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Home My WebLink About10295-z FORM NO. 4 · TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CORRECTED CERTIFICATE OF OCCUPANCY No Z~11134 Date AUGUST 16~ 198.~ THIS CERTIFIES that the building ADDITION Location of Property 645 GAGENS LANDING RD. House No. Street County Tax Map No. 1000 Section 70 Block 10 Subdivision Filed Map No. SOUTHOLD¢ N.Y. H~mlet Lot 33 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 22, 1979 pursuant to which Building Permit No. i____0295-Z dated JULY 9~ 1979 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 2nd STORY DECK ADDITION TO EXISTING O~E FAMILY DWELLING The certificate is issued to EDWARD & LINDA FASZCZEWSKI (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. . N/A PLUMBERS CERTIFICATION DATED N/A *THIS CO cORRECTED ON 2/24/93 -' 'B~uildi~g Inspe~t'6r - ' ~ Rev, 1/81 BUILDING TOW~ CLERK'S' OFfiCE SOUTHOLD, N,. Y. BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 10295 Z Permission is hereby granted to: at premises located at ......................... ~..~.L..!~ ....... '.....~...~...C.n.I-L.!3L.~-. ............. l..23..h. Lt~.h~.J.(.: .......... %d~ r .H/2..c. ~b.. ................................... pursuont to opplieation d~ated ............................. .~.?...?.~ ...... .~...~..., 1~.~....., and approved by the Building Inspector. Fee $.....!, .~,~...~, ,.~0,,. ...... /~- '7~)- FORM NO. 4 TOWN OF SOl. Office of the Build Town H Southold, ~ THIS CERTIFIES Location of Property . .6/+.5..C.age;s. House No. County Tax Map No. ]000 Section ...7.0.... Subdivision conforms the for ..... ,~ne. 2,2 ....... 19 79. dated ........ ~l~.ly..9. of the applicable provisions ~fthe law. ......... .deck. The certificate ¢ Suffolk County UNDERWRITERS )LD )ector Of Occu Date ............ 1_.6. a. s.t. ............ 19.8.2 .Block ..kq ...... No. Hamlet ·..Lot No .............. filed in this office dated Permit No. 1,q2,9..~2; ............... all of the requirements for which this certificate is issued is ......... Approval ...iS lessee or tenant) Building Inspector Rev. 1/81 FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occu No....Z.1.1.1.3.4 ......... THIS CERTIFIES that the building Location of Property . 5.4.5. ,G.age~s. House 31o. County Tax Map No. 1000 Section ...7.0.. Subdivision ............................... Filed conforms substantially to the Building ..... Jurm. 22 ......... , 1979. dated J:u.l.y..9." If of the [aw. The o ......... deck. arI.di.t.i.or~ ..... The certificate is issued to . and. (owner, of the aforesaid building. Date ............ 1.6. Street Hamlet · .l,q. . .33 ............. No... ~ .... Lot No .............. filed in this office dated 1. QZgAz ............... and conforms to all of the requirements is ......... Suffolk Count~ Approval .. UNDERW~S CERTIFICATE . hl/lg ................. .......................... ~ Building Inspector Rev1/81 '%N APPROVED AS NOTED ' FEE: ED ~NS~EcTIoNs: 1. BEFORE BACKFILUNG OUNDA. T}OH OR STAR-T ~RAMING 3. B~FORE COVERING PiPeS OF~.A~Y KIND 5, ALL CONSTRUCTION RE - *-,~=1, . QUIREMENTS ..... ~ CODE &'ZONING FORM NO. 6 TOWN OF SOUTHOED 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 al~ buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dlsposal-(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 peoperty showing all property llnes, 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. ,' 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 ....... New Building ............. Old or Pre-existing Building(~) ......... ~/Vacant Land i ........... Location of Property .~..ff~b~,. .... .L~.~. ?~'/!,/~,~..' ':-... /¢'.~ .~'.~/~ Z~ ,~, 6/. "' ....... 'z' Hou~ No. / ......... Stre¢ Owner or Owners of P roperty~~ ~"/~ ~¢¢.. ~~ ¢~ .............. County Tax Map No. 1000 Section .... ,~.~ ....... Block .../~ ........ Lot...~;~. ........ Subdivision .................................¢1 Filed Map No ........... Lot No .............. Permit No./~¢.~.~. Date of Permit . .Applicant ......................... Health ~ept. Approval ........................ Labor Dept. Approval ......................... Unde~riters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate ....... (?.d. ............... Constr,ction on above described building an~mee,s ~"~~sa~cabl~desaand · ................ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT G~b~'"~ TOWN HALL SOUTHOLD, N.Y. 119~1 TEL.: 765-1802 ~'~ Approvea , ~ ~,~../., 19 ~c~emlit No .............. / '- / Disapproved ...... .... ~ (~uilding Inspector) ~PPLIC~TIO~ FO~ BOIkDI~G Date 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, reh/tionship 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 applicatiommay 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 desc, ribed. 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 neces, m~y .inspections. / ' U' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plmnber or builder. ~ "'~' ' ' ............................. (ii i'n~''''' ' ' ' ' 'the tax roT(orq~tilt' iiii) ........................ If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No~...~...~. .~..~. ............... Plumber's LicenseNo ......................... 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 .~C; ............. Block ...f.~ ........... Lot... 4.A .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ............ ....... ~-~r. ...................................... b. Intended use and occupancy ....-~..~...~. .... .,. ~t,~.~,g.. ,~...rf~'~..r. ............. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... .~.~...6~9... (Description) 4. Estimated Cost . . .O..O. ....................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, 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 type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ............ . .......... 8..Dimensions of entire new construction: Front ... ~.o. ........ Rear ............... Depth . ./.~. .......... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11..Zone or use district in which premises are situated .......................... 05 .......................... 12. Does proposed constructiou violate any zoning law, ordinance or regulation: ...~. ............................ 13. Will lot be regraded .......... ~ ............. ~... Will excess fill be removed from premises: Yes _ 14. 'Name of Owner of premises~.,.g.'/~',q~g$~C .~..~'.04~.~.. Address~.~-~...~./../~. '7:' Phone No~°.5~.~2.~. .... ~. 'Name of Architect ........................... Address ................... Phone No ................ Name of Contractor . .. 5.~. ~ ~ Address . .,9 ~ . ................... ~k ........... Phone No. .~g~.~. ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether 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 NEW YORI~ , ~ ~ ,, ,~ COUNT~OF..~-~. ~. ~' ~ ..... ~d~.~f.~....~..~..~..~.~. ~ ....... being duly sworn, deposes and says that he is the applic~t (Name of individual signing contract) abow~ named. He is the.. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized 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 ~owledge and belief; and that the work will be perfo~ed in the m~ner set forth in the application fled therewith. Sworn to before me this ~ ......... ~ '?Y ;f '., ~ - ~ ~ ~z - ~~q~~ ............... /~ ~~iar ~c~2~" / ~ ~ (Signature of applic~t) ' m~on E~s ~h 30. 1~ ~