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Home My WebLink About12920-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-16519 Date December 21 1987 THIS CERTIFIES that the building Construct Addition ~.+:~^~n ..... ,. 5755 Depot Lane & 19105 County Rd #48 Cutcho~ue, N Y House No. ' .... 'S't/e~/ ...... h~et~/eJ' County Tax Map No. 1000 Section .... .9.6 ...... Block .... .4 .......... Lot 5 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 7, 1984 12920 Z ...................... pursuant to wlfich Building Permit No ...................... dated ....M.a.r.c..h..7. ,.. J .9.8.4. ........... was issued, and conforms to all o f the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR JOSEPH & GENEVIEVE CHUDZINSKI The certificate is issued to row,,e; f ffre' ' fv2ti ' :;: .................... of the aforesaid building. Suf~lk County Department of Health Approval ............ ~ (~ .......................... N654332 UNDERWRITERS CERTIFICATE NO .................................................. PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 ~O]2M NO. '~ 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) 12920 Z Permission is hereby granted to: , ~ ~ ~, 0 ,, ~.~,~0,_~-,~ ..?...,~, ... .~ ,-o ...~.~ ......... · '~..~ ......... ~......,~..~:~....~....,¢.~-~.. ~, ~re,,,e, ,~.,.a on~.~...~.S....~.~.~.~....%~3. .................................. ~o~., ~x ~o~ ~o. ~0~0 ~,~,,o~ ...... ~.~........g,,~ ........ ~ .......... ~, No....~ ................ Building Inspector. Fee $.~...~..t'...~.,.. ..... Building Inspector 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 This application must bo filled in typewriter OR ink, and submitted ~a ~===~a=a to the Building Inspec- tor with the following; for new buildings or new usa: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unu~al natural or topographic features· 2. Final approval of Health Dept. of water supply and sewerage d|sposal-[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 responslble for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings {prior to April 1957}, Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property 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: . ' ' t. Certificate of occupancv New Dwelling. S25.00, Acce.,.~ery '.$10.00 gu~[ne.~:J $50.00 2. Certificate of occupancy on pre-existmg dwell'rig $ .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 .... z ................ 6. Alteration $25.00 New C on s t r u c t I on 5.~.~o,_~. Old or Pre.existing Building ............ Vacant Land ............. ~-~>~ 183J Depot Lane ' Cutchogue New York Location of ~-roperty ................................................................... House No. Street Hamlet JOSEPH & GENEVIEVE CHUDZINSKI Owner or Owners of Property 096 4 5 County Tax Map No. 1000 Section ............... Block ............... Lot ............... · ' ' Filed Map No Lot No ,Subdw~s~on ......................................................... 12920Z 3/7/84 annllcant Wm. Beebe Builder · Permit No. Date of Perm,, ....... ~,.....,., ...... ' · N/A Labor Oept Approval Health Dept. Approval ................................................ N654332 Planning Board Approval Underwriters Approval ............................................. Request for Temporary Certificate ..................... Final Certificate .... Fee Submitted $ 25.00 Construction on above descmbed budding and permit meets all apphcablo cqdos and regula.ons. Applicant ~%L ~/-.-~. . ~ ..... II.v, 10.10.7a THE NEW YORK BOARD OF FIRE UNDERWRITERS ~SP, BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK NEW YORK 10038 /).re AU4~t?, 19~ Applic.tio. No. on/ile 276170-~ N654332 THIS CERTIFIES THAT only the electrical equipment os~d~escr~bed below and introduced by the applicant named on the abo~e application number in the premises of Joseph Chudzioz,ki, 1831 Del~ot I~ue~ Cutcbogu~ in the following location; [] Basement was exa,nined on ~'L~..y 30:. ]]~(~J; [~lst FI. [] 2nd FI. Section Block and found to be in compliance with the requirements of this Board. Lot OUTLETSFIXTURE SWITCHES FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS 7 7 9 7 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERs MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R ¥ I A W,G, NO. OFNEUTRA/ A W G, OF HI-LEG OF NEUTRAL Panelbo~rd/s: L-Tcir. Gary lNoxuski 4~ D Mop, sell Lane C~Athhogue~ N.Y. 11~5 ~c.2~l-E This certificate must not be altered in any manner; return to the office of the Board if ~Oco~rect. Jnspector~ COPY FOR BI may be identified their credentials. J ANY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN ItALL SOUTHOLD, N.Y. 11971 TEL 765-1802 This is to advlne you that the job under building permit no. 12920Z