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Home My WebLink About11743-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16913 Date ...... May 25, 1988 addition THIS CERTIFIES that the building ................................................ 3375 Wells Road Peconic Location of Property/:/t;tJs~ ~/o: ....................... '~'t/e~[ ....................... /'/~l'e~ 86 2 8 County Tax Map No. 1000 Section ............ Block ............... Lot ................. X X X Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated June 4, 1982 11743Z ..................... pnrsuant to which Building Permit No ...................... dated............................June 16., 1982 . 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 ......... Screened po'rah addition to existing one-family dwelling. The certificate is issued to BENJAMIN & JOAN KOWALCHIJK ..................... [o'~n'e;,'~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ............ N/A UNDERWRITERS CERTIFICATE NO ............... H002730 PLUMBERS CERTIFICATION DATED: N/A Rev. 1/81 Bmi~ctor SOU BUILDIN~ FERMi~ COi~PLETION OF THE WORK AOTH~RiZ~) : ~ 11743 Z P~rmission is hereby gra~ted to: .~,'~ ,' .... .a(.~..~../._/~ ., ~ . ~ .... at'~rerni,e~ 'oceted et ...,.%.~..:~:...~..'. ...... ,~:../..~.:!...!;.~..~;.~.~,.....,..,.~ ..................... .. . .... .... : ....... : ..................... : .... . .................... : ......... :: ........... ...:...:,., ............. ! ............ : ....... ;~ ......... ::.. Couhty TOx Mop No. ]000 Section' :~lo~k: ~.... ~.. :~t No....~t~ ....... ............ : [' ~ ~, ~nd opproved by the :..:. B~Jldlng I~spector." TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, ~his application must be filled in Wpewriter OR ink, and submi~ed tot with the following; for new buildings or new use: 1. Final ~ey of properW with accurate location of all buildings, prope~y lines, ~reets, and unu~al natural or topographic fea~res. 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 Unde~riters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and in~aila- tions, a certificate of Code compliance from the Archit~t or Engineer responsible for the building, 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming u~s, or buildings and 'pre-exi~ing" land uses: I. Accurate ~ey of p~pe~y showing all properW lines, ~reets, buildings and unu~al na~ral or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildings. 3.Date of any housing code or safety inspection of buildings or premises, or other pe~inent informa- tion required to prepare a ce~ificate, C. Fees: Add~o~s $25.00 ~O0~S l. Ce~ificate of occupancy Ne~ Dwe[[~a~ ~25.G0, Accesso~TL~]0.00 ~us~ness ~50.00 2. Ce~ificate of occupancy on pre-existing dwelling ~ 50.00 3, Copy of certificate of occupancy $ 5.00, ove~ 5 ye~s 4.V~ca~ ~ C.O. ~ 20.00 5.~[eG C.O. ~ 50.00 Date ..~P.~.:~.~ .......... NewCO~s ~c~o~ ...... Old or Pre-existing Building~T~ .~ .... Vacant Land ............. Location of ProperW ~.~.~ ....... ~. ~.~ .... ~ ..... ~ ~.%,~...~ ,~.. . Hou~ No. ~treet Owner or Owners of Property ~~.~.~:~, ~. ~ .~ .~ ~.~~ ...... CounW Tax Map No. 1000 Section ...~.~.~. ...... Block . ~ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.~¥~.~... Date of Permit ~ :~.:~.Applicant ~%~k~,. ,~,~ Health Dept. Approval ........................ Labor Dept. Approval ...................... ·. Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . .~.., ,~_..%.,cf, ;~¢.~ ..... Fee Submitted l J ...... Construction on above described building and permit mee:s al{ app icable codes and regulations. ~)r'~z~,"~{), 3~(~q~ Applicant .~.. ~ ............................ R~. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK t0038 MAY 2~3~98~ 5ZJ~Sig~F~8/~ H 00273~ ~pplicatio. No. on file THIS CE~IFIES THAT [] 2.~ Isl. .~tlon086 Bl°~k02 end found to be in compliance with the r~quirenlent~ 0K this Lot FIXT~JI~ RXTURES RAN~ OVENS EXHAUST FANS OUTi_~TS SWITCHES FLUORESCENT '! DRYERS FURNACE IdOTORS TIM~ ~Q,C)CKS MULTI,OUTLET ~ERS SYSTAMS NO. Of FEET SERVICE S E R V I C E BBNJA~IN ]37~ ~ELLS ROAD This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY ~R. ' Wg.~£ ,;V'/,~N '1 U FIELD I~SF~TION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY q. ODE FINA~ / ADDITIONAL COMMENTS: &' ! ! I I I I I .I I/ '1 '1 ,t -, ; II ,= ,, ~, · · I:1 _i}' ',' ', ,. l l~-n '-" ." ;: ' I!"~ .. .~.., '11~ ~~ '~ I I~,~ -~... ]I, ~j ·,n:'" ", I ,i'':'''~' ---'" ....... · . I~,~ ., ~-,,, ... . .?. ,..~ ~. ..~..:~i..~~ - ~'*~, " .' I,~ h~ ': ' Il, " ~ " "-" ' ~ · . ; :, .;:,,~h J'J2 I' ~, ~,',, ' ' I 0 '1 I~. I~ ''~ ..... .. I!1' '}' '" III Ill ll I' Il I1.~.1 ' ~11 I. I -':, l II I[ I IIIII '~ "- ':: I IIII I III II i '- I Il. Il I;;. [111 I [11 I'.1 III I.I; -I Il'II I .... III II II1'~1 I 1414 I' III I I.'~ ~ _ ZI ~ll;~l -III q I,:, i I II ~1 I III I~1 '111 ill III I'1 , ~ ~,~ ,~ ~111 fl I~' I I I;1' I ~'~ ";: ~:1~1111 I II I~11 .... ;: .... " ~' ~'1 II II I ,:: ,~ ~ ~ ~ · . .~.,~..~ ,;. '~, ,~ ~ ,' II1~ [:1.~ I'1 I'1'1 ' ,,~! I1~1 ~' III I,I I"lql;I-':~''~-- -~" ....i "'~,:- ....... ilt,1'~1 ~, ~'~ III H:I I~t I1'1 ~ ~ ~ .111 I~1,1 I11 I1'.1 Iii I1'1 7GS-ZS0Z BUILDING DEPT. INSPECTION FOUNDATION 1ST [~ ROUGH PLBG. FOUNDATION 2ND [~/~INSULATION [ ] FINAL DATir / 2,~/,,~ ,.