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Home My WebLink About20816-zFORM 'NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTF~ENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21053 Date SEPTEMBER 29~ 1992 THIS CERTIFIES that the building Location of Property 200 ROGERS ROAD House No~ County Tax Map No. 1000 Section 66 Subdivision Block 2 Filed Map No. ALTERATION SOUTHOLD, NEW YORK Street Lot 16 Hamlet Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 5, 1992 pursuant to which Building Permit No. 20816-Z dated JULY 13, 1992 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 ALTERATION TO CHANGE ROOF ON AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. VIRGINIA SCHMIDT (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ~ //Building Insp Rev. 1/81 lvO~,,M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~-N°. 20818Z Permission is hereby Bra .o...__....T~n~'~L~ ...... ..~....~ ................... .................................. ..... , . at premises located at ..~......0~.........~ ........................ ~ ........................ County Tax Map No. 1000 Section .... ..~...~...~. ....... Block .....,.~.....~=... ...... Lot No ....... I....~.. ............ ~u.uont to ~pp,,~t,o. ~t~ ......... ..~...~.......~.. ................ , ,,.,....~., ond oppro.~ b, the Building Inspector. Bull-ding Inspector Rev. 6/30/80 Form No. 6 TOkrN OP SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 · APPLICATION FOR CERTIFICATE OF 0CCUPANC~ L,~". A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. .~ 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a' certificate of Code Compliance from architect or engineer responsible for the building. 6. Submi. t Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons'therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2.Certificate of Occupancy on Pre-existing Building - $i00.00 3.Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4.Updated Certificate of Occupancy - $50.00 5.'Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 · / Date ............................... ,few Constructzon ........... Old Or Pre-exmstmng Building ......... Location of Pr°pertv''''~''~'l')-' '~x'~?.~'-~--~'~. ~?"~' i ~ ~)"~ ., House No. Street Hamlet Onwer or Owners of Property ....................................................... Cos~ty Tax Map No I000, Section .... ~.~ .... Block... ~ ...Lot. /.~. Subdivision ' Filed Map Lot Permit No.~..~.'~../.~, [.~.Date Of Permit.~.~/.~. ~. ~...Applicant..~./.~.~7./.77..~... Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Fee Submitted: Temporary Certificate ...........Final Certicate ........... .................. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 100;38 THIS CERTIFIES THAT o~ly the electrical equipment ~ ~scrib~ below and intr~uced by the ap~icant ~med on the a~ve application number in the prem~es of in the followlng location; ~ Basement ~ Ist FI. ~ 2nd FI. O~T Section Bilk Lot ~s examlned on ~ ~ ~] ~[~ ~ ~ ~ t [ 9 ~ ~ and.found to be in co.~pllance wlt h the req~drement s of thls Boord. FIXTURE FIXTURES RANGES OVENS OUTLETS RECEPTACLES SWITCHES EXHAUST FANS DRYERS FURNACE FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E A W.G. NO OF HI,LEG O~ CC. COND OF HI-LEG OF NEUTRAL GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identif[~B by their credentia{s. COPY FOR BUILDING DEPARTMENT. THIS COPY OF C,-K'i iFICATE MUST NOT BE ALTERED IN ANY MANLIER. INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieezorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 SEPTI~IBER 18, 1992 VIRGINIA SCftMIDT 200 ROGERS ROAD P. O. BOX 804 SOUTHOLD, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XXX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is ~r-wm~/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT $ 20816-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~NAL DATE INSPECTOR~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ~G. [ ] FOUNDATION ZND ]'~-~SULATION [~~MING [ ] FINAL REMARKS: ~ ~/ DATE fiELD -~OU~;DA~ION (1st) '~OU~DATIO;! (2nd) ~/'-~ ·PLUMBING ~IO~N N. y. STATE ENERGY CODE ~DDITIOi~IAL COMMEPJTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18011 BOARD OF HEALTH ~.