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Home My WebLink About11441-zFORM NO, 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy No. 2.1.09.59 .......... Date ......... &pril..26 .............. 196.2. THIS CERTIFIES that the, building ................................................ Location of Property . .7.60 ........... ¢,a.ao$..L.~r~9. ~E.~.~, .e pA~.o..n .......... C..u.t.c.h.o.g.u.~... House No. Street Hamlet County Tax Map No. 1000 Section .. t 0 9 ....... Block . .0.5 ........... Lot ...0. 1. ~ ...0.2. 6. ...... Sub division F.a. 5. ~' ~4 ~.,y.. F ~z p~. ............... Filed M~ip No. 6.0.~ 0~ ....Lot No.. 2 fi ........ '.. conforms substantially to the Application for Building Permit heretoforo filed in this office dated · ...O.c'~ o ~.e.~.. J 6 .......19.8. ]. pursuant to which Building Permit No. dated ....O.c.t, o~)~;e..30 ............. 19 .Si., 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...nr:i.v.a.t~e..or~.e.-:~'~;r,~J, J.y..cB,~.e..1 .l.i.q g, ..................................... The certificate is issued to ... Th.e,.c~d ov~..D ,, .&..Ann.a..4 ,. ~y.~l..1)~.q~..k;i.. ................ (owner, le.&tea of the aforesaid building. Suffolk County Department of Health Approval .1.1,30.-.1. 06.,..3Z3OY.82 ,..l~.q bt,.,..A,. Y.:L],~, UNDERWRITERS CERTIFICATE NO ...... II..5.569.0.6 ................................... Rev, 1/81 Building Inspector BuiLDING PERMIT (THIS PERMIT MUST BE KEPT ON ~H,E PP'E/~IS~S UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) ~ N°. ~i14~[ Z Date. .~ ..... ~..~. ............ , 19. : Permission is hereby gr~nted to: ............................. :.....~.,.~ ..:~ ,o......~~ ....... ~....~.~....~~,~ ....... ...... , ......... ~ ............................. ~.~.~.-~..~.......,.?..--~_~ ......................... Of premises Ioceted ~t 7d~ ....... ~-¢~." ~...... ~ ~ , .......................................................... ,.~....~Li:~..:...~...:: .~ : · ~ ......... i ........................ COU.W T~x Map No. 1000 Section ..... /~¢...~,... ~1~k pursuant ~o applicotion doted ... , ....... }...:....,¢ ............ , ]¢ ~nd ~opprov~ by the Bull ding Ihspector.~ : FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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. 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 or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .. ,A.~.z..i.1..2.~. ~..~.9.8..~ ....... New Building .. ~ ......... Old or Pre-existing Building ............ Vacant Land ............. I~ot #26 Fairway Farms, Cutchogue, N. Y. Location of Property ................................................................... House No. Street Ham/et Owner or Owners of Property .N.~. :..~..N,~..s,...~..h..e.o.d.o..~.e..~.~..s.l.~.b.o..~.s.k,~ ...................... County Tax Map No. 1000 Section . .1.O.9. .......... Block 05 Lot.. 14.26 Subdivision ................................. Filed Map No .... ~,l.-.5.,~.]Lot No ...... .~.0. ..... 10/30/8], .. Inlan.d, Homes, Inc. Permit No. 1,1441Z Date of Permit .......... ~ppllcant Health Dept. Approval 3/30/82 .Labor Dept. Approval Underwriters Approval N556906 .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ....................... 5.oo Fee Submitted $ ............................. Construction on above described building~it~meet~ all applic~Z~codes and regulations. ..... · lqbb/~ ~' '~fi~ ~ .... Rev, 10-10-78 FIELD ~NSP~CTION COMMENTS FOUNDATION (lst~ FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date~JrJ-~. 15 t l~b~ /lpplication No. o. fle 151120-81 N 556906 THIS CERTIFIES THAT only the electrlcal, equipment as described belo~v and introduced by the applicant_~ named on the abo~e~ appllcatlon' number in the reotlses ~[l~e~re ~4y~]ai~r~i~i, ~ood Way, (~e iao~, ~. fiarway Dl~i~, Oacchogu~, 1~.~. in the yollowing location; [~ Basement ~ 1st FI. [] 2nd FI. Section Block Lot w.~e~.,nl.edo. ~oril 6, 1982 and found to be in cornpliance with the r~quirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 20 26 DRYERS OTHER APPARATUS: 1-G.F,C.I. l-~moke De~ector E R V I C E 1 OF NEUTRAL 41o R~chard l%~lyea, P.O. l~ox 372, Laurel, N,Y. 11948 ANY MANNER. FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-180:3 Approved .0~'~.. ~..