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Home My WebLink About13137-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.q.,6.2. q.6. ......... Date February 7 1986 THIS CERTIFIES that tl~e building... 9,n,e,, ,f,a,m.i.l.y..d.w.e. ~ .1.i.n.g ...................... Location of Property ... 52.5. Highland Road Cutchogue Hous'o ~1o. ' .................... '~'t/e3i ....................... h3d~l'oi County Tax Map No. 1000 Section . ! .0.9. ....... Block . .0 .2 ............ Lot . .0 ?.6. :3. .......... Subdivision. H..~ .g.h.1. a..n.ct..~, s..~ .a.~.e.s. ........... Filed Map No.6.5 .3.7 ..... Lot No .... .3 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated · Ha y..1 .q .............. 19 ~ .4. pursuant to which Building Permit No..~.3. q..3.7.Z .............. dated .. ~lay..1.~i .................. 198z~., 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 ......... · .q~. £.a~¢i~y..d.W.e3.~ ~.ng ........................................................ The certificate is issued to ANTONE F. & DIANE M. SUROZENSKI (owner, ~.e~X ~,~X)X X of the aforesaid building· Suffolk County Department of Health Approval ...... ! .~.-.S. O, 7.7.0.. 1. ! ./.1.5./..8 .5 ................ UNDERWRITERS CERTIFICATE NO .............. ~ 7.3.2. 7. .6 9 .... .1/.2.7./..8.6 ................ Plumbers Certificate 11/6/85 Building 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) N? 13137 Z Permission is hereby granted to: ~:~/......,~.~...~..~.~....~ ........ C,.~:.g/-~ ~. ..Zff..~,.~.~..~ ./~.-..:..~..~.~ ....... ,o ........ ~,~.'..,,~.~.~.~_..:....~.~.~...... .~..~.,4~ z..~...~.......~..~..~j/...~ ~..~. ................. ............................................. g'~= ................................................................................'k'T" ......... : ........ ............. County Tax Mop No. 1000 Section ...:/..(~..~.. ......... Block ......~.....C~.. ..... Lot No..~../~..:..'~ ...... pursuant to application doted ....... ~..~.......~'.L ..................... , '~..*.~*., and approved by the Eluildlng Inspector. Fee $/...~./....~.... ...... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIF[CATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I~ 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 pZ~perty 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: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $ Z 5.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building .,. ,X~,, ....... Old or Pre-existing Building ............ Vacant Land ............. House No. Street Hamlet Owner or Owners of Property . . .~..~.'~%. O,~_.--~...~, . .'~... J%.O.r~...~. ..... .~.%/'%.~.P~ .R .~..k... County Tax Map No. 1000 Section ....~..~..~. ...... Block ... ~ ......... Lot...~.~ .~-'~ .... Subdivision...~..'.~..~h.~%~,..~. ~.~...-c...l~.'~-...~. ...... Filed Map No..~..~. ~ .~...Lot No ..... '-,~ ....... Permit No..~..%..¥.~.?. Date of Permit~. .? ?.: .~.<~ .Applicant....~...v~..-~9.,r~. ~.~... ~ %.[9..z..~. %~l~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction o9 above described building and permit meets all appliqable codes and regu, lations. Applicant . .~.... . ............. 0.o. =#-Z TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 119?l TEL. 765-1802 CERTIFICATION Building Permit Owner (._~'(~,~: I.b'o..¢.