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Home My WebLink About11022-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....~136.6.9. Date J..u.l~. 2/4 ~5 THIS CERTIFIES that the building ...... .a .d.d.i.~ .i g.m.: ............................... Location of Property ...'I. 3.0.0. .............. .lVI.a.r..a,~gp.k.a...Rtl... ............. .l~.a.~.~.i..t.u.c.k.. House No. Street Hamlet County Tax Map N~. 1000 Section ..... .'1.5.~....Block ......... ~ ..... Lot . ~12 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated January 30 8~ ~022Z ..................... ,19... pnrsuant to which Building Permit No ...................... dated ~ebruary 2 19 8fl , 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 ......... Solar hot air-hotwater collector addition to existin~ dwelling. FRANK & SUSAN KUJAWSKI JR. The certificate is issued to ..................... jd~n'e'r~ ..................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. NA5898g.O & NA589~.39 Building Inspector Rev. 1/81 FOEM NO. 2 BUILDING DEp~R~M. TOWN HALL SOUTHOLD, N,~ BUILDING pER/vIIT Building Inspector. ~ee ~../.~.....": ......... (THIS PERMIT MUST BE KEPT ONJTH,E PREN~IS~ UNTIL I~ULL COMPLETION OF THE WORK' AUTEIORI~ZED) ~? 1;10 2 2 Z Do,, .., ~,~.~rr. ....... ~.. ........ ~ ~..~? Permission is hereby granted to: ~, . ........ ..z~.~.~...~~4..~.., ........ ~.~.z~,..~.z~,.~..,.,......,... ,o ~ ~ ~ zz.~ ~. . . . / ~. . . .~ ~w/~. . ~ Z/,~ ~ ? . , ~.~ ................ ~, ....................................... ~ p~o~,~ ~o=~ o~ ..z.~D.~.....~/~o~....~ ................................... Coun~ ToX ~p ~o. 1000 Soction .,.~...,.... Bloch .~ ............. m,~. ~Lot ~o.. ~,~.~ .......... p~rso~nt ~o ~ppli*otion datod .. ~.....~ ...... :*,...., 1% ; ~nd opprov~ by tho 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 ia IIBIlIII~I 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 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, B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pZ'operty 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 requ ired to prepare a certificate. Fees; 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . House No, Street Ham/et Owner or Owners of Property .~...'~...~. ~~....~...X~'~. ~..~ ........... County Tax Map No. 1000 Section ././.~ .......... Block ....... .~. ...... Lot ........ /, .~.... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~ ~ 0 ~77k~, Date of Permit 2J ~ [ .Applicant Health Dept. Approval QI~ ~1 ........................ ~,//~.~ .~.~ ............. Labor Dept. Approval Underwriters Approval ~~3~)ct~(O d App ...................... Planning Boar roval ...................... Request for Temporary Certificate ..................... Final Certificate ...... ~ ............... Fee Submitted $ .'..'~ .~.. ....................... Construction on above described buitding and per~m//i'i~ meets all applicabl/e Jdescand regu~tio~s,' Rev. 10-10-78 THE NEW YORK BOARD, OF FIRE UNDERWRITERS BUREAU OF ELECTRI(~IT¥ 41 STATE STREET, ALBANY, NEW YORK 12207 THI~ G~I~I~ THAT o~y t~e ~t~col ffuipm~t ~ ~sc~bed ~l~ a~ intr~uced by t~ applicant ~m~ on ~he a~ ~pl~a~n number in ~he premises of F~a~n~ ~ujawski, ~,~rratooka Rd ~1300~ Mat~i~uck, in the following location; ~ Basement ~ 1st FL ~ 2nd FL Section Bilk ~ examined on and found to ~ ~n compliance ~ith the requirements of th~s Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES SYSTEMS NO. OF FEET OTHER APPARATUS: B R t C No,~OF E~CC~.COaO, A.W. O, OF CC COND. NO. OF HI-[E(~ A W,G. NO, OF NEUTRALS A.W G, OF Hi-LEG O; NEUTRAL G£enn R, Bradley ~.1). ~169- t{or~o~ Avenue i,~at t:ituc~, £q.Y. I1~52 BRANCH MANAGER Lic. #1227 " Per_ 11 COPY ~OR BU?OING .EPAETMENT. THIS COPY OF ~CE~T!~AI~ig~ST'iNgT it~AL'rERE IN ANY M~NNEK. NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC!TY 41 STATE STREET, ALBANY, NEW!YORK 12207 ~ THIS CERTIFIES THAT only the electrical equipment aa ~escribed below and introduced b~ the applicant n~med on t~ a~ application number in t~ premises of in the follo~i~g Iocatiou; ~ Basement ~ 1st Fl. ~ 2nd Fl. Section Bilk ~t w~ examined on ~ C e~ ~X~ A ~ ~ ~ ~ ~ ~ and found to be in compliance with the requirements of this Board. FIXTURE OUI'I.E'[S SWI'~CHES FLUORESCENT FIXTURES RANGES OVENS EXHAUST FANS I /,, Z I DRYERS FURNACE MOTORS APPLIANCE FEEDERS TIMECEOCKS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E OF HI.LEG OF NEUTRAL NO, O~ERCC~rCON D' OF Acc.W.coND.G. IqO, OF HI-LEG Lic. #1227 Fey. BRANCH MANAGER COPY ~OR BUILDING DEPARTMENT. THIS CO,~ OF IN ANY MANNER. FIELD '~NSP~CTION COMMENTS ~ '~- FOUNDATION (~s%) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMEN~,~: AUDIOUN 336,46 SEAL E- .?:,0'~ 1" D: I'~ONL!h'IENT . -7 INKED SEAL O~ '* ~[4 ~ J~ C~.