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Home My WebLink About16202-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z16429 Date November 23, 1987 THIS CERTIFIES that the building ....A.d.d.i.t.ig.n ..................................... Location of Property 3200 Deep Hole Drive Mattituck House No. Street Ham/et County Tax Map No. 1000 Section I 15 ...Block 17 .Lot 13 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated July 2, 1987 pursuant to which Building Permit No..1.6.2.0.2Z .... dated July 12, 1987 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 ......... 2nd story add~tzon to an ex~st~ng one story famzly dwell g. The certificate is issued to BE, NJAHIN & JOAN SKUBLISKAS .................... ?o¥.'o;, ................... of the aforesaid building. Suffolk County Department of Health Approval ..... N/A UNDERWRITERS CERTIFICATE NO. HS42687 11 / I I/87 PLUMBERS CERTIFICATION DATED: JOHN E. WALTERS PLUMBING AND HEATING ! 1/20/87 Rev. 1/81 FORM bro. 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT ('FHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ t6202 z Date ........ /.. ......................... 19..~..'7 Permission is hereby granted to: ....~...~.3...............................-~ ~ , ................ '. ...~~....~.~. ..........,,~.t...../. ...... ,o .~...~....,a...~..¢....~.....~..~.~......~..~ .at~.. ~ "~- · ~....~~....~..~~.¥..~.....q~.~....,~_ ......................... at prem ses located at. ~...~:...?..e~ ...~.~,~.....,.~..~../.).~..~..~ ... County Tax Map No. 1000 Section ......... J.J~..:~... .... Block ....... /....~. ........ Lot No ......./...~ ............. pursuant to application dated ...... ....~....~......'~... ................. ,19..~...~., and approved by the Building Inspector. , D Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hell Southold, N,Y, 11973 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF $OUTHOLD Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ to the Building In~ec, tot 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 featu res. 2.Finat 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. 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, ocdupancy 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. Foes: Additions $25.00 POOLS $25.00 1. Certificate of occupancy New DweJ. l~ng $25.00, Accessory ,$I0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0 3. Copyofcertificateofoccupancy $ 5.00, over 5 years ~..~ 4.Vacant Land C.O. $ 20.00 New C o n s t r u c t ~ o n ...... Old or Pre-ex isting Bu ilding ............ Vacant Land ............. Location of Property ....................... ,~o?OO .~./~'~-P /?..~:)/-..-/~. .... /??'.~,... ............... .,~.~.~"../,.T..~.K Hous~ No. Street ~an~let Owner or Owners of Property ....... ~ ~ L[.5~' . //g" /y. 14. County Tax Map No, 1000 Section ............... Block ........... Lot ........... Subdivision .................................. Filed Map No ........... Lot No ............. Permit No. //.~.~. ?.~...~Date of Permit' . .~./?:'./~'.~..Applicant ,/?~.~. Health Dept Approval ' Labor Dept Approval Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate Final Certificate ~ Fee Submitted $ ............................. Construction on above described building and~ermit meets all applicable codes and regulations. TOWN OF $OUTItOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTtlOLD, N.Y. 11971 TEL. 765o1802 fL2L.JL'_r_!, r J' c A 'r z o N l ¢:c, rt.i. fy I-h-~L the solder used in the water supply system contaSns less than 2/]0 of' 1% lead. s signature) Sworn] t.o before rne bhis ........ y E~B~ ANN N~IL~ .............. Note~ Public, State of New York No. 52-8525850, S~olk Term ~ires ~o~r 3~, ~9~ UND~TION ' (1st) UNDATION ( 2nd ) UGH FRAME~/'/ PLUMBIN/ SULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001381 j~ kh SUR£AU OF ~ov'cl~)er 1,'[,, [9~7 85 JOHN STREET. NEW YORK. THIS CERTIFIES THAT only the ~lectrtcal equipment ~ ~scrlbed beJo~ o~ int~duced by t~ applicant ~med on the o~ve 6pplicotion ~mber in the premises of Ben Skubl~skas, Deep Hole Dr., ~c~ea~ Dr. & ~ew S~folk Ave., ~uck, Ist FI. ~- 2~d FL Section Block Lot and found to be n compl ance with the req~drements qf this Board. FIXTURE SWITCHES OUTLETS FLUORESCENT FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS FANS 15 25 21 11 4-70 DRYERS FURNACE N~OTORS TIMECLOCKS NIT HEATERS MULTI.OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R OTHER APPARATUS: ~...~200 ~p. ~ransfer S~itch ~lOIE DET~T~$--1 OF CC COND 2/0 I NO. OF HI-LEG AWG, OF HI-LEG NO OF NEUTRALS A, WG OF NEUTRAL 2/O Jody Pumi[lo Pat Lane ~;~a~ titu~k, N.Y. 11952 1£c.#2300E This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be ident[fled by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ~,LTERED IN ANY MANNER. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG.' ~,~s · [ ] FOUNDATION 2ND [ ULATION FRAMING [ ] FINAL DATE INSPECTOR 765-J.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [~ROUGH PLBG. [[~FF~UNDATION 2ND [ ] INSULATION MING [ ] FINAL DATE TOWN OF SOUTIIOLD OFI:ICE OF BUILDING INSPECTOR ILO. BOX 728 TOWN IIALL SOI. ITIIOI,D, N.Y. 11971 October 21, 1987 TEL. 765-1802 Hunt Development Corp. Box 899 $outho]d, N.Y. ll971 To Whom This May Concern, Re: Benjamin Skubliskas We are unable to complete your Certificate of Occupancy because .of the following reasons. _~ An application for Certificate of Occupancy is not on file. /~_~/ ?;o underwriters Certificate on file. /]-_/ Thc! check is(outdated/not on file.) /[[/ No Health Dept. Approval on file. /~/ rk~ finol inspection has been made. Plense contact our office on this matter. Thank you for your cooperation. ~hli].