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Home My WebLink About12605-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z, .1.2.3.4..9 .......... Date .March. 13.,..198.4. ............... 19... THIS CERTIFIES that the building ....o. ne. f~mily..dwelling ...................... Location of Property .5.0.Q~5. ~/.$. Plain. Re}ecl ............................. saul;hoLd. House No. Street Hamlet County Tax Map No. 1000 5~ction .... (~70 ..... Block . 0.5. ........... Lot 0D.]. ............. Subdivision ............................... Ff~ed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..S.c.p.t....1,5 .......... 1983. pursuant to which Building Permit No..1-2605.7, ............. dated . $.~Dt,. 2.5 ................. 1983., 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 ......... ...a.d..d.i.t.%on. and. repair ....................................................... The certifa:ate is issued to Joseph Fasczcewski, Jr. ..................... /o'.;.L4'.'t~e'o'r'~3,;b,~'~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ....N./.A. ................................... UNDERWRITERS CERTIFICATE NO. 631043 Building Inspector 1,81 FORM NO. S TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12605 Z Permission is hereby gronted to: ...... ~.~....5..~,~.,......5...(.~.,.../~,.. ......... ~.~.~.~.~..~_ ...... ~ ..................... · . ....... ,,,.,,~.~~,,~.....-.....A...L.~...~...: ............. ~o ...... ,4~-~/. .~. . . ~. . . . . ~. /,:~ . . . . ,,~ ~. ~. ,,. .?~. ~ ~:~ . . . . . . .~. ~. . . . . .~.~ ~7. ~ ......... ..-:~..,~.~ ........ .w.~.~..,..= ......... 2:a~....~z:.=.a.z.~..~.~..,4~....~',~.. o,~.m,,., ,oco,., ~....,~.~.~ .......... ,~..,,~,.~.......~..~.,~.. ......................................... ..................................................................................................................... County Tax Map No. 1000 Section .... ~...~..... Block ...~...~. ........ Lot No..~C).].. ......... Building Insp~ctar. ........... Building Inspector R~v. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~outhold, 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 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 sir~ilar 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. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / 3. Copy of certificate of occupancy $1.00 landuse--?re-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date....~/~. ~/~. ............. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .~. ~,~.~. ............ -=.~../'~..~,~J. ~. ....... -,~l~.~.c~/~· House No. Street Ham/et Owner or Owners of Property ...~-~.~'.~'~/~. ~.... ~.~./~5~---~ ~.~..~..~.~. · · .~'.'---,~. .............. County Tax Map No. 1000 Section .... ~.Z~. ...... Block ...~. ;:~.~. ....... Lot .... .(~).(~. ~. ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~0~... Date of Permit .~./.~..~. ~..Applicant ... JD/'~-J..~-~'r~/.. Health Dept. Approval .... .~./~ ................ Labor Dept. Approval .... .~/.~. .............. Underwriters Approval. ~. ~.~/~): .~r~,~. .......... Planning Board' Approval ..... ~/~ ............. ................ r-ina L, ....... Request for Temporary Certificate ..... "' I "ertificate . .~.'.. ............. Fee Submitted $... ~. (.~:~. ................. Construction on above described building andf~rmit meets all applicable codes and regulations. Applicant .~-, ~. ~ ............................. Rev. 10-10-78 FIELD I~SPEC~TION FOUNDATION (1st) FOUNDATION {2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: '1 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ tiROUGH PLBG. FOUNDATION 2ND ~] INSULATION ~,,],.FRAMING [ ] FINAL REMARKS: DATE /////~/~? ~ INSPECTOR / / · w~ exam'ned on O~U~.~ J.~ ~ ~ and found to be in compt'ance wtth the requirements of th~s Board. F XTURE ~ EPT I I BXTURES I RA~ES ~C~KING DECKS OVENS DI~ WASHERS EXHAUST FANS DRYERS I FURNACE MOTORS ] ~TURE A~ANCE ~EDERS ;P~IALRECPT TIMECL~KS [ [~tt IUNITHEATE~; MULTI-OUT~T DI~ERS OTHER APPARATUS: G k ~ 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. [~1~--- COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Examined .~7../.,~...., 19~..~ Approved..-,~[-~.~...~ ~.., 19~.. Permit No.../. ~.~..~'-~ Disapproved a/c ........................ (Buildin[ Inspector) APPLICATION FOR BUILDING PERMIT Application NO.../· -~..<~..~. ...... INSTRUCTIONS a. Tlds 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 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 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· ....... (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. (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 ...... /..°c./ ................. Other Trade's License No ...... .M/~. ............ 1. Location of land on which proposed work will be done..~.~.... ~...~f..'q... ~'~ ............................ House Number Street Hamlet County Tax Map No. 1000 Section ....... (~...~... Block ....... .~.~. ..... Lot ..... .O..~. i .... ./... Subdivision ..................... .~. .............. Filed Map No ...... ~. ........ Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ..................................... ¢. .......... ~. .......... 3. Nature of work, t,, (check which applicable): New Building .......... Addition .... .~... Alteration .......... Repair ...~ ......... Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost .../t,~"~tffir~ ............................ Fee '4~0~7---~--~ (Description) (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 structures, ifany: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height .................... '.. Numbe~ of SIories ............. ,. ........ 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 ............................. 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed ~onstruction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .. 2-/.0 ...................... Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises .......... Address.. .Phone No. 7t~.~-.-:,~'.d..~.~..N.o. Name of Architect ............. Address . Phone No. Name of Contractor ~/,~..Bg~t...~t~O .... Address i i~4~}~i i .~}i ii. Phone No. ~.'?' ~'O~.' ~.' i PLOT DIAGRAM Locate clearly and distinctly all 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 NEW YORK,. COUNTY OF ..... ,~.~6~... S.S ...... .,.~/1~..~ ......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the. ~.~/g,~)O~..~... O~. t'C--,t~ ............................................................ (Contractor, agent, corporate officer, etc.) of said owner o~ 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 ~oefore me this ............ ~? .......... day of ...... ~.~.$ ......... , 19~..~ Notary Pu, blic, . ................... .~tff.~,~ T~m Ex,~ir~s [~arch B0, 1~ (Signature of applicant) il,¸ :1