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Home My WebLink About7621-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: 10/30/06 No: Z-31963 THIS CERTIFIES that the building ADDITION Location of Property: PVT RD (HOUSE NO.) County Tax Map No. 473889 Section 10 INNER BAY (STREET) Block 9 FISHERS ISLAND (HAMLET) Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 1, 1974 pursuant to which Building Permit No. 7621-Z dated NOVEMBER 5, 1974 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 WINDOW ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RICHARD & ELIZABETH DALKOWSKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A N/A PLUMBERS CERTIFICATION DATED Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 7621 Z Permission is hereby granted to: .z.:~.?...~...¥..t.~.~..t.~..t.......~...~....~.t.. ..................... ..... ~.,...o..,.~.:....?.~....a...z..e..~.~.~.~ .¢. ............................ ............ ~£st~e.~..~e~ ................................. ~o...?:?Z~.~¢....~...~.~..~.~..9~!....o..~.~...~.~.~.~.z~...~?...z.~:~ ............................................................. pursuant to application dated ............ .~.~.O..~. ....... .1. .............. , 19.7....,, and approved by the Building Inspector. Fee $.J.,~.:~ .......... Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: I. 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 I % 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. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and 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 - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. \u .~() - 0 \.0 New Construction: 'f-- Old or Pre-existing Building: -?"I't-~ QJ.. 5rv'\e.f P~,. House No. Street ~ K:~r&. 4- JO Suffolk County T"1' Map No I 000, Section (check one) R~\~d Hamlet ~h~#. h~~ Block q Lot I Lj Location of Property: Owner or Owners of Property: Subdivision Permit No. I~.). I Date of Permit. ) I~ lj. J'I Filed Map. Applicant: Lot: Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ,:)5',00 r)u-2 ~ \<1 \.,3 ~C 11&-S-~ Underwriters Approval: Final Certificate: x (check one) K Applicant Signature I4i 003/003 "t"OWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [] ROUGH PLBG. [ J FOUNDATION 2ND [] INSULATION . /' I ] FRAMING I STRAPPING [..-r FINAL , ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPEC'f~ON REMARKS: t1/. ~. F~ (j ,If} ~ ., DATE /~~~tI - / ~i,P/'/// I NSPECTO ; ~(.,:,~ '. 1'0_ NO. 1 . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOuTHOLD, N. Y. 'Examined ............)v5:!.;?.........., 19.:7.1 Approved .....................t.~................., 19..:..~.. Permit No. .2.rq..?::.I....~ 7~).1 Applicotion No. ............................ Disapproved a/c. ...... ........................................................... APPLICATION FOR BUILDING PERMIT Dote ..'4m...I.................................., 19.f.~.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving 0 detailed description of layout of property must be drown on the diagram which is part of this application. c. The work covered by this applicotion may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue 0 Building Permit to the applicant. Such permit sholl be kept on the premises available for inspection throughout the progress of the work. e. No building sholl be occupied or used in whole or in port for any purpose whatever until 0 Certificate of Occupancy sholl hove been granted by the Building Inspector. APPLICATION IS H.EREBY MADE to the Building Deportment for the issuance of 0 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 011 applicable lows, ordi~4bUilding code, housing code, and regulations. ....... (.s.ig!r-<~/:if;.~~!~... .tj~...;bCi.~.~..i.Y.!..~.... (Address of applicant) ()(,.:J~O State whether6plica~is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......~.....................................................................................:........................................................................... Nome of owner of premises ~.~..y~...~~................................................. If applicant is a corporate, signature of duly authorized officer. .......t/..........,......................................,................................. 1. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: .........K........................ Lot No.: .X................... Street and Number ....di.(>.If.,-".4tn y........c:r1:1....~.:.~.........t.........c.j...........,................. ... ._..m...._,. II Municipality'" ......:.... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....I.I.~...............................................;:.../....:,.......................................... b. Intended use and occupancy ...k~~...#~.......r:1It:....4..c:t..&............................ " 2. Cj 3.. Nature of work (check which applicable): New Building .................. Addition 1(:............. Alteration ..........t...... Repair .................,~moval .................. Demolition.................. Other ~rk (Describe) ........................................ Esti mated Cost ...... t.-5:tJ..a.. .IlQ............................... .Fee ......................... .L.f. ~.'?................................................... (to be paid on filing this application) If dwelling, number of dwelling units .......1...................Number of dwelling units on each floor ....2.............. :: g:~:i::S:u~:~~:::~ ~;..::~...:~~~~~~~:..~..~~;.~.~~:~;~..~~~.:~;:~;..~~.=~~.~:.~;.~~~..~~ Dimensions of existing structures, if any: Front .....,..~.IIl.X..i..s::' Rear ................................ Depth .................... Height ...1!:..~............. Number of Stories .......I.~.................................................................................. ...... ......... Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ......1..~..O....,.....Nw.nber of Stories .....1........................ Dimensions of entire new construction: Front ....~.:-:.I{)..XJ:..~.......... Rear ............................ Depth ........................ Height .......'Z~JL... Number of Stories ........I..'1f.::. ............................................ ......... ... .................. ............ .... ... ...... Size of lot: Front ..I:I.:f.~................ Rear ..!I.~.!...f./f................ Depth ..JIQ.!..2.J............. Dote of Purchas~.~.r.l..9.s.~....................Name of Former Ownerr~.~JE~.!w.c.. Zone or use district in which premises are situated ...........tfl~............................................................. .oo~s propose~n~~ction ViQlat}5'nyA~Oning 'ftW, ordinance or regulation? ......i.t.~....-;;;....................................... Nome of Owner of pre~....~.......Address fi~#.f~~J.$hone No.lt'7ltj~~.. Nome of Architect ..~.............................................Address ................;........................... Phone No. .................... ;- Nome of Contractor ....................................................Address ............................................ Phone No. .................... 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. PLOT DIAGRAM Locate clearly and distinctly 011 buildings, whether existing or proposed, and indicate 011 set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whethe~n::::;;:/L. wuf~ ~J:t:;{~ 7J,~. . II ;~I?~ , r~[nn/_J1AAA~ {I If ~; ~ tR~/r~ -.,~ ~~,,- - V If I' "'1}~..W~N~ 1AJ aftt- r~;/ 4- .:th.-1J~ STATE OF NEW lSS COI:l1:;..:/" ...... ...............$:. . ............................ ....................................................................being duly sworn, deposes and says that he is the applicant above nam~~~:ee O;si:~:Vi.~~~~................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly .authorized to perform or hove performed the said work and to make and file this application; that 011 statements contained in this application ore 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. swT~:,~~.M.~197'f~t!t/.;, .......... ....... .. ... Notary PUO'ic,_ ;...........31... .............. ........... ..... County (Signature of applicant) ~ . wCl-tf EILEEN G. WALL Notary Public, State of New Vor': No. 52.9509185 Qualified in Suffolk CounlY'l~ 1_ Expires March 30, 19~-