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Home My WebLink About12370-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. 'Certificate Of Occupancy NnZ11953 October 3 198.3. ................... Date . THIS CERTIFIES that the l~tliFd~ .... .i.nE.r.q .up.cl..P. 99.1 ............................. Location of Property ...1.1.8.0. ................ c.o.r.ey..C.r.e.e.k...~.a.n.e. ....... .S.o.u.t.h. ?.~.d ..... House No. Street Hamlet 97.s. County Tax Map No. I000 Section ........ Block . 04 . .Lot 016 Subdivision.. C. 9.r.e.X..C r.e.e.k...E.a.~, a..~.e.a. ...... Filed Map No.. 4..9 .2.3...Lot No...1.4. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..H~ty..1.1... ~ ......... 198.3.. pursuant to which Building Permit No...1.2.3.7.0...Z ............ dated ..... g..u .n.c.. 7. ................ 19.8. 3,. 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 ... an in,round swimming pool with fence enclosure. The certificateisissuedto ....... SANDRA RAVE & MARY TLOCZKOWSKI (owner, of the aforesaid building· Suffolk County Department of Health Approval not .applicable ' ' UNDERWRITERS CERTIFICATE NO .......... l~..~.Q ~ 99.7. .............................. Building Inspector Rev. 1/81 ~0~,~[ NO. ~ TOWN OF SOUTHOLD B~JILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 12370 Z Permission is hereby granted to: ........ ......... ............ .......... ~=z.~~......~.....~~..~~.~~ at premises ,~ated at ..~Z~......~~....~:...~e ................................. - .~.~~' ..~~. Z~ ~zz~. Coun~ Tax Mop No. 1000 Section ...,~.~.Z ...... Bilk ,.~ .......... Lot No. ~ ............ ~uildln~ PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY ~EGRAD~NG LOT -- DRIVEWAY CONSTRUCTION -- .- CESSEOOL CONSTRUCTION .... CELLAR cdNSTRUCTIO,N, OTN'ER ~~ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 featu res. 2. Fina~ approva~ of Hea~th Dept. of water supply and sewerage disposa~-(S-9 form or equat). 3, Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings 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 property lines, streets, buildings and unusual natural or topographic featu res. 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, Fees: 1. Certificate of occupancy $5.00 Certificate of occupancy on pre-existing dwelling 2. 3. Copy of certificate of occupancy $1,00 land use Date ...................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property.. ![ ~ © {~-~'~ ~ ."~-~-~-~-~-~-~-~.~ ~.~. ~.-~T~,.. ~O~~ ~ Hou~ No, S~reet Hamlet Owner or Owners of Proper~ ~ ~'~ t ' ~ ~ ~AO~'~ ~ County Tax Map No. 1000 Section__ ...~.~.~ ..... Block...... ¢ ~CLtg.... ... Lot.[k~.Y~d Subdivision..~'~.~. · .Filed Map No ~ ~ ~ ~ .). ..................... Lot NO.. ~ ......... / Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .,. ~ ................ Fee Submitted $ ............................. Construction on above described building and permit meets all ~,~licabl,~,codes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ,.re pp,icat,on No. N 605007 only the electrical equip~nertt as described below ~nd int~duced by t~ applicant ~med on tl~ above application number it~ the pre.dses of in the/ollowing location; ~ Basement ~ 1st FI. ~] 2nd FI. O~ga~ Sectlo~ Block Lot was examined on j~.l~ ~ ~ ~ and found to be in compliance with the ~equirements of this Board. SWffCH"S,~ FIXTURES RANGES OVENS DiSH WASHERS EXHAUST FANS FIXTURE DRYERS :L SYSTEMS NO. OF FEET E R V I Phil Gordon Dean 5erect Po3m; Jo:ffe:rmon ~tation, N.Y. 1177~ Li¢#llO1E ~N~RAt ~NAG'R · / 11 · ~, Per ~:~._~ This certificate must not be altered in any manner; return to the office of the Board if )nco~'rect. Inspectors may be tdenhhed by their credentials· COPY FOR BOlkOl~lO DEPARTMENT TH SCOPY OF DEflT F Ogive MUST~NQT BE- ' ' ~ " ALTE~D N AN~ MANNER. FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY q. ODE FINAL ADDITIONAL COMMENTS: '.'t: ' [J % .& Z~. /Z ~'o ..j I[. Environm2ntnt An~'!y3i.~ !L]Jt Building 4Q, :'LL!¥ (516) 751-7900 Peter A.A. Berle C onm~i ssioner Dear Ns. Facca} This is to iu~orm ,.,o~ that we !'ay~. r..;vi.,~,ed th: .,,,t~t,a~i,~n !ctter (or pemit application) filed ~,n ti/3~ lyf.? and n,~%2 dat~:rmined that it will not be necessa~ to file a pe~t applicatio,l (or secure a tidal ue~lands pe~it) to , *.. ,, .. .,.,-~ ~ .... ,. -'crates, Jorey Oreck La, Scu%hc~ L. I,. Y~ ;~sum{ng you have o%ta~ned all other necessary ,,ermJts, you may procaed with your projeat adhering t(~ the special conditions (if ~.ny) found on this letter. ad~acent 'to %':~tel~'--..'ay shall ~e 1¢7"t .