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Home My WebLink About12863-zFORM ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 18407 Z Date SEPTEMBER 22~ 1989 THIS CERTIFIES that the building__ Location of Property 43635 House No. County Tax Map No. 1000 Section Subdivision CONVERTION (uou~ 25) Street 075 Block 01 Lot Filed Map No. Lot No. PECONIC Hamlet 017 conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 15, 1984 pursuant to which Building Permit No. 12863 Z dated FEBRUARY 8, 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 convert existin9 buildin9 to one family dwelling The certificate is issued to of the aforesaid building. UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED FRANK CICHANOWICZ III (owner, Y~) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N 639047 7-22-88 CIO-89-006 ~ilding Inspector Rev. 1/81 TOWN 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) 12863 Z Permission is hereby granted to: ..... /..~,~z~......~4~,, ................ ....... .~_~l~'z~.~,...,~.,~. ..................... .... ,,..~...~x--./..~.~..~...= .......... ~. ...... ..//..~/ ,o ....~azz.~c4~.z'":...~.~z~......~.u.,,:,~.../,,~_ .....z.."~....~..,,,.l~...~/./.c..~ " -~ ' = -~ "' · ,u.,~ .c~..x.~. ./...qr..~.... ~ ..:~,,u~,.~..,,w..:?.......~..~z<:..~, ................. ~ ~.~...~.~ .. ,z..,<~.~. ............. County Tax Map No. 1000 Section ..~.../~.... ~...: .... Block ...~ ........... Lot No..~../...~... ......... ~ ~ / pursuant to application dated .~~'~X"~.~..../....~....., 19.~...~., and approved by the Building Inspector. Fee $....Z .~...~ .......... Rev. 6/30/80 TOWN OF SOUTUOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLH, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY NEW CONSTRUCTION -.-~...OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........ Location of Property ............... ?.~ Road HOUSE NO. STREET HAMLET Owner or Owuers of Property...~%~%.q~e~q~%e~.%I~ .......................... County Tax Map No. 1000 Section 3~ .... Block .~ ..... Lot .%Z'~ ...... Subdivision ....................... Filed Map ........ Lot .......... Permit No. ~ ..... Date of Permit -~-.-Applicant ................... Health Dept. Approval .P/~P/~? .......... Underwriters Approval Planning Hoard Approval ................ Request Fee Submitted: for Temporary Certificate .; ..... Final Certificate ..... ~ .......... ............. APPLICANT rev. 10/14/88 LABS, INC. ENVIRONMENTAL and INDUSTRIAL ANALYTICAL SERVICES Harry Goldmman Water Analysis Main Road Mattituck, NY 11922 Sample ~h No. 862~064 Date Collected: 6-30-88 Date Received: 7-1-88 Type: Potable Water Additional San~le Info. See Lab Report # ~10395 Collected By: D 99 Compound vinyl chloride .... m~thylene chloride . 1, ~ -dichloroethylene .~ ], 1 -dichloroethane . chloroform ..... ], 2-dichloroethane . . . 1 ~ 1,1-trichloreet_.~ane ......... carbon tetrachloride ....... 1,2-dichloropropane ........ 1,1,2-trichloroethylene ...... tetrachloroethylene ........ chlorobenzene. benzene . . toluene... m-xylene . . . o-xylene . . . p-xylene . . . o-dichlorobenzene ....... p-dichlorobenzene ........... Temik ..... Date A~l~z~ ~-~-~8' Results reported meet Suffolk County Drinkir~ Water Limits. Date Reported: 7-22-88 u9/1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 < 1 <2 John J. Molloy, P.E. Laboratory Director FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Sou~hold, N.Y. 11971 765- t802 APPLICATION FOR CERTIFICATE OF OC¢ 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 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 property showing uti property lines, streets, buildings and unusuat 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: Additions $25.00 POOLS $25.00 AL?ERATION $25.00 1. Certificate of occupancy ~[~ Accesso=y,$]0.00 ;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.O0 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ...J..¢~...~-..~...../..¢.~.~.... NewCons tz~uction ...... Old or Pre-existing Building ........... .~Vacant Land ............. Location of Property .... i. ........................................................... House No. Street Ham/et Owner or Owners of Property ....~...C...~,.(~.~.~..~//..(-'.~r .......~-- ........................... ¢/ .7. County Tax Map No. 1000 Section .... 7.~. ....... Block ............... Lot ..... ~ ........ Subdivision .............. --'---~- .Filed Map No ....... -....-Lot No ............. Permit No. ............/~.. ?.~. ~ Date of Permit ......... Applicant ...................... .~....~.. ....... Underwriters Approval... ~... ................. Planning Board Approval ...................... Request for Temporary Certificate ................... Final Certificate .. ~ Fee Submitted $... · .~. ,~. · .~.~,... ,~0.~.'-~. ~~" ¢:~ ~/~_/%z~ Construction on above described building and ~ermit meets.~ll ~pplic¢~le codec-~nd regulations. Rev. 10-10-78 FIELD ~NSFECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL ADDI ~L COMMENTS BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. I' ] FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL DATE TOII/N OF £OUTIIOLD OFt'ICE OF BUILDING IldSPECTOP, ILO, DOX 728 TOWN HALL SOUTIIOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable t:o complete your Certificate of Occupancy becau.~e .of the following reasons. /--//An application for Certificate of Occupancy is not on fil~.. /~/ No Underwriters Certificate on file. /__~/// The check is(outdated/not on file.) _ I';o !lealth Dept. Approval on file. /~/ No final inspection has been made. P]ea:3e contact our office on this matter. Thank you for your cooperation, Buildinq Permit l, _~ ~ __~._~ ~ Z Bull(ling Dept. ~ '+**/]/ ~o Plumber solder Certificate on file. ( all permits involving plumbing being issued after April TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR. P.O. BOX 728 TOWN ItALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because.of the following reasons. /Z; ~n application for Certificate of Occupancy /~No Underwriters Certificate on file.~ /~ The check is(o~t~d/not on file.)~ ~ /~No Health Dept. Approval on file. /~/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. ~Building Permit # / ~ ~ ~ ~ Z Building Dept. ~,~¢3~Nm~M ~o~:~3 ~co~ ***/]~No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) Memorandum from... BUILDING INSPECTORS OFFICE TOWN OF S. OUTHOLD TOWN HALL, ]~OX 728, SOUTHOLD, N-Y. 11971 765-1802 FORM NO, 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL PLEASE TAKE NOTICE that yonr application dated . ':~ .... (.?. ........... 19 .~..~'. ~ for permit to construct .... '-~-~(.J~.Z~/~ .............................. . ......... ~at Location of Property '~o:' ~e'~' ~ ......... S't/e3i ............. :~/'~3~,Y' V, co~.ty 'r~x ~ap No. 1000 Section . ~9. ~ ...... Block ... CQ.( ....... Lot . .~( ,7 ....... Subdivision ....... ~ ...... Filed Map No ..... .'777'~ ......... Lot No .... ,,"VVT,,'. ......... is returned herewith and disapproved on the following grounds .t(~... ~:7../'d.. ~: .5~U~ ~-- ~¢,& ~n~. .~. ~~ .v ...... -.. ~, . .~: . . . ...., ~ .. RV 1/80 .! FORM NO. 3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL FfieNo ................................ /~ Date..,. .......... .7. .......... , 19 ..... ~.z ~ ~ ,: ~' ' ~.. ,/t~ ~. . (j .......... PLEASEq~A~ENOTICEthatyourapplicationdated . .. /¢~tO, T~. ..[.~:,:~ ........ , forpe~n,ttoconst.ct ..... ~:~:~.~ .... ~ ............... ../~ ........... at t,ocation of Property .... ~....~. .... dg~2LL¢4,,-, ./~:r~: _~.~.~ ......... Z~.. X~.-/-~ ..~. .... t~ooso tvo. ~'treer ftat~lot County Tax Map No. 1000 Section '--- '~~ . Block __ ~7 Lot ~ Subdivision ................. Filed Map No ................. Lot No .................. ,s returned herewith ~na ~approved on t~e Collowin~ ~rouna~..~.~'~.&,%~-~>:'~..~. ...~ ..,...: ............................. : ............... /~. .~. .~_ ~ _~ .......................................................... Building Inspector RV 1/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ TEL.: 765-1802 Examined --- . .......... ~/SarfL~.~,/f" · A'p~ No ..... Approved .~..~....~.. ...... 19~..ee~nnit No. ~'~ 4:~ ~ Disapproved alc.. 7-.'~ .~.~..~....~:"~' ' -- ~-.Y~.. i{.. "T'O k:b'E.~ (Building Inspector) APPliCATION [:OR BUILDING PEFIMIT Date ~7)~4,-. .... l~. ..... 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 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 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. ...~.o..g~... ~.~c~To~.~... b~:d,~ zrT. t~... (Signature of applicant, or name, if a corporation) .C o. C~ o. .;.~ .c .... .~. . ~. ~ . . . ~ o.'4~.L.r>. ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .~.