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Home My WebLink About13706-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi[icate 01: Occupancy No..Z..1 .~.O.l.Z/ ......... Date ..... .~.o.v.e..m.b.e?.. THIS CERTIFIES that the building .... .~.c.c..e.s.s.qp. y..a.n.d...u.o.q d,, .s.t. qv. ? ............... Location of Property ~ 37130 Main Road Cutchogue s . Street Hem/et County Tax Map No. t000 Section . ~ ......... Block 3 .Lot 003 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Fe b. 1 .5 ....... 1985 pursuant to which Building Permit No. dated . F.e.l~ ,. ~.1 ................... 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 ......... .... ~cc.~ ~ or.Y..~l:.o?.~ge..hu~-~[.d. 5,~g..~nc~. ~.qqc). ~.g. qy~ ............................ The certificate is issued to RICHARD BRUCE LEBKUECHER (owner, of the aforesaid building. Suffolk County Department of Health Approval .. iq/ UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 Building Inspector TOV/N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-° 13706 Z Permission is hereby gronted to: ..... ..................................... et premises located at ,...,~..,.Z./.,,ff..~.Z ......... pursuant ,o application c~ted .~,w~.... ...... /.,.~.. ................ ,]9...~,',.~.,~and approved by the Building Inspector. uullding 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 ~a Im.me~aa 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. Su bm it Plan n lng Board approval of completed site p lan requirements where app l icable. 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: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4 .Vacant L~/~. O. $5.00 New Building ............ ~~ ........... Vacant Land ............. Location of Property .~..7./. ,~. ?..../.~..~/.~, .~..~? fi}.~ .......... .~..~..~.~.. ~.~//. ~.(~ ~... ~,,. ,~ ~4 ~ House No, ,Street ~arn~ qwner or Owners of Property , .,~/./~/.-/../"~ ~)., ,~,/'~(//(g.~..4..--~..~.~..~:~.~./7/~-~/~,~;.. County Tax Map No. 1000 Section .~..~. ......... Block .... .~. ......... Lot....'~. ........... $15.00 Date .......................... Subdivision ................................. Filed Map No ........... Lot No .............. Perm;t No./:~..V~..~. ~.~ Date of Permit .......... Applicant ~./~C~.~./C..~..~./'~.~./.~. 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 permit meets all applicable codes and~regulatiops. Applica , . ...... FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~eOUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 Regulations, for the construction of buildings, additions 9r alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, i~6~dinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for~ece~~~~ ~ ~ ~,~ (Signature ~afit, or name, if a corporation) ..... (Mailing addYess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~.?~7/.~.. ................. Plumber's License No ......................... Electrician's License No ....................... · ~.~ ...................................................... ~PPRO¥,~D .Al- NOTC~D ......... Name of owner of premises .~../.~/'f,~.'~.D...~..~/.G~..~.~t~./~/~..~.~.C~-~-(/-~?-'?:p.'.~.' [-~ (as on the tax roll (fat~est de_ed) BY: NOTIFY BuILDi'NG DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCflON MUST BE C:)MPL,?TE FOR C. O. ALL CONSTRUCT[ON SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY Other Trade's License No ...................... CODES. NOT RESPONSIBLE FOR 1. Location of land on which proposed work will be done. DESIGN OR CONSTRUCTION ERRORS. . .Y / .0. ........ : d, ................... ..: .:. h.of . .c .......... House Number Street Hamlet County TaxMapNo. 1000Section . 47. .... .:. ,- ...... 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 . .~/.0.~.~. ........................................................... b. Intended use and occupancy . ./~..C.: .~.c.'-5.~.L~-~7 ................................................... ,/ 3. Nature of work (check which pplicable): New Building ..... ' .....'Addition .......... Altera i~n .... ~ ...... Repair .............. Ren oval . ',i :_','t~ ' TM ' "' ' Demolitior~ .., ........... ,, ,Other Work ~./.O.D..~.(:J ...... ' ~ ,,~,u~ ,~ ~ ~ .4,c~t~- (Description) 4. Estimated Cost .... '~...d"Z~7.. · t .~ ............... d ........ Fee...~.. ~.. ~..~.?. ..................... (to be paid on filing this application) 5. If dwelling, number of dwelhng umts .......... ; .... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specifyjjcatu~e~ a~d extent o f each tyjpe of use ...................... 7. Dimensions of existin~ structures, if any: Front... tYl..T..~'Y...... Rear . 1 g..~..o~.~. .... Depth . .~..O....~z,q_. ~/.-- .... Height . .,~7. · .~..e?lc ....Number of Stories.. ] ................................................... Dimensions of same structure w~th alterations or additions: Front ~; ....... Rear . ~...... ..... Depth . ~d,<C . .~O'Acg~... ....... i. ·. Height . ..~ ......... Number c~f Stories../. ................... (~ Dimensions._of ~ntire:av~v construction: Front ../~ .42.e~f7 .... Rear ./.~ 't2.e-.e: .F'.... Depth..~r.O. ~r?-~ ~. Height ../Z.~2~t .... NumberofStories.../ .......... i ......... iiii ............. i...ii.iii.iiii 9. Size of lot: Front . .6./-/..1°.~. ?~.'~*. ........ Rear.. ~...7... ~2.~v~. ........ Depth ,o~. ~. ~..12..c~. ........ 10. Date of Purchase .......... : ................... Name of Former Owner ............................. 1 1. Zone or use district in which p3emises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ,~O.....-...............~ ...Willexcess fill be removed from premises: Yes No 14 Name of Owner of premises . Address Phone No ~' Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot, ,7~ STATE OF NEW YORK, ,,4, COUNTY OF .......... !S.S ............................. , .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is 'the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du!y 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 manner set forth in the application filed therewith. Sworu to before me this ; [3 .day o ........... 19 NOTARY PUBLtC, ~ew ~~/: / /~ (Signature of an~ ~' ' :t~ ~o. 47078/8, Stff~olk t,ountv ~erm