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HomeMy WebLinkAbout10786-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12910 Date October 22 84 THIS CERTIFIES that the building .... .A.d.~. ~.i.o.n. .................................. Location of Property . .1.5.6.0..M.i.l. 1..e.r..R. :9:.W..' . .&..8.5. .D..ep.r. Path Mattituck House No. Street Hamlet County Tax Map No. 1000 Section . . .19.6. ...... Block . ...1.0. ......... Lot ...0.2.8.: 2. ......... Subdivision .......... ~ .................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..J.u..ly. ...... 1. q ....., 198. 9. pursuant to which Building Permit No .... 1. Q 7 .8.6.Z. ........... dated ....... .J.u. 1. y ..... .1.8 ......... 198.0.., 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 Existirkg Dwelling The certificate is issued to STANLEY & JEAN KOROLESKI (owner, Y'e'~'.see"o'r of the aforesaid building. Suffolk County Department of Health Approval .... .N./..A .................................. UNDERWRITERS CERTIFICATE NO ............ .N./..A .................................. Building Inspector Rev. 1/81 ~OK~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10786 Z Permission is hereby granted to: .......... ~:~z~ .....~.~. ~z~.: ................ ......... ~.0 ....... ~.,~.×...7~ .................. ........ Z:-Z'.,,,~z2:7',',',~ ~..~. ~..., .~....: ............ , ~o ...... ~~......~..... ~/~p~. ~...~.~...~./~ ....... ..~1/~ ............................................................................................................................ ~, ~,~,~ ,o=,~ ~~.. ~...~.. z~a..~.//~ ~ ............... .......................................................................................................... ~~~.:~...~'.. pursuant to application dated ............... ./....~., ................. , 19c~..., and approved by the Buildino Inspector. ,z~T..-z... ~ Fee $ ........... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Bo This application must be filled in typewriter OR ink, and submitted-,ia:~c;t-~ 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-iS-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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings end "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. Fees: ,<~--'~ 1. Certificate of occupancy ( ~5.00~/ / 2. Certificate of occupancy on pr'L~ex~ting 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 .~E.c, [.(,~ ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .................. .~. ~ ..................................... House No, Street /-/am/et Owner or Owners of Property ... ~' · ~t ~W - ~. e ~' ~ County Tax Map No. 1000 Section /0 ~o Block .../. ¢-3. Lot. O~;~' ~ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..~.O.7. ~.G,,, Date of Permi ....... Applicant .... ~':JLr~ .... :....e.¢pj.c,~.~,j .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... e b ~ e ~ Fe Su m'tt d $ .'-,,~ ........................ Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 ~FIELD INSPECTION~ COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION pER N.Y. STATE E~ERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Approved ........... ,1 ........... (Bmlding Inspector) APPLICATION FOR BUILDING PERMIT Application No. ~t~. Z..~. · ........ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue 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 braidings, 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 buildings for necessary inspections. .... ..... ............ (Signature of a,f,~licant, or name, if a corporation) ..... (Mailing addEess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises -.~B \~... (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..../.~.(7..~-/...~. ........... Other Trade's License No ...................... Location of land on which propose.~d work will be done....-,%~¢.~7 T...~,, ..,, . ~.. ~ ~ ...................................................................... House Number Street Hamlet co tv, x 0oo Se .o ......... ............. ........ Subdivision .................................. Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........./ 7~ H,~'.[~..' .&{~.4'~ I.t'.r~,. ....................................... 3. Nature of work (cheek which applicable): New Building .......... Addition . ~ ..... Altera~n Repair .............. Removal ............ Demolition .............. Other Work r.'x. ~ 0 : --~/~'- Z (DesCription) 4. Estimated Cost... E~..© Fee (to be paid on filing this application) ' I 5. If dweliing, 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 t_~xpe of use .... ~ ............. 7. Dimensions of exist)ng structures, if any: Front.....~-..~". ....... Rear ... 5 .~. ...... Depth..~. ......... Height .... OD,~: ...... Number of Stories ... ?. ................................................... Dimensions of same structure with alterations or additions: Front . ..~-~ ........... Rear...~.~. ........... Depth ....... .~ .......... ... Height ...9_ ............... Number of Stones ........... . ........... · . ~.. I . ' ' ' ' £ I 8. Dlmenstons of entire new construction: Front .... /.~ ......... Rear ..... /~ ........ Depth ............... Height ..... .~. ........ Number of Stories '" q~ r ............... ~ ........... 9. Size of lot: Front ...I.'],.q'~... ........... Rear .......... ~ .......... Depth ... oTq:>~' ............. 10. Date of Purchase ..... ~7./-/~ .................. Name of Former Owner .... 4.~e._...~.i.¢7. ol 2;. .......... 11. Zone or use district in whic'-h premises are situated ..................................................... 12. Does proposed construction vio!a~e any zoning law, ordinance or regulation: ...lkJCl ......................... 13. Will lot be regraded ........ iN/. ~. .............. ,.. Will excess fill'be removed from premises: Yes No 14. Name of Owner o f premises .. ~.~tr~akgt~ .I.~:~tij, o~/.O Address . .~a~:uC ~ ....... Phone No. ~?/~.-.~. q. ~>J~ .... Name of Architect .......... ' ......~' .......... Address ................... Phone No ................ Nmne of Contractor ......... !. Address .......... Phone No. Locate clearly and distinctly all ibuildings, ~'~ether 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 NEVg YORK, . COUNTY OF .~. y~t..~,&-?~./-. ~. .... $.S .............. Deing au y swo , Reposes says that ne is the applicant (Na~e of individual sign{ng contract) adore named. He is the .. ,. ................... ~ ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly autho~zed to perform or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be performed in the m~nef set forth ~ the application filed therewith. Sworn to before me this ............ ~.~.,...day of.,. ~ ........... 19~ , ............. ' ~mmls~10n ~,m '~---"? ~ (Signature of applic~t)