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Home My WebLink About12996-zFOR~ BO. 4 TOWN OF SOUTHOLD BUILDING DEPAi~TMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20181 Date AUGUST 28, .~991 THIS CERTIFIES that the building ADDITION Location of Property 1050 BUNGALOW LANE & 695 CENTER ST. MATTITUCKt NY House No. Street Hamlet County Tax Map No. 1000 Section i23 Block 2 Lot 15.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 9, 1984 .. pursuant to which Building Permit No. 12996-Z dated ~kPRIL 9e 1984 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 NEW FOUNDATIONt CONCRETE DECK AND ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EDWARD R. ~ SARA JPAqE GROHOSKI (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-195371 - JULY 9, 1991 N/A ~%ding Inspector Rev. 1/81 ffO~,~[ NO. e, TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12996 Z Permission is hereby granted to: ~ ........ at premises located at ..{..~..~..~....~..'~...~ .~...~...~..~,..~...-~.3,~.....~....~..--~.'~¢-~......~.~.e3~: County Tax Map No. 1000 Section .... J.....~..~ ......... Block ...... ~...~... ....... Lot No .....~.~.,../. ....... and approved by the pursuant to application dated .... (~'~ ''~)..~,,~.~.......~. ....................... , Building Inspector. ~. $....~..~ ........... Building Insi:mctor Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 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. 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: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50-. 00 3. Copy of certificate of occupancy $ 5.'00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewC°nstpucti°n.. · ... Old or Pre-existing Building ............ VacantLand ............. Location of Property I 5o . House No. /4D~ Street Nam/et Owner or Owners of Property . County Tax Map No. 1000 Section .../. ~ ....... Block ...~'~- .......... Lot. / .~. Subdivision ................................. Filed Map No ........... Lot No .............. Permit NoJ/~.~. ~ .Z.. Date of Permit ............ ~.~.~.~. Applicant. ~-~?J.~..Z~.,~./~.-~..../~7... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all ap~licable,c'~des and regulatio, ns. TOWN OF SOUTItOLD OFFICE OF BUILDING IN~PECI'OR P.O. BOX 728 TOWN HALL ~ SOUTItOLD, N.Y. 11971 AUGUST 13, 1991 TEL, ,765- t 802 MR. EDWARD GROHOSKI P.O. BOX 627 MATTITUCK, N.Y. 11952 To Whom This May Co¢cern, We are unable ko complete your Certificate of Occupancy because .of the following reasons. /~/ An application for Certificate of Occupancy is not on file. /~//No Underwriters Certificate on file. /~he--~' ~ check is(c~Js~not on file.) $25.00 /5/ No llealth Dept. Approval on file. /5/ No final ins.pection has been made. Please co~tact our office on this matter, Thank you for your cooperation. Bui]ding Permit I~ I 2 2 , 9 6 Z BuildinrI Dept. ***/5/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) ~ THE ABOVE BUILDING PERMIT HAS EXPIRED, AND IT IS UNLAWFUL TO OCCUPY OR USE SAID STRUCTURE UNTIL THE CERTIFICATE DF'OCCUPANCY HAS BEEN ISSUED. PLEASE CLEAR UP THIS MATTER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN IiALL $OUTHOLD, N.Y. 11971 TEL. 765-t802 This is Co advise you that the job under buildlag permit no.. 12996Z issued to Edward Grahoski on __4_~9/84 __ for Addition is completed a final inspection has ( ) has not ( x ) been done. and tn order to complete this file, it is necessary that !n Certificate of Occupancy be issued. Please fill out the Unclosed form, return same to the above office with a check for $25.00 payable to the Town of Southold. Please {ndlcate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or t, se is ual. awful without a Certificate of Occupnncy. Please. help u,~ to clear up this mettcr ~o that legal action does not have to be taken. Thank you for yo.r prompt attention. Very truly youths, Victor Lessard Executive Administrator VL:gar encl. BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [ ] FRAMING [ ] FINAL : REMARKS: ~/~ DATE, INSPECTOR, 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .-~9~. ,~. .., Approved ...~.~ ...~.., 19S.'