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Home My WebLink About16065-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z-16289 Date October 15, 1987 THIS CERTIFIES that the building ACCE S SORY BUILDING 4520 New Suffolk Road New Suffolk, New York Location of Property .......................................... House No. ' ........... 'E't/a~i .... Hamlet County Tax Map No. 1000 Section 117 .Block ...0.7. .......... Lot 08 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated May 20, 1987 16065 Z ..................... pursuant to which Building Permit No ...................... June 14, 1987 dated ............................. 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 ......... ACCESSORY BUILDING AS APPLIED FOR The certificate is issued to FRANCES J. f PEggY MAJESKI ..................... /ol;.'o;, x .................. of the aforesaid building. Suffolk County Department of Health Approval ..... N / A UNDERWRITERS CERTIFICATE NO... N/A N/A PLUMBERS CERTIFICATION DATED: ~ BuildJSfg Inspector Rev. 1/81 FOB,M[ NO. 0 TOWN OF SOUTHOLD BUILDIHG DJ:PARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 16065 NO- Z Permission is hereby granted to: , · · ..- , County Tax Map No. 1000 Section ..... ~.J....-/. ......... Block .......~..~ ........ Lot No .......~....~. ............ Building Inspector. Building Inspector Rev. 6/30/80 FQRM NO. 6 TOWN OF SOUTHOLD Building Department Town Hail Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ,., ~ 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 naturat 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 instaila- 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 p~operty showing all property lines, streets, buildings and unusual natural or topographic 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: Additions $25.00 1. Certificate of oacupancy New Dwelling $25.0.0, Accessory,,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.updated C.O. $ 50.00 Date. October 8, 1987 Newconstz"uction Old or Pre-existing Building Vacant Land 4520 New Suffolk Lane New Suffolk, New York Loaation of Property .................................................................. House No. Street Had;let FRANCIS J. MAJESKI & PEGGY MAJESKI Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section 117 Block 07 Lot 08 Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. .16065 Z fP it . Date o erm cant ................................ Health Dept Approval ........................ Labor Dept, Approval .................... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $ ~0.00 Construction on above described building and permit meets all applicable codes and regulations. Applicant Francis J. Majeski Rev. 10-10-78 3.33 OUNDATIO:; ( 1 st) OU!~DA T IO}~ ( 2nd ) OUGH FRAHE & FLUHBING L';SULATIO~; FER N. Y. STATE ENERGY CODE FI]~AL · ADDITIO}IAL CO~.~&M'E~ITS: BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. I SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N,¥. 11971 TEL.: 765-1802 CALL ................ .... AY201987 ~lsapproved a/c .................... ~ ~ ~ 17 ............................... ~ .......... ~ . !(~*,¢;'~ <>~ :~,,~7~O~ (Building Inspector) APPLICATION FOB BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. Tiffs 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 .g, ho!e'or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspe~.tor..,~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the T0?la ~of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bujldiims, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply w~th all, {lpElicable~ la~% or&nances, building code, housing code, and~ regulahons, and to admit authorized inspectors on pre/nises and in building tbr necessary inspections, (Signature of applicant, or name, if a corl~oration) . (Mailing ~aSdress of applj/aht) State whether applicant is owner, lessee, agent, architect, engineer, general 6ontractor, electrician, plumber or builder. ...... .......................................................................... Name of owner of premises .. ..... .