¢~.~ . ........... Name of owner of premises .. ~k~ ~... ~..[.C~-.~.I~J~J. OGQ.I.C.'~.~... j~. ' ' (as. on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ~ .o ~. O...~ ~ .~ ............ ~.~ ...... (Name and title of co.orate officer) Builder's License No ...... ~.~ ............... ~. ~ Plumber s License No ........................ k~ ~ '/ ~lectrician's License No.. ~.. ~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done ........... .~9 O7/.~.. ~. ~.~7. ....... : ........ .... ...................... ..................... House Number Street Hamlet t'/CCounty Tax Map No. 1000 Section....~. =~. .......... Block ...... ~ ....... Lot .... I.'7...__~_x ...... .. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) ' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: /a. Existing use and occupancy .... '~,dd,~../'~...,~MJ~. .................................... Intended use and occupancy .......... 'a~' u,.,?;: ~t.~a,gli;}0;~ ..O.r~ ........................ 4. Estimated Cost... ~ p<.O.~, .d). ..... $. If dwelling, number of dwelling iunits. Nature of work (check which applicable): New Building .......... Addition'. ......... Alteration . Repair Rembval Demolition ' Other Work (,to be paid on filing this application) .......... 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. D~nens~ons of~.ex~st.ing., structures, if any: Front ..... .q<.~ Rear ... g, ~5.. ...... Depth..o~"~:~ ......... Height ..... ...... Number of Stories ..... ~. ~i ii i .................................... Dimensions of same structure with alterations or additions: Front ... :g~.~ .......... Rear .. ~ ........... Depth ....... ~ ......... !.. Height ...... ~./ ............ Number of Stories ..... /. ~.. ~ ......... 8. Dimensions of entire new construction Front .... ~[~.....~.. Rear ....... F. ..... Depth .... ~ ~,~ ~ Height ....... ~> ...... Number of Stones ....... /.. ~. l~. .......................................... 9. Size of lot: Front .......... , ........... Rear ...................... Depth ...................... 10. Date of Purchase .......... , .................. Name of Former Owner '. 2>..1 ........................ 11. Zone or use district in which premises are situated ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~ .............................. i3. Will lo~ be regraded ........ ~q].O ................ Will excess fill be removed from premises: Yes >~ No 14. Name of Owner of premises .. ~ ................. Address ............. '....'}-. Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ........ i ................. Address ........... : ....... Phone No ................ PLOT DIAGRAM 1 ' Locate c early and distinctly allI buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street andblock number or description according to deed, and show street names and indicate whether interior or corner lot. ~ STATE OF NEW YORK, ~S.S COUNTY OF .... ~'O.-~.t~.~.. ~ .............. ~ ~.~-~.. ~>,g,~ t'. .............. being duly sworn, deposes and says that he is the applicant (Name of individual sign}ng contract) above homed. ,~ He is the ................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this application; 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 ~brth in the application filed therewith. Sworn to before me this .-~ i ~~1~' C~ Notaw Public, . ............. .d'~),~ .,";'(~..~C..~.... County /' ~ .~ .~ , ............... , ~.~I1~, #~t ¥~ (Signature of applicant) MAF C,F [ "' AF, LEA: Z, 3,~,43 ACkr.~ Ii ";'it sho~l,:l 'be noti~tl :thai -s]nce ~ property is located in an agrcu tord brea, the poss b ty '~xJsts that the ~ater supply may confab t~ mOunt~ of pesffcid~ and/or nit. res. ~ial analys~ ~7~ req~. / Te~+ Hol~ ~/~::~:~;~.ra. ~.'w York Stat. I TOWN OF SOU~HO~O I SUFFOLK COUNTY, IMAIN ROAD I~vr~c~ / / / _r,,, for water distributing system~ piping sbaJ~ be of WPes K or L onl~ §CCL~CY OR IJF OCCU?~HC¥ / ~P,PROVED AS NO?ED - ~ NOTIFY BUILDING DEPA~RTMENT AT 76S-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1, FOUNDATION - ~O REQUIRED FOR POURED CONCR~E ~. ROUEN - FR&MING & PLUMBIN~ 3, INSU~TION 4. FINAL - CONSTRUCTION MU~ BE COMP[ ~g FOR C.O. ALL CON,RUCTION SHALL MEET THE REOUIREMENTS OF THE N.Y. ~ATE CONSTRUCTION '& ENERGY CODES. NOT R~SPONSlBLE FOR D~IGN O~ CONSTRUCTION ERRORS. i'¸ JOB NAME: '- ,,~----~..6,',S.. ' LOCATION: LJLJ JOB NAME: