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Home My WebLink About13102-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... .z.-. 1.5...5.5.7 ...... Date .... .~ p.r.~.!' J.,.. ! ?.8.7 .............. THIS CERTIFIES that the building DECK ADDITION Location of Property . 645 Jernlck Lane Southold, New York House No. Street Hamlet County Tax Map No. 1000 Section 070 ..... Block 3 .Lot 4 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated May 7, 1984 .. pursuant to which Building Permit No. 13102z dated May 7, 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 ......... DECK ADDITION TO EXISTING ONE FAMILY DWELLING LOUIE BALAC ICH The certificate is issued to ..................... jo~n'e),~~lg× .................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .... N/A N/A PLUMBERS CERTIFICATION DATED: : '~uJd~ng Inspector ......... Rev. 1/81 FORM' NO. S TOWN OF SOUTNOL'D SUIL.DING DEPAP, TMENT TOWN HALL. SOUTHOLD, N. Y. BUILDING PERMIT (THIS ~£PJ~IT /~UST ~£ KEPT ON THE P~E~I$~:$ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? i3102 Z Permission is to: hereby grontecl . ..................... .~.~;..~:.~,~:~....~_ ................... ~~~_:.:-~ .~, I/~'~/ ~o ............... ~k.~ ...... ~. ..................... ~ ................................................. .~......~.~..~..~~ ~.~. ....... ~ ............. :~ ~ ~ ~~ ............. ~,~ ........................................... ~ ~,.~ ,~ ~ ..... ~..~..~.. ...... ~,??..~.....~-~.~......~:~~.~ .......... · ";'7"""~7~'~~.~, ~ ....... : ...... u...:;..~. ...... ~- .......... :....~ ....................................................................................... .. ~. .~S ~.~&~....2..~.~.%.r~..~ .............................. .... ~., .~.c~ ~-. ........................................................................ co~ ,~ u,p ~o. ~000 s,t~o~ ..... .~.~.~?. ...... m~k ....... ~ .......... lot Uo ....... ~ .............. pumuant to a~lication dat~ .~.~..~ ......................... , 19.~.5., and approv~ by the Building Inspector. Rev. 6/30/80 FORM NO. $ TOWN OF 8OUTI4OLD Building Department Town Hell Southold, NoY. 11971 765- t802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ,~obis application must bo filled in Wp. ewrtter OR in,k., and submitted ~ azaaam=a to the Building Inmec- r with the following; for new buildings or new uso. 1. Final survev of property with accurate location of all buildings, property Ilnes, streets, and unu~a! 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 in~talla- 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. For existing buildings {prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate ~urvey of p=operty showing all property lines, streets, bulldlngs and unusua~ 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 occupancv t~ew l)~el].~ng.$25.00, &cce.~.~ory ~$10.00 ttu~u~e.~:~ 2. Ccrtificate ~f occupancy on pre-existing dwelling $ .50.00 3. Cop¥ of certificate of occupancy $ 5.'00, ove~ 5 yea~ $10.00 4,V~cant ~,ana C,O, $ 20,00 $ 50.00 Date. ~lr;. gb..~.7. ,, .'1.~7 ........ 5. u~dated C..O. 6. ~lteratlon $25.00 New C on a t c u c t, i on ...... Old or Pre.existing Building ............ Vacant Land ............. 645 Jot'nick L'ane, $ou'chold . Location of Property ................................................................... O Owners of Property ' 070 County Tax Map No, 1000 Section ............... Block ........... Lot ............ Subdivision .................................. Flied Map No ........... Lot No .......... Permit No. Date of Permit Applicant ............................ Health Dept. Approval ........................ Labor Dept. Approval ........................ U d App I PI ' gB damp n erwrhers rove . . . o ...... o .......... anmn oar reval . ' : Request for Temporap/Certificate ................... F[na~ Certificate o .%< .................. Fee Submitted $ ............................. Construction on ebove described building a~mects~l'~'~l°Zand/z~-~3,-~,,--~ regulations. Applicant ~,".(.,,~. 4,/ ..... .~ ~..~'~ .................... 10.10.70 ~ ~5~s 7, ~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN IIALL $OUTHOLD, N.Y. i 1971 TEL. 765-! 802 This is Co advise you chat the job under building permit no. 13102Z issued to Ron Morxzzo (Louie Balacich) on __5.