~. Permit No. ] .~...~.% Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. TNs application must be completely filled in by typewriter or in ink and submitted 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 drawn on the diagram which is part of this appli- cation. e. 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 issued a Building Permit to the applicant. Such permit shah 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 shah have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary i.~ections. ~-7 ,~/ / .~ ' f (Signature of applicant, or/dame, if a corporatio ) . . ?. . 9. . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner ' ' If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... .~.a~..[.~0 .............. Plumber's License No ......................... Electrician's License No ....................... Other ~l'rade's License No ...................... /0,,)-"-0 ~9 ~,,~ 1. Location of land on which proposed work will be done..~.ff./~..~'/p.t~.. ~./~... ?1.~-. .(..C .,~/e.C, ..~..7f-.. ............... House Number Street Hamlet County Tax Map No. 1000 Section ...... /..~..'~. ...... Block ..... 0.~, ......... Lot...~ ~ / ............ Subdivision }c/ ' Filed Map No .... 3(. Lot ..f. (Name) : 2. State existing use and occupancy of premises and intended nsc and occupancy of proposed construction: a. Existing use and occupancy ..... ,~ .~...~. ............................ ' ............................ b. Intended use and occupancy ..................... ?,. ·: ~'~ .'/. ,'. ..... '. ................ 3. Nature of work (check which a~plicable): New Building ..... ' .....Addition .. Adteration .......... Repair .............. RemOval .............. Demolition .............. 0 t her~_~Work..,~/~. ~,~.,~' ' (Description) 4. Estimated Cost ........... t ......................... Fee ...................................... "" (to be paid on filing this application) 5. If dwelling, number of dwellingiunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... i ................................................................... 6. If business, commercial or mixed occupancy, specify n~ture and extent of each t/ype of use .................... 7. Dimensions of existing structures, if any Front...~.~ .......... Rear .c.,~ ~. ......... Depth ........... Height ........... Number of Stories .... .-~..-.~. ...... · ....... Depth...-~'~.../..~./.' ..... i.. Height .......... . ............ Number o~ ~i~es... ~.'~<~ i i. 8. Dimensions of entire new construction: Front ,-~...~,:: ...... Real~.~../ ........... Depth . .~r-q "?~ '~... Height Numberof Stories /_9.,~'...~.. ........ ' "i i" ." 9. ,~ze of lot. Front .......... ~ .. .......... Rear ...................... Depth .... , ................ 10. )ate of Purchase .. :,t~ .~....~ ~..,,~.. ............ Na~me of Former Owner .~f./.37..-~....,~."~..'~..~'..~5'./7'. ........ 1 I. Zone or use district in which pr~mises are situated... ~f..~.-~.~' ~)~'~r~..r~.'~':'.~'~. · ·. i ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .. r(,~'..~¢ ......................... 13. Will lot be regraded ........ ~ ..... ~,.,~. ,~.. ,,...,.. Will excess fill be removed, from premises: ~-~ No. 14. Name of Owner of premise .~,~e~'~./~'...~(;~,~. Address P~ .~*'~P.,e~d~'~. .... Phone No~.~ .~;~. ff.~..... Name of Architect ......... ~ · · ., .......... Address ................... Phone No ................ Name of Contractor . . ...... Address .O. .....Phone No. q~-~-f¢?-..~d. ~ PLOT DIAGRAM Locate clearly and distinctly al1 buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot. STATE 0~] S.S ....................... being duly sworn, deposes and says that he is the applicant '.(Name of individual sig~ng contract) above named. He is the ...... ~-g,~... (c ontractor, agent, corporate officer, etc.) of said' owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this appliqation; 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 forth in the application filed therewith. Sworn to before me this .......... ......dayo Not~y-~ublic, . . ..~.~.~...,.~ ..... i... ~t~,'~7~ ¥~ ~ ' (Signature of apphcant)' i I Term I:xpires