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Home My WebLink About8117-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22174 Date MARCH 2, 1993 THIS CERTIFIES that the building_ AI)DITION Location of Propert~ 395 JENNINGS ROAD SOUTHOLD~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 54 Block 7 Lot 15 Subdivision Filed Map No. Lot No. confoms substantially to the Application for Building Permit heretofore filed in this office dated JULY 31, 1975 pursuant to which Building Permit No. 8117-Z dated JULY 31, 1975 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 G~RAGE ADDITION WITH STORAGE TO EXISTING ONE FAMILY DWELLING. The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NOo PLUMBERS CERTIFICATION DATED Rev. 1/81 EDWARD & CECELIA CZELATKA PENDING - FEB. 24, 1993 ////Building Inspector 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) 8117 Z Permission is hereby granted to: aOuthold BUild aeeessory storage addition at premises located at ~em.~i~gs Road Southold pursuant to application dated ..~ ,..~J..~ ...... 19.~.~.., and approved by the Building Inspector. tee ........... ...................... b',]ii~'i":"~' ' i'~~ ........... APPLICATION l~O~ NO. $ TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector 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 installations, a certificate of Code compliance from the Architect ~r Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 19~7), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of propert~owing 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. ate of any housin, g~c'ode or safety inspection of buildings or premises, or other pertinent in- formation required ~prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 j 2. Certificate of occupancy on pre-existing dwelling or land use $.5.00 3. Copy of certificate of occupancy $1.00 ~...~ / ~" '~"~" New Bqilding ................ Addition(~..~...r..~ ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... ~.L . .~ ................... ./......,~..7../ Subd,, s o, ............................................................... ,.atB,oe,, No ............. ,-,ause Permit No..,../..!...Z..-Z:~..... Date Of Permit .~./.~..//~.~. ...... Applicant ~....~ ............................ Health Dept. Approval ..... I~,~/,,','zl ...................................... Labor Dept. Approval ................................................ Request For Temporary Certificate ........................................ Find Certificate Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County FORUM NO. J* TOWH OF SOUTHOLD BUILDIHG DEPARTA4ENT TOWH CLERK'S OFFICE proved .... ................................. * ...... ......................... / ? ............................. ....... ~/(BY~ildin~ Inspector) / APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No ....................... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Iot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 issue 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 or alterations, or for removal or demolition, as herein described. The oppiicant agrees to comply with o[[ applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (Signature of~appllcant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premi .................................................................. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......... ~....~~ .......... Plumber's License No ................................................. Electrician's License No ............................................. Other Zrade's License No ............................................... ~/ /~_ ~.~_ ~ Location of land on whic/~propos?d wo, rk~will.be d,~ne. M~P~.~No.L~-~.-~. -*¥.~..~...~¢'. Lot No. ~ ..................... Street and Number .~~,~.......--~..~* -~.~' ............................................................ ........ State existing use and occupancy of~ise~a~d~intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...x~r,~4...~:-.~r.....~=*. ......... ~ ......... ~ ........................................................................... b. Intended use and occupancy ~ ........ ~..~...:.L~ ....................................................................... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ...~ ......................................... ..~. ~/..~....~.. .... (Description) 4. Estimated Cost ............................................Fee f~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ..../.. ...................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ _., Number of Stories ............................... ....~ 8. Dimensions~.,,bf entire new construction: Front ..._~..~. .......................... Rear ...~......~/, ................. Depth .~ ............... Height ..~...r. ........... Number of Stories ...................................................................................................................... 9. Size of lot: Front ..... .......................................... Rear ~..~....~'. ...................... ., ....... Depth/..~.....~'.. ................... 10. Date of Purchase ...... /...~..~/..~. ..................................... Name of Former Owner~ "' ~ ~~.~,,~........':'~--~' 11. Zone or use district in which premises are situated ..................................................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regroded. ...........,,/j,,~A--o-'"r)-'-"'-- Will excess fill be removed from/)or_emises: (/~__,) Yes ( ) No 14. Name of Owner of premises .~,~--,~+c......-xzm~... .................................. Address~vr~z~.,nw:- .............. Phone Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorr~ property lines. Give street and block number or description according to deed, and show street names and indicate ~vhether interior or corner lot. ................... ~~.~.~ ........................... being duly sworn, deposes and says that he is the appliconl (Nam'e~'of irkiJ/vidual signing contract) above named. (,~./,.,_ _ ~.,~_, He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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 lhe work will be perfFrn~d in the manner set fa~h in the application filed therewith. Sworn to b~....., meday thiSof ~ ~ ~ ~ Nota~ Public .............~////~.~ C au n~ ................................................................................................. ~//~ (Signature of appl cant) // THE NEW YORK BOARD OF FIRE UNDERWRITERS THIS CERTIFIES THAT ~[~ ~]Dkr~R~ CZELA~KA, 395 JEflNIflGS ROAD, SOU~HOLD, FgBRUARY 24,1993 ~s examin~ on and found to be in compliance u'ith the requirements of this B~rd. FIXTURE LK~A [ IT I fiXTURES / / I I / ~RVI~ ~ONNKT K. OF S E R V I OTHER A~ARATUS: *NO VISUAL DE~ECT~ "An electrical survey has been made of the exposed electrical equipment in the premises i~dicated," "~o obviuus unsatisfactory condition was found, 395 JENNINGH ROAD SOUTHOLD, NY, 119/! This ce~ifica~ m~t ~t be alfred in any manner; return to the office of the Board if incorrect. {nsp~rs may be ide~fied by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 70S-~.M2 BUILDING DEPT. INSPECTION ( ] FRAMING REMARKS: FOUNDATION IST (]ROUGH PLBG. FOUNDATION 2ND []INSULATION []FINAL DATE 7GS-1BOZ BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING [-']'~NAL REMARKS: ~ ~,~'~ ~ DA~ INSPECTOR :~~