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Home My WebLink About14049-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..$ J 3.5.33 ......... Date ., ,J,u..n.e, .1.? ...................... 19 .8.5. THIS CERTIFIES that the building ...... P,.d..d ~.~.~.o..n ................................. oca i of Pr crt 255 Breitstadt Court Southold L t on op YHouse ............................... No. b'treet- ........................... County Tax Map No. 1000 Section , 79 ......... Block ....9 ........... Lot .. 024 S ..... "Map of Smithfield Park" uoalvlslon ............................... Filed Map .70 .Lot No. conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ·..lq a ¥, .20 ........... ,1985· pursuant to which Building Permit No. 3.4.Qt} 9 Z .............. dated ..... ~.u.n.e.. ! .7 ............... 198. 5.., 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 ......... Com]qlete second floor The certificate is issued to ........ ~.0.1~$ ~?..T.. ~.P~Q$ .P.~.L. .............................. of the aforesaid building. Suffolk County Department of Healtlx Approval ...... [q / ~ ................................. UNDERWRITERS CERTIFICATE NO .............. ~ b 95.4.~ ............................. Rev. 1/81 Building Inspector I~OBM NO, ft TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No ~4049 Z ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ............... · ... .......... .;, ~.~~'-? .................... co,,~ Tax Mop No. I000 S,t,o, .... .7...~ ......... B,~k ........ .~ ........ 4, No....~..~../.. ...... pursuant to application doted .... .~..~. ............ .~.....~... ...... Ig~....~,~and approved by tJ~e Building Inspector. Buildfng Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLtCATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This appl cation m.ust be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec° tot with tha following; for new bui d ngs or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Haalth Dept. of Water supply and sewerage disposel-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters, 4. Commercial build{ngs, Industrial buildings, Multiple Residences and s m lar 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: I. Accurate survey of peoperty showing alt 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 $5.00 2. Certificate of occupancy on pre-existing dwelling / land 3. Copy of certificate of occupancy $1.00 use --Pre-Existing C,O. $15,00 Vacant land C.O. $ 5.00 Completion New Building o.~ 2nd floor Old or Pre-existing Building ............ Vacant Land ............. Location of PropertY5.5. .B.r.e.i.t.s.t.a.d.t..C~ ~ .~Q~Qi.~ .~,¥, .................................. House No, Street Haml#r Owner or Owners of Property Robert T, Kro. e.p.e] ............. County Tax Map No. 1000 Section ..... 7..Q ........ Block ...~ .......... '. Lot..0.2.4 ........... Subdivision .','.~..a.R .q~ .~.~.%~tt~%~%~ .~.~'~ ........ Filed Map NO..4.7.7.0, ..... Lot No,., ~- ......... ,erm t ? oate of ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underw it rsApproval~.~ ~/., --~..~ Pla ni gBoa dAppro · · r e ......... n n r va ..... ~ .......... ,. Request for Temporary Certificate ..................... Final Certificate ..... ~. ................. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 O, te O't.~'.~ 11, 1985 -~pplleatio,~'o.o,~.file 336183 THIS CERTIFIES THAT ' N 695453 only the electrical equipment as described below and introduced by the applicant named on the above applicalion number in the prernises of Fishman, 255 ~reitstadt Court, Southold~ N Y in the followlng loc,tlon; [] Basement [] ]st FI. ~ 2nd FI. Seclion Block Lot was examined on J~ 6, 1985 and found to be in complian,,e with the require,~ents o~ this Board. OUTLETS RECEPTACLE.~ ! SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS SERVICE DISCONNECT NO. OF S E R V I C E Southo/d, N Y 11971 This certificate must not be altered in any manner; return to the office of the Board ' ' correct, Inspectors may b~-~ by"~r~entlals. . COPYJ ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approve./7 ...... l . fT mit Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMITDate ..... ,,-~"~.. INSTRUCTIONS a. Tins 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 tiffs 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 shail be kept on the premises available for inspection throu~aout the work. e. No building shail 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 agree~ to comply with all applicable laws, ordinances, building code, housing cod~and regulations, and to admit authorized inspectors on premises and in building for necessa ' sp ,ions. · · (Si~a/0t'fire of applicant, or name, if a corlf~'ration) (Mailing address of applican4,)' State whether applicant is owner, lessee,, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... A). ......................................................................... Name of owner of premises .................................... (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 ...................... 1. Location of land on which proposed work will be done .................................................. ........ ~~... ~.~. ~.~..z.A..~ '.~.,,. 9. 5. ......... . .J'.~..~ ./_/¥./. ~ ................... House Number Street Hamlet Oou.tyTaxMapNo.,000Section ..... ........ Block ..... .7. .......... Lot .... ........ ,.~. ~. ~ I/ Subdivision . ./~...~..(~. · · · ·..TJX../..~_~.~. .~ ........ Filed Map No...4~..77..O ....... Lot ..... : ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ? ............................................. b. Intended use and occupancy ........................... .............. ' ............. 3. Nature of work (check which {pplicable): New Building ..... ' ..... Addition ...... . .... Alteratio~ .......... (Description) 4. Estimated Cost ~.~ ~ . Fee '_fi/., df '~ (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ....... ~. ...... Number of dwelling units on each floor ................ If garage numbei of cars i ' 6. If business, commercial or mixed occupancy, specify nature ~,nd,extent of each type of use .., ................. 7. Dimensions of existing structures, if any: Front ..... .~. ~.; .... Rear .... ' ~. O ...... Depth .. ~...~. ....... Height ............... Number of Stories .... ~.. ................................................. Dimensions of same structure With alterations OJLadditions: Front .../~//.~e~ct~ .... Rear .................. Depth ................... i'" Height..~~f~-Stories ................... Dimehsions of entire new construction Front ............................... ~ ..... Rear ....... no,,,h,. ................ H~g .... Ng~ber of Sto..e ............................................. 1 I. Zone or use district in which piemises are situated... ~. :~('~Z ~-d77~..~. ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~qT~. .......... n ............ 13. Will lot be regraded ..... .MI/. 4 ................ Will excess fill be remoyed from premises ,~d'/,q-- ~ No Name of Architect ......... i .................. Address ................... Phone No N amO of Contractor ........ ~ .................. Address ................... Phone No ................ PLOT DIAGRAM I,ocate 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. OCCUPANCY OR FOLLOWING IN~ECTIIONS: ~. ROUGH - FR~F~O'~' ~ / 3. TNSULATION ~ ,. / 4. FINAL - CON'STRUCTION '~OST BE COMPLETE FOR C.O. ALL CONSTRUCTION' SHA~L 'ME~T THE REQUIREMENTS[ OF THE '~.'~(. STATE CONSTRUCTI~)N & ENER~t~ CODES. NOT RESPONSIBLE DESIGN OR CONSTRUCTION copper tubing is use¢ I[or water distributing ystern; piping shall be STATE OF NEW~YO~_~. · ~.. ,~.; ,~. tO,, , , 7~. ~-d-. .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigfling contract) above named. He is the ...... f5w,9[~. ......... ; ......................................... J (Contractor, agent, corporate officer, e~tc.) of sa!d owner or owners, and is dully authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannOr set forth in the application filed therewith. Sworn to before me this I l~ot?~eublic, ...... , ........... Cou NO. 52.4655242, Suffolk County Commission ~xpires ~arch SO, l~a"7