~ INSPECTOR BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ]FRAMING [ ]~FINAL REMARKS: ~,/~-~' DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H.Y. 11971 TEL.: 765-1803 APPLICATION FOR BUILDING PERMIT Application No/.Z'.Z~/. ~ ....... Date .~,~.~.....°C. ..... ,19 INSTRUCTIONS a. This application must be completely filled in by tyjmwriter or in ink and submitted in triplicate to the Buildi~ luspector, with 3 sets of planK, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of 10t and of buildings on premises, relationship to adjoining premLms or public str~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which depart of'this 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 issue a Building Permit to the applicant. Such perm: shall be kept on the premises available for inspection throughout the work. e. No building shall be ocgupicd or used in.whole or in part for any purpose whatever until a Certificate of Occupan~ shall have been granted by th~ Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for th~ issuance ora Building P~rmit pursuant to t~ Building Zone Ordinance of thc Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinanccs~ Regulations, for tile construction of buildings, additions or alterations, or for removal or demolition, -~, her~in describe{ The applicant agrees to comply with nil applicable laws, ordinances, building code, housing code, and regulations, and admit uuthorized inspectors on premises and in buildings for necessary inspections. (Sightnture of apphcant, or name, if a corporation) " ....... . ...... t ........... ~ .... ..~.t. ~ ........... · (Mailing address of applicant) - State whether applicant is owner, lessee, agent, architect, engiueer, general contractor, electrician, plumber or build~ .a ......................................................... . .................. . ...... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. PERMIT INCLUDES APPROVAL .TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY (Nazne and title of corporate officer) Builder's License NO ..... ~.~...~.'.'.~ .............. Plumber's Licens~. No ................... Electrician's License No.' ...................... Other Tradc's License No ...................... RFGRADING LOT DRIVEWAY CONSTRUCTION CESSPOOL CONS rRUCTION CELLAR CONSTRUCTION OTHER 1. Location of land on which proposed work will be done ................................................ · ..................................... .... : · ........... Ho b St ft I ...... usc Num er reet am et County Tax Map No. 1000 Section ..... ~ ......... Block ....... ~ ......... Lot .... .~i~ ........... Subdivision ' Filed Map No Lot (Name) 2. State existing use and~0ccupancy of premises and intended usc~ and occupancy of proposed construction: a. Existing use and occupancy ....'~.~ .~ .g~ *t~.~ .o,_~r.~ .............................................. :N,n~m of Contractor .,. Nature of work (check wMcb applicable): Ne'.',' Building .......... Addition ....'~ ..... Alteration ......... Repair .... Removal D~molit[on Other Work Est/~ ted C F (to be paid on filing this application) If al(veiling, number of dwelling units ............ Number of dwelling un,ts on each floor ............... lfgfirage number of cars If business, commercial or mixed Occupancy, specify nature and extent of each type of use .................... Dimensions of existing structures, if any: Front..~ ~ .... Rear . .~ .?.~g~... Depth .~. Haight ~. ~,gB. Num, ber of Stories .... I ............ ................. Di~enstons eFsame structure with alterations or additions: Front . ·. : ...... Rear . .G.q ......... Depth ~. [ *" t DiniensiOns of entire new constrtiction: Front .&~. E~. Rear &o *W .. Depth .. ............ N m~ber of Stems ..... [ ...................................... t ........... Size of lot: Front ., ~9.9 .t ....... ,.. ......... Rear .... .t~.~.e ............ ~epth .... k~.9 .............. Date df Purchase ~ 7 IQ7 ~.['. ................ Name of Fommr Owner v~.. ~¢~9.%~ ...... Zofie ' d smct in which premises are situated 'Do~s proposed constr etlon vm ate any zoning law ordi regulation: Will lot be regraded ...... ;~: ....... No,he of Owner of premises~; ~9~ ¢~G~ J ...... Will excess fill be removed from premises: Name o~ Archi eft ........................ '.. Address ................... Phone No ................ PLOT DIAGRAM Locate el.early Kd distinctly ~I btli!dings, whether existing or proposed, and. indicate all set-back dimensions from mrty lines. Give street and block ntm,.ber or description according to deed, and show street names and indicate whether ( ' '" ~'ti~gcontract) d. being duly sworn, deposes and says that he is the .lapplicant is the (Contractor, agent, corporate officer, etc.) satd owner or owners, and is duly authorized to perform or have performed thc said work and to make and file .plication; O/at all statements conafiae~ in this application are true to the best of his knowledge and belief; and that the be performed in the mannor set forth b~ the application filed therewith. to before me this ), , -- . ..... ,..(.. otary Public ..... -' '~ ..... . · County