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HomeMy WebLinkAbout29196-ZFORM NO. 4 TOWI~ OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29311 Date: 03/14/03 T~IS CERTIFIES that the building ADDITION Location of Property: 95 VISTA PL CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) Co%~nty Tax ~ap No. 473889 Section 83 Block 1 ~t 21 Subdivision Filed ~ap No. Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 7, 2003 pursuant to which Building Permit No. 29196-Z dated NLARCH 7, 2003 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. ~e certificate is issued to FREDERICK & CAROLYN LUBANSKI ( 0WN~R ) of the aforesaid building. SUFFOLK COUNT~ DEPARTMENT OF ~{EALT~ ELEC'~RICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATmU N/A N/A N/A ture Rev. 1/81 FORM NO. 3 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) PEP34IT NO. 29196 Z Date MARCH 7, 2003 Permission is hereby granted to: FREDERICK & CAROLYN LUBANSKI 95 VISTA PLACE CUTCHOGUE,NY 11935 for CONSTRUCTION OF A DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES 26480. at premises located at 95 VISTA PL CUTCHOGUE County Tax Map No. 473889 Section 083 Block 0001 Lot No. 021 pursuant to application dated MARCH 7, 2003 and approved by the Building Inspector to ex~pire on SEPTEMBER 7, 2004. Fee $ 150.00 - ~ Signature ORIGINAL Rev. 5/8/02 FORM NO. 3 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26480 Z Date MAY 2~ 2000 Permission is hereby granted to: for : FREDERICK LUBANSKI 57-64 65TH ST MASPETH~NY 11378 CONSTRUCTION OF A DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. at premises located at 95 County Tax Map No. 473889 Section 083 pursuant to application dated MARCH Building Inspector. VISTA PL CUTCHOGUE Block 0001 Lot No. 021 2~ 2000 and approved by the Fee $ 75.00 Authori~e~ Signature ORIGINAL Rev. 2/19/98 Form No. 6 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This appiication 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). Approval of electrical installation from Board oh 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. Submit Planning Board Approval of completed site plan requirements, For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vp~e-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 tha applicpnt. 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-existinR Buildin~ - $100.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date · · · ~ -~.~ ~l~,~ ........................... New Construction ........... Old Or Pre-existing Building ................. Location of Property ................................... House No. ~ Street Hamlet Onwer or Owners of Property.. ~0..~.'.'i{.~... ~. ? ....... ~..v .................. County Tax Map No 1000, Section...f.~. ....... Biock .... / .......... Lot..~..~ ............... Subdivision Filed Map Lot ..... Permit No.~.~..~.?..©. ..... Date Pe .......................................... Of rmit Applicant · · Health Dept. Approval ............... . ..........Underwriters Approval............ ............ · Planning Board Approval .................. .. .. . . Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted:~ $.~.~.~.~.~.... ¢ ................ -- BUILDING PERMIT REVIEW CHECK LIST Owners Name: ~ ? Reviewed: Architecff Date Engineer: -- Submitted: SCTM #: District: 1,000 Section: ~ ~ Block: / Lot: ~-/ Loca.on: *~- ¢"S& Single & separate Required certffication: (Yes / Nol Subdivision 0 Rcq. Actual: _] [Lot coverage __ Proposed ] Req Proposed: J [Rc.a~ Yard Proposed: __] Project Description: f~ ,/~dAq AGENCY PERMITS REQUIRED FOR REVIEW Permit NO YES Number Suffolk County Health Dept. New York State D.E.C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flbod Zone: Notes: ,iC SerVices · .U'l , ,/ .........~'-'" SCAt ,CO..DE:Iii'.. C)~ H,~,AJ,'I'i.j:i'~,IJVi _t~--~L'K~-. -- . : J' ' 13TA, TEM~b · ., ~;' ,'.~.:' ,~j:~,O.u~,~, ~ , ,';,",~ ..... 1 ..... ~" ~' ' ' .,....:.:",,.,..,~::A,~.,~, ~,,; ,,: ..:...,..:,!~..,.~...,~4,. ,.-... . .. -..:', . ...:,." :'.. , ,,~"' .... . ...... ~-*.,...~,...,~ ~ · ...... : ..... ~ 4, "'"'~'"~":';.-,.* ',-:." ,~ ,~, z -*'~ ~.t~)..,t.~, 765-1802 BUILDING DEPT. INSPECTION [ ~I~UNDATION 1ST [ [ ] FOUNDATION 2ND [ [ ] FRAMING [ [ ] FIREPLACE & CHIMNEY ] ROUGH PLBG. ] INSULATION ] FINAL 765-t802 BUILDING DEPT. INSPECTION [ ] FO~ATIONIST [ ] ROUGH PLBG. [ ]~)I]NDATION 2ND [ ] INSULATION [~ FRAMING [ ] FINAL ] FIREPLACE & CHIMNEY DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INS.~/L~ON [ ] FRAMING [,L.