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HomeMy WebLinkAbout14705-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. g.! ).3.3.7. .......... Date ........ ~. p.p.k~...9 ................. 19 .~.6. THIS CERTIFIES that the building ..... P~ d..d .~.~. ~. 9 ¢..~.n. cl...a.~. ~ e. ¥.a.t: ~. 9 .n ................ Location of Property .. .... ,'1.4.605. Za ~ r~. ~.o. ~ cl ................. ~l.a.~ t;, .5 b,u,qk, ............ MOUSe ire. Street Ham/et County Tax Map No. 1000 Section . .1.1. q ....... Block ..... Q .8 ........Lot .... 0..6 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..~laJc. ch. 2.6 .......... 19 ~3.6. pursuant to which Building Permit No... ~..4 y.0.5, g. ............ dated .... ~ a.v.q h. 2.7 ............... 19 $.~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which ttfis certificate is issued is ......... ....~.O.d...t 9..a.n..d..e.n.c..~ 9.s.e...d.e.c.k...a.~.~.a.c..157.d...~9..d.~e..~.J_.~.n. ~: ....................... The certificate is issued to RONALD W. & DOROTHY J, SCHWEIZER ..................... ...................... of the aforesaid building. Suffolk County Department of Health Approval ..... ~1/g .................................. UNDERWRITERS CERTIFICATE NO ............. .~/~ .................................. Building Inspector Rev, 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PEar'IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14705 Z Permission is hereby gronted to: ~ ~-~ . ......... ...... z~...~.....//./.Z, ........................................... ....... ...,~.~. ~.~ .~..~.c,... ~...~..., ~...., ./z ~ ~.... ~.~.....~.....~ ...... ~<~..~a ~.....~....~.~..~... ...... ~L.~.~ ........................................................................................................................... ~, ~.,~ ,~,~ J, /.~a~:. ~.~ .............................................................. ....................................................................................................... ~.~~,..~.z~ County Tax Mop No. 1000 Section ..... ~..~...~.. ......... Block ...(~.~... .......... Lot No..~..~ .......... ~ursuo,,t to opp,ico,on dot~ ........ Z~.,~...~.L...Z:~ ............. 19.~d, ond opprov~ by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted t~,-.-.--~ 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~perty showing ail 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 $15 o 0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. updated C.O. $15,00 Date ...~.:.~..~. [.~?.~q ............ New Building .., Old or Pre-existing Building . ~ . Vacant Land ............. ............. Location of Property ..'/ '--- ~?~.' .~' .~/.-%~. ~i ?./.~/./~../¥Z? .... . .~.~. ~/..~.z~, ./-_~.. ......... House No. Street Hamlet Owner or Owners of Property ................. County Tax Map No. 1000 Section ...././.~. ........ Block ... 8 Lot .~, .... Subdivision ................................. Filed Map No .......... Lot No .............. Perm it No/..~. 7~. ~.-..~ate of Permit~K/~.~./,~.. ,Applicant./~ .~., ~. ~.'.~'.~-~..~ ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and per~i~eet~pplic~bJe codes and regulations. Rev. 10-10-78 FIELD ~NSF~TION DATE COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & ?LUMBING INSULATION PER N. Y. STATE ENERGY C,ODE ADDITIONAL COMMENTS: Examined. ~'~./~. ~ ........ 19t~. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c .......... :~ ........ ,~ ......... ..................................... (Building Inspector) APPLICATION FOR BUILDING PERIVIIT Received...7/.