(]inq Permit t~ .L ~ ~ ~ ~ Z ELl.[].dinq Dept. ***/~/ r;o Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) FORM NO. 1 TOWN OF SOUTHOLD CNECK BUILDING DEPARTMENT SI~PT[C TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-18013 CALL MAIL BOARD OF HEALTH 3 SETS OF PLANS '~'''':~ SURVEY .......... ..~O~. .... FORM · 4~J)~ .[.%. 19~? Examined..., · · Approved...~a'~. I.~. .... 19~. ?. Permit No. J../o. .&.°. .&. .'~. Disapproved a/c ..................................... ................................ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS .. 7.~.~-:. % t 0/$.. TO: Date . .//.2~.. ........ , 19f 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 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. Tt~e applicant agrees to comply with all applicable laws, ordinances, buildiog code, housing code, and regulations, an, d~o admit authorized inspectors on premises and in building for nec~g~y in%pe~ctlons.~ / _/ ~*~ . ~ /~ / ~ ~. --(Signatureof~l~plicant,.ornam?,iracorpora~i°n)_~/_.~_ -- ./:. ................ (Mailing address of a~plicant) State whether app,Uc~nt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....~.~.,~l...('.%_~. CK~. -.~. i.~..~. ................................................................. Name of owner of premises ......... ./.~. ............................... . ........ (as on the tax roll or latest deed) ) ' r If a lic ~a corpor ti 'gn ture ~ly authorized office . ,,, .... B,,I~ ,r's License No...2~_,././. (.~v..-..'q.....) ...... Plumber's ~icense No. s~.~..P~./...~.'...~. · ./~../.~.~ Electrician s License No./~"~../707.0..C~..4J.. &.~..~'. Other Trade's License No ...................... 1. Location of land on which proposed work will be don% ................................................. t~o u~e..~N.ug~9....~. ~.~..t..~.- ..... ~ir~e t~'~ ~ ................. ~t~ 'm'l~ ........................ County Tax Map No. 1000Section .~...°-2T../'{...J..[,-~... Block .... !./. .......... Lot...]..'~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy ~f,,premises and intended use and occupancy of.-~oposed construction: a. Existing use and occupancy ........ : ............... ' b. Intended use and occupancy ............................................... 3. Nature of work (check which appli'cable): New Building . .'...' ..... Addition ......... teration .; ..... -;... Repair .............. Removal .............. Demolition ............. Other Work ............... 4, Estimated Co ...................... 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, qommercial or mixed olccupancy, specify nature and extent of each type of use ...... ~7. ............. 7. Dimensions~of_e~,i~ting structures, ~f any: Front .... *-~..' ...... Rear ...~.~..'.;... Depth ...".2-...(? ........ Dimension~};oi; ~rl~,l~cture withialteri~tions or additions: Front ... ~. ......... Rear: ,ff...~...' ........ Depth .... ~.L:~ .............. i Height . .,z~-,-, ............... Number of Stories .... i.~-. ............... 8. Dimensions of entire new construction: Front .... ,~..~.. ..... Rear...~..~. ........ Depth . .~-..~ .......... Height .... /. C,.) ........Number of Stories .... t. ................................................... 9. Size of lot: Front ............. ~ ......... Rear. ........ . ............. Depth ...................... 10. Date of Purchase ............. : ................ Name of Former Owner ............................. i 11. Zone or use district in which premises are situated .............. ....................................... !12. Does proposed construction violat~ any zoning law, ordinance or regulation: ..... .AJ.I~ ....................... 13. Will lot be regraded ........... ~rkJ~) .............. Will excess fill be remo. ved from premises: Yes No Name of Architect . ' .. Address ................... Phone No ................ 15. Is this property located w~thin 300 feet of a tidal wetland? ~Yes ..... No ..... *If yes, Southold Town Trust!ets Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and, indicate all set-back dimensions from 9roperty lines. Give street and block number or description according to deed, and show street names and indicate whether :nterior or corner lot. STATE OF NEW YORK, S.; 20UNT~ OF ............ ~ .... , .... .k,-~.\ .~d.59:~ .... I ...................... being duly sworn, deposes and says that he is the applicant (Name df individual signing contract) tbove named. te is the...~..~.o~. .... 2 .~.., ! (Contractor, agent, corporate officer, etc.) ~f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this ~pplieation; that all statements containled in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this .............. ~ ....... day of..i'..'~.' .br..lr.q..-- . ,19 ~./~/ qotaryPublic, ..~_~......~...0~...ff..~../.. [ ''.I '~2~~. ~ M~ I*IREN I~ D£ VOE i ............... xm'~ffgC,~oof~owy~ 'x ~ (Signature ofa ' _ NQ,,.4707878, Suffolk County (':,~, ~ ~it~ ~ch 30,1~..2.~ / pphcant) i LLI