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Home My WebLink About16643-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy No... Z.: .1.7.q [ ,2 ....... Date ...3 .u.n.e...2 9.,.. ! .9 .8.8 ............... ONE FAMILY DWELLING THIS CERTIFIES that the building ................................................ Location of Property 600 Indian Neck Lane Peconic, N.Y. House, No. Street Ham/er County Tax Map No, 1000 Sectiou . . .0,8.6 ....... Block . ...0.4 .......... Lot .. ]: .8 ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated November 18, 1987 16643 Z ..................... pursuant to which Building Permit No ...................... dated..................N°vember 23, .......... 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 ......... ONE FAMI'LY DWELLING WITH ATTACHED GARAGE AS APPLIED FOR The certificate is issued to .... LAWRENCE J. SUSKEVICH ................. ?oT,.'o'r, ..................... of the aforesaid building. Suffolk County Department of Health Approval . . ,8.7.-; 8. 97.2.3. .2.7..J.u..n .e..9. ,...I .9.8. 8. ........... UNDERWRITERS CERTIFICATE NO.. ?.E.N..D .I.N.G..-:..J.u.q e...2.0.,...1 .9.8.8. .................... PLUMBERS CERTIFICATION DATED: June 18, 1988 -Stephen O~Connor .......... Bnilding Inspector Rev. 1/81 I~ORM NO. B TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALt. $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) NO_ 16643 Z Permission is hereby granted to: ....... ............. ,,~;~ .~ .~.~.~....~..~2~... ~ ............................................................. Coun~ Tox M~p No. 1000 Section ..... ~.~ ......... Bilk ...... .~.~ ....... Lot No ..... ~..~.~ ............. pursuant to oppJication dot~ ...~.~..~..~ .................. , 19.~].,, and opprov~ by the Building Inspector, Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 BLDG. DE, PT. TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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 featu res. 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 peoperty showing all property lines, streets, buildings and unusuat natural or topograph ic 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 ~r land use $ !o! $5.00 3. Copy of certificate of occupancy $1.00 Date ....... New Building ............. Old or Pre-existing Building(Z) ......... = ZVacant Land ...... House No. / Street Hamlet Owner or Owners of Property ~ ~ ~ ................................. '' CountyTax Map No, 1000Section .... O~0eL' Block D~¢ Lot Subdivision.~-')t~.~./~...~ .... FiledMapNo..,~j.~.,~' .... LotNo..~. .......... Permit No...~----~. Date of Permit..//l. .3/.//?Applieant 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 pg.~l~e_C~.all app~~nd regulations. A cantj ~'~'~---"~ ...~.'.~ PP ~': .... .~ ...... -'-' ',' ..... ~..~_ ....... .-. ............ 7 .... . ..... Rev. 10-10-78 TOWN OF SOUT~OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. 16643 Z Owner LAWRENCE J. SUSKEVICH (please print) Plumber~~! ~. "_~[ ([}lease print) I certify that the solder used in the water.supply system contains less than 2/10 of 1% lead. ~umber s signature) Sworn to before me .this 19 Notary Public HELEN K, DE VOE NOTARY PUBLIC State el Ne'g York No. 47078711, Suffolk Co~lnty .~5; Term Expires [,,,leith 30 1S.----~"' FOUNDATION FOUNDATION ( 2nd ) ROUGH FRAME~ .PLUMBIN~ INSULATION PER N. STATE ENERGY CODE FI~AL AD ON~L C( MENTS: 0 Io5. 765-~802 BUILDING DEPT. INSPECTIrON FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [~ROUGH PLBG. [ 1 FOUNDATION 2ND [ ] INSULATION [/J/FRAMING [ ] FINAL DATE ;//~//fi? INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [/~"~UNDATION 2ND [ ] INSULATION FRAMING FINAL REMARKS: DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []/ROUGH PLBG. / FOUNDATION 2ND [,'~ INSULATION [ ] FRAMING r ]FINAL REMARKS: *-~_.,~ ~, ~ DATE 76S.1802 BUILDING DEPT. ~ ,~~- INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ J FOUNDATION 2ND [ ] INSULATION [ ]FRAMING [ ~//~FINAL ~ DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION '~FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING FINAL DATE ~, , ~PP~O¥~D O ~ ~-.,~/ 2t,1 ~e water supply and sewage d~spos~l ~ystems fo~ this residence will conform to the standards o,~ the Suffoik County De~>arfment of i'lea[th Services FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y, 11971 TEL.: 765-1802 Examined ./~....e~....~....~.-~., 19~.~. Approved .~. ~ .(-~9....~..~., 19~.7. Permit No. I k ~.q .~.. Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~ Tins 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. 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 necessary inspecJ~o~s. . /~ , /~ ....... ..... (Signature of applicant, or name, if a corporatfion) ........ :.t . . . . q &e. . . . .,go. ., .............. ........ i~iii~6~ address ~p ' [~ ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant ~1*~ation,~n~ureJduly authorize, e.e~officer. .... ~ (Name and title of corporate officer) Builder's License No ...... 't ............ ~' "~'" Plumber's License No....~..~ .9. · .~. ·..~?. · .~)' Electrician's License No.. ~..t~...(..4q4%./~. ~-ff.... Other Trade's License No ...................... Location of land on which proposed work will be done...?d..~. ............. ~,.o..~.': ?.+....,t?~?. :~....,,.,. ?~ ~.. ............. ~.~...~,'..~.. ..................... House Number Street County Tax Map No. 1000 Section ....... ~.~ ......... Block .... Subdivision./~/~'9..b~./?~..'......~ff4.. ............ Filed Map No. (Name) Hamlet ........... Lot .... /, .~... .......... ...)./~' .~'. ...... Lot ............... 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 .....~6. ....... .?./ ................................................... 3. Nature of work (check which applicable): New Building .......... Addition .. i ....... Alteration .......... Repair .............. Removal .............. Demolition ........... i.. Other Work ....... , ........ ~ i (Description) 4. Estimated Cost ......... , ................. Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling.u_nits .... .~f.~. ..... Number of dwelling unit~ On each floor ..... ........... If garage, number of cai's .... ~ .................................... ' .............................. 6. If business, commercial or mixed occupancy, s[~ecify nature and extent of.each typic of use ........ ; ............. 7. Dimensions of existing structures if any Front ........... Rear . i Depth Height Number of Stories Dimensions of same structure witl~ alterations or addition~: Front .......... ~. ~ .... ,. Rear .............. Depth ...................... 'Height ........... o..,.g ....... Number of ~,tories ............. r ........ 8. Dimensions of entire new construction: Front .... .~. ~..¥ ..... R'ear~ . '~*. ~.q'. . Depth .. ~.~ .......... Height ..... ]~ ........ Number of Stories . t0~9.~. ......... i. i ....iI. .'." 9. Size of lot' Front /,1''~ Rear Z$~.. '~ 10 fP N fF · Date o urchase .......... ., .................. ameo ormerOwner . ............................ 11. Zone or use district in which premises are situated i . 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~t.o ........................ 13. Will lot be regraded ....¥~.~. i..~: .,9.' ........ '... Will excess fill b%remov~ ~om premises: Yes 14. NameofOwnerofpremistes,~...~....d.~.~.¢~..~...Address~..~.q~.~,~.*.,.__.. "e'. PhoneNo . Name of Architect ,. / .,~ , Address .~.~-~'~,Phone No'' ' X ' ' ' Name of Contractor. ~. ~.~(*~. ~. ]~,~:~.¥', ._~/ .... Add/e~s~'~.[./..~..~.. ~,?: .~. ~.. Phone No..'~'.¥~Z .,~..... 15. Is this property located w~thint.00 feet of a tidal wetland? * (es ..... No ~..,. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, in{ .icate all set-back dimensions from property lines. Give street and block ,number or description according to deed, and sho~' street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF .... ~ .......... -- . ..........('I~a'n~ e~i:~l'~s~}~i~?'c'~o?n'~/c'/tg, g ) ........... being duly sworngd~[ ~ t.ap:licant above named. ~t~ ~ :' He is the u~~ ~.~! ~ ~=~ ........................................................, .... (Contractor, agent, corporate officer, etc.)~ of said owner or owners, ~d is duly author~ed to peff6rm or have performed the s~ id work an~r~[6~ ~nd file this application; that all statements contained ~ this application are true to the best of his ~owledge an~.~e ~nd that the work will be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me this ....... /.~. .............. day of...~..., 19~2 f Nota~ Public, . ...... ~ ............. County ~ ~ ~ ~5 ~ ~o. ~2568, 8~k ~' 3 i (Signature of applicant) ~rm ~lr~ ~r 31, 1~~ ~ SLFFOL~ COUNTY DEPART&'~rJ~ HE, A~)'~4 ~ SINGLE FA~ILY ~U~ ~Y DAT~~HS. REF. NO. ~~ The ~wag6 d~spos~ ~nd w~ter supply t~ ~ ~ I~n have ~en ms~tcd by t~ ~ ~/~ LO'/' ~, 7~:) '7,c:;z (~ S.A-F // ,> JLDER uSED tN WATER suPPLY sYSTEM CANNOT ExcEED 2/10 of I% LEAD. PLUMBER CERTIFICATION ON LEAD cONTENT BEFORE CERTIFICATE OF OCCUPANCY o F 0 U /' :..,,- '".-,-'¢q: , ;: ,, :":' ~;'M~/~/'.: ' , " , , . , ., : ," ~ . , ' . - .:, ' - ,' : .,. ':',--.' ,,'.,;-, :, , . ~ . a t ~~ ~/~ ...........~ ~ - ..................... .................. j . : .... , ...... ~,..., ~l~Z . ... __ . ' ' ~ .'. ' . ----' ...... DI ~ ., , , _ r , ' ' ', . ,: , .... USE ~ ~ .......... = ~. ,~ .......... - ', ......... S''~ ,' .... "- EAD. .... ........ , ', ' ':j : - . ,',.' ' .' .... '' ...... 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