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Home My WebLink About15947-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17545 Date NOVEMBER 28, 1988 THIS CERTIFIES that the building. ALTERATION Location of Property 272 LUTHERS RD {BREAKWATER RD) House No. Street County Tax Map No. 1000 Section 113 Block 03 Subdivision Filed Map No. Hamlet Lot 07.4 Lot No. conforms substantlai1y to the Appllcatzon for Buzldlng Permit heretofore f~led in thzs off~ce datadAPiLLL 17, 1987 pursuant to which Building Permit No. 15947Z dated APRIL 28r 1987 was zssued, and conforms to all of the requzrements of tha applicable proviszons of the law. The occupancy for which this certifzcate ls issued ls CONSTRUCT PARTITIONSr IN C~T~R ON ONE FAMILY DWELLING. The certzfzcate zs zssued to DOUGLAS IAN SHAW & OTHERS (owner, X~) of the aforesaid buzldlng. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A Building Inspector Rev. 1/81 TO~N OF SO~THOLD B~ILDJNG D£PARTM£NT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15947 Z Permission is hereby granted to: .......................... 1o. , Ilq ~_. at premises located at ...ee'~...~...~......~._~....~... ............. ~.~.,~ .................. County Tax Map No 1000 Section ..... L./...,~.. ....... Block ...... .(~....~ ...... Lot No....-].:...~'/ ........... pursuant to application doted .... ~......./..~. .................. , 19..~...7., and approved by the V Building Inspector. Bullding Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOU't'HOLD Bufldmg Department Town Hall Southo[d, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. Thru apphcat~on must be fdled in typewmter OR ~nk, and submitted m~ to the Building Inspec- tor w~th the followmg; for new buildmgs or new use: 1 Final survey of property w~th accurate location of all buildings property hnes streets, arid unusual natural or topographic features. '~J~ -~';? 2. Final approval of Health Dept of water supply and sewerage dlsposal-(S-9 form or. equal).~l~4 3. Approval of electrical ~nstallat~on from Board of F~re Underwriters. /~464 .~ 4. Commercial buddmgs, Industrial bulldmgs, Multiple Residences and mm~tar buildings and installa- tmns, a certffmate of Code comphance from the Architect or Engineer responmble for the bufldmg. 5. Submit Planmng Board approval of completed site plan requirements where apphcable. B. For exmtmg buddings (prior to April 1957), Non-conformmg uses, or buildmgs and "pre-ex,stmg" land uses' 1. Accurate survey of p~operty showmg all property lines, streets, buddmgs and unusual natural or topographic features. 2,Sworn statement of owner or previous owner as to use, occupancy and condition of buddmgs. 3. Date of any housmg code or safety mspectlon of bufidmgs or premises, or other per, merit mforma- t~on required to prepare a certificate. C. Fees' Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Cert[flcate of occupancy New Dwellzng $25.Q0, Accessory ,$]0.00 Business $50.00 2. Certffmate of occupancy on pre-existmg dwelhng $ ]00.00 3. Copy of certffmate of occupancy $ 5.00, over 5 years $I0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewC°nstructl°n. .~.,,.. O[dorPre-extst[ngBuddtng ............ Vacant Land ............. /ocat,on of Property ..... '~~ (~.~.., .~., .., ./~.'..~.~ ....... House No. Stree £ Hamlet: Owner or Owners of Property.~.0~3~.~ ....................................... 1~14. ~ 4~ .~.'-~..0/'..~, ........ County Ta× No. 1000 Sect,on ..... t.t ....... ............ Lot..g . .......... Subdw,mon ~,t~/..1¥ ...Filed Map No. N~t' .Lot No. Perm,t No. ~-~.~.7.~- · Date of Permit ......... Apphcant . .Vr~.,..~.-~, .'~.,..~'..-~-r. Approva ,[~.~. ................ Labor Dept. Approval ........ Health Dept. Request for Temporary Certificate .................... Final Certificate .~. ............ Fee Subm,tted $..~-.~. ?<~.~. .................. Construction on above described bufldmg ancLperm~t meets all apphcable codes and regulations. Co 175Y OU~;DATIO~ (1st) OUNDATIO~ ( 2nd ) OUGH FRAME & PLUMBING ~'JSULATIO~; PER N. Y. STATE ENERGY CODE ADDITIO?~AL COMMENTS' Victor Lessard, Principal Building Bulld~ng Department Southold Town Hall Ma~n Road Southold, New York 11971 Inspector Re: 5uildlng permit # 15947 z Dear Mr. Lessard, At this time, I would like to request an lnspectlon for a Certificate of Occupancy for the above-noted building permit. October 27, 1988 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~/FINAL Examined Approved Disapproved a/c FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1803 · , 19~.'1 Permit No I g%~'~."~.. BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY .......... CHECK .......... SEPTIC FORM ............. : NOTIFY CALL ................ MAlL TO: (Bml&ng Inspector) APPLICATION FOR BUILDING PERMIT Date /~/0/-~. /7 , 19; IN STRUCTIONS a. Ttus apphcatlon must be completely filled m by typewriter orln mk and submitted to the Bmldmg Inspector, wit sets of plans, accurate plot plan to scale· Fee according to schedule. b Plot plan showing location of lot and of bmldmgs on premises, relationship to adlommg premises or pubhc stg or areas, and glvmg a detmled description of layout of property must be drawn on the diagram which is part of ttus ap cation. c. The work covered by ttus application may not be commenced before issuance of Building Permit d. Upon approval of this apphcatlon, the Braiding Inspector will issued a Bufldmg Permit to the applicant. Such pm shall be kept on the premises available for mspectlon throughout the work. e. No braiding shall be occupied or used In whole or in part for any purpose whatever until a Certificate of Occupa, shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmlding Penmt pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmance Regulahons, for the construction of braidings, additions or alterations, or for removal or demolition, as herein descnb The applicant agrees to comply with all apphcable laws, or&nances, bmldmg code, housmg code, and regulations, and admit authomzed inspectors on premises and m braiding for necessary lnspe~hons (Si=nature of apphcant, of-~ame, if a corporation) (Marling address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bmh Name ofowner ofprem,ses -~m~/~Z,,~['~.~d~>.~,~f~.¢,. (ason thetax rol~orlat?t~eed) If apphcant ,s a corporat,on, s,gnature of duly authqr~ed ~ficer (Name and t~tle of co,orate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY Bmlder's hcense No ..... Plumber's License No . .. Electrlman's License No Other Trade's License No .... Location of land on wlnch proposed work will be done ltouse Number Street County Tax Map No 1000 Section //'~ (Name) Hamlet Block ~'~ ... Lot. Flied Map No ·.. Lot State existing use and occupancy of premises and Intended use and occupanc~ of proposed construction b Intended use and occupancy .......... Nature of work (check which apphcable) New Building ...... Additmn .......... Alteration Repaxr Removal ..... Demobtlon .... Other Work ....... ' 4 Estimated Cost ............. 5. Ifdwelhng, number of dwelhng units . /. (Descnphon) .. Fee... .... ......... .. .... ..... .. (to be prod on fihng th~s apphcat~on) ·. Number of dwelling umts on each floor 6 7. '~-8. If garage, number of cars ~,. ...................................................... If business, commermal or m~xed occupancy, specify nature and extent of each type of use .. . ,'~'e¢ ..... D~mens]ons of ex~stmg structures, af any. Front ..~. ~ . Rear ............ Depth ............. Height . . Number of Stones ...... ,~ :~ ........................... Danensions of same structure w~th alteratmns or add~tmns'~r~~.. Rear .......... Depth ........ Height . ~ ......... Number of Stones ................. D~mensmns of entire new construction Front /f.~' ...... Rear ...... Depth .......... Height ...... Number of Stones 9 S~ze of lot Front ,x~.~~ .... Rear ........... Depth .... . ........ 10. Date of Purchase /~'..~, . . / ...... z I~,ame of Former Owner .~f_,j.,~ct.~-~a4.-'t~, ..... 1 1. Zone or use dmtnct ~n which premmes are s~tuated /~'r yO. .................... 12 Does proposed construction wolate any zomng law, ordinance or regulatmn' ,,,v/~7 ........................ 13. Will lot be regraded r,/o . .~ ............. Wall excess fill be removed from premises: Yes Q 14 Name of Owner of premises . - .,4~""*~..~z~,--. Address . . . Phone No Name of Arch~tect ,,'f','~. . ~ .... '.. °....Address ...... PhoneNo ........... Name of Contractor . .,¢'/.~". .......... Address ......... Phone No ..... 15. I~ this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southold Town Trustees Permit maybe required. PLOW DIAGRAM Locate clearly and dmtmctly a/1 buddmgs, whether ex~shng or proposed, and~mdmate a/l set-back d~nens~ons fro~ property hnes Give street and block number or description accordmg to deed, and show street names and ~ndmate wheth, interior or corner lot. OCCUPANCY OR USE iS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY STATE OF NEW YORK, COUNTY OF. (Name of individual s~gmng contract) above named .. being duly sworn, deposes and says that he is the apphca He ~s the ................ (Contractor, agent, corporate ofhcer, etc.) of smd owner or owners, and zs duly authorized to perform or have performed the smd work and to make and file ti appbcatmn, that all statements contmned m thru apphcat~on are true to the best ofhts knowledge and behef, and that t work w~ll be performed zn the manner set forth m the apphcatmn filed therewzth. Sworn to before me thru ....... -/-7-. day of .... ~ .... 19~2 $otarymubhc, . .... '~..~.'....~.~ .~.~'~.. County /~.¢~ ~ ~ It~.t'll £ ~ ~ ........... ~(klgnature of ~l~pl}c~,