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Home My WebLink About10921-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 AL I? ERA T I 0 N Locatlon of Property 455 Summer Lane Southold, New York h~ds'~ '~'o ....................... 's't/e$i ..................... h$r~/ei County Tax Map No. 1000 Section .... 0. 7. 8. ..... Block .. 9.9 ........... Lot .... 1.3. ........... Subdivision .............................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 16, 1980 pursuant to which Building Permit No. 10921 Z dated .... O..c .t.o.b.e..r..1.6. ,...I .9.8. 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 ......... ENCLOSE EXISTING PORCH [4ITH GLASS - bio HEAT AS APPLIED FOR The certificate ~s issued to CHARLOTTE GADOFiSKI . ..................... ?oYn'o;,'~¥~i~x .................... of the aforesaid building. Suffolk County Department of Health Approval ....... ~ ./.~ ................................ UNDERWRITERS CERTIFICATE NO ..... }t00227 I - ~Iay 3, 1988 PLUlqBERS CERTIFICATION DATED: N/A Bui~fng Inspector Rev. 1/81 N°. BUILDING ~ PERA&ITi CrH~$ ~/~rr ~u$'r ~ K~P'r O~ T~H~ P~S~$:UN'nL 10921 Z Permission is hereby gro~ed to: to ....... .~.~...~..~..~..~ ....... ~'~./..~.Z ...: ........ /-,2,.~.....Z: .... ~ ............... ~,-~....: ........... ~,.,.....~ at premises ,ocoted o,. i...~.-:~-~ ....... ,.,,~4<~,~ Building Inspector. Fee ...................... ~..~.~ .... ~......,,..~... .... , .~ ............. .Z~. .......... County Tax Mop No. 1000 Section .... ..~...~... b,.,. BlocE i..;: ........ [Lot NO....t~'./..~ ......... pursuant to application dated .............. ~i.~'....,....!.,.?,.., 19. ., and approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ 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 installa4 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 p~operty 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: Additions $25.00 POOLS $25.0OALTERATION $25.00 1. Certificate of occupancy New Dwelling.$25.(lO, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20,00 5.Updated C.O. $ 50.00 Date May !3, J.98.8 .. NewCons t~uction ...... Old or Pre-existing Building ............ Vacant Land ........... .. Location of Property........,....455 Summer Lane. Southold, New York House No. Street Ham/et CHARLOTTE GADOMSKI Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section ... 7.8 .......... Block ... ,9 ........... Lot .... ~.3 .......... . Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 10921z Date of Permit 10/16/80 ................... Applicant Henry & Charlotte Gadomski Health Oept. Approval ........................ Labor Dept. Approval ........................ .................... Planning Board Approval ..................... Underwriters Approval ~002.2.7 ] . Request for Temporary Cert:iflcate ..................... Final Certificate ....................... Fee Submitted $ 25.00 Construction on above described building and permit meets all applicable codes and regulations. Charlotte Gadomski Applicant .................................................... Rev. 10-10-78 F~IEL.~SPECTION FOU~AT~ON (~st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined ~.(,' 19.~.~. Disapproved a/c ........................... .~ ....... ....... ~PP[IC~TIO~ FO~ BHILDIffiG ~IT Application No. ~..~..??.~.[ ........ Date.../.¢6 ........ , 19 ~./0.. 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 drown 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 tbis 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 Depamnent for the issuance of a Building Permit pursuant t~) 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 buildings for necessary inspections. . ~ .... Ddignature of applicant, orname, ifa op t'o ) (Mailing address of al~plicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpremises~ ~ ¢ ~?~.J~).P/t(~-.~~.-~..~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corpot:ate officer) Builder's License No .................... 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 Hamlet County Tax Map No. 1000 Section ...~..~ ............ Block .... .~.~. .......... Lot.. (9/~5 Subdivision ....... (.tv .... ~ff~¥.Y..(-~. ~¢.~.~. ..... Filed Map No.. ~.(.9.~..~. .... Lot ..... /. ~ ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occ pancy ..... ~., ;~4.~./ ...... *.~..~.~ .............................. b. Intended use and occnpancy .... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration Repair .............. Rembval .............. Demolition .............. Other Work ............... ~=~! '*(-/'~"~ .~. /. ~'7. ~ (Description) 4. Estimated Cost ....... /.l...~d. :t~...t./ .................. Fee ............................... i (to be. paid on filing this application) 5. If dwelling, number of dwelling lunits ............... 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 structure wlth alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... tleight ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. [)ate of Purchase / 1 1, Zone or use district in which premises are situated ........ f/~./. ....................................... 12. Does proposed construction rio!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect .......... i ................. Address ................... Phone No ................ '--~.~.Na~o~ofContractor...........................~ Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. ,,, ................./oo STATE OF .NEW YORK, ................. ~..O.'~..~ . . .~. ~4.(~.~..? .~..~.]. .............. being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. He is ~he O ClDg3~..}- . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty 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 for.~ in the application filed therewith. Sw°rnt°bef°remethi~--~'~ day o; ~f./~.- Notary Public, . ................................ Counter (Signature of applicant)