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HomeMy WebLinkAbout15963-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N Y. Certificate Of Occupancy No Z16.684 Date March 2, 1988 THIS CERTIFIES that the bmld]ng .A..1 .t e r a .t [ o n ................... Locatlon of Property 55000 Main Road Southold H~use NO ............. S't/ed .................. H~r~l'e't County Tax Map No 1000 Section 6 2 Block .. .0..2 ..... Lot .. . .0.1 ......... Subdivision .............. Filed Map No .... Lot No ........... conforms substantially to the Application for Building ?ermit heretofore filed m this office dated .Aprll 23, .1.98.7 pursuant to whlch Bulldmg Permit No . J5.9.6.3. z ...... dated .M a.y 7. ? .1.98. 7... was issued, and conforms to all of the requirements of the applicable provmons of the law The occupancy for wluch ttus certificate is issued ~s .... .CQnverg.e~ng attach, ed. g.ar.a.ge.t.o q.ff.i.ce..s .a.s..ap.p. lz.e.d .fo..r.. .. The certificate lsissued to . RUDOLPH H. BRUER ....... i6w. er,'~,~i~:~'~ ............ of the aforesaid building Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO PLUMBERS CERTIFICATION DATED: N/A N850989 1/22/88 Henry J. Smith & Son, Inc. Oct 16, 1987 Rev 1/81 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) N9 15963 Z Perm:ssion is hereby granted to: ~.~~.....~..~. ................ ~ ....... : ............ ~ ........... ~.._~._~.-~ ............. at premises located at .................................. ~ ......................... ..~ ................... pursuant to application doted ...... ~ .~r~--~~.....~...~ ......... 19.~...~.., and approved by the Building Inspector. Fee */..~.:..~. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Budding Department Town Hall SouthoId, N.Y. 11971 765- I802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This applicaUon must be filled in Wpewriter OR ink, and submitted m ~ to the Budding Inspec- tor w~th the followmg; for new buddings or new use' 1. Fmal survey of properW with accurate location of all buddings, property lines, streets, and unusual natural or topographtc featu res. 2. Fma[ approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electmcal mstalIation from Board of Fire Underwriters. 4. Commercial buddings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engmeer responsible for the buildmg. 5. Submit Planmng Board approval of completed rote plan requirements where applicable. For existing buildings (pmor to Aprd 1957), Non-conforming uses, or buildmgs and "pre-existing" land uses: 1. Accurate survey of p~operty showmg all property lines, streets, buildmgs and unusual natural or topograph ~c features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any housmg code or safety mspect~on of buddings or premises, or other pertment informa- tion required to prepare a certffmate. C. Fees: 1. Certificate of occupancy New Dwelling $25.Q0, Accessory ,$ ]0.00 Business $50.00 2. Certificate of-occupancy on pre-ex~sting dwelling $ 50.00 3 Copy of cert~ficate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 ~-~ 5.updated C.O. $ 50.00 Date ...:??...';?~.~.J./:'.4/. ...... New C on s t, r u c t, z on O id or Pre ex,sting Budd[ng Vacant Land Locat,on of Property..~..~."~3~.../~g~ ~/~-., ./~.... ~ ~_~.O./...g-~<.. ................ House No. treet: Ham/et Owner or Owners of Property ... ~.[~.~JL~/.p,~.. /.~....~.~ ./~..~..r~. ........................... County Tax Map No 1000 Section .. ?,o. ~ ...... Block ... c~ Lot Subdivision ................................ Fded Map No .......... Lot No ............ Perm,t No. /.~. ~.43.~'. Date of Permit . .Apphcant .. .~.. ~.. C/ ~ Health Dept Approval ........................ Labor Dept. Approval ........................ Unde~mters Approval ..................... P1anmng Board Approval ...................... Request for Temporary Cert[hcate .................. Fmal Certificate ....................... Fee Submitted $ ~ ~. $ E R V I C MULTi-OUTLET DIMMERS G & $ KXect:ic Lic#SYa-g Box 215 C~d~i ~A~AGR Southold,~e~ York 11~71 11 Th~ ce~f~cate must not be altered m any manner, return to the oH,ce of the ~ard ~f mcorred Inspectors may be ~dent,fmd by t~e~r credentials ~ BUI~ING DEPARTMEHT THiS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY ~NNER ~ HENRY J. SMITH & SON, PLUMBING, HEATING & FUEl- OIL MAIN ROAD SOUI'HOLD, N.Y. 11971 (516) 765.3690 Inc, CERTIFICATION Date. October .1_6_,_198_7___ Building Permit No._~5_9_63~ ........ Owner Rudol~,Bruer Plumber Hen~z J. Smith & Sonz Inc. I system certify that the solder used in the water supply contains less than 2/10 of 1% Lead. Sworn to before me this 16thday of October , 1 9_83__ · #4844893 Notary P~blmc Notary Public, Suffolk County OUNDAT!ON (1st) 0UNDATION ( 2nd ) 0UGH FRAME & PLUMBING NSULATION PER N. STATE ENERGY CODE FIUAL ADDITIO~AL COMMENTS 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [.~OUNDATION 2ND £ ] INSULATION FRAMING [ ] FINAL DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND ['~'~NSULATION [ ]FRAMING [ ]FINAL REMARKS:, '~j ~.