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HomeMy WebLinkAbout12378-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ...... N..e.w..D.w..a.l.l.j:n. g ............................ Location of Property . .1. 7. .2.0 ............... ¥9.n.n.e.c. 9.t.~' . D..r.. ........... .S. qu..t.h.o.1..d ...... House No. ~ Street Hamlet County Tax Map No. 1000 Section . .0.5. 5. ....... Block ...0. 4. .......... Lot . .0.2. 3. ............ Subdivision.. Xe.n..n.e.q°.t..t. .P.a..r.k ............ Filed Map No..5.1.8..7...Lot No...4.6 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .~..qy...1.7. ....... , 19 .8.3. pursuant to which Building Permit No .... .1.2.3.7..8.Z ........... dated ........... .5.u.n. ?..1.0. ........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 ......... New Private One Family Dwelling. KAPUSTKA, STEPHEN & BEVERLY The certificate is issued to ........................................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval .......... 1..3 7.S.O. 7 7.8 ....................... UNDERWRITERS CERTIFICATE NO .................. bi...6.{4. 1. .1.6 ....................... Building Inspector Rev. 1/81 ~OB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12378 Z Permission is hereby granted to: ...... ~..~.~....&..:....~.~~,.~ - ....... ~,.~~. ...... ~..~ ..................... ....... ~~..~..~..~ ................. .~ ,o ...... ~.~'.......~...~~...~~~ ~ ....................................... at premises I~ated at ...~ ....... /~~/~.....~.: ......................................... ........................................................................................................ ~~...~.~ .... ...... ¢~~-~ ........ ~~7 ............. X~.~.~.~ ....................... Co~ T~x M~ No. ~000 Se~.o...~ .......... e~ ....~..~ ....... ~o~ No..~.~ .......... pursuant to application dated ...... ~......~ .................... , 19.~ ~nd approv~ by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hell ,?~uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte .'.d-!~. -JF, l~cctc 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 features. 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 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. B. 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 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, Co Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.O. $15.00 Vacant laud C.O. $ 5.00 Date .... : .~. I..L~f.. ,'~..~,. ....... New Building ....~.. ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .~...~. Hou~ No. Street Hem/et Owner or Owners of Property ...~.~ ~ ~..~.~ ~ ~ .... ~~ .......... CountyTax Map No. 1000 Section~~ ........... Block ...~ ......... Lot..~ ~.. Subdivision...~f.~.~. ~ ..... Filed Map "o. ~ ~.$.~...Lot ,o, . .a.~ ....... [ d Appl,cant Permit No, ~Z~.~ ~ate of Permit .~...~~.. · Health Dept. Approval )~ - ~ ' ~ ~ .Labor Dept. Approval Unde~riters Approval .~. ~H~ t~ ~ .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ........................ Construction on above described building and permit meets all applicable codes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC~ITY THIS CERTIFIES THAT only the e~c tricaJ equipment ~ described below and introduced by the applicant no.ed on the able ~pplication ~umber i~ tl~ premises of Steve ~p~t~, Yemx~tt Drive% Rt~. ~ ~ ~1 AvenUe, ~ld, in the following location; ~ Basement ~ 1st ~7. ~ 2nd FI. Section Block was examined on ~ ~.0 ~ ~ and found to be in compliance with the rqquirements of this Board. FIXTURE OUTLETS SWITCHES DRYERS FIXTURES RANGES OVENS DISH WASHERS FANS !NCANDE$CENT~7 FLUORESCENT SYSTEMS NO. OF FEET OTHER APPARATUS: 1-~. F. C.I.. 1--,,qmoke Detector E R V I C NO, Oi~E~C, ECONO A. WG OF CC CONO. ~0 AWG, OF HI-LEG NO, OF NEUTRALS 1 OF HEUTRAL 2/o Steve F.