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Home My WebLink About13189-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13286 Date March 29 1985 THIS CERTIFIES that the building .... 0. n..e..f.a.m..i.ly..d..w.e.l. 1. $.ng ...................... Location of Property County Tax Map No. 1000 Section . .1. 1.4 ....... Block ...6. ........... Lot .... .q .4 ........... Subdivision...V. 5:..~.~.a.~e...~.a.n,o.? ............. Filed Map No. 3.6.6..9 .... Lot No.. 1 7 .. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .M.a. 2-..25 .......... ,19.8.~. pursuant to which Building Permit No. 1.3. ! .8.9. Z. .............. dated .... .g.u.n.e...4 ................. 19 .8.6., 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 ......... One f amil)r The certificate is issued to . FRANK CICHANOWIC Z III (owner, of the aforesaid building. Suffolk County Department of Health Approval ... ~..-.S.Q v 3.0..q ./.12./.8. ~ .................... UNDERWRITERS CERTIFICATE NO. #N673999 q/q0/85 PLUMBERS CERTIFICATION 3/28/85 Rev. 1/81 Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13189 Z Permission is hereby gronted to: ..~~rt~--~.....;...,..'~.:..... J. ......... ..~..;a,, .... , ~~...~.~ ~..~... ~ ~..~... ~ ........................................................ ;'"':' ............ :'""~ ............ ~'"':""'~"'r .................. ot premises Iocoted at ../..~...:.~....~. ........ .L~...,4~C~$.,.~,~.,.,...~.~ ................ Co.n~ Tox Mop No. ,000 Sec,,on ..... Lt.f. ......... B,~ C, Lo, No. /. ~ Building Inspector, Building Inspector Rev, 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate 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- lions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approva~ 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 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. Fees: 1, Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling 3, Copy of certificate of occupancy $1,00 4.Vacant Land C.O. $5.00 $15.00 Date March 29th, 1985 New Building ....X.X.X.X ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property 1070 Village Lane, Mattituck, N.Y. 11952 House No. Street Ham/et Frank Cichanowicz 111 Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section 114 Block 5 Lot ] ~o. Subdivision .V~gg¢.Z~Pg? ................... Filed Map No. 3669 .... Lot No. 17 .. 13189 Z. 6//~/84 annJi~nnt Frank Cichanowiez Permit I~o ...... Date of Permit Health Dept. Approval 1480 30 .Labor Dept Approval ..... Underwriters Approval 673999~1 [10/85 .......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ., X 5.00 Fee Submitted $ ............................. Construction on above described building and e codes and regulations. Applicant ....... . .~cr...Y~..%-..~ ....... ~ .................... Frank Cichanowicz 111%1~ R...,0-,0.a/ FORM NO. 6 BuildingTown Hall Department Southold, N.Y. 11971~ · ,. APPLICATIQN FOR CERTIFICATE OF OCCUPANCY h~strt~c tic)tls must be filled in typewriter OR mk, and submitted m duplicate to the tJdm ~g; for new buildings or new uso: ,su~ey of property with accurate location of all buildings, property lines, streets, o~ topographic features. ~roval of Health Dept. of water supply and sewerage disposaf-(S-9 form d of electrical installation from Board of Fire Underwriters. ' 4.' buildings; Industrial buildings, Multiple Residences and simih C~te of Code compliance from tim A'rcbit~ct 0rE, nflmeer~r0spo~sible.~ lannlng Board approval of c0rnpieted site pian requ reme 1ts where ~g',bbil~ings (prior to April 1957)~ Non-confqrming uses, or buiidihg~' '~ ~ey of peoperty showing all property lines, ~reets, features. ,' ~ent of owner or previous owner as to u~e occupancy ~nd con'd~ti~ F,'housin~ (;ode or safety, inspection of buildings or p[e~ises, to prepare a ce~ificate, af bccupancy on pre existmg dwe!lio~ ~c ~an(I u~;e "~ /~$5.~)0" ,rtff~cate of~bccupancy $1,0 / , "~ .... ....... Old o ..... a La0e, ;M~titu ., .... ~, ,,. N~ Wzllzam & Patrzcza Baxte ., :: ' ::~ ~i per~y , ~9b~$. ~ Jane ~9~ ~gC, an~ i~qGt,b.~ .PZ ~.~ :,,1000 Sbction .,,, 114, , .~,.,,.~Bl6bk '~ ,:.,~.,6. .... ....Filed "Map ~e Applicant .., '~ _: .. Da of Permit .... .,~.... ~,.-~.,%, )p,ov~l .....~........ ....... Planmng Board Approval ,..~. ,, . ...... Applicant am -, TOWN OF SOUTIIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION (please print) Plumber . (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (p~mber' s signature) Sworn to before me this 19 ~-. // Notary ~ub ' Notary Public ,~County ~ ~ARY PUBLIC, State of ~w Yor~ No. 4787124, Suffolk ~ ~erm ExpJres March 30, (516) 283-4567 Distinctive Landscape Concepts (516) 734-6366 Route 25 Peconic, L.I., N.Y. 11958 /o 70 C FIELD -INS~'~CTION FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (1st) (2nd) INSULATION FEE STATE ENERGY QODE FINAL COMMENTS ADDITIONAL COMMENTS: TO\VN OF SOUTHOLD OFFICE OF BUILDL~G LNSPE(TFOR TO\~ .~ I-L.\ L L $OUTHOLD, N. Y. 11971 TEL. 765~~£02 M EM OR A ND U M SUBJECT: Building Permit Applications Building Permit applications for all new buildinzs and additions to existing buildings_ shall include ~'~..~ £ollowiflgi ~ ACCUP~ATE PLOT SURV~f SHO,,_i,G. Eb:isting or proposed s '--~ uc'-'~ure Dimensions of set backs zrom all bouun~__es ~'~ Ti-~'~E-. Sz~b OF BUILDING PLat\rS TO INCLUDm.