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Home My WebLink About13029-z I~OB~ NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERNIIT MUST BE KEPT ON THE PREMISES UNTIL FULL COtvIPLETION OF THE WORK AUTHORIZED) N? 13029 Z Permission is hereby grante~L~o: ,-~ , ~ / ~ E~., ./, .~..~.~,..~.~...~ ..... .~~.~....~..:.%....L..~.~.~.~. ....... ,o ...~,~......~......~.~..~.~.~~'~ ....... ~ ............ / County Tax Map No. 1000 Section ..... ./....0......~. ...... Block .......... ~ ....... Lot No ........ t....~. .......... pursuant Building Inspector. and approved by the Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD 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.Finat 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 Re~sidences 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 property 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. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory ~$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ,5-? ~'~--~.~. New C on s t, r u c t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... House No. Street Owner or Owners of Property . ./~.~, .~, .~-~.'.r., ../7~)/~' /~.&.~. ;~A,/.~ ................. County Tax Map No. 1000 Section .. ,/4%~.~. ........ Block .... .7 ......... Lot... J, .~. ........ ~..~. ,~-~..-7;,, ~. ~f¢, ~..-~. ......... Flied Map No..~.'--..7..~..7. Lot No../. Z ........ Subdivision .~./.~. ~ 'J Health Dept Approval /..~.5.~.o.t/ .Labor Dept Approval ................. Underwriters Approval , ~ ,-, ,'7 .............. Planning Board Approval ....... / ............ Request for Temporary Certificate ..................... Final Certificate ....... ~, ............... Fee Submitted $, ~[~);~,,~,, Construction on above described building and.~ermit meets all applicable c.odes and regulations. -~-_o.~/~z), ~d63(~ Applicant/~, .'-~?, ,~.../.;..l¥~,. ,~_.~, .................... TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALE~ $OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. ~_~O~Z (please print) (please print)-- I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to before me this ~O day of ~ , Notary Public, ~ County Notary Public HEt,EN K DE VOE NOTARY PUBLIC, State of ~w Yerk _ No, 4707878, Suffolk County, f~" ~erm Expires March 30,1,~ ~' ;/ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ ~Ch 20:].~)~7 85 JOHN STREET, NEW YORK, NEW YORK 1OO3,'8 Date /Ipplleatlon ~vo. o. ft~ 2828~ /84 THIS CERTIFIESTHAT N7 9 9 4 2 3 only the e~trtcal equipment ~ ~serlbed bolom and introduced by t~ applicant ~med on the a~e application number in the prem~es of FIXTURE OUTLETS 17 ~ 2nd FI. Section Bloct~ Lot and fourld to be in coo~pllance telth the requlretnents of this Board. RECEPTACLE! ~ FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FAN~ ~ SWITCHES FtUORESCENT 43 17 FUTURE APPLIANCE FEEDERS DRYERS FURNACE MOTORS TIME CLOCKS UNIT HEATER! MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTNER APPARATUS: 1 ~aoke S E R V I AWG, OF HI LEG ~rka Sleet. Corp. 1680 ~ton Avco ~].~,~d~,, N.Y. 11716 This certificate must not-be altered in any manner; return F,OR LDING DEPAR r. THIS I office OF CERTIF Lic#627E loard if ,identified by their credentlafs. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR ILO. BOX 728 TOWN IIALL $OUTtlOLD, N.Y. 11971 TEL. 765-1802 This is to advise you that the job under building permit no. 13029Z issued to Robert Kosciusko on ~3_2/84 for New Dwellinq~ is completed and a final inspection has ( ) has not ( x ) been done. In order to complete this file, it is necessary that n Certificate of Occupancy be issued. Please fill out the enclosed form, return ssme to the above office with a check for $25.00 payable to the Town of Sonthold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and srrnnge with this office for an inspection date Occnpnnc¥ or ,se i.~ unlawfnl without a Certificate of occupancy. Please help tls to clear tip this matter so that legal action does not have to be taken. Thank you for year prompt attention. Very truly _y~, Victor Les~ard Exccutlve Administrator VL:gar encl. FOUNDATION FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CpDE FINAL ADDITIONAL ~ITS: EMER~Y CALCU LAT~ONIE:, F"L, ooI~-~ INSUL. A, TI Oh~ &'rcAvI1Y kT JOI~T .~l Iq.oo L~, = . o4,,61 Uo= · o.4.4 MEET'~ THE* Col:~e* · 1.q~ ,, WA.L[,,_: =~ Ir~ Felt Io~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I~ULATION FRAMING ~] FINAL REMARKS: 76S-1802 BUILDING DEPT. INSPECTION · [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ suLATiiON [ ] FRAMING [ ] FINAL' REMARKS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL , ' ,~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined....(~.~..[.~.., 19~.~. Approved ....k~. ~..t~... ! ~.., 19}tJ. Pemit Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19.. · Date .................. , 19... INSTRUCTIONS a. This 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. 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 issued 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises~. (~...~...~t..~...j~.&...~....~ f~..°~.O...~.~ ................................ (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 ......... ~ ................ Electrician's License No ....................... Other ~rade's License No ...................... ~ ¢~ql, O~.~ .0,.~..~.~ .-~.. t~. I. Location of land on which proposed work will be done ............ ... I. ....... . . . . . / . . . . . ..... . . . ......... -.. ...... House Number Street Hamlet County Tax Map No. 1000 Section .... /.O.~. ......... Block ..... .F'{ ........... Lot....~'r..\.~ ...... SubdivisionS. i~...~..~.... ~,.~ ........ ' ...... Filed Map No. S.~.~ .~. ....... Lot.. ~"~. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · .............................................. a. Existing use and occupancy...~ ~.~. use and occupancy . ~ .~'~¢....~..~ ,~ ...................... ........... b. Intended 3. N~tUr~e ~o f work (cfi~c~ w~i~el~ . Eltima~ea'~b'~t,'?~ If dwelling, number of dwellit If garage, number of ears .... c o 9. 10. 11. 12. 13. 14. )licable): New Building ...~..', .... 'Addition .......... Alteration .......... vel .............. Demolition .............. Other Work ............... ...................... Fee .... ~ .......................... (to be paid on filing this application) anits ............... Number of dwelling units on each floor ............... Does proposed construction vie Will lot be regraded ........ Name of Owner of premises .. Name of Architect ......... Name of Contractor ........ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............. :.. Re. ar .............. D~p. th ............... Height ............... Number of Stories......~ ............................................. Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i · · Height ...................... Number of Stories ...................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front .......... i ........... Rear ...................... Depth ...................... Date of Purchase Z'~,r¢..K¢-~. ~../~.~' ............ Name of Former Owner .~?.¢./..~o.. ~./.6 ¢-.~. ............ Zone or use district in which pr&mises are situated ..................................................... [ate any zoning law, ordinance or regulation: ................................ ................... Will excess fill be removed from premises: Yes No ................. Address ................... Phone No ................ ................. Address ................... Phone No ................ ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, !S.S COUNTY OF ................. [ ............................ i .................... being duly sworn, deposes and says that he is the applicant ~'(Name of individual signing contract) above hamed. He is the ..................... (Contractor, agent, corporate officer, etc.).,~~ of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this apphcat~on, that all statements contmned m this apphcat~on 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 ~ ................ day o17 ................... , ... Notary Public, . ./.,~..~..?~.. .... County : ..... ................... Tq0TARY PUBLIC, Sta~e a[ New Yor~ (Signature of applicant) [~0.4707878, Stlff01k Co'ml~y.~,,~ 0