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Home My WebLink About14154-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15943 Date July 13, 1987 TI[IS CERTIFIES that tile building addition to existing dwelling. 200 Location of Property ...................... .Sixth S%reet Laurel House IVo. Street Hamlet County Tax Map No. 1000 Section 12 6 .Block 1. .Lot 12.1 Subdivision.. X .Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .J.q 1. y..9.,. 19 8 5 pursuant to which Building Permit No. 1415 4 Z dated ....... J.u..1 y.. 2. 3. ~..1. 9. .8 .5 ...... was issued, and conforms to all o f the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..... ~n...a.d.4i..~.ip.n...~9..a.n., .e.x.i.s..t.i.n.q..o.n.e.-~ f..a.m.i.~.y. ¢.w.e..~ ~.i.n.~.: ................... The certificate is issued to CAROLINE &. WALTER LOSCHEN ..................... /o¥.k '~ge2t~Y. tt ..................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... N789264 UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A ....... Bui'¢'Inspecto~ ............. Rev. 1181 FORM NO. ft 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) N_° 14:~.54 Z Permission is hereby granted to: __ · ............... ..~.'~.-/..'~..... ~...~_z.~ .......... .... ./.o.~.:~...../..~ ..................... .......... ..~. ~.~z~./.. ~..../..-......//. ~./. ,o ........... ~.~.~.~...~. z~.zz. ~z...~..~......~..~.~.~.~.....r~...//.~.....~... ......... .............. ~.~.-'...~ ............ ~.~..... ~.~.~_~. ........................................ ../.... ......... ot premises Iocoted at .......~,~. ...............~/,,..~. ....... ,~~.7......~,.,.~/,~-~,///~f.~...~,~..~ ~/ . .~-~:../.. County Tax Map No. 1000 Section ........ /..~i~ ......... Block ...... (~)~. .......... Lot No...~..~. ...... pursuant to application dated .......... J.~./.y.......~.. ...................... ,19..~, and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~ 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 Enginber 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 featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of anv housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancv New Dwelling $25.O0, ~Accessory ,$t0.00 Business $50.00 2. Certificate of~occupancy on pre-existing dwelling $ 50,. 00 3. Copy of certificate of occupancy $ 5.00, over $ years $i0.00 o.oo 5.Updated C.O. $ 50.00 Date ................. NewCOnstruc%ion ...... Old or Pre-existing Bu[Jding ............ Vacant Land ............. Location of Property ..................................... House No. Street ~amlet Owner or Owners of Prope~y ~~ ~ ~~ ~'~C County Tax Map No. 1000 Section ,,,~.,, ......... Block , . Subdivision ................................. Filed Map No ........... Lot No ............. Permit No././LI..~.~ Date of Permit . 7/~, .~/¢~,~..~pplicant . P/¢.¢.~¢4¢'//~, ~ ,~,4¢..~.~../..~.~...~.~ Health Dept. Approval ........................ Labor Dept. Approval ...................... . Underwriters Approval .................... Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $ .~. '~ '~'g'¢'--~/-'~' 5~ Conltructio-n on above described building and p~.ermit meets all applicable codes aod regulations. ................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy January 20, 1987 ..t~ ,,,,,,~i~a,lo. ~,,. o. ~i~ ~ N 789264 THIS CERTIFIES THAT o~y the electrtcaJ ~ulpment ~ ~seribed below and i~t~duced by the applicant ~ed on thence application number in the prorates of Wal~er G. Loschen, 200 - 6~ ~tree~, Laurel~ NY 011 126.00 01.00 012.000 ~s examined on ~a~ ~2~ ~ 7 and found to be j~ co.ipli~ce wlth ~he requireme~t~ of this Board* FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT DRYERS FEEDERS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO* OF FEET SERVICE DISCONNECT S E R V I C NO, OF CC, COND A W G, A, w, G HO, OF NEUTRALS A, W G NO, OF HI-LEG OF HI-LEG OF NEUTRAL Ot ER APP RATUS~ -- ~aa~oardz;1 16c~r.,125ampso, 200'- 6~[t S~e~ GENER~LMANAGER Per~ ~ ~ This certificate must notbe altered in any manner; return to the office of the 8oard if incorrect. Inspectors may be identified by their credentials. COPY FOR B~L~iNG DEPARTMENT. THiS COPY OF CERTIFJCA~E M~ST:~NOT BE ALTERED IN ANY ~NHER. FIELD I NSP EC~I'ION COMMENTS FONNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: TOWN OF $OUTHOLD OFFICe. OF BUILDING INsPEcToR P.O. BOX 728 TOWN HALL 8OUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because ,of the following reasons. /~/~ An application for Certificate of Occupancy is not on file. -_/--/ No Underwriters Certificate on file. /~The check is(outdated/not on file.)~L57dO /5/ No Health Dept. Approval on file. /5/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. --Building Permit --~_~/ ~ ~ Z # / - ***/--/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) 7GS-180~ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING £/~AL ( , ,,//?