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Home My WebLink About11523-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zl1391 Date December 20 ................. · ................................ 19.82.. THIS CERTIFIES that the building .................. 6730 Nassau P oi~2't' 'I~t .................... ~'.' Location of Property . .50.0.0. .... Wunneweta Road Cutchogue House No. ' ' ' St/e~.f ............................ Hamlet County Tax Map No. 1000 Section . .11. J ....... Block . .1.5. ........... Lot ...0..0.6 ........... Subdivision...~J.a~.s.~.~..P.o.%ri..t .............. Filed Map No..1 5 6 .Lot No. 1 3 1 conforms substantially to the Application for Building Permit heretofore filed in this office dated December 18 19 8.1. pursuant to which Building Permit No. '11523 g dated . . .D.e.c.e..m.b.e.p..2..3 ............. 19.8.1. , 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 private one-family .d.wel. l. in~. with attached garage. The certificate is issued to .....S.t.e. phen Malachowski ............ ?oYnb;,'/&;&'d~tb~h.~ ..................... of the aforesaid building. Suffolk County Department of Health Approval 11-80-129 12/15/82 Robt. ~ Villa UNDERWRITERS CERTIFICATE NO.. N 577825 , P.E. Rev. 1/81 11523 Permis$ior ToWN 0~: ~ BUiLDiNG TOWN HALL SOUTH'0LD, N~ Y. BUILDING P,ERMITt (TH S PERM T MUST BE KEPT ON T~HE Pi~EN~IS~S UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ~; Z ~o'te ~~.~i~:..~....!..~...g., ,9..~/ is hereby granted to: ........ at pj'emise~s located at .. Co~htv T~ Map No. ~000 Sect~o~ ,..../.~/.. ..... pure,ant to application dated Bull, ting I~spector. Rey.i 6/~o~'8o and ~approved by the ' ; i: ' Build'tug'Inspect°? FORM NO. 6 TOWN OF SOUTHOLD Buiiding Department Town Hall Southold, N.Y. 11971 APPLIOATION FOR CERTIFICATE OF OCCUPANOY Instructions This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1o 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--tS.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 ahd "pre-existing" land uses: 1o 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 pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Fee Submitted S ....... New Building ...X ....... Old or Pre-ex'isting Buildinq(X) ' _~G'q :~O __ tq~g~/~u e't- ~7 ...... =/Vacant. Land -, , ' ........... ~ Hou~ No, S~ree ~ Ham/et Owner or Owners of Property .......... ~ .................................. County Tax Map No..1000 Section . Z/,/ ......... Block , ] ;~ ......... Lot, .~..' .......... · ..,., .............. Filed Map'No. ./~ ...... LotNo .......... P ,m t No o¢ ....... ' ....- .............. ' Health Dept. Approval .Z~f'~...Z ............ Labor Dept. Approval ..~ -, ....... ..,.. Unde~riters Approval , . ...... Planning Board Approval .......... ~ .., yC ' ~ Request for Temporar ertificate ..................... Final Certificate .. - . Construction on above described building ,,,.,o.,o.,a ¢ Iz(;o(rZ. and pe~r~it'mee,;s all appL(cable~:odes and regulations. 1000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY Sept,,mbe,: I?A:/°'" ~...~..~.~o.~.s,,~ N 577825 Stephen Malachowski, s/s Wunn~e~a Rd. ,Corner Bayberry Rd. Cutchogue, ~p~o~r ~ ~ Section Block Lot FIXTURE FIXTURES RANGES OVENS DISH EXHAUST FANS OUTLETS FLUORESCENT 33 67 ,32 DEYEES FUENACE FUTURE APPLIANCE FEEDER5 TIME CLOCKS UNIT HEATERS MULTI-OUTLET DHVlJVlERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: 1-G.F.C.I. 2-Smoke Detectors S E R V NO, OFERCC~COND A. W G OF CC, COND 2/O I C E 2/0 NO OF HI-LEG AW.G, OF HI-LEG Ruland glec. Co. P.O, Box 143 Mattituck, N.Y. 11952 1tc.242E cefti:ficafp must not be altered in any manner; return to the office of the Board if incorrect. Inspecto}s beJ may COPY THIS credentials. FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING e INSULATION PER N. STATE ENERGY qODE Ye FINAL ADDITIONAL COMMENTS: . . . _~~ .... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 Examined .W,C<. 19U7 ./ Approved'~'..~..'~..5 .... 19(~/. Permit No././,~.'.~..~.~. Disapproved a/c ................................... , ;. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No .......... INSTRUCTIONS a. This application nmst be completely filled in 'by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according te schedule. b. Pict plan showing location of lot and of buihlings on premises, relationship to adjoining premises or public stre¢ or areas, and giving a detailed description of layout of property nmst be drawn on the diagram which is part of this aPE cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc:al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern sbalI be kept on the premises available for inspection throughout the work. e. No buildiug shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall bare been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordiuance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and adnrit authorized inspectors on premises and in boildings for necessa~g.~ect~s. ,,to. (Si£nature of applicant, or name, if a corporation) .....: ............. (Mail{,Jg address of applicant) State whether applicant is oxw~er, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, Name of owner of premises .................... ~)~?.~.~..":?ffJTT... ~ (as on the t axrollorlatestdeed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... t;~.. ~..'.~. ............ Plumber's Licens~ No ..... .~...~. ~../? ......... Electrician's License No... 2..(-/..'.~.. ~ ........ Other Trade's License No ...................... A I Lo cat on ofland,o~whic~proposedworkwill be done., f.~.~.~ U~~..~ ........ h pr.,. .... House Number Street(ffoo~) Hamlet ~ County Tax Map No. I000 Section .. [/4 ............ Block ...~ ........... Lot.O~ .......... Subdivision . . : T . . Filed Map No ............... Lot .............. (Nmge) 2. Stat~ existing use and occupancy of premises and intended use and occopancy of proposed construction: b. Intended use and occupancy ....... t. Nature,of work (check whict, applicable): New Building .. 'X ..... Addition .......... Alteration .......... Repair .............. Removal ........... Demolition .............. Other Work ............... , (D ipti ) Estimated Cost ... .~ .................... Fe .................. (to be paid on filing this application) ;. If dwelling, number of dwelling ,units .... ~ ..... Number of dwelling units on each floor...~ .......... If garage numberofcars h If business, commercial or mixed occupancy, spec~y hatnre and extent of each type of use .. ,~ ............... I. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height Nnn~ber of Stories Dimensions of same structure w~th alterations or additions: Front ................. Rear ................. ' Number of Stories Depth .................... :.. Height ........................................... ~. Dimensions of entire new construction: Front .... ~.~ ...... Rear ... ~,~ ....... Depth . .~.~ ....... Height ..... ~.~. ~ , . Nun~ber of Stories ...... .~ .......................... ). Date df Purchase ...~ 0..~.t .~ .................. Name o,f~or~er ~r ............................ l. Zone or us~_distfict in which pr~mises are situated .... ~.~~.. ............ ::'. ................ 2. Does pmpo.ed.- constructiqn vioiate any zoning law, ordinance or regula,ion: . ~.. 2 ...................... ~. Will lot be regraded .... M~ ................... Will excess fill be removed from premises: ~ ~o L Name of Owner ofprejl~ise}~.~.~ddress ,~.~~.~one No.B.~ 2 ~ .... Name of Contractor . ~ .~~, .. Address~~ ..... ~.'~.~. Phone No. 7.$g,n 6.&.~ ~.. PLOT DIAGRAM Locate clearly and distinctly ~I, buildings, whether existing or proposed, anti.indicate ~1 set-back dimensions from roperty ~ffes. Give street and block)mmber or description according to deed, and show street names and indicate whether rATE OF NEWARK, ., ;~ ~ ...................... being duly sworn, deposes and says that he ~ the applicant (Name of indMdual sigfi'ng contract) e is the (Contractor, agent, corporate officer, etc.) f said owner or owne~, and is duly authorized to perform or have performed the said work and to m~e and file this )plication; that all statements cont~ained in this application are true to thc best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. worn to before me this .............. day o. ..... 19 ota~ubli~, . ........ ~ ....... ~M~Cou nty~ ~. ~.$1258ff0, 8uff0,1k Coun~ (Signature of applicant)