HomeMy WebLinkAbout16454-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Zt8202
Date ~3LY 24~ 1989
THIS CERTIFIES that the buzldzng
Location of Property 565 PINE NECK ROAD
House No.
County Tax Map No. 1000 Section 070
Subdivision
SOUTHOLD
Block 05
Filed Map No.
Street Hamlet
Lot 30.2
Lot No.
conforms substantially to the Appt~catzon for Building Permit heretofore
filed in this office dated SEPT. ~0r 1987 pursuant to which
Buildzng Permit No. 16454Z dated SEPT. llr 1987
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate zs
issued ~s INGROUND POOL & FENCE.
The certlflcate is issued to ROBERT KOWALSKI
(owner, ~)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTHAPPROVAL N/A
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Rev. 1/81
N0275~4 AUG. 12~ 1988
N/A
IrO~ NO. B
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
16454 z
Permission is hereby granted to: ~ ~ ~1
...A,...~,g~.~.~.... ~....... ............
.................. ...............
..~..__~ ...... ....... ~:...~.....~....~ .....
· ~ ............................ .~:;..::::.~....: ....... L,....,.~K....~..~. ...... ~:~-.~,...,;-].. ...................
~t premises located at .~,~.~..~.,.._.~/.:~......A~.., .~. ~.....~,...~..: ................................
County Tox Map No. 1000 Sect,on ....... .C~.."~..(~ .... Block ...... ~..~... ...... Lot No...~...~: .~.
pursuant to opplicat,on doted ....~.~.~ ..~..'/..~.. ......... 19..~..]., ond approved-- by the
Building Inspector.
F.e $..L~....: .........
Building Inspector
Rev 6130/80
FORM NO. 6
TOWN OF SOD~TIIOLD
BUILDING DEPARTmeNT
TOWN HALL
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUFANC~ INSTRUCTIONS
A. This application must be filed in typewriter OR ink and submitted to the Building
Iospeetor with the following; for mew buildings or uew 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).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that solder used in system contaius less
than 2/10 of lZ lead. ~
5. Commercial buildings, industrial buildings, multiple residences and similar
buildings and installations, a certificate of code compliance from the Architect
or Engzneer responsible for the building.
6.Submit Flannimg Boazd Approval of commpleted site plan requirements.
B. For existing buildings (Prior to April 9, I957] non-conforming uses, or buildings
amd "pre-existing" land uses:
I. Accurate survey of property showing all property lines, streets, buildings and
unusual natural or topographic features.
2. A properly completed application, a consent to inspect signed by the applicant
and a certified abstract of title issued by a title company whlch shall
show single and separate ownership of the entire lot prior to April 9, I957.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent information required to prepare a certificate.
C. For Vacant Land Certificate of Occupancy:
[. An application for vacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of the entire lot prior to April 9, 1957 shall also accompany
the application. If a Certificate of Occupancy is denied, the Buildzng Inspector
shall state the reasons therefor in writing to the applicant.
D. FEES:
I.
3.
4.
5.
6.
CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, ~_~-~o~_b~.-~. Accessory building $25.00
Addition to Accessory buildings, $25.00 - Businesses $50.00.
Certificate of Occupancy on pre-existing dwelling - $I00.00.
Copy of Certificate of Occupancy - $5.00 - over 5 years - $I0.00
Vacant Land Certificate of Occupancy - $20.00
Updated Certificate of Occupancy - $50.00
Temporary Certificate of Occupancy - $~5.00 Residential
$50.Dfl Co,~ercial
~v..I0/14/$8
FOUNDATION ( 1 st)
FOUNDATION
2.
f2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
HAP OF PROPERTY
.SURVEYED FOR
ROBERT
AT
~OUTHOLD
town oF SOUT~OLO,_~.Y,
supply
have ,been
and fo~n~
).~
./
SUFFOLK CO. HEALTH DEPT, APPROVAL
~ORM TO THE ~ANDAR~
SUFFOLK CO. DEPT. OF H~L~ SERVICES,
APPLICANT
SUFFOLK COUNTY D~T, OF .EA~TH
SERVICES ~ FOR ' A~PRO~AL' OF
APPROVED~ ' ' , ~ . ,
T~
3. Nature of work (check which applicable). New Budding ..
Repair .. Removal ....... Demolition
Addition ..... A/teration ...
........ Other Work ......
(Descnp~tion)
4 Estimated Cost.. .9~)~).1~' ~ .......... Fee ...........................
~ (to be paid on Fdmg this application)
5. If dwelhng, number of dwelling units ........ Number of dwelling umts on each floor ...........
If garage, number of cars ...............................................
6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ...............
7. Dwnenmons of existing structures, if any Front .......... Rear .......... Depth .......
Height Number of Stones ' ' '
Dunens~ons of same structure with alterations or additions Front .......... Rear ..........
Depth ......... Height .......... Number of Stones ...................
8. Dimensions of entire new construction Front ........... Rear ............ Depth ...........
Height ........ Number of Stones ...................................
9 Size of lot Front ............. Rear ................. Depth .................
10. Date of Purchase .................. Name of Former Owner ..................
I 1. Zone or use district in which premises are situated ............................