-~;'~ .... 21 SETS OF PLANS .......... SURVEY ................... CIIECK .................... SEPTIC FORH .............. Disapproved a/c .... . ......................... ~..~. ~ (B uil'dTr~o In sp ect or ) 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 se'ts 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 coverOd by tins 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 b6 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 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 authorized inspectors on premises admit and in building for necessary ins~)ections. -- ( ignatdfe of applican , ';or na e, if a o poration) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~/.[. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth, orized 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 .................................................. ............. . . .............. ........................... House Number Street Hamlet County Tax Map No. 1000 Section ...... ~.{'.: ...... Block. ~ Lot. Subdivision..~,~ ~;.~ ~ .~/,) '~/~)~:~ ~' '(~a~ Filed Map No ............... Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ~/~[~ t~..~f~-.{'( b. Intended use and occupancy ,,, ~ 3. Nature ot wor,k (c,~heck which applicable): New Building ........ Addition .A/teration Repair ..... · '{~' '.~,.:.- Remloval .............. Demolition .............. Other Work .... .~2'~ ~-'c /7, ,? ' ~ (Description) 4. Estimated Cost . · ~. 1~. '67 ~ ¢ .. ~."-~ ..... : ......... .~'ee ~1.~' (to be paid on filing this application) 5. If dwelling, number of dwellinglunits .... ] ..... Number of dwelling units on each floor · Ifgarage, numberofcars .... [ ........................... : ..... . . . If business, co,mmercial or mixeld occupancy, specify natu[e and extent of each t3,pe of use ,, ,.... ....... e ....... 7. Dimensions~qf ~xisting structures if any Front ~- '. ~; ~..rtaav [~ ~, t 'ho',*h' 2~ ' ' · -,s,a~ · . ,.~ .......... c~umt)er oI~itorles l ?~rnenslons o[_,s}~e structure with alterations qr gddltlons: Front .... &/~ ...... Rear ..-.o~. ~ ......... Depth ..... .5 .K .......... i · · Height ... ]..(2. ............... Number of Stories ...... [ ........ 8. Dimensions of entire new construction: Front Rear .............................. Depth ............... Height ............... NU~,mber of Stories. . .... ........ -~. .... 9. Sizeoflot Front .~ ('?. Rea~ ' ',~'~ .......... ' .... ;' .... ,~7 ........... ..... "':&;'I 'c" ',;',) ............ ~"~ .............. vep,_m .t :.~. ................. 10. ~,ateo~ruranase ../.7.(-c'.~..(.LrP:..~,).Rd.~7 .~..¥TNameofFs)rmerOwner / g~/',/,0 11. one or use dmtnct in which premises are mtuated... J~.ed~o~-,~,~-~ ~ , 12. Does proposed construction vioiate ~iny zoning law, ordinance or regulation: ................................. 13. Will lot be regraded ......... ]~,.'(5 ............... Will excess fill be removed from premises: Yes ~ ('~ 14. Name of Owner of premises ~Jl~./..(.¥..xdL ~:'/'/~'/.//~ffdress . .~.~.t~{~,~. ~..~¢.Z/tl... Phone No,,~..~.7.&.,~. ,,.~..~'~.../ Name of Architect ... t ' ' ;1~,' ': ...... :,~. ..........,Address .................. . , l~hone No ..... ,~... ~. Name of Contractor.. L- g. t i ~.~.../.~...~ .~, ...... Address .i&.tt:2,5..~.077,.4~/.v~..~i;~one No. ,.%~.~. ? .51.7. .7. 15. Is this property within 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 ail set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEeW~¢o~ / ~ /' I COUNTY OF~ 1..~.'.. S'S // (') ' ....t~__.~ A,~'~ .~ .['~(...~-~k.m~-'-~ ~ ~ l .C~. ........... being duly sworn, deposes and says that he is the applicant ' ('N me of individual signing contract) above named. He is the ~ ~.../~-.. 7.~. (Contractor, agent, corporate officer, etc.) f smd owner or owners, and m dulYiauthonzed 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 bet forth in the application filed therewith. Sworn to before me this ..........· ,,,. , ....... :day. . ., . ~ . No. 48798061 ~/ ( g pph nt) Notary Publlo, State of New Yo~c - ~ualifl_ed in Suffolk C~)unt~ ~ommlsaion i-xpire$ Decem,be~ q