~ ~ ,~' ~',, ~'~ L"~ ~,,,~,,~,~.-,~.,~,,,..~.,,,,,,,,, VAN TUYL ~ oUN-,'. ~.. :, .. FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~ 2- 19~ Approved .~:.~.... ?.~ .... , 1977. Permit No..f./.~). ~7 ?.-.~- Disapproved a/c .......... ~ _~.~.~'~'~. ................... /. / (Buhd:mg~Inspector) APPLICATION FOR BUILDING PERMIT Application No. //.~..d.~ ~.-~. ...... Date ~.,d...~./. .5.(17 ....... 19~:~. 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 promises 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 buildings, additions or alterations, or for removal or demolition, as herein described· The applicant agrees to comply with all applicable laws, ordinances, buiJding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary i~?4~pections. , . . /~ _, . .... ...... ( g at fappicar~or]~ame, ifacorpor~.tipn) ..... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ........................................................ Name of owner of premises ....... .~.~..~--~/.~. I~' /t,/,lr~/-/&a. (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 ......................... ....... Other Trade's License No ...... 1. Location of land on which proposed work will be done .................................................. .. l ? ? ...... ~..~e~.~., ~.~.. ....................... . .M...,~:..,..~>..~. ........................ House Number Street Hamlet County Tax Map No. 1000 Section t t ~'- Block .... ~. ............ Lot...O./. } .~7~. ........... 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 ..... / . . . .~.. ?.tv/.. :..~....~v. ........................................... ~/.~.../~..~ :. ~.e. ~ .~../...~2:.. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building'. ......... Addition V'/ Alteration Repair .............. RemoYai .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost .......... : ............. ..... Fee ...................................... , (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~ .... ~/.?. .... Number of dwelling units on each floor .... .A/./.~. ....... If garage, number of cars ..... : .... .,~/(.~ .............................................. , ............ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... .~f./'.."/ ............ 7. Dimensions of existing structure~, ~f any: Front .... ~t.$. ........ Rear .. ff.~ ......... Depth ..... ,,g ......... I-Ie~ght ............... Number of Stones ............................... i ......... Dimensions of same structure wi~h alterations or additions: Front ..... ~lgf .... g.I... Rear .~'i~' ' i ...... Depth .... .~.4.~. ~, .......... i.. Height .... 5.~..'~..~ ............ Number of Stories ..... .-5~,~..~. ........... 8. Dimensions of entire new constrUction: Front .../.q.'.t.q~. ..... Rear .... .t ?f. to '~ Depth ~o · ~'" Iq eight .... t.~. t. ........Number of Stories ..... ! 9. Sizeoflot: Front ..... /.z.!f.'.: ........... Rear ..... ! :l.~' Depth 10. Date of Purchase .... ti .~ .zT..-. Z~. .............. Name. of Form,et' O~ynar .... .~'. ¢..e/.~ .,,..~. ~.,,.~ .......... 11. Zone or use district in which pre. mises are situated ........ ~'.... £/-~.~...~'~T...~.... .7. 12. Does proposed construction violate any zoning law, ordinance or regulation: .... '.A(q ....................... 13. i ~"'~ .. Will excess fill be removed from premises: ~/~ Yes No W 11 lot be regraded ......................... 14. Name of Owner of premises . .~'. '..~g,t-~.~b/..~..'~.... Address {~.~.~.."~Z~..q?.~....~P:. Phone No... ?q~'...~.t~.lq. .... Na of A hit ~.~,¢ Add " Ph N " me rc ect ...................... ress ................... one o ................ Name of Contractor ......... i..~..~...~. ......... Address .......... ': ........ Phone No ...... :'. ........ PLOT DIAGRAM Locate clearly and distinctly all lbuildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block: mmber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF .NEWFYORK~. .z ~ S COUNTY IOF .N~,Jf~ .--~.. '~' , ..... ~~...~. ~ ]~~J~., being duly sworn, deposes and says that he is the applicant (Name of individual si~.mg c~ract) above named. He is the ...................... ~ ................................................ ~ ....... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perfom or have perfo~ed the said work and to m~e ~d file this application; that all statements contmed ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the manner set forth in the application filed therewith. Sworn to before me this ........... :~0~~f,;~ ~;&~ ' f (Signature of applic~t) I , ' ' Term Expires March 30, 19~