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Home My WebLink About16680-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25719 Date: 05/12/98 THIS CERTIFIES that the building ADDITION Location of Property: 39160 MAIN ROAD (HOUSE NO.) (STREET) County Tax Map No. 473889 Section 85 Block 3 PECONIC (HAMLET) Lot 10.2 Subdivision Filed Map No. -- Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 11, 1987 pursuant to which Euilding Permit No. 16680-Z dated DECEMBER 17, 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 ADDITION TO EXISTING ACCESSORY BUILDING AS APPLIED FOR. The certificate is issued to DAVID CICNANOWICZ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A N/A ~~~'f'~nin spect o r Rev. 1/81 FO~M' NO. 0 TOVCH OF sOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP. MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_16680 z Permission is hereby granted to: ....... ~~t. ~.~.. ;/~ . . to ..... ~ ............ ~ ........ Y.. at premises located at ..~..~.~.....6~.. ......... ....~...¢W~R....I~... ........ .~..~.~..c~.. ........................................... County Tax Map No. 1000 Section .... .C~).~...-~.'. ......... Block ....... ..Q.....~. ...... Lot No...../....O.:..~ ..... pursuant to application doted ~.....%..~ ............... , 19..~...~.., and approved by the Building Inspector. Fee $,.~k,:,,...' ......... Building Inspector Rev. 6/30/80 Form No. 6 APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '7pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. ~ Fees ~ 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildinm - $100.00 3. Copy of Certificate of Occupancy - ~ .2..~¢. ' 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ............................. New Construction.../.. ...... Old Or Pre-existing Building ........... Location of Property ........................... ~..~ ............................ House No. Street Hamlet Onwer or Owner~ of Property ....................................... County Tax Map No 1000, Section ........... Block ....... .. ......Lot .... ' ........... · . . Subdivision ................................... Filed Map ............ ~Z ....... Permit No...i.~.?..~.. ..... Date Of Permit..] J.~..~ ......... Applicant..~.~~ ....... Health Dept. Approval ..... ..~7.~-. ................ Underwriters Approval ........ ~'~.~-,~,-. ....... Planning Board Approvalr. ....................... /~ Request for: Temporary Certificate .......... Final Certicate. Fee Submitted: $ .... .~. ~--' ....... i ............. Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD January 26, 1998 David Cichanowicz 39160 Main Road Peconic, New York 11958 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX XX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is (not on file).$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 16680-Z {Add to accy.) Please contact our office on this matter. your cooperation. Second,notice. Thank you for SOUTHOLD TOWN BUILDING DEPT. OUNDATION (1st) OUNDATION ( 2nd ) OUGH FRAME & FLUMBING ~NSULATION PER N. Y. STATE ENERGY CODE FI .AL - ADDITtONA'L COMME~;TS: fr. 9oroge 81. DG. DEP¥~ TOWN OF $OUTHOLD 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEAL TH .-~jJ~ 3 SETS OF PLANS SURWY ...... CaECK SEPTIC FORM ............. : Examined ~. } .q.., 19 $.q. Disapproved a/c ..................................... ................................. (Building Inspector) APPLICXTION FOR BUILDING PERMIT INSTRUCTIONS NOTIFY CALL ................ MAIL TO: Date ........... , I9. 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 wilt 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 inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .../(?./~/.~!P..*'.(~/./.??~...~.~.0/~) '-4~/~/~'~'-~'~ ·" .... (as on the tax roi1 or latest deed) If apu/-i¢'mWo4s a cor. lm4'atio~m, signature of duly authcg~ed officer. ....... (Name and tit of corpora~,offi~ er) ALL CONTRACTOR'S MUST BE SUFFOLK~COUNTY LIGENSED ~ Builder's License No ........ CQ MJ.A]~? ~...~.O.I.n/~,- 1~ I/¥,.~//- Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ............ ..... ................. ................. House Number Street Hamlet County Tax Map No. 1000 Section ~.'.-). ......... Block .... Lot.. ........ Subdivision ................................... .. Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises anti_intended use and occupancy of proposed construction: a Exisfinguseandoccupancy '.?.Q.I~...?.~.}:eO~./.[A//???..~.?~.? .~.~.l.~../~.4Z f?~..O..t!~.'.~.'.~ ........ b. Intended use and occupancy .... ~..C..~..~. *~-~. 0.?'. 7....~-~!1.).~..~..~. ~)h/..~./O ~.. ~ ·/~./~J ...... 3. Nature of work (check which applicable): New Building ' ' Addition. i.~... .... Alteration .......... Repair .............. Removal .............. Demolition ........... ,... Other Work ............... 4. Estimated Cost ..................................... Fee .......... , ............................ (to belpaid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling un{ts on each floor ................ If garage- number of , cars ........................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each ty )e of use ................... .. 7. Dimensions of existing structures, if any: Front ............... Rear ............. Depth ............... Height ............... Number of Stories ........................... ~ ............................ Dimensinns'of same structure with alterations or additions: Front ........... J ..... Rear .................. Depth ...................... Height ...................... Number ol Stories ...................... -.8. Dimensions of entire new construction: Front ............... Rear ....... J ....... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ' ... Name of Former Owner ............................. 11. Zone or use district in which'premises m-e situated..................." ........... .... .... ' 12. Does proposed construction violate any zoning law, ordinance or regulation: ... ~ ............................ 13. Will lot be regraded . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises. ................... Address ............... . ....Phone No ................ Nmne of Architect ........................... Address ............... , ....Phone No ................ Name of Contractor .......................... Address .... : .......... i ....Phone No ................ 15. Is .this property located within 300 feet of a tidal wetland? *Y~s ..... No ..... *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, i~dicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and mdmate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................ .h. Y- .... (Name of individual signing contract) above nmned. being duly sworn, deposes and says that he is the applicant Count~_ ~ ~, ~. ~ ~ (Signature of applicant) He is the .... (.~. /CC (Contractor, agent, corporate officer, otc,)' of said owner or owners, and is duly authorized to perform or have performed the smd work and to make and file this. application; that all statements contained in this application are true to the best ofhi~ 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 ] ................... day of ....... ,19.. i