HomeMy WebLinkAbout13150-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18906
Date MARCH 20~ 1990
THIS CERTIFIES that the buildin~
Location of Property 50025 MAIN ROAD
House No.
County Tax Map No. 1000 Section 70
Subdivision
ADDITION
MOUTHOLD, N.Y.
Street
Block 5 Lot
Filed Map No. Lot No.
Hamlet
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 2, 1984 pursuant to which
Building Permit No. 13150-Z dated MAY 26, 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 AS APPLIED FOR
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
VIRGINIA FASZCZEWSKI
N-030274 - SEPTEMBER 7~ 1988
/ /~ Buflding Inspector
FOUM' NO. t
TOWN OF SOUTHOLD
BUILDING DI~pARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PEPJ~IT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 13150 Z
Permission is hereby granted to:
.~.~..~,...~:.~%.~ ................
~...~..o..×...~.~ ............... ~ ..................................
.~..~~.:,~.,...u...~:~.~ ........... . ,~ ~ ..
,o ........
===========================================
County Tax Map No. 1000 Section .... ..C~....~.....C). ....... Block ...... ..~..~... ........ Lot No ........~..~...~ ..........
pursuant to application dated ....... ..~..~..-~. ..................... , 19.~...~..., and approved by the
Building Inspector.
Rev. 6/30/80
TOWN OF S0~T~0LD
HUILDIHG DEPARTZENT
TOUN BALL
SOUT~0LD, NEW YORK
765 -- 1802
11971 '~',
APPLICATION FOR CERTIFICATE
NEW CONSTR~CTION "~---~-..OLD OR PRE-EXISTING
OF OCCUPANCT
~UILDIN~ ...... VACANT LAND ........
HOUSE NO. STREET UA~LET
Counc~ Taz Hap No. 1000 Section ...... ~lock ..... Lot' . ........
Subdlvisinn ....................... Filed Map ........ Lot ..........
k tS .' .Da e Per.it
- - Applicant
Health Dept. Approval .................. Underwriters Approval ..............
Planning ~oard Approval ...............
Request for Temporary Cer%ificate ....... Final e age ........
C rtific
Fee Submitted: $ ~ ~
FORH ~0. ~
TOWN OF $OUTIIOLD
BUILDING DEPAR'r/,~NT
TOWN I1AL~
765 - 1802
APPLICATION FO/: CERTIFICATE OF OCCUPANCY INSTRUCTIONS
This application must :be filed in typewriter OR ink and submitted to tile Building
Inspector with the folilowlng; for new buildings or new uso:
[. Final survey of property with accurate location of all buildisEs, property lines,
streets, and uuusuall natural or topographic features.
2. Final approval of Dealtb Dept. of water supply and seworase-disposal(S-9 form).
3..Approval of electrical installation from Board of Fire Underwriters.
4. Suorn statement fro~ plumber certifying that solder used in system contains less'
than 2/[0 of IZ load.
5. Commercial buildinsb' industrial buildings, m~ltlple resldesces and similar.'
buildings and installations, a certificate of code compliance from tho Architect
,or Engineer responsible for tile buildina.
6. Submit Flanniu~ Board Approval of completed site plan requirements.
For existing buildlnssi (Prior to April 9, 1957] nou-couformlng uses, or buildings
and "pre-existing" land uses:
L Accurate survey of ~roperty showlnE all property lines, streets, buildings and
unusual natural or 'topographic features.
A i .
2. properly completo~ appl~catlon, a consent to inspect signed by the applicant
. If a Certificate of{ Occupancy is denied, the Building Inspector sball state the
.reasons therefor inlwriting to the applicant.
3. Date of any housinglcode or safety inspection of b~ildings or premises, or ether
pertinent information required to prepare a certificate.
For Vacant Land'Certif~cate of Occupancy:
1. An application for ~aeant laud Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership Of ,the entire lbt prior to April 9, 1957 shall also accompan~
the application. I~ a Certificate of Occupancy is denied, the Buildisg Inspector
shall state the reasons therefor iu writing to the applicant.
FEES:
'l. CE~Ti~'~CAY~ OF Q~CUFAN~t -. New'D~elling $25.00, Additions to Dwelling $25.00,
Alteration tO Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00
Addition to Accessory buildings, $25.00 - Businesses $50.00.
2. Certificate of Occupancy on pre-existing dwelling - $100.00.
3. Copy of Certificate of Occupancy - $5.00 - over 5 years - $10.00
4. Vacant Land Cnrkificate of Occupancy -- $20.00
~- Updated CertifiCate of Occupancy - $50.00
6. Temporary Certificate of Occupancy -$]$.00 Residential
Commercial
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLI~, N.Y. 11971
March 5, 1990
JOSEPH & VIRGINIA FASZCZEWSKI, JR.
P.O. BOX 378
SOWI?HOLD, N.Y. 11971
TEL. 765-1802
,3RD NOTICE~ ,~EP~4XT EXPXRE~
To Whom This May Cohcern,
We are unable bo complete your Certificate
of Occupancy because ,of the following reasons.
/V/An application for Certificate of Occupancy
is not on file. '(ENCLOSED)
/~//No Underwriters Certificate on file.
/~W' The check is(l~x~4__.al~X/not on file.) $25.00
/~/ 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 # ! 3 I 5 0 Z
Buildinq Dept.
***/~/ No Plumber solder Certificate on file.
( all permits involving plumbing being
issued after April 1,19S4 )
OCCUPANCY OR USE IS UNLAWFUL WITHOUT A CERTIFICATE OF OCCUPANCY.
