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Home My WebLink About15720-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. Certificate Of Occupancy Z-15362 March 18, 1987 No .................. Date ................................ AIRTIGHT INSERT IN EXISTING FIREPLACE TI-IfS CERTIFIES that the building ................................................ 5425 North Bayvlew Road Southold, New York Location of Property ............................................................... House No. Street Hem/et 079 03 2 l County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated February 26, 1987 15720Z ..................... pursuant to which Building Permit No ...................... February 28, 1987 dated ............................ 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 ......... AIRTIGHT INSERT IN EXISTING FIREPLACE EDWARD & MURIEL SCHWINDT The certificate is issued to ..................... io~,,,.o.r,~ i~dvoet~ ~.f .................. of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. N / A N/A PLUMBERS C~RTIFICATION DATIgD: //~uilding Inspector Rev. 1/8~ l~OB~ NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 15720 Z Permission is hereby granted to: ~ ....... Z]~'"'iT;;' ........ /' ...................................... ~..,~. ~ . . ~,..~.~....~.....~~...~.~.....~...~.~ ........... ..................... .......... ........................................................ at premises located at ..~....~.~..~..........~...:....,..v~.....~....~.~....~..,. ..................................................... County Tax Map No. 1000 Section ..... ~0...?...~ ....... Block ...... .(~ ....~... ..... Lot No... ~)~ ) Building Inspector. and approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLO Bu ilding Department Town Hall $outhold, 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 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 ,$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. $ 50.00 Date .................... NewCons truct ion ...... Old or Pre-existing Building ............ Vacant Land ............. < ~X'~ ~ /~/b ' ' Location of ProperW J ~ /, ~y4 I~Z~ NOU~ NO, ~ ~ Street Owner or Owners of P rope~y ~. ~ ~ .~.~.. ~. ~:~/~... ~. ~.~;~/~ ~. .... ~ .... ,O0O t,on ........ ......... ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ PJanning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... · Fee Submitted $.. ~ ........... Construction on above described building and~rnit me. ets all applicable codes ar~ renu latiqos. ~ App icant .. .:.. Rev. 10-10-78 76S-tSe2 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ]ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION FRAMING [ ]FINAL DATE INSPECTOR OUNDATIO.~ ( 1 s t) OUr~DATI 0:~ ( 2nd ) OUGH FRAME & FLUMBI~IG i~':SULATIOM PER N. STATE ENERGY CODE Ft:;AL ADDITIO~IA'L COMMEIITS: · _".. f · Examined ~r .~...%..~.$.., 19 Approve~-.a~A~...'~..'~.'$.., 19~ 7. Permit No./..~:?.~..~. .9~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ....... MAIL TO: %"7d~--' So INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspec:~:, with [ 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 street,. or areas, and giving a detaiIed description of layout of property must be drawn on the diagram which is part of this appli cation. c. The work covered bu. this application may not be commenced before issuance of Building Permit. d. Upon approval of tlxis application, the Building Inspector will issued a Building Permit to the applicant. Such permi shall be kept on [he premNes available for inspection throughout the work. e. No building shall be'6c~upied or used in whole or in part for any purpose whatever until a Certificate of Occupanc: 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 tN Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o 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~_~_=a ~7--~, ~ ~__code housing 9~de and regulations, and t¢ admit authorized inspectors on premises and in building for necessary inspections~F~ ~/~ ~f~// (Signature of applicant, or name, if a/J~oration) (MaiIing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .... ?...4:'7.4' ....... ;.> ........... :; ........... /-a ............... .................. Name of owner of premises ~..~...~'...~.~..~...?7/.~.d./?~..~.~.... O .C ./7(..~/./..'~..-~./.'-~-... ~..~.' ................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .... ~ ............. Plumber s L~cense No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ................................................ · .T.. ................... .... House Number Street Hamlet Count,, Tax Map No. 1000 Section -2F- ............ Block .3 ............... Lot .d/. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name } State existing ose and occupancy of premises and intended use and occupancy of proposed construction: a.b. Existing use and occupanCYlntended use and occupancy ....... ...... ,,q-m:z,v4.~'~' '~A~' ' ' ' '~' ~' ' ' ' '~' ' ~' ' '~.~ ..... .~ ,o · v~ ................................ ................... ?---'r-"-.- 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... ReRair .............. Removal .............. Demolition .............. Other Work .,~///~ ~"/y'/~ /~:2/,0~'~ /~.<"~'~..~- /~c~/i~Y'''- ~ ~ (Description) 4. Estimated Cost '~'Z~.,-~ 0~ ~ Fee "~'~ ~' ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ... ?.. ......... Number of dwelling units on each floor ................ If garage, number of cars .......... .~. .............................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions'of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 1 2. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ i5. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from >roperty lines. Give street and block number or description according to deed, and show street names and indicate whether nterior or corner lot. OCCUPANCY OR · USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY ;TATE OF NEW YORK, S.S 2OUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bore nmned. (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the :ork will be performed in the manner set forth in the application filed therewith. .worn to before me this ........... .~..~. ........ day of ...... ~ ........ , 19 ~.~. ~otaryPublic,..~..~.~...~....~...~'~.... .... County ~'~/ / ..... ~'ll~.~, ~ ~ ~ ~ (Sign~fi~e of applicant)