- ~' Foundation plan ,-~ . Floor plans .. Elevations Cross Section showing: Foundation Floor joist Ceiling joist Insulation Rafters All construction detailing, shall meet New York State Building Construction Code and conform to New York State ~'ner~r Conservation Construction Code. DAT~: April 6, 1979 DEPARTMENT OF HEALTH SERVICES COUNTY OF SUFFOLK PE'~'ER IF. COHALAN SUFFOLK COUNTY EXECUTIVE May 22, 1984 Mr. Frank Cichanowicz III P.O. Box 180 Peconic, NY 11958 Dear Mr. Cichanowicz: SUBJECT: BOARD OF REVIEW HEARING REGAiIDING 14S0-30, PROPERTY E/S VILLAGE LANE, 1033 FT. N/OMAIN ROAD, MATTITUCK, (T) SOUTHOLD At the hearing held on May 4, 1984 you had an opportunity to present your appeal of the department's ruling on the subject application. In accordance with the provisions of Section 220, Article 2 of the Suffolk County Sanitary Code,.the determination of the Board of Review is as follows: Based on the information submitted, the application is approved. Very truly yours, ~J2hairman, Board of Review cc: Mr. Royal R. Reynolds, P.E. Mr. Gary Flanner Olsen, Esq., Main Road, Mattituck, NY 11952 Mrs. Walter R. Jackson, P.O. Box 845, Mattituck, NY 11952 Mr. Henry Kuhn, Village Lane, Mattituck, NY 11952 TUT-NOT£ GARY FLANNER OLSEN COUNSELLOR AT 1AW P, O, BOX 38 ' MAIN ROAD r~ATTITUCK, i. L NEW YOrK 119~2 {~16) 298-4844 t0: Southold Town Building Department Hain Road Southold, NY 11971 k Re: Baxter to Lynch File #3673 Enclosed herewith, please find an ~ application for a Vacant Land Certificate~ of Occupancy in re the above captioned matter, and my attorney's check in the sum of $5.00. SIGNED Enc. :. 1/16/84 DATE: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 . . TEL.: 765-1802 Approved · ., 19~' '~' Permit N°' / ~) <dc] :~ Disapproved a/c .......................... ' ........... Application No .................. (Building Inspector) APPLICATION FOR BUI LDING PERM IT 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 issne 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 Occupai~cy 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 necessaryeinsp~ions. ~ AD - i .,; .... ''' i~i~l;it~r'e of ~pplicant, or name, if a ;N~rporat'o ) (Mailing address of applSffant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ .... ....................................... F'~xo~-Z ~[~/~/,~ooo,c~ ~ ......................... Name of owner of premises - · ..... - ...................... (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ~7o C9,//~:~-..Z...-e?v...~ ............... .................................. ./77/..o. . ............ House Number Street · . . //< Cohnty Tax Map No. 1000 Section ........ ~. ........ Block ..... Subdivision.. ~?.t./../.~.. ~. .... ./..5~.7...~: ./~. O.~...- .... Filed Map No. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy,...~....~- ~.~..~.~ ........................................ b. Intended use and occupancy .. 3 .......... ~, ......... ~ ..................................... Hamlet .......... Lot .... .~: .~. · .......... · .,~..~-.~.- ~.. .... Lot .... -/..7 ...... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... '~ (D ripti ) ' ese on 4. Estimated Cost ......... . ........................ Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling Units ................ Number of dwelhng umts on each fioo ...... If garage, number of cars ..... ! .... [ .~...~.c~ ..................................... 6. If business, commercial or mixed occupancy, specify~,--'natUre and extent of each type ,°f use ........ ......... 7. Dimensions of existing structureS, if any: Front.. ~, .......... Rear ...-$7~... ........ Depth . · .~.,-~' · · · 1.'ff. ! Number of Stories '. ..... I ................................................ Height ............ Dimensions of same structure with alterations or additions: Front ................. Rear ................ ' Height Number of Stories Depth ...................... 8. Dimensions of entire new constrUction: Front ....(,~, ........ Rear ... ~ ........ Depth .. · .Z,.. ~,~. ..... Height ........... Number of Stories ......... ,~ ~. :,'; .................... ~' ,:d,~,' ? ........... 9. q~,2,,*'l,~; ~;,,,,t I~C~ -~- .. Rear .i~..~.,.f~ . Depth ...4-~>iO ............ Date of Purchase ~..-;. ~,~..-:.f~ 9. · .. N~ame of F~ormer Own,~er ... .--v. ............ Zone or use d~stnct ~n winch premises are situated ~ .~..~ ¢ Clx. ,~. ............ Does proposed construction violate any zoning law, ordinance or regulation: ............................. · a ed . q~.~:~-... Will excess fill be removed from premises: _ Yes (rN0~ Will lot be regr d ..... 7' ....... Name of Owner of premises . .~.~to.~..C-4.c/ff~A~. g,Address ,..L,~.q4...~...?-,~..~'.. Phone No..'~3..~.~[~'2~. · · Name of Architect .~,~ ~. .... ............ Address ............ Phone No .............. Name of Contractor ........ Address ................. Phone No ............... lO. Il. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockl'number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................ (Name of individual si above named. S.S ...................... being duly sworn, deposes and says that he is the applicant ning contract) He is the ...'..".'. ............. ., .............. ; .............. :. ...................................... (Contractor, agent, corporat~ 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 contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the man,er set forth in the application filed therewith. Sworh to before me this !, ' '. ........................ dayiof ..................... ,19... xx.~.X~ignature of applicant]l r~ ~ 8 ~,~:, 1'7 7 , 5 /8 I I )oo. oo / /