/_../// / ~'~ / _//2'-: _ BUILDING DEPT. INSPECTION []FOUNDATION ~LST [ ] ROUGH PLBG. []FOUNDATION 2ND ~/INsULATION []FRAMING, [ ] FINAL r REMARKS: ,~'~,~ ~'/~~ ~ ~~ 'FORM NO. 1 TJDWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL &OUTHOLD, N.Y. 11971 TEL.: 765-1803 , ~LOG P~EPT L;~ TO\/;~'q Ok SOUTHOLD ~ Examined . Z.~' ..... , 1 ~.~..~ kpproYed ..... 1 .~.. Permit No../.~.4~ .... Disapproved a/c ........ ~' '_____.~___~' :" ........ 't~ ..... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date .7/· ,C~. ....... , 19 .~f.c~' a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 ~ets 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. i 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 ~hall be kept on the premises available for inspection throughout the work. i e. No building shall be occupied or used in whole or in part for any purpose"whatever until ~t Certificate of Occupancy ~hall 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. '~he applicant agrees to comply with all applicable laws, ordinances, building code, ~ousing code, and regulations, and to ~idmit authorized inspectors on premises and in building for necessary inspec~ons (Signatuj~e of applicant, or name, if a corporation) (Mailing address of applicant) ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (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 done ........................................ . .......... !'. ............. ....... House Number Street Hamlet County Tax Map No. 1000 Section ..... [ o~ ~ Block ...[. ........ Lot , [ .~: ]. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) g. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ./..~.~F([]'~/ ~SI~Pt~[~, , b. Intended use and occupancy ............................................... "8. 10. 11, 12. 13. 14. Nature of Work (check which applicable): New Building ..... ' ..... 'A Repair ... Removal .............. Demolition ... Estimated cost ...... .~ .~. 0.i0.,I ........................ Fee~.~ If dwelling, number of dwelling units ............... Number of d~ If garage, number of cars .... ~ ................................ If business, commercial or mixed occupancy, specify nature and extent D~mens~ons of existang structures, ff any: Front....'~ ........ Rea Height ............... Number of Stories.. ! ................. Dime~sio~ns..qof .~ame structure ~vith alterations or additions: Front ..~. Dimensions of entire new consiruction: Front . .-~. ~.. Rear Height .............. ~Number of Stories . .]. ~ .... ).~j ......... Size of lot: Front ../~.O. .... i ............ Rear . ~. ............ Date of Purchase .......... ................... Name of Forme Zone or use district in which p~emises are situated ................. Does proposed construction violate any zoning law, ordinance or regula' Name of Architect ......... i. Address Name of Contractor .. Z.~~/~: ...... Address .......... PLOT DIAGRAM Locate clearly and distinctly a~l buildings, whether existing or propo~ property lines. Give street and block number or description according to dee~ interior or corner lot. STATE OF NEW YORK, i S.S COUNTY OF ................. , ............................ j ..................... being duly (Name of individual signing contract) above named. He is the., .................... ~ ............................... ~ (Contractor, agent, corporate et of said owner or owners, and is drily authorized to perform or have perfor application; that all statements contained in this application are true to the work will be performed in the manner set forth in the application filed there' Sworn to before me this tditio . .~.... ... Alteration .......... ........... Other Work ............... f~"(~ .o...... (Description) (to be paid on filing this application) elling units on each floor ................ ,fq . ?pe o use ' ' . .......... Depth ......... ..................... ? ......... ~umber of Stories.../ ....... · ........ .~ ............. Depth . ~.~.. ...... · Owner .. ion: .............................. ~e removed frqm premises: ,._yes ~-,._ '..~.,,,f] ,;9...~,. A[tt~ Phone No..~, 1~. l.-.7...I.~..~.. ,',',~, .......... Phone No ...... .......... Phone No. Tg.7.~. .~.. . . d, and, indicate all set-back dimensions from and show street names and indicate whether iorn, deposes and says that he is the applicant ~cer, etc.) ~ed the said work and to make and file this best of his knowledge and belief; and that the 'ith. I'~ F .DI1C, ...... tC~'q-'/~,J~, ,~7, · .: ~>. ':. ............ County . .~t.. ,~ ,,O .~~ NOTARY PUBLIC, State ol New York .................. MO, 4707878, Surfak CO~O~ f ~ (Signature of applicant) Term Exo~res ~a~ch 30, ~9~ / i "Z.'D CC, i ~ ~ ~, -t 3~ -~. ~ IO .--, -n m 0 ~ ::E r- .... 0 rn--/-O00 ~2. - =~. z~ z'~ ~ ~:~c~ q o z ~, ~ 7o_ z ,~,~ -- ~ :' ---t x~ m ,.-, Z ..~ ;:~ m Z m :~. ,O 0