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Home My WebLink About16057-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...g.I. 5. 9.8.6 ......... Date .... .J.u. ~. y..2.3. :..1.9.8. 7. ............. THIS CERTIFIES that the building .... A d..d.3..t.i 9 .n ................................... Ln~.tinnnfPrnnartv 5570 Main Bayvie~ Road Southold .............. --'Ho.to .......................................................... No. Street h3~iel County Tax Map No. 1000 Section 78 .Block 4 ..... Lot 4 0 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~ .aT....2 .7.,.. ! .9 .8,7 pursuant to which Building Permit No.. ! .6 9.5.7.z. ............. dated . .J~n.e.. 1.2.,.. 1.9.8.7 .............. 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 ......... Deck addition to existin~ dwelling. The certificate is issued to JOHN BURKHARDT ..................... ?oYn'dr, '~I¢~,g~,~r ..................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ...... N/A PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 lvO~ NO. I~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 16057 Z Permission is hereby granted to: , ~ ,. , .................... . l at premises located a,t~...~.....~...~..~.. ~... ................. County Tax Map No. '000 Section ..... 2...~,.. ...... Block ...... ~ ............ Lot No....,,Z,~,,.,~. ......... pursuant to application dated .....~-~...~ ........ .~.....~......., 19~...Tand approv~ by the Building Inspector. B,~(Iding Inspector~' ~ Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.¥. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 p~operty 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: Additions $25.00 1. Certificate of occupancy New Dwelling. S25.00, Accessory,Gi0.O0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ -5.00, over _5 years $]0.00 5.Updated C.O. $ 50.00 Date .... [ .......... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property '3'~)r'7 0 /.~. 4/../~/ .~..~. :~ ~.._/~...~. ./..~..: House No. Street Hamlet Owner or Ow.ers o, roparty .... .... ..................... County Tax Map No. 1000 Section ....--'~7..°~. ....... Block .....--.~/.. ....... Lot ............... Subdivision ......................... .~" ' 'I ' .Filed Map No ........... Lot No .............. Perm tNo //~.~ 0~.7.~Date of Permit //.~!/q.'~.Applicant...~.'..../~...~..~.../~...'G/.~../~..../~...~'.. .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $...~.~.. ~. ~C; . .~.. .............. Construction on above described building and permit r~eets all applic.~.ble codes and regulations. Applicant.. ~,. ~.~~..~ .... e,o, z 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOARD OF HEALTH .~.~.. 3 SETS OF PLANS ....... SURVEY ......... SEPTIC FORM ............. : · pp 0u a/c ..................................... ................................ (Building Inspector) NOTIFY MAIL T0:~.~ APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building 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 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 R&gulations, 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, ordinance'~] ~bt~i!ding code, hou~a3g code, and regulations, and to admit authorized inspectors on premises and tn building for necessar~p~eti0ns: 7,~ // !/~ ./,~ ..,~,,~ ' ~ . ...~.ff. ,/~. ~/.W/ ........... /.(Signature of applicant, o_~name, if, a corporation) x. .... ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general ~ontractor, electrician, plumber or builder. Name of owner of premises .... Zf.~. ./~... ~:... ,~...~. ,~, ,~, ,'~...~.~..~..C ................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .............................................. 0,( UPANCY OR (Name and title of corporate officer) . ALL COIITRACTOR'$ 1.1UST_BI~ S, IJIJ, F.O~LK C,OUNTX_Iw~CE Builder's LicenseNo ...... ~-~..,~:"~.~2~./?--~....~3~'~'r.'O~_ USE IS UNLAWFUL Pluinber's License No ......................... WITHOUT CERTIFICATE Electrician's License No ....................... Other Trade's License No ...................... OF OCCUPANCY Location of land on which proposed work will be done .................................................. ..... ................ ................. House Number Street Hamlet County Tax Map No. 1000 Section .... ?.?. .......... Block ..... .~f ........... Lot...~./.~). ............ 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 .~.b,,k/{6~.~./..~.-- g~{~/~ffC~ b. Intended use and occupancy ~~O ~ ~ ~ ~ ~ -- X 0~ ~/W~ 3. Nature of work (check which a~plicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ........... Other Work ............... 4. Estimated Cost ............ i ......................... Fe ....... ..¢~.~ ....... ' . . . ~ (to be paid on filing this application) 5. if dwelling, number of dwellingiunits ............... Number of dwelling units on each floor ................ If garffge number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each 'Wpe 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 .......... r ........ ,.. Height ...................... Number of Stories ...................... 8 ' ' ~ ' ~ ' Rear Depth '--. D~mensmns of entire new construction: Front ........................................ Height ............... NurnbBr of Stories ..................... : ....................... .. ............ 9. 10. Date of Purchase ..... /.~.~ ~..--';...~ ............... Name of Former Owner ./ti'...z~..6/..~.¢~'d~'./~..~..~../.~' ...... 1 1. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ i ................... Will excess fill be r.emoved from premises: Yes No 14. Name of Owner of premises .. i ................. Address ................... Phone No ................ Name of Architect ......... i ................. Address ................... Phone No ................ Name of Contractor ........ ~ ................. Address .... : .............. Phone No ................ 15. Is this property locatedlw~thzn 300 feet of a tidal wetland? *Yes ..... No ..~.. *If yes, Southold Town TrUstees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. AI ROVED NOTED NOTIFY BUILDiN~-DEPARTM ~ENT Af 76E-1802 9 AM TO ~ ~ ~R T~ ~LOWING INS~ONS: ~NDAT~ON ~O FOR ~ED ~N~ETE ROUGH FRAMING & ~UMBING & ~SULATION 4. F~AL CONSTRUCTION MUST BE COMmiE ~R C.O, ~L CONSTRUCTION S~L THE REQUI~MENTS ~ ~A~ CONS~J~ & ENER~ ~, N~,~LE STAI E ~F NEWYORK,. .,,, ............................~ ..................... b~in~ (Name o~.md~dual Sigv~g contract) above named. ~: "~ He is the ..................... i .................................................................... i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements con(ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this I ............ ......... dayo ......... NOTAItY PUBLIC, Stale of ~w Yo~ ......... .............. ; ~m Expl~ ~h 80,1¢-~-'-/ ~./ (Signature of applicant)