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HomeMy WebLinkAbout12380-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z14012 Date November 19 .................................................. 19.85.. THIS CERTIFIES that the building Dec k CUTCHOGUE Location of PropertyHouse"' 4..3No..O.. S. ? .I.L.L.W.g. T. .E.R. . A. y.E. { .... 'S'tt:ebi ....................... h3r~iol County Tax Map No. 1000 Section ..... J 9.2.'. °..0.Block ..... 97.'.0..© .... Lot..o.0..2:.0.0.o. ....... Subdivision ............................... Flied Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .M.a. 2..3.7 ........... 19 5.2. pursuant to which Building Permit No....~ .2.3.8.0. .Z ............ dated ....... J. urge..~.3 ............. 19.8.~., 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 ......... Deck addition to existing dwelling. The certificate is issued to .... JOHN KUJAWSKI & JOSEPHINE KUJAWSKI. (ownerxi[s~A )~ f~/Y~f~ X of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. N/A Re~. 1/81 Building Inspector FOU~ NO. ~ TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL CQMPLETION OF THE WORK AUTHORIZED) N? 12380 Z Permission is hereby granted to.2_._~ ..... ~>..~:..:.~~.-..~.....Z~.~ ~,~ ~ .......... ~o..~. ...... .,...~c ........................ :.. .... ........ ~zc.~?.~.~: ?.,......,.~.?: : ~o ...... ~2~..~,~....o....~.7.. ....... .O....~..c,~.....,~.~...~.z.2.O..~....."27o.....,~.../.~.Zxz,d.c? ........ at premises located at .......~.-~...~..~?.......~..d...K~.../.~//d'..~.~t~.....~.Z.~.;, ....... ..~..Z,d.~7../...~?/~../~,: County Tax Map No. 1000 Section ...~..~..~.. ......... Block '""~'"7 ......... Lot No ...... ~..O..Z2 ....... pursuant to application dated ....~,~...~ ......... ../...~... ................... , 19Z.-~..., and approved by the Building Inspector. Fee $ ............... Building Inspector Rev. 6130/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~=uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted-~a=dutHieeteto 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. §. 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwel ng / land 3. Copy of certificate of occupancy $1.00 / Use--Fre-Exist~ng C.0. $15.00 Vacant land C.0. $ 5.00 Date ~ove~ber 15, ~ New Building J< ?~.. ~, ,~, ,~.. Old or Pre-existing Building ............ Vacant Land ............. Location of Property. 43Q. ~'. Stillwater Avenue Cutchogue House No. Street Hamlet John Kujawski & Josephine Kujawski Owner or Owners of Property ................................ County Tax Map No. 1000 Section 103,00 Block 07,QQ - . 0(13.000 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 ,. ,X .............. Fee Submitted $. 5.., .(L..Q. ....................... Construction on above described building and per--eels all apj:~ic~ble c~es and regulations. Applicant .. .. . R~v. 10-10-78 Y ~ L,,,, CUTCHOGU~ FIELD INSPECtiON COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: §CCU? HC¥ OR APP~ROVED AS NOTED 766-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION ~ ~O REQtJtRED FOR POLIRFD CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULA:-~N 4. FINAL - C~?,%TPUCTION MUST BE COMPl ETI: FOR. C. O. ALL CONSTRUCTION S~IALL MEET THE REQU}RFMVNTS OF THE N,Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..~.<~A,.(~...( .-~...., 19~.? Approved . .~.~./~f.~.'. /~. .... , 19f~..~. Permit No. ~. 2~.~... Disapproved a/c ..................... ./~.. 'i .....~ / (B~iqding~Inspector) APPLICATION FOR BUILDING PERMIT Application No../. ?.. ~...~.'. ....... 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 permi(t 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 9f 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 i~nections.~ ~ /,(,tSigna{_ure of applicant; gr name,_if a corporation) (Mailing addre/ss of applicant)/ State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises ~f4~...e~. 5~~-'~/-~../~~fW. ' .-~... '. ........................ f// c~ (as on the ta~/~I1 or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ......................... Electrician's License No ....................... Other Trade's License NO ...................... 1. Location of land on which proposed work will be done ................................................... House Number Street County Tax Map No. 1000 Section .... ~1. Q..~. ......... Block ..... .o. '~ .......... Lot... ?..6.5 ' Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and in'tended use an~d occupancy of proposed construction: a. Existing use and occupancy ................. _ ............. b. Intended use and occupancy ......... ~~ ~ ~ .................... · 3. Nature of work (check which applicable): New Building .......... Addition. L)~.Q.q'~-... Alteration .......... Repair ..............Rembvai .............. Demolition .............. Other Work ............... · ,a o o.q !o o (Description) 4 Estimated Cost. ' 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 mixe.d occupancy, specify nature and extent of each type of use ............... ~ ..... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ......... ; ..... Height ~0. ~t .......... 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 .............. · ........ Depths. ..................... 10. Date of Purchase .......... [ .................. Name of Former Owner ...... ~.-. ~. ~l.4ff~q ~..~..... ...... 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 ........ [ .V~. p ................. Will excess fill be removed from premises:, Yes 14. Name of Owner of premises .'~...~ .Ckko~./.~ .... Address .~t~c~.tt5 .U~.. ...... Phone No. ].~q: .q3~.~..'"'~. Nme of Architect ......... i ................. Address ................... Phone No ................ Name of Contractor ........ i .................. 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 NF~5~RK,// COUNTY O~F ~~... ........ · .... (Name of individual sign!ng c~ontract) above named. being duly sworn, deposes and says th~ is the applicant ~/~is the .................. ~ ....................................................... i (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 conthined in this application are true to the best o~wledge and belief; and that the work will be performed in the manne~' set forth in the application filed therewith. Sworn to before me this ............. /~..~. · .day o~ · · · ~g/~./~j~~/~ ...... , 19 ~._~. - - vo, .......... '/ -.%