~pustka 611 M~plo 8tree~ Gr¢~nport, N.Y. Lie. GENERAL MANAGER ",, ,~ Per '1'1 Th s cert f cate must not be a tered n any_ manner;, reiurn to the off ce of the Board f ,~c°rrect Inspectors may be identified_ by their cre~ehtlals. ~ ~ DEPARTMENT. THIS COPY OF CERTIFICATE MUST,~O~ BE ALT~R~ IN AN~ MANNER. FIELD INSPECTION FOUNDATION COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY q~DE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT~ INSPECTION ~ '7 7'7 ,- [u~]~OUNDATION 1ST [ ] ROUGH pLBG. FOUNDATION AND [ ] INSULATION [ ] FRAMING [ ] FINAL R~.~MARK$: ~[X/ 765-1802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST []ROUGH PLBG. []FOUNDATION ZND []INSULATION []FRAMING ~* , [ FINAL~ REMARKS: /~ ~*- /?~r~_4 ~-~' /M,.~IPECTOR 7G5-~.802 BUILDING DEPT. INSPECTION FOUNDATION ZST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING FINAL Examined .~.~.'. ,.~. ~.. Approved .J.~.~.~:..v ~t~.. d~ ~7 -9 Y FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c .............. ~ ....... '~'/' '//'~ . . .~./--:- .// APPLICATION FOR BUILDING PERNIlT INSTRUCTIONS Application No../..~r-'-7..~. Z~. · ...... a. Tkis 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 throu~jaout 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 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary~ '"--(Signature 6f applica~ij~;~a~io'n') .... · .......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ................................................................................. Name of owner of premises .... ~.X.~.~..~...~,c,,.....(~.. :....~ .~.~ .~. ................................ (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 .... Plumber's License No...~.~. ~ . .~....-~.~ . -? Electrician's License No..~( .... .t ..... ~.. ...... :. Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .... ..... ......................... House Number Street .~.,'~" i~ Hamlet I (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .~h.~.f~c~,.~.....~.~.. ....................................... use and occupancy . .~'~e~..~. ~'~>.~.~, .... .--....' ....~... ~..'~TO~.~¥....~..~.e-zV~.c~..c{ ........ b. Intended 3. Nature of work (check which applicable): New Building . ./~-~....... Addition. ......... Alteration .......... Repair .............. Removai ............ Demolition .............. Other Work ............... 4. Estimated Cost ...~ ..... {~) .... '. ~ ............... Fee ........................ (to be paid on filing this application) 5. If dwelling, number of dwellingiunits ..... ~ ........ 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 ...... · ......... Rear .............. Depth ............... Height ............... Number of Stories ....................................................... Dimensions of same strncture with alterations or additions: Front ................. Rear .................. Dept ................... ;.. Height .................. :... Number of Stories ........ · · 'i 8. D~mensmns of entire new constructmn: Front . . .G~i~. ........ Rear ............... Depth . .