CL[AR, UP THIS MATTER AS SOON AS POSSIBLE SO THAT LEGAL ACTION DOES NOT
1lAVE TO BE TAKEN.
Thank you.
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION ZST [ ] ROUGH'pLBG.
FOUNDATION ZND [ ] ~ISULATION
FRAMING [//~ FINAL
DATE , INSPECTOR
~OU,~DA,ION (1si,}
~ioUCt! FilA!.IE &
PLUMBING
3.
I!!S/J[,ATION ['ER N.
S'I'AT E Ek' g P, GY
C,ODE
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N,Y. 11971
TEL.: 765-1802
Approved.....~ .~..~.(~ ·., 19~.~· Permit No../.~]:S..~...~: .
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
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 °f 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 a licant agrees to comply with all applicable laws, ordinances, building code, hou~sing code, and regulati~ons, and to
PP ......
admit authorized inspectorS on premises and m bmldmg for necessary/tn~)ectlons. (-~ /
"(~plSl/~,~, r~or poration)
.........
(Mailing address of applicant)
applican~Ssee, agent, architect, en~neer, general contractor, electrician, plumber or builder.
State
whether
Name of owner of pre,roses. ~.G,~.P ~. .... /~ .~ .~.qL.w_~/~ .¢~9..~. ....... d,.. ~q...~k ......
(as on the tax rolt orla ee ) O'"(DI~o~ .,~t~
If applicant is a corporation, signature of duly authorized officer.
..... ~:O...~. ~. ~w/.< ............................
(Name and title of corporate officer)
Builder's License N°' ' ' '~f' ' '~' ' '~" '?' f~ ..........
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location ofland on which proposed workwill be done..~./~.....~./?.( .g~... · .~.~..~./.~. .......................
5. ................ . ............... ....................
House Number Street Hamlet
County Tax Map No. 1000 Section ...(~.. ~..~. ........ Block .... .6)...~.i ......... Lot (~) /
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of prqposed construction:
c~ ~; ~_ ff zq,Y? / ~ (,.v.~. ...............
a. Existing use and occupancy ...... ~, ............. ~. .................... -/j.- ·
b. Intended use and occupancy ........................................... ~ .................
( ppli ) '
3. Nature of work check which a cable: New Building .......... Addition ...... Alteration ..........
Repair .............. Remo(~al .............. Demolition .............. Other Work ...............
4. Estimated Cost ...... ~ .............. Fee .............................
' '~' (to be paid on filing this application)
5. If dwelling, number of dwelling ~nits ............... 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. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure wiih alterations or additions: Front ................. Rear ..................
Depth .................... [. Height ...................... Number of Stories ......................
8~. Dimensions of entire new construction: Front~...~.~. . ._~?..~.t/(~... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9. Size of lot: Front ...........~ .......... Rear ...................... Depth ......................
10. Date of Purchase ........... ~ .................. Name of Former Owner ........
1 1. Zone or use district in which premises are situated.. . ¢..~: .. ..........................................
12. Does proposed construction violate any zoning law, ordinance or regulation ~..Q ..............
13. Will lot be regraded ..... ~LO., ................... Will excess fill be removed from premises: Yes N~)
14. Name of Owner of premises I ........ Address ................... Phone No. ~.67. 7~;~'....
Name of Architect ........................... Address ................... Phone No ................
Name of Contractor ......... ~ ................ Address ................... Phone No ................
Locate clearly and distinctly all
property lines. Give street and block
interior or corner lot.
STATE OF NEW YORK,
COUNTY OF .................
PLOT DIAGRAM
bu/ldings, whether existing or proposed, and, indicate all set-back dimensions from
umber or description according to deed, and show street names and indicate whether
;.S
............................ i .................... being duly sworn, deposes and says that he is the applicant
(Name of individual sign!ng contract)
above named.
He is the ...................... 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 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
Nora. Public, .. ...... Count
NOTARY PU9LIC State of New Yetl~ , /_..J L...,/-~ (Signature of applicant)
~o. 4707878, $~Jff~J~k ~o~mtv
Term Expires Mmch 30, 19~
TOWN OF $OUTHOLD
OFFICE OF BUILDING iNSPECTOR
P.O. BOX 728
TOWN HALL
$OUTIIOLD, N.Y. 11971
TEL. 765-1802
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because,of tho following reasons.
/Z/ An application for Certificate of Occupancy
/~s not on file.
/Z~ No Underwriters Certificate on file.
/5/ The check is(outdated/not on file.)
No Health Dept. Approval on file.
/5/ No final inspection has boon made.
Please contact our office on this matter.
Thank you for your cooperation.
-Building Permit # ~ 3 50 Z '~¢~
Building Dept.
***/~/ No Plumber Solder Certificate on file.
( all permits involving plumbing being
issued after April 1,1984 )
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECI'OR
l).O. BOX 728
TOWN ItALL
SOUTHOLD, N.Y. 11971
TEL. 765.1802
This is to advise you that the job under building
permit no. 13150Z issued to Joseph Faszczewski Jr
on 5/26/84 for Addition is completed
a final inspe£tion has ( ) has not ( x) been done.
and
[. order to complete this file, it is necessary that
;t Certificate of Occupancy be issued. Please fill out the
enclosed form, return same to the above office with a check
for $25.00payable to the Towa of Southold. Please indicate
to Whom the Certificate of Occupancy is to be mailed, and
arrange with this office for an i.spection date
Occupancy or use is unlawful without a Certificate of
Occupnncy. Please. help .s to clear up this matter so that
legal action does not have to be taken.
Thank you for your prompt attention.
Very truly~,
Victor Les~ard
Executive Administrator
VL:gar
encl .
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