12 Does proposed construction violate any zoning law, ordinance or regulation ................
13. Will lot be regraded ...... /5(0 ........ Will excess fill be removed from premises' Yes ' ' '
14 Name of Owner of premises .. / P~..6t~./~.SJC2]... Address ............... Phone No .... ~. ......
Name of Archttect ....................... Address .......... Phone No. .
Name of Contractor j~. J~'7~.~.~'. ,Sa../~ .... Address . ,O/~.7-~?<'... Phone No
15. Is this property located w:tthin 300 feet of a t~dal wetland? *Yes ..... No .....
*If yes, Southold Town Trustees Perm~raay be required.
PLOT
DIAGRAM
Locate clearly and d~s~nctly all bu~dmgs, whether existing or proposed, and indicate all set-back dtmenslons from
property hnes Give street and block number or description according to deed, and show street names and indicate whethe~
interior or comer lot
STATE OF NEW Y~K,/f/~//~ - -
COUNTY OF .~
..... ~.1~ gJlg~-/t) ! ~ .~ ~'/~ ~ . ~ .... being duly sworn, deposes and says that he ~s the apphcant
(Name of m&vidual s~gmng contract)
above named
He ~s the ...... ~'~ ~~ ....
(Contractor, agent, corporate officer, etc )
of said owner or owners, ~d m duly authomed to perform or have perfo~ed the said work and to m~e ~d file tNs
apphcation, that all statements contained N th~s apphcat~on are tree to the best of hm ~owledge and behef, and that the
work wflI be perfo~ed m ~e m~ner set for~ m the apphca~on filed ~erew~th
Sworn to before me th~s
.........
Disapproved a/c ..
BOARD OF HEALTH ......
3 SETS OF PLANS .......
FORM NO. 1 SURVEY ..........
TOWN OF SOUTHOLD CHECK ..........
BDILDING DEPARTMENT SEPTIC FORM .............
TOWN HALL
$OUTHOLD, N Y, 11971
TEL' 765-1802 CALL ................
MA L To:
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date ...~//O 19
a This apphcatlon must be completely filled m by typewriter or in mk and submitted to the Building Inspector, wi
sets of plans, accurate plot plan to scale. Fee according to schedule
b. Plot plan showing location of lot and of bmldmgs on premises, relationship to adjoining premises or public sir
or areas, and g~vmg a detailed descnphon of layout of property must be drawn on the diagram which is part of this a!
cation
c The work covered by this application may not be commenced before issuance of Budding Permit
d. Upon approval of this apphcatmn, the Building Inspector will issued a Budding Penmt to the apphcant. Such pet
shall be kept on the premises avmlable for inspechon throughout the work
e No buddmg shall be occupied or used m whole or in part for any purpose whatever unt~l a Certificate of Occupa
shall have been granted by the Bmldmg Inspector.
APPLICATION IS HEREBY MADE to the Braiding Department for the ~ssuance of a Bmldmg Permit pursuant to
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordmance.-
Regulahons, for the constructaon of buddings, addltaons or alterahons, or for removal or demolition, as hereto descnb
The apphcant agrees to comply wnth all apphcable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in building for necessary inspections
. ' ......
(S~gnature of applicant, or name, if a corporation)
(Marling address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrlcmn, plumber or brai&
Name of owner of premises . . ~O~/'~c~7'' ~Ot~tt'$1,2 ~ ....
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and htle of corporate officer)
ALLBullder,sCO.TRACTOR'SLicense No ltg$sgZ S?~,F.~. K COIII~T¥ LICEI'i'$1~D
Plumber's License No ....
Electrlman's License No . t/hbl)~)'~.)0 f=vkd-~/-'~tC..
Other Trade's License No ....
Location of land on which proposed work will be done.
House Number Street
County Tax Map No [000 Section
Hamlet
Block .-5'~. .. Lot ~?F .Q~
Subdivision Fded Map No Lot
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction
a Existing use and occupancy
b. Intended use and occupancy ~_.~././'~.~,.~..757.~.~ . . LtJ I . ~ .......
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICrTY
[ ~. JC'US'P ]i~ ~ ]9~5 JOHN STREET. NEW YORK, N~~38 N 0~]
~ Application No. on
THIS CE~IFIE$ THAT
o~y t~ e~t~ ~u~ment ~ ~ ~ a~ int~ by t~ ~t~t ~ on the a~ ~t~ numar ~ t~ ~m~s
R~C~ARD KOWA~SKI, 435 PIN~ NECK ROAD. SO)ITHOLD N.Y.
was examined on
NXTUII BXTURBS
OUTLETS SWITCHES FLUORESCENT
1
[] 2ndt FI. Section Block
and found to be in cotnldiance with the requlreme,tts of thls Board.
~R~S CO(O(I~ D~CK~ O~=NS P. XEA~T FANS
DRYm FUINACE MOTORS
S~RVIC:E DISCOflN~'T S E R v I C
OTHER AI~ARATUS:
G.F.C.I:-I
environm~nia it i.s advi. sab].*, t*o
bare ~re~tt~t te~f:/a~d or
u~d~ by a qua] [~ied per,on.
~I~TTI:TliCI(, NY, ]1952
OF CC. COND.
,[CENSg NO. 2300 K
This certificate must not be altered in any manner; return to the office of the if incorrect. Inspectors their
CO~Y Pm BUILDiHG DEPARTMENT. THIS ~OPY OF ~~ MOlT NOT BE AL'r~IIB IN AHY ~.