~. .... , 19 .~.. Permit No.//..~..~..(~.Z Disapproved a/c . ' ................... ([ APPLICATI£ a. This application must be completely filled Inspector, with 3 sets of plans, accurate plot plan to s b. Plot plan showing location of lot and of build or areas, and giviug a detailed description of layout uilding Inspector) ~! N FOR BUILDING PERMIT NSTRUCTIONS by typewriter or fn inl~ and submitted in triplicate to the Buildi ;ale. Fee according to schedule. [ngs on premises, relationship to adjoining premises or public stre~ )f property must be drawn on the diagram which is part of this apl: State whether applicant is oxw~er, lessee, agent, architect, engineer, general contractor, electrician, plumber or bnild, General Contractor I Name of owner of premises Tl~¢.o. clQ~:e. ~qy.$$3ibq (as on the tax roll or latest deed) If applicam ~s a corporation, signature of duly authori zed officer. .}obert E. Hiltz, Pres. (Name and title of corporate officer) Builder's License No ........................... Plumber's License No....5.1.7. 7? ................. 2148-E Electrician's License No ........................ Otl~er Trade's License No ....................... 1. Location ofland on which proposed work will be :lone. s/w corner of Fairway Drive ..~Z40 & Cases Lane Extension, Cu~chogue House Number Stree Hamlet Subdivision .................................... Filed Map No ............... Lot .... 2.6. ........ (Name) 2. State existing use and occupancy of premises and i trended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................. b Intended use and occupancy 1 Family Dwelling !rig Department for the issuance of a Building Permit pursuant to t >uffolk County, New York, and other applicable Laws~ Ordinances ons or alterations, or for removal or demolition, as he, rein describe ws, ordinances, building code, housing code, and regt~lations, and ~gs for necessary inspections. INLAND HOMES, INC,: (Signature of applicant, or name, if a corporation) Box 117, Mattituck: .N.. Y. 1195.2. (Mailing address of applicant) shall have b~en granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Builc Building Zc ~e Ordinance of the Town of Southold, Regulations~ for the construction of buildings, addit: The applicant agrees to comply with all applicable admit authorized inspectors on premises and in buildi cation, i c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprc?al of this application, the Buildinlg Inspector will issue a Building Permit to the applicant. Such pern shall be kept on,the premises available for inspection t~roughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan f ( 'pli bl ) ildi Alt 3. Naturelo work checkwhicl, ap ca e:NewBu ng....X...... Addition.......... eration ......... . Repair ' Rcm6val Demolition Other Work Estimated Cost .. $40,000. O0 (to be paid on filing this application) ;. If dwelling, number of dwelling hnit~ 1 Nnmber of dwelling units on each floor. Il' garage number of cars i. If business, commercial or mixed occupancy, specify ngture and extent of each type of use .................... t. DimenSions of existing stmctnre's, if any: Front ............... Rear .............. Depth .............. tleight Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth .................... tleight Num b~rso f Stories ....... ~ ...... .......................... 3~ 4'~' L Dimensions of entire new construction: Front .... 7...5 ......... Rear ............... Depth .............. Height ............... Number of Stories .............. /. Size of lot: Front 265 , 263 ................... 15'5' ............... ........... : ........... Rear ...................... Depth ....................... ). Date 6fPurchase ....... ;...i .................. Name of Former Owner .... .B.a.x.~.e,r .................. I. Zone or use district in which premises are situated ............................. ~.~Does proposed construction violate any zoning law, ordinance or regulation: ...............................