~ (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) ,,' '~ .t ,r jl~ ~,I. ql iii[ I~ ,u :, : . , u I, ," , , , 1/ ' ~ '" ' ,, ' ' ~ ~"h' Vl"~ ,' ~ '" ~"' ' p~_~'l~ Thi~'~r~ific~te must n~t be olfered i~,a~y mooner~Ul~ef~rq to the office o{ the Board ~f incorrect, Inspectors m~y FIE~D I~%PECTION COMMENTS FOUNDATION (lst) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS BUILDING DEPT. INSPECTION [~OUNDATION XST [ ] ROUGH PLBG. ~ ~ FOUNDATION 2ND [ ]INSULATION [] FRAMING [ ] FINAL TOWN OF SQ[JTHOLD BUILDING DE, PARTM ENT TOWN HALL ,. ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved . . No. ,:'?/. .¢:7. / Disapproved a/c -~ ~-~ (Building Inspector) APPLICATION FOR BUILDING PERNIlT Received ........... ,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 [~remises or public streets er 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 necessa inspections. '-~~ ~a (Signature of applic tion) .-. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~X'x'rc~.~--- ?.....o..~. ~:\ . .~...I.% .~.~.... ~ ..... .~.k~. ["%O..'~.~-J'x~ I<~ .............. (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 ................. ' ......... Other Trade's License No ...................... 1. Location of land on which proposed work will be done..~3~.k~.~. House Number Street Hamlet County Tax Map No. 1000 Sectioa ' .[ C~ .......... Block ..... .~. ........... Lot .'~.. ,..~.... , Subdivision.~.l~l%0~ad. ~'~q'~.~e-~ ................ Filed Jylap No% ~0 ...... Lot ............ .... (Name) /-}l~r- :ab~ 19-)"1 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: g,d en'}lcat- . . . - . a. Existing use a~ occupancy. ~~..~. J.~s.,,~. ~1~ ..... b. Intended use and occupancy .. ~n05~. :~..~...~.1.~..~..~.Ju.t(]. ~ 7 .... ~ [.~. ............................. Locate clearly and distinctly all property lines. Give street and block interior or corner lot. 3. Nature of work (check which ap'plicable): New Building ...'~. .... 'Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4: Estimated Cost ....... r~.~).~ ..... Fee .... *'- (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ] ......... Number of dwelling units on each floor ................ If garage, number of cars ..... i · 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...~,%a cA~t~.~ ~ ....... 7. Dimensions of existing structur{s, if any: Front ............... Rear .............. Depth ............... Height ............... Nuntber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..... ~ ............... Height .......... ; ........... Number of Stories....~. ................. 8. Dmaenslons of entire new construction: Front . .~ .q ......... Rear . .¢.4~ .......... Depth . .~.} .......... Height ............... Number of Stories ..... '2 ..... ~.... ........................................ 10. Date of Purchase . .~)£C,..4~."11.I. [.'1.~ ............ ; Na~e o,f¥omqr Owner CO!I.e. ,.,Ladmg 1 1. Zone or use district in which pr~m~ses are situated.. ~ .~. K~-StdelT~.l~t/.L-...-k .~F.l(zl4. [-{/.[C..A.L ................ 12. Does proposed construction viol,ate any zoning law, ordinance or regulation: .....~..l~Ch ...................... 13. Will lot be regraded ......... ! .... ._ .......... ,... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ,~.~. ).~..~=~U,~.~Y~et[g. Jq41. Address /qO-.~l .'~Lc~. ~..r~.~.. Phone No. g.~.xq~.b.] ...... Name of Architect ............................ Address ................... Phone No. i~.,N, qq~..'~S.-. Name of Contractor ......................... Address ................... Phone No ................ PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from aumber or description according to deed, and show street names and indicate whether STATE OF NEW YORK. . S.S COUNTY OF '.~.~.kl.l~. F.O. ~ .~. .... ../~.h'.-EbO..~.....~. .... ~,.~ ta.r.o.~gD ~. Ic. 1 ........... being duly sworn, deposes and says that he is the applicant (Name of individual sign!rig contract) above named. He is the ...................... i ................................................................... I (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 contqined in this application are true to the best of his knowledge and belief; and that the set forth in the application filed the~e~Vith. work will,' be perfor~aed in the manne! Sworn to before me this . · ........ ~t .............. day of ..... Nffr^R¥ PUBLIC, Stat0 of Ne~ ¥0r~ .............. No. S2.4§2477! pplicant) Commission Expires March LE FAMILY DWELLING ONL.Y )UNTY DEPARTMENT OF HEALTH SERVICES ,PPROVAI. Ol: CONSTRUCTION ONLY ~MENT-OAT~ FOH APPROVAL T0 C~ST~UCT . pest,cid,s ~d/or S~t:;ol onal~sis ~/~required, SURVEY FOR ANTONE K SU~OZENSKI ~ DIANE M. SUNOZENSKI LOT NO, ~ , "HIGHLAND ESTATES" AT CUTCHOGUE O~rE: ~ OF SOUTHOLD SCALE: /'"-' NO, 84 -~08 i~ UNAUTHORIZED ALTERATION OR AODITION TO THIS SURVEY I~ A VIOLATION OF SECTION 7209 OF THE / ~'x ::>.'// /:-- . ~¢o.. ?' . , ~ / ¢079 ~" o.< Spm:;ul analysis ~/~reqt~ired. SURVEY FOR 81NGL~ FAMILY DWE~LLI~q'~ ONI.Y ANTON~ ~ SUNOZ~NSKI ~ DIANE M. SUNOZENSKI ~o~[ ~OUN~ b~A~TM~Nf O~ ~?~ S[~WC[S LO~ ~0. 3 , "HIGHLAND ESTATES' AT CUTCHOGUE su~vE~ m ~ wo~o~ ~ sEc~o~ z~o~ o~ ~E A~ ~ ~ ~ : NEW YORK STATE EDUCATIOg LAW HEALTH DEPARTmEnT-DATA FO~ APPROVAL TO C~STRUCT T~E ~n~O~ ~0~ w~O~ T~E SU~E~ IS ~E~REO TEL'~J~-~O'~"~' I1 YOUNG ~ YOUNG ~OS~ANDERAVENUE RIVER~AO, NEW YORK ~N W. YOUN~, PROFESSIONAL ENGINEER N0~: ~ = ~O~U~ ~ ~ ALDE ~ ~0~N~Y ~ ~1~ ~ I~ ~ ~1~ N~ ~5~ AND ~AND SURVEYOR N.Y.S UCEHSE NO. 1~84~ HOWARD W. YOUNG~ LAND SURVEYOR The se~al~e disposal and rater tnspeot~ by tht3 de~rt~e~t ~ fo~d Chief Of ~eneral[ En~nee~tn~ Service2 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE~ FOR APPROVAL OF COi'4S'i;'.UCTION ONLY DATE 'dS RIFF. NO.~ .. ., APPROVED HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT N THE WATER SUPPt. Y ~NO SEWAGE DISPOSAL SYSTEM FOR THIS RES I WILL CONFORM TO THE STAND~ROS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. ADDRESS TEL NOTE: m = ,ffONUM-~NT FOUND SUBDIVISION MAP FILED IN THE OFF/CE OF TH£ CI £RK OF SUFFOLK COUNTY ON APRIl 26, 1977A..c FIL£ /VO G5..~7 ~ ~ LOCATK)N OF WELL(W),SEPTIC TANK(ST)8 CESSPOOLS(CP) SHOWN HEREON ARE FROM FIELD OGSERVATIONS A/dO OR DATA OBTAINED FA'OM OTHER S SURVEY FOR ANTONE F SUROZENSKI 6~ DIANE M. SUROZENSKI LOT NO. ,~ , "H/Gl-lLANO ESTATES" AT CUTCtYOGU£ TOWN OF SOUTHO£D SUFFOLK COUNTY, NEW YORK NUNAUTHOR1ZED ALTERATION OR AODITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EOUCATiON LAW GUARANTEED SOUTHOLD CHICAEO AUG. G, 1985 APt?IL 8, 1.955 DATE APR//. .E~ SCALE. I'.= NO. YOUNG a YOUNG ALDEN W. YOUNG~ PROFESSIONAL ENGINEER AND LAND SURVEYOR N Y.S UCENSE NO 12845 HOWARD W. YOUNG, LAND SURVEYOR N YS, LICENSE NO 45893 400 OSTRANDER AVENUE RIVERHEAD~ NEW 'YORK