~'FINAL [ ] FIREPLACE & CHIMNEY INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [/~'] FINAL [ REMARKS: ] FIREPLACE & CHIMNEY DATE INSPECTOR FIELD INSPE-TIOH P. EPORT DATE INSULATION PER N. Y. STATE ENERGY CODE .FOlm NO. J TORN OF SOUT~OLD BUILDIN~ DEPARTMENT TO~ HALL 8OUTHOLD, N.Y. ! TEL: 765- 1802 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... ~k_..__.5 k:G~it ................... CALL .. ~2_~.~:. L.. ~. ' APPLICATION FOR BUILDING PEP, NIT Date ................ ,19 .... INSTRUCTIONS a. This application must be completely filled in by tlff~ariter or in ink mxt submitted to the I~dlding Inspector vll 3 sets of plmas, rote plo£ plan to scale. Pee according to schedule. b. Plot plan ~tx~rlng location of lot and of buildings on prmflses, relationship to ~tjoinlng pranlses or pablie s~,ets or m, ~d giving a deuiled deecuiption of l~t of property mast be dr~an on the di~gran daich is p~rt of this ap¢ication. c. ~ ~ corm'ed by ~his applicatio~ may not he eam,-meed befone ism of Building Permit. d. Ulxm app,o,ml of this applica£ion, the P~ilding ~tor ~ill issue a Building Pemit to the applicant. Such pemit simll be kept on ~ p~,u~ises available for inspection throvsixmt the ~ork. e. No building shall be ooo_ ~ted or used in tt~ole or in part for any purpose dnstever until a Certificate of APPLICATI(It IS ee.~,~x ~ to the Building Department for the issuar~e of a Building Permit lmrstmnt to the Buildi~ Zone Ontinance of the To~ of ~onthold, ~uffolR County, ~ York, and other applicable L~as, Ordinances or l~-gulatioos, for the construction of buildings, ~ddlriona or alterations, or for r~=,~val or demolition, as herein described. 7he applicator agrees tO ,'~.ly vith all applic~ble lz~s, ordlnanees, building eocle, housing code, .,-egulatiev.~, :mc! t: ~A~t mtlqe.~rize_.! iv_%'~'_.tcrg ~ l;=~==: m'J in N.:i!ding for .~'~acn.~.~'5' in:T~ctioa, a. . ............... (Sigr~tura of appllcanl~, or na~e, if a corporation) .. 5 ..... ' ........... ..... ........ ..... (Mailing address of appllcant) State ~ahether applicant is c~er, lessee, agent, architect, engineer, general contractor, electrician, pluaber or builder 0oo ,,/~-~_ .................................................................. £R,c I< ............................... Nan~ Of o~er of prints es ...E./~..~..~. ........... .~...~ .~. ~ .0..LX. ,~.,' .b .?..{~..~../?..'~. (as on the tax roll or latest deed) If applicant ia a corporation, signature of duly ~atborized officer. and title of corporate officer) Builders License No . Plumbers Linense No ................... Eleetrieians Liee~se No ....... Other Trade 's License ~ ..................... I. l~'_ation of land on ~Jaich proposed ~ork vill be done .............................................................. ............................................. .G..v.~ . ........................................ House Number Street Hamlet I c~ T~x ~ .~. ,~ s~tio, ..~.~.~ ....... mo~ .... - ........... ~o£ ................ Subdivision ....................... . . . .. .. ..... ... Filed Map No ............... . Lot ............... 2. State existing use and ~ of premises and intended use and occupancy of prolx~sed construction: a. Existing tt~ ~ ecet~mey .... /~gtQ/~.~..~. ............................................................. If garage, ~r of ~rs ......... ~f~ ......................... Dim~i~ of ~ st~e ~th alterati~s or ~itions: ~t ............... ~ar . ~ ~pth .................... ~ij~t .................... ~r of Stories ............... Di~nsi~ of entire ~ ~stxtlm: ~t ................ ~ar ............... ~p~ .............. I~i~t ......................... ~r of Stories ..................... Si~ of lot: ~t .................... ~ar .................... ~pth .................... ). ~te of ~rdiam ..................... ~ of Four ~r ........................................ ~ of ~tr~tor ................................... ~ress ............................... H~ ~ .............. PLOT DIAG~H ~r interior or co~r lot. Cam of individual signing contract) (~tractor, agent, co.rate officer, etc.) [ mid ~r or ~rs, ~ is duty ~khori~ to ~rfo~ or h~ ~rfo~ ~ ~id ~ ~ to ~ a~ file this ~licatlon; flm~ all star--nfs c~tai~ in ~is a~licati~ a~ t~ to ~e ~st of his ~1~ a~g ~l. iefl arg hat ~e ~ will ~ ~rfo~ in tl~ ~m~r ~t forth in ~e a~li~ti~ fil~ ~M~. ~m to ~fore ~ ~is .... ~r~ ...... day of .?~. ~ ~'. ~t~ ~lic ........ ~....,¢. ....... UNDA J_. COOPER Notary Public, State of New York No. 4822563, Suffolk CeuntY-, Term Expires December 31,'~4~ ~-~--~ v (Signature of Applicant) · ~/![ ! ,~ ~/[ I ~ ~/l Ol