~.' .......... Height . . I~u~mber of Stories ...... ~ .......................... i ............. 9. Sizeoflot: Front .... I"~:~.~. i ........... Rear.. [i~ot'! ......... i ..... De'it';il X~o~...~. ............ 10. Date of Purchase g'~.Uqqw~o,*-~. .~.~ N e of Fo ~"e'c~.),~ .l~...~.~.~.~.~ ............ ..... , ................ I~tln rmer Owner . ~v..~'~,:m.. 11. Zone or use district in which promises are situated ..... .~.~ .~ ~ .~.~.~. ~ .*~. .............................. 12. Does proposed construction violate any zoning taw, ordinance or regulation: ........ k"X.(~ ................... 13. Will lot be regraded ....~.~;. .................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises . .~XYe~.~,q-~..~x'~Address . .Cv...~'~..C.~.~..~q~. ...... Phone No..~3,~.14.~..'X~.~ .~... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ........ , ................. Address ................... Phone No ................ PLOT DIAGRAM Locate 'clearly and distinctly al~ 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 lot. STATE OF NEWZO, R_K,., 'S S COUNTY/JEff?.. '~.' .~. ~>.~.~..., !' du, worn, (Name ot inaiviaua~ s~ning contract) above named. He is the (Contractor, agent, corporate officer, etc.) of saki 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 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 t.h. is/9 ........... d.?. yENNEGO'I'T ~;~ot~ COUNTY 9~A~u ~ STEPHEN W. KApUSTKA --- '- AT SOUTHOLD ~. DATE: NOV. 29, 1982 ~ac[~.l,.~- ... ~-~ beea SUF~O~ COUNTY, NEW YORK NO. NEW ~RK;~TATE E~CATi~ LAW SECURITY of Oeno~al ~ nee~ ~ief ~ -.~ SU~V~'S INKED ~A~ OR EMBOSSED SEAL SHALL HEAL~ DEpARTMENT-DATA F~ APPRO~ ~ C~STRUCT *NO ~H~ ~LF ~ ~ ~ TIT~E C~P~Y, eOV~- YOUNG 8 YOUNG mVER~AD, NEW YORK ~, 8T&KE ~LACED O' PiPE FOUND' .AL~EN W. YOUNGt PROFESSIONAL ENGINEER GOUI~ ON OCT. I, Ifil AS FILl NO. Sle? AN~ ~ND suRvEYOR N.Y.S. UCENSE NO 2845 AREA, ~l.ell I.F. HOWARD W. YouNG, LAND SURVEYOR ~ DRIVE ,__,,,. l~5.1z'~' ~ ~ 8INGLE , ~ ~ FAMiLy DWEL ' ~ ~ LING ONLy- ~ t°t -- ~ S. 83~ ~ '" ~ F:.'.~ ,?':'~':V' '. :2: :.' .... ,~ :::; ......... ~;~ ~'~ ~,'I,~ ~O~lY g~$ /,3' :.: su~ S~.~N W..~UST.~ LOT 46, "M~P OF ~ENNECOTT PARK" AT SOUTHOLD D~[, ~OV. ~9, ~9e2 ~WN ~ SOUTHOLD SC~L[, ~" = ~0' SUF~O~ COUNTY, NEW YORK NO. 82-7Ze ~ u~u~lz[e ~LIE~IO~ ~ ~omT~O~ ~ ~S GUARANTEED TO= ~w ~qRK ~T~TE ~C~T ~ L~W SECURITY TITLE ~ GUARANTY CO. · ..,~..,. ~ ~~ , .~.... L,.. o..o.~,., .,.,o. ~ / ~.~ '" I. } YOUNG e YOUNG " --:-' ~ · ~TAK[ PLACED O' PIPE FOUND SUBDIVISION ~AP FI~ED IN THE OFFICE OF THE CLERK OF SUFFOLK : ALDEN W, YOUNG, PROFE~IONAL ENGINE ER COUN~ONO¢[I,I,aI48,ILENO. SII, ~/ AND~AND suRVEYOR N.Y.S. UCENSE N0.,2845 ARK~, ~1~8~4 S.R : ~ * ~l HOWARO W. YOUNG, LAND SURVEYOR NOT[FY BUILDING n~ 765-1802 9 AM TO 4 PM FO~ THE FOLLOW fNfG fF~SPECTION~' L FOUNOATIOH - TWO R6~''~D FOR pOURED CONCPETE 2. ROUGH' - FRAM[~G ~ ~, FINAL - CQNsTFU"Tf3N MUST BE CO~RDfETE FOR C 0 ~LL CdNST~Ud~tOH SNAEL ~HE REqUIREmENTS OF THE N,~, ~ATE CONSTRtJ~IOhf ~* If cOpper tubing is used for Water distributing sysiem; piping shall be of types K or L only DATE: B P. ¢¢ FEE: BY: NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR PCURED CONCRETE 2. ROUGH - FRAMING 8. PLUMBING :3. INSULAT!ON 4. FINAL - C~N%TRUCTION MUST BE COMPLETE FOR C O ALL CONSTR~JCTION SHALL MEET THE RE©UIREMENTS OF THE N.Y. STATE CONSTRUCTfON & ENTRGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERPO~S. ! q 1-