~7/84 __ for Addition is completed and a final inspection has ( ) has not '( x ) been done. ~n order to complete this file, it is necessary that ;1 Certificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for $25.00 payable to tile Town of Southold. Please indicate to Whom the Certificate of Occupancy ia to be mailed, and arrange with this office for an inspection date Occupancy or use is nnlawful without a Certificate of Occupancy. Please. help ns to clear np this matter so that legal action does eot [lave to be taken. Thank you for ynur prompt attention. Very truly _y~, Victor Lessard Executive Administrator VL:gar encl . FIELD FOU:]DATION (1st,) FOU ND/~'£ ]~0II ( 2nd FRAME & PLUMBING IIISULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMM_E__N~TS:, FORM NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .... .~ .~.~ ..... 19~.~.. Approved . .~%'.~., 19~. q.. Permit No. t .~.~..~...~..~.. Disapproved a/c ..................................... Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT 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, 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 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 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 buildings for necessapJ~pection~~~/~g~r)5 ~ (Signature oii~li~i~, oCdf/m'i a cornOratio,)... · F~/(Mailing address of applicant) State whether applicant is owner, lessee,~e~ engineer, g~neral contractor, electrician, plumber or builder. Name of owner of p:emises...~/f~ ..................................... (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...t~..7 .......... .~.7.7~...~' Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will .be done ..................... .~ ...... ·...~./q ............. House Number Street Hamlet County Tax Map No. 1000 Section .... . .'7...O. .........Block .... '..~. ........... Lot .... /..cfi.. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy o~.~remises/and intended use and occupancy of proposed construction: a Existing use and occupancy '"'""(-~ t.~. ~ b~ Intended use and occupancy' ~ ~; ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... /~,~. ,~. ~¢::> (Description) 4. Estimated Cost Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................ If garage, number of cars .... i ................................................................... 6. If business, commercial or mixed occupancy, specify nattire a~,extent of each typefof use ........... t ......... 7. Dimensions of existing structur;s, ifany: Front... ~ (6 Rear .. I ~ . . Depth 1~ ........... Height ·..~ .......... Number of Stones ................... ~.~. ~ .................... / ........... I)irnensions of sa~e structure with alterations or_additions: Front .. ~.~ ........... Rear ~.~ ............. Depth ..... I~-' ........... i.. Height ...,.2.t .~ .! ............ Number of Stories ............ , ......... 8. Dimensions of entire new const~ction: Front .... t~' ......... Rear 6" ............ Depth . .[~. ........... ttelght ............ ~:~ Number of Stones ........................................................ 9. raze of lot: Front ...................... Rear ...................... Depth ................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which prsmises are situated ..................................................... 12. I)oes proposed construction vioiate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .. ~ ................. Address ................... Phone No ................ Name of Architect ........ i ....... · ......... Address .............. , ....Phone No ................ Name of Contractor .'.~.0t~.. i ~..0/~ Jt.'Z..Z. ~.. Address ~.~..O'~.~./~./.~. ~.. Phone NoTd'&-.. 5T7.72- 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 76541802 9 AM TO 4 PM ~FOR THE [OLLOWING ]NgPEC3qONS:[ ~, ~OUN~AT~N - TWO ~[QUIRED 2. ROUG[i - FRAMING ~ PLUMBING 3. INSULAz'~`~b~ / 4. FIN'~L C.3h~'q'I;:[1.'~ 3N MUST ~E C"~P'FTF FOR C ~, ALL CONc'rR~ICT, . ON SH~LL, MEET., ~HE RFOI''prMENTS OF ~HE N. ~ --~A'TE- 'CONSTRUCTION ~. iNERGY ~ODES. NOT RESPONS[BL~ ~P- D~IGN OR CONSTRUCTIO~ ~RORS. STATE OF NEW YORK, COUNTY OF ................. [S.S ............................. ; .................... being duly sworn, deposes and says that he is the applicant . (Name of individual sig~ing contract) above named. 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 application; that all statements conthined 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 NOT^RY [ UBLICt State of New s,'er~ (Signature of applicant) No 4707878 Suifoik let,,1 Expires iVbrch 30, 19~