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HomeMy WebLinkAbout12007-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No....Z.~.1.6..2.0 ........ Date April ~ 4, 19 85 THIS CERTIFIES that the building New Dwelling & Accessary 2805 Main Road Laural Location of Property House IVo. Street Hamlet County Tax Map No. 1000 Section ....~25 ..... Block ....0.1 ......... Lot ..... ~ar~;..Qr. 2., 3 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated September lO 19.8..2pursuant to which Building Permit No. /1200,7. Z. dated ... IXlovemb. er..9 ............. 19.82, 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 ......... for a new dwelling & accessary Barn The certificate is issued to Tom Wowak (owner, lessee or tenant] of the aforesaid building. Suffolk County Department of Health Approval . .q..~r?.°.-. 77 ............................... UNDERWRITERS CERTIFICATE NO .... N..5.9.5.8.8..6 ...................................... nuilding ~nspector ~ Rev. 1/81 BUILDING 'D£PAR?MI~NT TOWN HALL $OUTHOLD, No Y, BUILDING'PERMITI :'~ (THIS PERMIT MUST BE KEPT ON 'I~HE P,,k~lS~ UNTIL I JLL COMPLL~I"ION OF THE WORK AUTHOR. jZEO) Permission is hereby granted to: pumgant to application dat~ , .'._~, 19. and approv~ by the BuJld~ng I~sp~tor. FORM NO. 6 TOWN OF SOUTHOLD Building Depar~men[ Town Hall SouthoJd, N.Y. 11371 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OB ink, and subn~ittad in duplicate to the Building lnspec- tot with the following; for new buildings or new usa: 1. Final survey of property with accurate location of ail buildings, property lines, streets, and unusual natural or tooograohic features. 2. Final approval of Heaith Dept. of water supply and sewerage dispose --(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar ,bu Iding~ and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all prooerty 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. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. / 1. Certificate of occupancy $5,00 ~ "/'/$ 2. Cartificat~¢of occupancy on pre-existing dwel lng land us~ ~. b 5.00 3. Copy of c~rtificate of occupancy $1.00 Date .. New Bu~Jdlng ............ Old or Pta-existing BuJldJng(.,'~) ........ =/Vacant Land Hous~ No. ' .............. : ......... Ham/et Owner or Owners of Property Ivj¢. ~ Jo'(Ag County Tax Map No.,t000 Section "( ~ ~' - Block --~. f Lot...~.?..o,~. ~, .~. Subdivision....~' ............ Filed Map 'No ........... Lot No. ............. Permit No. /;~ OO~ Date of ~) ........... r ........ &pplicant ~(~ "Health Dept Approval ' L~bor Dept Approval - '4Jndemzriters Approval ........................ Planning Board Approval .................. Bequest for Temporary Certificate ' ..................... Final Certificate ...... Fee ~ubmitted S...~./~ .~).. ............... ~... . 'Construction on above described building and~j~ ~des and regulations. Applicant....I/,. /.~.~ ........ THE NEW YORK BOARD OF FIRE UNDERWRITERS  BUREAU OF ELECTRICITy FeDI*A~,'~ ~o,,~ .[~s JOHN STREET, NEW YORK, NEW YORK 10038 ..,~ ~..,,~.,,o.~o.o.~,,~ N 593886 THIS CERTIFIES THAT only the electrical equipment ~ desc~bed below and intr~uc~ by the applicant ~amed on the able application number in the premises of was exau~ined on ~b~ lrf , 1983 and found to be in compliance with the requlreutents of ~his Board. SERVICE DISCONNECT lO. OF OTHER APPARATUS: S AWG. OF CC, COND NO OF H~-tEG A. WG OF HI-LEG MULTI-OUTLET SYSTEMS NO. OF FEET NO, OF NEUTRA EXHAUST FANS OF NEUTRAL Box 1:307 Westh~ton Beaah, N.Y. 11978 Lic~65 I '~ ,, ~NI~RAI. MANAGER 11 '~his certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspect0~'s may be\l~d by their credentials. DEPARTMENT. THIS COPY OF ( Y MANNER. 765-1802 BUILDING DEPT. INSPECTION FOUNDATIOI~tST [ ] ROUGH FOUNDATION 2ND [ ]INSULATION FINAL' FRAMING D~] R£MARKS.'/, '~ ~/,?~ .~. ~ A ~ D TE ~.///'.~ //?// ~ INSPEC~r'OR~' F I E ~,-D I~SPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. COMMEN%S ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CpD FINAL ADDITIONAL COMMENTS: FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ To '~---~_/~.~....~.~ .~./~ ~.F~/~. ........ · ~_..O..,...~..x..../.&. ............ · . .../ ..../ ...... £. .... PLEASE TAKE NOTICE that your application dated ....~'. ~/T2-.~. ~' .¢~..../(.C~.., 19 for per~it to const,,ct C~,: .~,.A ~.//.~ ....... ~'5< ...... ~,~ ..................... at Location of Property ./~, _~. ~. ~-~..~?-/- .':Q ..d~. tW.c~..CT~/ / House No. ' ........... '~t/e~{ ................ ,. County Tax Map No. 1000 Section ... ~.~f..~.~.... Block .... (~../'. ..... Lot ~.C~2..-~..~-.. Subdivision ..... ~ ...... Filed Map No....~. '..--W. ........ Lot No .... ~ ......... ~turned herewith and disapproved on the following grounds .,~--,O ~.~. ~...~>~. :-' Bflilding Inspector RV 1/80 FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1B02 E×amined..~(..-..~ ....... , Approved ./.g., .~.., ~.) ...... ,19 .~-~.'.YPermit No.. Disapproved a/c ............... ~ .......... .~.. ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. ~..~?.Ofi..~. ....... Date .0..~. ).' ..... /..O .....19 ?.~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 issued 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 fo~ 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, Suffollc County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for,r,~moval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bufldinf~/code?,//h~ousing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspec, fgS.ns%/,g/_/,~__~ ... ~..~ .~?. ~-. ,..~..©.,.. ~(Signature of applicant, or name, if a corporation) , ~o.,..~..~../.~/.,, .~.~ .~.~/.o. ?.~.C., (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................... Name of owner of premises ./~. ~ ...... .t'LJ.(D....c'~A~....c~. ........ .O~J..OC3O. K. ................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized of ricer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License/~o.~.:. ,~.%e~ c~(.~T~ - Electrician's License No.~. 3. Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ...................................................... O.ce .~' . ..................... House Number Street Hamlet County Tax Map No. 1000 Section ..... /..'.~. ~ ...... Block ..... .Q .[ .......... Lo~..~..~.l~'P..~...~..~ .,~. Subdivision .... .K. ............................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......~.q..]d?~q~ ......................................................... b. Intended use and occupancy .. ?.~.~?. ~ .... b~....~..~Y~/l, fTr~ .,tY~J... ~ ........................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... oo~ ~ ~..~.f. ~.~.. (Description) 4. Estimated Cost . . '~>'~'-2 ..... : ......................... Fee . . - ....................... (to be pa/d 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 mixe~ 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 of entire new construction: Front . . 7.,~ .~ ......... Rear ...7...~. ( ........ Depth . .~.6.: ......... , ,, / Height .. ~ f. .......... Number of Stories ................. l ........................ * ............. 9. Sizeoflot: Front ~.c~p.(. ........... Rear..~. ~..2~ 7.2 Depth 7/~, .~.~' .. · ?. ............................... ....... 11. Zone or use district in which premises are situated...[~¢g. ~.,: t,.'l ...................... ~.. ............. 12. Does proposed construction violate any zoning law, ordinance or regulation: .. ~1.O. ........................... 13. Will lot be regraded ...... .~.o.: ................... Will excess fill be removed flcom .l~romises: Yes ~ 14. Name of Owner of premises ~7~:~ ¢J~j~4~ . Address ~t~..,l'.,~.,~o~.T..z~.~...-~.~.~l~o'~e No. ~.q~). ...... Name of Architect ... ~7.,...~_ .~'~ ................ Address . .V.l?.~¢...A..~...~.aP,~.'~aone N,~~'~ ~'~. Name of Contractor .o~.h.~.. ff.~.r.F.~?/.~ ~..~. ......... Address .~..&.~..i.3!...,f".~.'~p~[. .. . Phone,~.,.,.N~.~.__. .~ ' PLOT DIAGRAM Locate clearly and distinctly all lbufldings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block dumber or description according to deed, and show street names and indicate whether interior or corner lot. ~ ~,~4,~ STATE OF NEW .,YgR. K.,, ~ ~ COUNTY O~F. M'~'~.. I~. ....... ~'~ ....... .