~...ff.~.... J.~....'J'7 .... I7]. ~'7...~. i~ .~.../~...'] ........................ · (as on the tax roll or latest deed) If applicant is.a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED 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 d o~e~. ~. 0... N .~...Md...~.. ?...~..~..o~ ..~. ~;/...~..,~.../~.~ ...... ........................................................ .W. . ?. . . ., ./v../ .... House Number Street Hamlet County Tax Map No. 1000 Section .... //...7 ......... Block ..... .7. ........... Lot ..... ~ ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... /~. O..1~. ~ · b. Intended use and occupancy ......... ~...T'...~.. ~. J.~..~.. ~: .... .g. PJ'..t~.D.. .......~..~..~..~...-q.~...~. k. ...... 3. Nature of work (check which applicable): New Building ......... Addition .......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work ............... .~2 ~ (Description) 4. Estimated Cost ...... i ......................... Fee ...................................... (to be paid on filing this application) 5.If dwelling, number of dwellinglunits ............... 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 hse " 7. Dimensions of existing structures, if any: Front ........ Rear .... ·: ....... '.. De~.!h,, '.L... Height ............... Number of Stories .. ~.. ..... '.. ' ........... ' ........ '..'..' .....'.. ............. Dimensions'of same strfi,~ture With alterations ~r ~ions: l~ront ................. Rear .................. Depth ............. . ..... i-. Heigh~t ~'.~ [. · '~'i~.~'~'~' · · ~, Number of Stories ...................... .... 8. Dimensions of e~.nti)'e new eonstruct!oq ~ .~. ~.~..~...~.~1~,,, ..... ~..~.o. ..... Depth :7...."~. .......... Iteight ..... ~ ........ Nun}l~¥~l~ ~ ~.~n. ~:~,~. ~..- .................................. ..... 9. Size of lot: Front ..~-.... tN~J .%1.'. tn..~ lll~e"~,~t.~ fi. ...... · ......... Depth ...................... 10. !)ate of Purchase ....... .~.V, .~.~,.. ~'~..~. ~,.~.t~.~a_~el~ Former Owner ...... ; ...................... Zone Or use district in which ~ ~e-aim~J tt~d .~.. ~,.~.~.~.~. ff~- ........ ' .............. : ............... 11. Does proposed construction v~f~ ~ ~a~ or regulation: ........ 12. 13. Will lot be regraded ........ o1.~~. ~ .~.'~...~ .~.~'~..~.~Vill excess fill be removed from premises: Yes No~ 14. Name of Owner of premises .-~-~.~. /P/[~. ~'/..Address .~...~'. ~'.o~'..,~.4./~.. Phone No ................ Name of Architect ......... i ·..~{ ~..~..'Y ..... / Address .................... Phone No ................ Name of Contractor ........ !...~.J ......... :. Address .... ; .............. Phoj~e No ............. 15. Is this property locatediwithin 300 feet of a tidal wetland? *Ye~ . .~.. No~ !'' · If yes, Southold Town Trustees Permit maybe required. i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether property lines. Give street and block interior or corner lot. STATE OF NEW, YORK .... ~lOOt3~ t:~tg,~'A~*~q~ ~ pUjMBING COUNTY OF ~~ .... . ~'~ 3. ~N~3~ILATI, O~;o , , .... [~ ~ ~ ~ .~...~ ..... ~ ~. ~{ ~ } being duly sworn, d~go~a~s~ks~ffi~t~hd~s, th~hcant (Name of individual signing contract) ~t~ CC~;'c~UC'/!O~ S~cL ~wr ] above named. T~ ~EQU~:I~:i~[:NTS (~ ~ ~'Y ~ He is the :... 2. ~...'~..~'.~ .... : '" '" 6~E* N()I ~S~E g~ ~ ,(Contractor, agent, corporate officer~ ~ CD,STOlON' ~3g%,. · of said· .owner' 0r owners, ~d is du}y authorized to perform or have perfomed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be performed in the m~n6r set forth in the application filed therewith. Sworn to before me this ...... .............. ............ Notal7 Public .......... . · .~ ~'. .~..~ ..... Notary Publi~;~tate O '~ , .. , . . , '1'' (Signature of ap~licdnt) ; . , ' ,'m~ ~ Suffolk ~oun~ L/~ AP~OV;O AO NOTED ;; NOTI~ ~tt.D}NG OEPA~TM~ AT FOU,,OW~NG tNS~'~ONS: