HomeMy WebLinkAbout9250-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
UPD~i'~D
~TIFI~ATE OF O~uu~ANCY
No Z-22934 Date
APRIL 5, 1994
THIS CERTIFIES that the building
Location of Property 4150 ALDRICH LANE
House No.
County Tax Map No. 1000 Section 120
ADDITION & ALTERATION
Street
Block 3
LAUREL~ N.Y.
Hamlet
Lot 13
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 18, 1977 ~ursuant to which
Building Permit No. 9250--Z dated MAY 18~ 1977
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 FIREPLACH~ PATIO & BAT~KOOMADDITION & KITteN ALTERATION TO
EXISTING ONE FAMILY DW~T.T, ING *
The certificate is issued to BARBARA KUJAWSKI (owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*NOTE: THIS UPDATES CO Z-8097 D~~28,~j,~ ~/~ ~~-'7'1977' ~
Rev. 1/81 // Building In~pe~or '
FORM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
CTHIS?ERMIT MUST BE KEPT ON THE PREMI-~E5 UNTIL FUL~
CO~ETION OF THE WORK'AUTHORIZED) ~ ~
9250 Z
at p/~mises located at/....~/.~. .... , ............................... ~. ............
Building lnsp~tor.
,
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
........... ~c_ ..~ .,
No. ~°c° ? 7 Date ..........................
THIS CERTIFIES that the building located at ...................... Street
...... .......
eonfor~ substantially to the Application for B~lding Permit heretofore fried in t~s office
dated .. ~ / ¢ .... , 19~ Y. pursuit to which Building Pemit No.
da~ed ..... ~.~ ~. ..... , lg~., was issued, ~d conforms ~
ments of the a~plieable provisions of tho law. The oee~ey for which ~i~~te ~
issued is ~~~ ~.~ ~~
The certificate is ~sued t~~ ~'' :~~esseL' Lr 't~'i '2~ .........
of ~e aforesad building.
S~olk County Department of Heal~ Approval ~ ' ~
U~ERWmT~as C~aT~m~TE ~o...N ~. ~ ................
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 t~' buzlding
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. Submzt Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildzngs 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,
Alteragions 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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .........................
New Construction.~ ......... Old Or Pre-existing Building .................
Location of Property.. 4J50 ^Idrich bane, ta~reI, New York I1948
House No. Street Hamlet
Onwer or Owners of Property. Barbara Kujawski
County Tax ~ap No 1000, Section..l~? .......... Block.~ ..............not. J~ ...................
Subdivision .................................... Filed Map ............ Lot ......................
Permit No ................ Date Of Permit ................ Applicant .............................
Health Dept. Approval .......................... Underwriters App~ ......... __ .............
Planning Board Approval ........................ ~ ~~.~
Request for: Temporary Certificate ........... Fi~n~l Cer~c~. .....
Fee Sa itted:
UUy r~muner utsen, tsq. APPLICANT
J&Cu~o~/ - P.O. Box 706, Cutchogue, NY 11935
JOYCE M. WILKIN$
Notary Public, State of New York
No. ¢952246, Suffolk Courlty_~
Term Expires June 12, 19..~%
FOl'{,~l 1'~O. 6
TOWN OF ~SOUTHOLD
Building Department
Town Clerks Office
~outhold, N. Y. 11971
CERTIFICAT.E OF OCCUPANCY
Instructions
A. Th~s application must be filled in typewriter OR ~nk, and submitted ~n DUPLICATE to the Building
inspector w~th the following; for new buildings or new use
1. Final survey of property with accurate location of all bu,ld,ngs, property lines, streets, and
unusual natural or topograph,c features·
~. Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal).
3. Approval of electrical installation from Board of F~re Underwriters.
4. Com)mercial buildings, Industrial buddings, Mulhple Residences and similar buddings ahd
installations, a cert,ficate of Code compliance from the Architect or Eng,neer respons,ble for
the building.
~. Submit Planning Board approval of completed s,te plan requirements where applicable·
B For existing buddings (prior to Aprd 1957), Non-conforming uses, ar buddings and "pre-existing"
land uses:
1. Accurate survey of property showing all property hnes, streets, budd,ngs and unusual natural
or topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings
3 Date of any housing code or safety inspectJon of buddings or premises, or other pertinent in-
formation required to prepare a certificate
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelhng or land use $5.00
3 Copy of certificate of occupancy $1.00
blew Building ................ Addition ................ Old or Pre-ex~sting Building ................ Vocant Lond ..............
/ v
Subdiv,sion ................................................................ Lot No ............. Block No..: .......... House No,:J...~...)..,
Underwriters Approval ........... ...~/..,!..~ ........................ Planning Board Approval ................. ..~.....,1~. ......
Request For Temporary Cerhficate ....................................... Final Certificate .......~..~..~.. .........................
Fee Subm,tted $ .... ~..'.~ ..........
Construction on above described building and permit meets all apphcable codes and regular,ans.
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