~..AY. .... .7~.,. .... ~..~.~. ~).~./~. being duly swprn, deposes and says that he is the applicant (Name of individual signing contract) above :named. He is the ...................... ........ .~x.:~ ................................................ i C (Contractor,~nt, corporate officer, etc.) of said owner or owners, and is duly au'thorized~m-l~rf6rm or have performed the said work and to make and file this applic*.tion;~that ail statements contained in this application are 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. Sworn to before me this ........ ......... ...... t2 .(;y. · .......................... I ~'~0~[i~. ~1~_ .?!. ~ ? // (Signature of applicant) N~ 52.8125~50. S~O~K uouJW/ properties formerly i. ourel SUFFOLK COUNTY HEALTM DEPARTMENT SURVEY FOR The ,~,?w~-.~ d':. ..... ~ AT LAUREL DATE: JULY 26, 1982 * ~e .,,.( R~d v, mter· supplTf TOWN OF SOUTHOLD SCALE: I": I00' tt}~pecte¢] ~v ~.;! ' i'~:o".~ ;.~:eut acid ~'ound SUFFOLK COUNTY, NEW YORK NO. 8:>-401 ~'t~ ~,, ,e~t, [:~,~t,e~ ~, /"~ l] ~U/~&UTHORIZED ALTERATI0140RAODITION TO THIS GUARANTEED TO: HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT A14~ ON 1415 BEHALF TO Tie TITLE eOMPA14¥, eOVUTH- OTHER THAI4 T"OSE ,140.N HEREON. TO AOOITIONAL 114ST ITUTIONS OR SUEISEGUE AFPLICAHT, PROPERTY U14ES OR FOR THE ERECTI014 OF FE14CES ~-~'~'~-"~ ~ " YOUNG YOUNG YORK ALDEN W YOUNG, PROFESSIONAL ENGINEER AND LANO SURVEYOR N.Y.S. UCENSE NO. 1:~845 HOWARD W. YOUNG, LAND SURVEYOR iloVl or '82 SEP 10 t. tM: 8:22 "it should be noted that since property is located in an area, the possibility exists that water supply may contain amounts of pesticides and/or nitrates. Special a nalysis"~Jff ///~ r(~o ui~%-"~ · ,,,~l~r". SUFFOLK COUNTY DEPARTMENT OF HEALTH SEItVICES FOR APPROVAL OF CONSTRUCTION ONLY ~*THEHE AR~ NO O.~EL. ItlI~E WITHIN I00 FEET OF THIS PROPERTY WILL CONFORM/~O/T~Rg STAN~ OF THE SU~K COUNTY DEP~TMENT ROAp SURVEY FOR THOMAS WOWAK AT LAUREL TOWN OF SOUTHOLD >SUFFOLK COUNTY', NEW'YORK N LE4AUYNO~IZED AL~'ERATION OR ADDITION TO SURVEY IS A VI~ATION ~ SECTION 7~OG ~ THE NEW YORK STATE E~CATIQN ~W ffCOPIES ~ ~IS SURVKy NOT KA~G THE LAND SURVE~R~S INKEO ~A~ OR EMBO~SEO SE~ SHA~L NOT BE CONSIDERED TO BE A VALID TRUE COPY NGUARANTE~S INDI~TE~ HEREON ~LL RUN ~LY OWNERS PROPERTY LI~ES OR FO~ THE ERECTION ~ FENCED m_I yOUNG YOUNG "% m m ALDEN W. YOUNG, PROFESSlONAL ENGINEER ~ ~NO ~0 suavgvoe ~.Y.s. UCENSE NO. ~Z845 DATE: JULY 26, 1982 SCALE= I" ~ I00' NO. ' 82-401 GUARANTEED TO: COMMONWEAL NEW YORK I I tr -I lt'cOpper'tubihff i~ for water distributing system; piping shall be of types ~K or L onl',/ ~copper ,ubi,,g i~ o**~ water dis~ri6uting ~/s~em; piping shaJJ be of ;~ypes K or L only copper Su~ing is used For water distributing system; piping sha~J be of type~ K or L only -I ~APP~o~r~o AS DIOIL~ 765-T802 9 A~ TO 4 PM FOR THE FOLLOWING INSPECTIONS~ t. FOUNDATION - TWO REQUIRED FOR POURFD CONCRETE 2. ~OUGH - FRAMING & PLUMBING 3, INSULATION 4~ FINAL - CONSTRUCTION ~UST BE CO~APLFTE FOR C, 0 ALL CONSTRUCTION SHALL MEET THE REQUIREME~S OF THE N,Y. ~ATE CONSTRUCTION $ ENERGY CODES.. NOT ~ES~NS[BLE FOR "AlteratiOn of th s DOcument 41 aAIt~roflon o~ th~ DocUmenl a,xf;elot b~' e Llcllled Profe~- ~ Eagl~eee, b illegol". . GI'ordon ~,r. Ahlori;, .P.. 'R. 0 If copper lubin0 t~ for water distributie~ system; pipia~g shclN be of types K or L only I~ copper tubing ~s used for waler distributing sys'em; piph~g sha~l be of types K or L only eCCD HC¥ OR o don APP~O¥:D AS NOTED DATE: ~ _B.p. NOT~Fy BUILDING D~'PARTMENT AT FOLLOI^/ING INSPECTIONS. I, FOUN r~ATiON FOR POURED CONCRETE 2. ROUGH- FRAMING ac PLU~4DING, 3. INSULATION 4. FINAL . 'CONSTRUC:rlOi, BE COMPLETE FOR C O, ALL CONSTRUCT ON SH~LL M~i· THE RE~UIRE,~E~TS OF . STATE CONSTRUCTION & ENERGy} CODES. NOT RESPO~SfBL~ FbR DESIGN OR CONSTrUCTiON ERFtORS,, 1 .I 'Al~ral~n ol th~ ~umenl ~c~pt b), a Llceased Prof.- N.Y. ~ ~ ~. 0~ Of (~ordon ~:; Ahl®ro, Pi