~No t. Wil. lot be reoradedo .....................' . ..:...Willexcess fill be rem_oved from premises: _Yes No L Name Of Owner of premises rkeo,lyl¥.s, il..bp.r.s.k..J-. Address . .O..r?.9.o.n...R.d., ...... Phone No. ~.8..4.3..3.2 ...... Name of Architect .... ~ ................. Address ..... Name of Contractor ~[i'~I~I~:O HOME.S, INC, . Addressl~.O.X.. 11'7 ;Ma~;"t;itUt:kPh°ne No. 5.~}~i-¢6~i ii iI ..................................... Phone No ....... PLOT DIAGRAM Locate clearly and distinctly Jli buildings, whether existing or proposed, and, indicate all set-back dimensmns roperty lines. Give street anti block terior ~ ~ from munber or description according to deed, and show street names and indicate whether rATE OF NEW YORK. OUNTY OF...S.U.r..r9.kn. ...... :S.S Robert E, Hiltz : ................................................ being duly sworn, deposes and say~ that he is the applicant (Name of indMdual sig~iing contract) ~ove name'd. e is the Contrac'cor ! (Contractor, agent, corporate officer, etc.) f said owner or owners, m~d is dn!y authorized to perform or have performed the said work and to makb and file this ~plication; that all statements contained in this application are true to 21~e best of his knowledge and belief; and that the 'ork will be performed in the manngr set forth h~ the application filed therewith. worn to before me this ~..~2]"' - ~- - / [tOTARY PUBLIC, State of New ¥Ih~ ........ ~/ / No, 52-8125850, Suffolk Coud~/~ RobOt t' E, ' .r~ )' Term Ex,ires March a0, tg.,. H£1t:z(~lignatux.,._)~xcant~ - TITLE NO, 8108-05540 F~ I~W~Y D~IVE .,.,~, WOOD WAY .,,,. , . · I Lot · 88. 8 o" I , THEODORE D. MYSLIBO~SKI ~ ANNA J. MYS~I'BORSKI OAT~ ~'~"' ~0 ~2 ~. P. 9.~9. ~~~ LOT 26, "MAP OF FAIRWAY FARMS" MAR. 5, 1982 AT CUTCHOGUE DmT[= SE~T. al, ~he ~o~a~e disposal et'~ w~".~r m~pp~ ~N ~ SOUTHOED SC~E~ 1",50' · o be sa%/sf~o%or~., ) [/ / /~ ~) ~.~ ~UT.~IZ[O A~T~TI~ ON ADD~TION m ~IS GUARANTEED TO: Chte~ of General Eng~neer~nM CMICA~TITL[ HEALTH DEPARTMENT-DATA F~ APPRO~ TO C~STRUCT ~ ~ ~g WHOM THE SU~EY IS PRE~AR[O ~ Z~'~.~' '~ ~ W NEANEST WATM I~ N~MI~ NSOU~C[. ~ WAT~, ~I~T[ ~IC__ M~TAL A~NCY AND LENDINI INSTITUTION LIS~D~~ ~ ~ I · I I~UI~ ~ IUUI~ RIVER~AD, NEW YORK SUBDIVISIONMAPFILEDINTHEOFFIGEOFTHECL~KOFSUFF~K~OU~ ALDEN W.~NG, PROFESSIONAL ENGINEER ~ ~ I HOWARD W, YOUNG, LAND SURVEYOR ~L~TW~W~L(Wi,~ICTANK(S~6CES~OLS(~}~NH~E~ ~ ~) N.~S. LICENSE N0.4589~ · ,- ,. r~ ~ u~* I ~ TITLE NO. 8108 '03340 'Bt sip, ~ P~f' t,:~ ,F~I~W~Y D~IV~ ,,.,~ WOOD W~Y ~.0O, _.. ~.~e'zo'T z~as/' .,~ ~.~?x~'~ ........... i Lot ~5 ~ I ~D~ ~ ~ ~0 SU~Y FOR THEODORE D. MYSLIBORSKI ~ ANNA d. MYSLIBORSKI SUFFO~ COUNTY D~PA~T~NT OF HEALTH S~RV~C~S LOT 26, "MAP~F FAIRWAY FARMS" AT CUTCHOGUE OAT~: SEPT. ~1, ~OR AP~OMAL O~ ~S~RUCTION ONLY ~N ~ SOUTHO~D SCAL~: ~ SUFFOLK CO~T~, NEW YORK NO. _.....,...,o...._..o.... ~o~ ~ cossmlsio ~o. si I viuo rs~l copy HEALTH DEPARTMENT-DATA FOR APPROVAL TO C~STRUCT AND ~ ~-~ ~HACF m THE TITLE C~Y, eOV~fl- t ~/~ ~ ¢~, '~ N ~F ~. TiX~P ~i~OO SECTION I~8 I~CK ~ LO~(~ HE~E~, A~D TO ~i AIIISNEES OF THE LENDINS '~ } [~,~;~1~ /~ OTHER THAN THOSE SHO~N HEREON. OWNERS , ~, ~ ~L~A~ I ~, ~ox n/ ~ [v~Zmtuc~, N. Y.~52 ~[./[/[ ~ [~ ~ ' ~1 IAI~ ~ V~l IAI~ ~~DER AVENUE , ~. /~1~ ~ I~1~ RI~R~AD, NEW~RK o~ FEe. ~, ~7, ~S F~E ~ ~O~. ~ AND LAND SURVEYOR N.Y.S UCENSE NO. ~ ~ HOWARD W. YOU~, LA~D SURVEYOR ~E ~ffi FIELD ~ATIONS ~D OR DATA OBT~NEO FR~ OTHERS OCCUPAHCY OR USE iS IJNLAWFIJL VflfllBUT CERTiFiCATE NOTIEY BUILDING D£PAP. T~ENT AT FOLLOWING INS~-ECTIONS. D 1. FOUNDATION - ~O ~EQUI~E ................. ~'-~D CONCRETE ~'INStI~,~I'~2' ROUGH: ~RAMING & PLUMBING ............................ ~[L-"~IJCTION SHALL ME~ THE REOt R~MENTS OF THE N.Y. ~ATE ~ONSTRUCTION & ENERGY CODES. N~T RESPONSIBLE FO~ DESIGN OR ~ON~RUCTION ERRORS. 4. {Z4 ,I OWNERSHIP OF DOCUMENTS TH-~E D2AWINOS AND SPECIFICATIONS AKE INSTRUMENTS OE $:LVICE FOR PROJECT NO, (~/~/~.-AND SEIALL REMAIN file ~JiOPERTY OF THE ARCHITECT WHcTEIER THE PROJECT FOR WHICH THEY ARE MADE IS EXECUTED O~ NOT. THEY ARE NOT TO BE USED IN ANY OTHER PRG)JEC_T _EXCEPT BY WRITTEN AUTHORIZATION OF THE ARCHITECTJ . L;_'.-_-- '_ ..... FiLL'Z/it -_~L-LL'L-_' J' ' I I