-.Z~.... ,19~..' INSTRUCTIONS · a Tins application must be completely filled in by typewriter or in ink and submitted~to the Bttild~ector, with 3 ~ets ~f plans, accurate plot plan to scale. Fe~according to schedule. ~ b. Plot plan showing location of lot ahd 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 promises 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 i_nsp~tions.,~ /~ ~Signatffre of app ' ,/Or nam(, if a corporation) · ,/~lA. .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nmne of owner of premises ...f.~ .A/.'q/d..~.....~.. ,~.'./~..d).Zff. O..Z?~.. :.-(.. ~.. '.~/. '.~?..~. './.~. .......................... (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 .... ~ .............. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be do~m ................................................. z/ _ ~, , .~ , . ,.,/ . . ......... .. ................ :./. ........... : House Number Street Hamlet County Tax Map No. 1000 Section .... .//z~. ......... Block .... .~. i ........... Lot....~. .............. 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 .... .'~..~? .tf.~./.-.&.~...~.A/..~.~...~./f./d./.Z/.~. .................................. b. Intended use and occupancy ........................................ ./. ~ ~ ~. ......... · 1oI .tou.too .to so.uolu.t ;totBoqa ol~o!pu[ pu~ so~u looals ~oqs p~ 'poop ol ~ulp:ooo~ uoBd~osop Io ioqmnu ~ooiq p~ loo~ls oA19 'souff Xl~odo~d ~oq suo!suo~p ~o~q-los I~ o~o~u~,pu~ 'posodo~d ~o ~uBs!xo ~oq;oq~ 's~p~nq I~ ~I~ou~s!P P~ ~I~OIo ..... o~ ..... so~ ~ ~pusl~oa I~pt~ ~ ~o ~oo~ OOg utq~ po~eooI i~aodozd s~qa si ................ oN ouogd .... ,~ ............... sso~ppv .......................... ~o~o~%uoo ~o auraN ................ ON oUOgd .... : ............... sso~ppv ........................... ~o~[qo~V. $o .............. 0 ~0 .... .......................... oN soA :soslmoaa moaj p0Aomoa oq [I~J ssooxo [I[~ ........ ~ ' '~ .......... poprJ~l oq lo[ [I[~ '~1 ............................, l .... :u°BeIn$°~ J° °°uuuIP~° '~Ul ~ulu°z Xu~ 0;~IOIA u°[$°n~lsu°° P°s°d°xd s°°ff ...........:' ................ · ' ' po~un;ts ~ sost~o~d ~otq~ ut lotJlstp osn ~o ouoZ ' [ I .........................~ ....................... so~o$S jo ~oqmnN ............... lq~[oH ............... ~ldo~ ....... : ........ ~o~ ............... luo~ :uoBo~lsuoo ~ou o~quo jo suo[suo~[~ '8 ............... 2 ...... s°~°lSiJ© I°qmnN ................ }~ ' ' ' l~[OH .............. ,'¢~ ..... ............. }~ff' ~o~ ..... ~ ....; '~7 ' ' ' luoxd :suoB[ppu ~o suoBu~oli~ ql~ o~nlomls oamsjo suo[suo~G ......................................................... souols JO. xoqmnN ............... l~mH . ........ ....... ~ldoG ....... ~ ....... ~oH ............... luoa~ :Xu~ M 'som~o~ls ~u[ls[xo jo suo[suom[~ 'L ..................... osn jo o~1 ~o~o jo luolxo pu~ o~nl~u Axoods 'Xou~dnooo pox[~ ~o I~Oxo~moa 'ssou[snq JI '9 ............................ ~ ............................................ sago jo ~oqmna 'o~m~ JI ................ ~ooff qo~o uo s~tun.. ~mllo~p. jo ~oqmnN ............... / sl[un ~u[IIo~p JO xoqmnu '~u[lIo~p JI '~ (uoB~o[[dd~ s[ql ~ug[~ uo pged oq oi) (uoBdl~saa) NOTE~ · ~ MONUMEN~ ' '~OUNG & YOUNG .... SURVEY Wh, RRC. N WALOVOGC. L. Sheet __ of Prep. by __ Date 7 B.?. ~ Sheet ____ of ____ Prep, by __ Date Checked by __ Date ____ Design Ident,: SH.No. __ County P.I.N. Job Title -- Prep, by Date Checked by Date County P,I .N. Job T~tle No. Prep, by Checked by