issued to Generiere Chudzinski on ~3_Z7~4 for Addition is completed and a final inspection [las ( ) has not ( X ) been done. [. order to complete this file, it is necessary that a Certificate of Occupaucy be issued. Please fill out the enclosed form, return same to the above office with a cheek for $25.00 payable to the Town of Southold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for nn inspection (late Occupancy or nsc is unlawful without a Certificate of Otc.panty. l'lea~e help ns to clear up thins matter so that legal action does not have to be taken. Thank you for yo,r prompt attention. Very truly y~, Victor Lessard Executive Administrator VL:gar encl ?t,5-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL DATE ,/~ INSPECTOR~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: FIELD INSPECTION COMMENTS FOUNDATION (15t) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CpDE FINAL ADDITIONAL COMMENTS: Approved ....% .O~L.t~.,,.'~ . ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Received ........... ,19... Disapproved a/c ..................................... ................................ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 tins 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, in~s./~____~£.l:t..~X~:~.~ (Signature of applicant, or name, if a corporation) .... ................ (MaiFmg address 0f~pplicant) State whether applicant is owner, lessee, agent, architect, en~dneer, general contractor, electrician, plumber or builder. ............................. , ................................. Name of owner of premises .C.~/~/ff. [..'~.'.~..~':.....~.'..r .~.~.~. f? .~5.....~.~: f~...~...~. :.~.//×.t.?./.~../. ..... (as on(fine 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 Trade's License No ...................... 'SAO.~ .?i ..~.5 1. Location ofland on which proposea work will be done ..... ~.F.~. ......... f.. ......... ...................... ero. . .............. 75 x. ........... House Number Street Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... 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 ...... [... ~..'~. ~..~. l .( ..~.../~..iV.c7//'l'~"L'I ........... ./~.c/ffl.f.[?~., ............ b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition ....... Alteration .......... ~ Other Work R.epalr .............. Removal .............. Demolition ............................. : (Description) 4. Estimated Cost ...... J..~ · .O~. · ·~..'. ............... Fee ...................................... ~'- (t g thi ppli ) ~ o be paid on illin s a cation 5. If dwelling, number of dwelling umt ...... Number of dwelling units on each floor ......... If garage, number of cars .................................................................... 6. If business, commercial or mixed occupancy, spec/fy nature and extent of each type of use ..................... 7. Dimensions of existing structure~ if any: Front ............... Rear .............. Depth ............... Height ............... Numlber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth i Height Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...........~ ........... Rear ...................... Depth ...................... 10. Date of Purchase ~ . Name of Fenner Owner 11. Zone qr use district in which premises are situated ..................................................... 12. Does ph~tposed construgtion viohte any zoning law ordinance or regulation: . .~./_) .......................... 13. Will lot be regraded ....... ._., ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~.'~M,ff~, .~.. ~.~ Address ......... , ......... Phone No. ~7r4{..~/.9~.~. f~.. Name of Architect ....... ~9,-d~~u..~.~'A. ddress .. ~.~c~,~.~4, .... Phone No. '.' .............. Name of Contractor ~ ~.~f~o.~.~ Address Phone No. .... PLoT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from deed, and show street names and indicate whether property lines. Give street and block humber or description according to interior or corner lot. STATE OF NEW YORK, , o S COUNTY OF .... ~). .//fi*t.¢r~ .................................. being (Name of individual sighing contract) above named. [ duly sworn, deposes and says that he is the applicant He is the ..................... i ................................................................... i' (Contractor, 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 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 forth in the application filed therewith. Sworn to before me this ...................... day of ............. 19 Noting7 Public, ~ ~. ........ Go?nty , m^,Y :.<..:. - :-. /th; ................ , ~1o. 52-4524771 . (Signature of applicant) Qualified m Suffolk Counht f~/mission Expires M~rch 30, x,