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Home My WebLink About12639-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12510 Date June 5 .................................................. 19...84 THIS CERTIFIES that the buildh~g--new dwellin~ 605 southo a Location of Property ................................................ House No. Street Hamlet County Tax Map No. ]000 Section ... Q.7.~. ..... Block 09 ..... Lot .0.5.0. 'g]% OO~ a~ B.~Yvi.e.W pN 5..5.4.7. Subdivision...H1 w ....... Filed Ma o .... Lot No. 8 conforms substantially to the Application for Building Permit heretofore fried in this office dated Sep.t.ember 15 19 8..3pursuant to which Building Permit No....1.~. Z dated ..... S..ep.t.e.m..b.eK .2. .6 ......... 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 ......... family dwelling ....... a Driva%e one- · The certificate islssued to THEODORE S. KUDLINSK,I, JR. & THERESA M. KUDLINSKI [owner, of the aforesaid building, Suffolk County Department of Health Approval .. ~LX-.$Qr.i.5.9. ,..5/.1..1 ./.8.4. :..R.o.b.t~ :........A' Vi~.la ,. UNDERWRITERS CERTIFICATE NO .......... N..6 4 0.4,6.1, .............................. Building Inspector Rev, 1/81 FOBM NO. ~ TO~N OF $O~THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12639 Z Permission is hereby granted to: ~.~ ~~.~ ~. ..L~..~.....I.~..~?.~ ........................................... ...~.~~..~......~:.%.~......I..t~...~..~... ,o.~.~....~...~ ...... ~...~ ~ ~..~.~~ ....... ....... ~.. at premises located at ...~..Q.~.....~...~...~.,~....~.*...;--~.......~.~ ..................... County Tax Map No. 1000 Section .....q~..-]..,,~. ....... Block ...... ..~..~ ........ Lot No.....(~...~...~... ........ pursuant to application dated ........ I.~:~........., 19..~.~, and approved by the Building inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~Jouthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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. 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 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 ! 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 land C.O. $ 5.00 Date .................... New Building . ..~.. ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~.. · .~. · ....~/,.~., ././../?.o..o.~....~----_.~.../~.... Hou~ No, Street Hamlet Owner o~ Ow,,,, o~, ro,,rt~ .'~ ~.~ ~. ~'. ~ ~ ~ ~.~;~.7~...~'~..~' .......... c~ ~ ~.o. ~0o0 s~o... ~3~ ....... ~oc~ .... ~.~. ...... ~o~..O~.Q ....... Subdivision..~k ~.. ~..~.~ ~':~iled Map No..~ ~ ~? .Lot No .... ~ ........ ........... Permit No. ~.~ . . Date of Permit .Applicant . Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ~ ~O ~/ .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... ........... Construction on above described building and permit meets all applicable coded regulations. Applicant... ~.~.~, .~~ ............. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as ~scribed bel~ and introduced by~ applicant ~med on the fbove application number in the premises of in thefoHowi~g ~oc~tlon; ~ ~asement ~ Is~ FI. ~ 2nd FI. Section BIoc~ wasexaminedon ~p~ 9~ ~ andfoundtobelncompllanc~withtherequlrementsofthisBoard. FIXTURES RANGES ~ OVENS FIXTURE SWITCHES DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLQCKS DISH WASHERS EXHAUST FANS MULTI-OUTLET DIFA~ERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPA ~tATUS: 3-G.~:.C~I., 1-Smok~ Detector NO. OF CC* COND pER ~ OF CC. COND, a/o NO OF HI-LEG NO OF NEUTRALS 1 OF NEUTRAL Paul Ikun~s Tovm Harbor Lane $outhold~ N.Y. 11971 This certificate must not ~be altered in any manner; return to the office of the Board if incorrect. Inspector's I~IG DEPARTMENT. THIS COPy OF C GENERAL~LI~NAGER Per- may be identified by their credefftlaJs. I INANY MANNER. ~S?ECTION DATE COMMENTS ION (1st) ION ( RAME & ION FERN. Y. ~ ~ TE ENERGY QODE FADDI~ONAL COMMENTS: FInD FOUNDATION FOUNDA 2. ROUGH 3. INSULA 4. 7~s.~8o2 BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. ]FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ,, ,INSPECTOR FOUNDATION 2ND [ ] INSULATION FRAMING REMARKS: [ -~FINAL ' DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 . .~.~l~...~. ?.., 19~ .~. Permit No. ! ~..(q.'.~..~..~ Approved... Disapproved a/c ..................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ........... cl/!~...., 19 8~ a. This application must be completely filled in by Wpewriter 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 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 {>f 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 regulation_s, and to admit authorized inspectors on premises and in building for necessary inspections. _ ,, (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ............................................................................ Nameofownerofpremises / HEoboI?-~z. .~.~ ..~..U. DLI.A(~I.~.I. I ~J-g' (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 ...... .]>D .{~4 . . J~..~'. ). ~... Plumber's License No .... ?iR. Id. ]...[~.IYI~. ~ . . . Electrician's License No...~.CI~. Other Trade's License No ...................... I. Location of land on which proposed work will be done ................................................ -.. ......... .t-{. .o. . . '.P.o. .,t. .............. .&. .o. .o. .r. q ...................... House Number Street Hamlet County Tax Map No. 1000 Section .. ~..~.~ ........... Block ...~..~. ............ Lot..~. ~.~. .......... Subdivision../~./~.~.. tg.~. fi/' '/'~'//~'PP'(Name) '~ ........ ~'~' ' '/')/' '{~}' Filed Map No.. ~...~.7. ..... Lot . ~ ............ 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy .... ~//~.~./~..'~ ./~..U./..L-0/et(.~...Z.O..T-. .................................... b. Intended use and occupancy . ,.~II~GI~- .~.t?~..I.l~.t/./.~...ff~...~tk.)l*/OT'- .~..,~.]:Z. . // 3. Nature of work (check which applicable): New Building . ..~.. ..... Addition .......... Alteration .......... ' Repa r ....... ~ .... Remgval .............. Demolition .............. Other Work ............... ~O ~ ~ ^., ~ (Description) 4. ' ' ~ - '"26~ ?70 Estimated Cost...6r.~./.6Lt/../~ ......................... pep ...................................... (to be paid on filing this application) 5~ If dwelling, number of dwelling ?nits ... Ofl/~ ....... Number of dwelling units on each floor..O..~.,~.. If garage, number of cars . . .'J~ .~/.O. .............................................................. ..... 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 structure with alterations or additions: Front ................. Rear .................. Depth .................... !.. Height ....... .~.~,, .~. ~ ........ Number of Stories ,., .............. ,,. ..... ~ 0" -'~" ~' " 8. Dimensions of e~tire new construction: Front .~... ~ ..... Rear . t~....g.~. O.. Depth 37.., O. ....... Height ..../~.~.IL~. ..... Nun~ber of Stories ~F_ . . 9. Size of lot: Front ./.~.O/ .... ! ........... Rear ../.~.~ ................ Depth // .................... 10. ~ate of Purchase ..... ~.//.7./,~. .............. Name of Former Owner ~/.Z,..~rF~ff.Ft~t. 11. Zone or use district in which premises are situated ..................................................... 12. Do~s p'roposed construction vioiate any zoning law, ordinance or regulation: ./~/.0 ................. ~ ....... 13. Will lot be regraded ......... i .................... Will excess fill be removed from premises: (Yes) No 14. Name of Owner of premises .-17~oo, o~i~. [~.op.~t~t~,4 .,T..t~ Address ~t~t.~ t~. ~our/~.~. Phone No. 7~q .-'~ .... Name of Architect . ,/~.arr~..c.~ .~..,. '.'7.. ??-t.~t.~.~... Address .2~v. crq. r. ~ :/.~.rpT.-~. ~.0.m'7 Phone No. 5r'~v -f6 ~'~-' Name of Contractor. ~.~O...~..I.~. ............ Address~.#,,,t$.lA..' ~t~q~.0~.~.. Phone No. At.lt. PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and~ indicate ali 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 NEW YORK, 2. *. 71~.4~..°.~. · .°tY~. · · .~.'..~.q ~ 9.' .'°.r?. ! ~ .~.~.: ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .............................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 be'fore me this , i~ , ¸%. ~e Oe~eg6 dtspoeal and water"supply l~speote~by thls-de~rtment ~ fo~ ~e be ~tl~faoto~ ~ _ . Se~teea RODERICK VAN TU_.YL, P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. /.~-.~O-/.~ STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS rESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT, OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF, NO: APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL OWNERS ADDRESS: DEED: L. 9~'7g' P, ~5¢~] Iii tEST HOLE I STAMP SEAL SUFFOLK CO HEALTH DEPT. APPROVAL h.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOr THIS rESIDENCE WILL CONFORM TO THE STANDARDS SUFFOLK ,¢0 DEPT OF H~ALTI-~EI~VI~:EbS. APPLICANT SUFFOLK COUNTY DEPT, OF HEALTH SERVICES ~ For APPROVAL Of CONSTRUCTION ONLY APPROVED: ~ ' SUEFOLK CO. TAX ~AP DESIGNATION: DIST. SECT BLOCK PCL. OWNERS ADDRESS: TEST HOLE STAMP ~L. SEAL 'b RODERICK VAN LICENSED LAND SURVEYORS GREENPORT NEW YORK