric Corp.
1004 Jeru~aJ. en-t Ave.
~-k~rrick, N Y 11566
Lic 330 E
11
This certificate must not be altered in any manner; return to the office of the Board if Incorrect. Inspectors may be identified by
Mr. ~ Mrs. Herbert Schlmkus
565 Bayview Avenue
Southold, New YorK, 11971
June 27, 1985
Town of Soutflod
Biu~ding Department
Town Hall
Southold, N~w York, 11971
RE:
issuance of ¢.0. for completed
new 2nd floor (dormer) at -
565 BayviewAvenue, Southold, NY
As requested, attached pl~e find the $5.00 for issuing the Certificate
of Completion on the above premises. Also, as your office requested, the New York
Board of Fire Underwriters statement by the inspector stating that he has in-
spected the 2nd floor and is in the process of issuing a Certificate of Compliance
with his district office is a~taehed.
Since I am applying for a new mortgage, I need this Certificate of Completion
as soon as possible to be sent to my address.
Thanhi~ you for your cooperation in this matter,
En~Is.
HERBERT SCHIMKU$
~235 NASSAU BOUL~:VARD
~ARDEN CITY S0., N. Y. 'J153C~
51~ !Yo 5-1822
FIELD INSPECTION
FOUNDATION ( 1 s t
COMMENTS
FOUNDATION
ROUGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
C,ODE
FINAL
ADDITIONAL COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST ~/ROUGH PLBG.
FOUNDATION ZND [ ] INSULATION
DATE
INSPECTOr,
76S-1802
· BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG,
[ ] FOUNDATION 1ND INsULATI
[ ] FRAMING [ ] FINAL
DATE INSPE~OR
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y, 11971
TEL,: 765-1803
Examined. · · '9
Approved ~...I.Q.., 19IL). Permit No.! 53
Disapproved a/c .....................................
Received ........... ,19...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspectof} 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 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. ~ !
Di~S~(/N & D,~/i, Fi' g~ 5ER¥IG.:5 (Signatiz/e of ap~r name, if a corporation)
207 Roxbury Rd. So. Garden City N. Y.
JOHN E, STUMPF 485-7923 .............................................
(Mailing address of applicant)
State whether applicant is owner, lessee _,~g~e~n~ architect, engineer, general contractor, electrician, plumber or
builder.
(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 ..... .~..~..(P.....~'.P..~.6~.1/1 ....
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
· .......... .... v ........................................
House Number Street Hamlet
County Tax Map No. 1000 Section ..~.~..Z ............. Block......t~ ............ Lot.........~22 ..........
Subdivision ............... ~ .................. Filed Map No ..... ~ ...... Lot ..... ~ .......
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ... ~.~..~.1-'~..~. ................. -~ ..........
b. Intended use and occupancy
.......................... ~...... · ,.,: ;;,',;, ': ;.~?, ..........................
3. Nature of work (check which ~pplicable): New Building Addition . ./~.. Alteration .' .....
Repa/r Removal ................ .P.o.~. ~ ....
.......................... Demolition ..... ....... Other Workl ........
: I (Description)
ih hii'n application) .............
5. If dwelling, number ofdwelling units ..... ( ~; I~e' 't
....... Number o£ dwelling units on each floor '1' ~'~' ...........
If garage number of cars i
6. If busaness, commerctal or mixed occupancy specify nature and extent of each type of use ..'75 .--7 ............
7. Dimensions of ex sting structules if any' Front .~ ,3,2:~, . Rear 32 .q,. I~
Height ....r}..~. ....... Number of Stones ...... [. ................
Dimensions of sam. e structure with alterations or additions' Front 32, .5 .... ~,,~' ' 'E ~'. ~ ..........
8. ~mensmns o~ ennre new construchon: Front ............... Rear ............... Depth ...............
He~g t ............... Number of Stories
10. DateofPurchase ...~..t/ [~) ........ Rear .... tff?.?.? ............ Depth ....Z.Z.;."7.¢! ...........
1 1. Zone or use district in which p~emises are situated .... /Z....~g.. ....
12. Does proposed construction violate any zoning law ordinance or regulation:' ~o ...........................
13. w~ or ~e regraneu ....... ~:../'~.O .............. Will excess fill be removed from premises Yes
14. Name of Owner of premises . ntg. <a6/~t/ft.2~ . . . Address 3'G 5'7...t'3~.t{/t~Y~M .... Phone No..q4~:~..'./.g.g.Z .....
Name of Architect ......... , .................. Address ................... Phone No.
Name of Contractor ~70 Ttr>'~,f.a ~. ~(:l?~.~q.O. 3'E. ..............
........ : ................ Address ..... 'Phone No. ff~.~..': .~?~. ....
PLOT DIAGRAM
Locate 'clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-bec ~ dimensions from
property lines. Give street and block! number or description according to deed, and show street names ar indicate whether
interior or corner lot. ~
STATE OF NEW YORK,
COUNTY OF ......
(Name of individual signing contract)
above named.
He is the
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly. authorize, d to perform or have performed the said work and to
application; that all statements contained in th~s application are true to the best ofhis knowledge and
work will be performed in the manner set forth ~n the application filed therewith.
Sworn to before me t~
........... ~. ........ ,..~day eli ~lill.~. .~.~.~ ......... 19
Notary Public ......... County
%/ N*, · ~ ,,.
,
being duly sworn, deposes and says that
he is the applicant
nuke and file this
eljer; and that the
ffe;ignlture ~f applicant)