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Home My WebLink About9152-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22720 Date NOVEMBER 10, 1993 THIS CERTIFIES that the building Location of Property 365 SUNSET WAY House No. County Tax Map No. 1000 Section 91 Subdivision ADDITION SOUTHOLD, NEW YORK Street Hamlet Block 1 Lot 12 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 31, 1977 pursuant to which Building Permit No. 9152-Z dated MARCH 31, 1977 was issued, and con£orms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALI~H APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A JOHN & AVIS ZAZECKI Rev. 1/81 FORM NO. ~ 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) 9152 Z Permission is hereby granted to: ..~.ob~....Z~ze~t .............................................. ................... ~.~t~.o.~ ......................................... at pren~ises located at .~o.t...1.~.8....~ecLa~...]~&e~3..~2~k .............................................................. ............................................... ~ae.,.Wa~. ........... ~out~o:~l. ....................................................... pursuant to application dated .......................~.3r.....3~ ............... , 197.~...., and approved by the Building Inspector. , ~- ~'orm No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application 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). 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. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings 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. 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 - $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 New Construction ........... Old Or Pre-existing Building...~.~ ....... ' .... Location of Property .......... . ....... House No. "Street Hamlet 0nwer or Owners of Property..~/.~.. ~% .,.~..~. ~/.....?..~. ~..~.d-. ,~../. .......................... County Tax Map No 1000, Section ..... ¢'./. ...... Block ..... ./. ......... Lot .... /..~%~. .............. Subdivision .................................... F%led Map ............ Lot ...................... [~ermit No ....... Date Of Permit.~.]~.?/~ '~ .Appllcant...~..~ .... ]{ealth Dept. Approval .......................... Underwriters Approval ......................... ?lanning Board Approval ......... .. .............. Request for: Temporary Certificate ........... Final Certicate ........... ?Ce Submitted: $..A~7...~.~. ~ ................. C0% q20 - IPO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEP, K'S OFFICE SOUTHOLD, N. Y. Approved ............... ..~.! .......... ~.~.../......, 19.~..~ Permit No ....... : ......................... Disapproved · APPLICATION FOE BUILDING PERMIT INSTRUCTIONS Application No ................................. C o. 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 accord ng to schedule. b. Plot plan showing location, of lot and of buildings on premises, relationship to adjoining premises or public streets az areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is par~ 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 o 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 port for any purpose whotev, er until o 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 applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~D .................................................................... .o...~ZO...~. ~' ................................................................................................................... ~, Name of owner of premises .~.~ .~.¢.~.f~.¢.~-. .................................................................... ~) If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~g~t~...~.~.~f~.¢:~;~, .................... Plumber's License No. Electrician's License No ............................................. Other Trade's License No ............................................... ~=c,) O Location of land on which proposed work will be done. Map No.: Cec]~,~..J~ea. cb...~=]c. Lot No ..... .1..7.8 ............. Street and Number ...~..~.~..~.f~....~,~...~.g. t3~.(~.t;...~a.~.~...-qc).tzY-bo~.~...~.,.¥. .................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... fl,.~.~.L~,j~g .................................................................................................... b. Intended use and occupancy ................ .~ ............ ..~.~..t..~.....~.~.~.~...t.~g..q .................................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition ~ ........... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... 4. Estimated Cost .~2~...5..Q.0..:..0...Q ............... Fee ~- ~ (Description) (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 ....~3C)..*. ................. Rear ...... ~0..* .................... Depth .~C) .............. Height ..... ~,.0..*. ............ Number of Stories ........ ~. ...................................................................................................... 8' 38' Dimensions of some structure with altercations or additions: Front ......... ~. ........................ Rear ............................ Depth ........ ~C) ................... Height ........... ~.0 ............. Number o~Stories ............................... 8. Dimensions of entire new construction: Front ......... ~J:ll~..a! .............. Rear ....... ~-~.e....8.~. ....... Depth ...... .3.~).'. ........... Height ....... LC) ........ Number of Stories ................... ~1. ................................................................................................ 9. Size of lot: Front .................I~.Q ................................... Rear ............. I~.~ ......................... Depth ~,.~.Q .......... ~....~ ........ 10. Date of Purchase~ ~ .~.~,V.......]...~.?..6.. .......................... Name of Former Owner .~..~.~'j.a.~,$.~...~.........~..~..~..~.~.,O.~.ff..:..:. 11. Zone or use district in which premises ore s~tuated ~ ........................................... , ....................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... r~. ............................................ I3. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..~..o..b....n....~...a.~,,e.¢:l¢.~ ..................... Address ...~.°.,.~.~.,h.,°..Z~x.~.e..~.-Phone No....7...6..5.,,-.~8..3..6.. Name of Architect .............................................................. Address ................................ Phone No .................. : .... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate dearly end distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Iol. STATE OF NEW YO~K,~,~ ~ l c c COUNTY OF ...~..f~., ............... ;.....~b,~..~ei~,]~.j, ............................................... being duly s~worn, deposes and says that he is the applicam (Name of individual.signing~ con'~raci0 above nome& 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 th s opp ication; that all statements conta!n~d in t~is application are true to the best of his knowledge and belief; and that' the work will be performed in the manner set~ ~orth in the application filed therew th. Sworn to before me this , , ...... .~.,. ............ day of 'v'"':~" ~ .......... , 19Z ..... '~. . JlIDI-FI'I T. TERRY l~O~21~ Public, SLate of New York No. 52.0344933 Suf/o~k Count.v,f,//,