~.n ~:ct, ur~l state. DJL: RH: cg Attached: Receipt e.e. Lin.: E,:force~ent cc: U.S. Army Corps of Engineer~ Ru;,;ional Permit A,!mlni~trat~/ ~ ~ ~ ;/',~ ! 10o? Date !s~uc~ Expl. ~tion Date NL~'~YOI~ S~AT~ D.F. PARTivlF. NT OF Bull.din8 40, SDI~--Room 219 Stouy ~rook, NY 1179~ (516) 75Z-7900 I~I£Oi~AL CONsEltVATIO~* Rg~ Ve,~'mit No. Y~acc.a New ~ers, S~dra p. ~ve ~d ~ p. Tloczkowski Ga~ Flaker Olsen co~l~!ono, relevan~ tec~lo~.,oe applicable 1~ ~ aa such, ..... Job $~te. ................. ,. ~ other °ct8t~1 '/l~oteo Ye shaii change of P~-'cel,, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~..~.0... 7. ...... 19~..~ Approved Z ....... i9P. Z,,e,-mit No../Z...TZ.q Application No.../'..'.~.ff.~...~? ..... Disapproved a/c ~ APPLICATION FOR BUILDING PERMIT Date ... ~a.y..'] .'1., .......,19.8.3 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 pubfic 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 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 thc 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ........ .s.w.:i,m., in.g..P.o.q:k .s .................... (Signature of applicant, or name, if a corporation) qk.y..P.o, gu.t.,..NY .............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ....................................... .Aae. ................................................... Name of owner of premises ..... .Sg.~td.r..a: .R.a.y .e..&..M..a.ry..T..19.c.z.k. 9.w.s.k.i. ................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... 6.'1 ................. Plumber's License No ........ .I~/.g ............. Electrician's License No ...... .q. q0.q .-J~ ......... Other Trade's License No ..... ~/A ............. 1. Location of land on which proposed work will be done ..... ldest/k Core7 Creek lane .............. ...I.l.gO. ................. O~eek..Lame ...................... Sou.t;hold ............... 4.. House Number Street Hamlet County Tax Map No. 1000 Section ....~. ~.~ ......... Block ....... .O..~.: ..... Lot .... O..~.~. .... .//... Subdivision..Coeg .Ore.ekz .]~.~.a~e~ .............. Filed Map No. ,z*92.5 ........ Lot.,. d& ....... ~. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. RasidB~ce ............................................. b. Intended use and occupancy fl.Gx36..5.ngro.und, s.w. immilag, po.al, wiJ;h..~.'..f, enca .~co..nolte ........ Repair .............. RemoVal ......... Demolition ......... Other Work...l~-¢>ec. ...... (Description) 4. Estimated Cost ....... ~ ,5. 9. 5. .- 9 .O. ...................... Fee~.../.~ ........................... (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 structure~, 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 ............... Rear ............... Depth ............... Height ............... 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 regraded ....... y.e.s. .............. Will ex,ss fill be~re~eOt~edLf~o.m premises: ~ No 14. Name of Owner of premises Sa, ndra Rave" ' Address .~.o.~.e?..?.e ........ Phone No...7..6. ... 8.5 .... Name of Architect ..... N.../~i i. i i i i [ i i [[ i i i ii [ i Address ................... Phone No.. Name of Contractor. Swim..14;%Itg. ~.O01S ....... AddressR~Je. ~3~.~p. qk. 7 .... Phone No. ]~/~'~0.{)i i i i Po int PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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 lot. See Attached survey STATE OF NEW YORK, COUNTY OF.. ~.u.f.f..19.k....... S.S Michele Smith (Name of individual signing contract) above named, i being duly sworn, deposes and says that he is the applicant He is the ...................... !. b~9.n,g. ............................................................ (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 am true to the best of his knowledge and belief; and that the work will be performed in the mannek set forth in the application filed therewith. Sworn to before ,ne this ........ }.[ ............... day of... Notary Pub!lc, . .......... ~ ......... {/ --zq~'t'~TTM Notary Public ¢;tat,., o{ lqnw Y~ r],~, , (/, , ,"/, ,~, ~', ~ , , ,~,~_~,~-~, ,/~ ........ k../ No, 52-4526/K~3 . ' .... . ' ' ' aualiiie~ i,-, su{v,,~ co,,,n, tv.. /- /F .... / ~Signature of apphcant)