~J~j 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION I- ) FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: / / 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [~NAL REMARKS: DATE ~/'/~7 INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y, 11971 TEL 765-1802 ~'~.,.~..c~']' I9[ql Examined . , . Approved "~ , 19~ .'/. Permit No 1 ~"~(~ "~ Disapproved a/c (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ece].ved ........... ,19. /--/¢ Date . .~/3£t [ . .~-/t -, 19 .o a Tins application must be completely filled m by typewriter or in ink and submitted to the Budding Inspector, wltl sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showmg location of lot and of buildings on premises, relationship to adjoining premises or pubhc sire or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl 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 ~ssued a Building Permit to the apphcant Such pert ~hall be kept on the premises available for mspectmn throughout the work e. No bufldlng shall be occupied or used in whole or in part for any purpose whatever until a Certfficate of Occupan [hall have been granted by the Bmldmg Inspector APPLICATION IS HEREBY MADE to the Bulldmg Department for the ~ssuance of a Building Permit pursuant to t Building Zone Ordmance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of bmldmgs, additions or alterations, or for removal or demohtmn, as herein descnb. The applicant agrees to comply with ail apphcable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and m building for necessa~nspectlons (Signature of applicant, or name, if a corporation) (Marling address of applicant) State whether applicant is owner, lessee, agent, architect, enggneer, general contractor, electrician, plumber or bmld lder". . .. . ... ........... meofownerofpremises (as on the tax roll or latest deed) If apphcant is a corporation, signature of duly authorized officer nd title of corporate officer) Braider's License No. Plumber's License No Electrician's License No ~. "t (J Other Trade's License No Location of land on which proposed work will be done House Number Street County Tax Map No 1000 Section (~ ~'- Block Hamlet Lot... 2 Subdivision .. . Filed Map No ... Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy .(~ ~'f t ~ f-'"4' ................ b Intended use and occupancy 3 Nature of work (check which applicable) New Budding ..... Addition ...... Alteration Repmr ..... Removal ......... Demolition ........... Other Work .......... }~ ~ S ~[~J~ q ~ A ..(/0 .......... ~.ii~-- ~ (Description) 4 Estmlated Cost ......... (~,0 ...... Fee~..w,~..'. ....................... (to be paid on filing this apphcation) 5., If dwelling, number of dwelhng units ...... Number of dwelling units on each floor ......... If garage, number of cars ......................................................... 6 If business, commercml or mixed occupancy, specify nature and extent of each type of use .............. 7. Dmaensaons of ex~stmg structures, if any Front ....... Rear ............ Depth .......... Height ............. Number of Stones ........ '~Z ............... ,,d ...... D~nenslons of same structure with alteratmns or additions Front ..~q ......... Rear ZO .... Depth .,~-°/2 ~ ~. ....... Height . .. /,~..: ....... Number of Stones ...... ~ ......... 8. Dunenslons of entire new construction Front .,~/0.6r'Feq44~.~.. Rear .............. Depth .......... Height ......... Number of Stones /..,~ . .~.qz. ts. o..,~..5'..~,('M/4.~t~.C-. .................. Size of lot Front ............. Rear ............ Depth .................. Date of Purchase ................... Name of Former Owner .. Zone or use district an winch premises are situated .............................. Does proposed construction violate any zomng law, ordinance or regulation . .fh.© ........... Will lot be regraded ...... k'h ~ ............. Will excess fill be remove,d from premises Yes Name of Owner of premises [~[~PL-..(;~.tJ..~.C . Address l"l~. 0.~% ~ .'-~0 .. Phone No '~o ~7 ~ ~,)~L.. Name of Architect ......... , ........ Address Phone No ........... Name of Contractor '.~O~O..(:~f.~o,.~ ....... Address ~o~L~UJ/~ ~(~,.i Phone No .~./a ~--1 ~ 10. 11. 12. 13 14. PLOT DIAGRAM Locate clearly and dtstmctly all buildings, whether existing or proposed, and, ~ndicate all set-back dn-nenslons ftc property hnes Give street and block number or descnptlon according to deed, and show street names and mdmate wheth interior or comer lot STATE OF NEW YORK, COUNTY OF .... s.s · .~ ~.e...~.. ~./'d2~.~/O/ .... being duly sworn, deposes ~d says that he ~s the apphca ......(Nam ~gm~g contract) above named He ~s the ............. ~6~ Z~ C~ .... ~2~/~.~ .................. (Contractor, agent, co.orate officer, etc ) of smd owner or owners, ~d ~s duly authorized to perfo~ or have perfo~ed the sa~d work and to m~e and file apphcahon, that all statements contorted m th~s apphcatton are true to the best of h~s ~owleflge and behef, and that work wflI be perfomed m the m~ner set forth m the apphcatmn filed therewith Sworn to before me th~s ............. ~....day of ..... ~'.4 ........ , [9 ~ 7 $ot~Pubhc,~. 7 .......... ~q~. County N~aW ~bli~ SI~O ~ / ............... No 4822563, Surfak CounW ~ (Signature of apphcm T~rm Expires December 31, 10~ ~ OCCUPANCY OR 1