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Home My WebLink About17448-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17362 Date SEPT. 28~ 1988 THIS CERTIFIES that the buildin~ ALTERATION Location of Propert~ 5200 NASSAU POINT ROAD House No. Street County Tax Map No. 1000 Section 111 Block Q8 subdivision Filed Map No. CUTCHOGUE Hamlet Lot 15 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated Sept. ]6, ]988 pursuant to which Building Permit No. ]7448Z dated Sept. 20, ]988 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 REPAIR WORK ON FRONT WALL OFF C~LRAGE~ DECK ROTTEN. The certificate is issued to ROBERT LUDEMANN (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building I~spector' ' Rev. 1/81 FOB~ NO. O 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~ 017~8 Z Permission is hereby granted to: ~'~ ...~..~.....~....;..~~..~~ ~. .... ~.~...~~....~.~.. ~t pre~ises~ated at-..~...~......~.~....~~.~~ ......... ..................................... ~...~..,..~ ....... ~.~.~.~ ................ ~ou.~ ~x ~ ,o. ,ooo ~ec,,o.....~./J .......... ~,~ ...... ~ .......... ~o, ,o ..... /..~ ....... Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPAN Instructions RLDG. DEPT. ;_Y~,~TOWN OF $OUTHOJ:2, ....... A. This application must be filled in typewriter OR ink, and submitted in duplicate 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: I. Accurate survey of peoperty 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 any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of eertificate of occupancy $1,00Date ~T;~, ./ .......... ~ New Building ............. Old or Pre-existing Building ., ._~. ..... Vacant Land ............. County Tax Map No. 1000Section ... /// . Block .,..~ ........ Lot,, ./ ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.7.~/. '.~/~..'.~,Date of Permit ~../.~...r~Cicant...~.J~.~..,~. 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 QILapplica~,ble codes and regulations. Applicant .... ~..~,~, .~;-. ..... / ....... Rev, 10-10-7a ?'iELD l,,S, ~,,-LU I ][DATE FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONA'L COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved . .F-,'~. .... , 19 .~. Permit No../..~...~../It~ 2 Disapproved a/c ..................................... Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMITDate~., 1~ 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. APPLICATIOIq IS HEREBY MADE to the Building Department for th~ issuance 0f'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, orfor removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hou~sing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspect, i, qns. (Signature of applicant, or n~me, iz a corporanon) · ............ State whether applic, a,~ ~j~[~, ~ architect, enCneer, general contractor, electrician, plumber or builder. N~me or own¢l~~l.~; idt~}t' ~;i~) ......................... If applicant is a co~orafl~J~ilI~'~le~l~l~:~l!horlzed officer. Builder' SlBlg~f~l~d~.t ' "`t~' ~~'''~' Other rrm~[~'~g? ?:~!?? ~?. ':")".' ~ .') 1. Location of land on which proposed work will ~ done. ~ ~~. ..... 37 9. P ..... ........ House Number Street Hamlet County Tax Map No. 1000 Section ........ /[ ./ ..... Block ....... ~ ......... Lot.. 2~ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of Pr0Posed construction: a. Existing use and occupancy ..... ~. b. Intended use and occupancy .................................................................... ....... .,... Removal .............. Demolition .............. Other Work .......... . ..... q~f ,, i ~//.., ~ (Description) 4. Estimated Cost ,/.. ....... ............................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling iunits .............. Number of dwelling units ~n each floor ..... , ........... If gara e, number of cars ~ . . . 6. If business commercial or mixed occupancy specify nature and extent of each type of use .. .... ¥ ........... 7. Dimensions of existing structur6s, if any: Front...~ ...... .~.. Rear .............. Depth ............... Height ............... NurOber of Stories ... z./. 3.. · ~ t Jt~~. .............................. Dimensions of same structure with alterations or additions: Front . ..~ ............. Rear .................. Depth .................... ~.. Height ...................... Number of Stories_ ...................... 8. Dimensions of entire new constrUction: Front...iQ. ~ .... Rear~3. P~r.a:,c,~.. ,ffd/vt~P~-~. ~._~ .~~. Height ...............N~mlber,oqStories '., i:3.: .... . .~A~. :...:. {/. ~..\/Y.~.'~: ?..~../_Q/. ,'5.~. Tya~..t'. 9. Size of lot: Front ........ Pt '~6 '~ ..................... Depth ~. ....... ~. ............. 10. Date of Purchase ........ :.'.i .......... ~. ....... Name of Former Owner ............................. .... hp' ' ' 11. Zone or use &strict ~n winc rem~ses are s~tuated ............................................... ,.. ..... 12. Does proposed construction vie!ate any zoning/aw, ordinance or regulation: .. ](t~. ........................ 13. Will lot be regraded ...... ~-a. · t. · ~._+ · · .~ ........Will excess fill.~l~ removed from premises: Yes No 14. Name of Owner of premises ~.~dress., ~ ..... ~ .... Phone No. 7..~. Name of Architect ........ I~ .!., ............ Address ................... Phone No ................ Name of Contractor ~.~.~~~._Address .. ~'~i ....... Phone No. PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block aumber or description according to deed, and show street names and indicate whether interior or corner lot. OCCUPANCY OR USE IS UNlgWFUL WITHOUT CERTIFICATE STATE OF COUNTY OF .... ~.?....~..~..~..~.~ ~.~ (Na~e of individual sil~n~ng contract) above named. ''~'' APP ,IIO L ._ Al NOTID 766-1802 9 ~ TO 4 1~4 FOR ~ FOLLOWINO INBI)l~CllONS: ?. rq~DAT~ . T1A~#r~BD 2, R~GH. ~INO i ~BINO · n~A~ . ~U~.MUST BE COMP~E mn c.o. ALL ~N~ON 8~LL ME~ THE RE~~ ~. T~ N.Y STATE CONi~N, I,~, He is the" i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly anthonzed 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 manne~ set forth in the application filed therewith. Sworn to before me this ~ ............. I..~ ........ dayof ..... . ~... .... , 19 ~.~. Notary Public, ....... .0..~- ..... County H£ D~VOE ~,klR LLF~K~t~ of New Yo~K N0'1 I ' 5378, ~.lfol~ Count~a (Signature of applicant)