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HomeMy WebLinkAbout15347-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z-15882 June 25, 1987 No .................. Date ................................. THIS CERTIF1ES that the building ONE FAMILY DWELLING WITH ATTACHED WOOD DECKS Location of Property ....5.0..M..i .a.m.i...B .1 y.d. ~..&..M.i..1.1..R.o..a .d ........ P. e..c .o.n.i.c. :..N....Y: ...... House No. Street Hamlet County Tax Map No. 1000 Section .. 6. .7 ........ Block ... 0..7 .......... Lot 03 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated September 26, 1986 pursuant to which Building Permit No. 15347 Z dated.................September 26, ..... 1986.. .... wasissued, and conforms to all ofthe requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ONE FAMILY DWELLING WITH ATTACHED WOOD DECKS AS APPLIED FOR The certificate is issued to DAVID C ICHANOWICZ ..................... ?o¥.'o;, ..................... of the aforesaid building. Suffolk County Department of Health Approval 85- S O- 250 UNDERWRITERS CERTIFICATE NO. N 796008 April 14, 1987 PLUMBERS CERTIFICATION DATED: Rev. 1/81 TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUiLDiNG PEPSi, IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15347 Z Permission is hereby gronted to: L...~.~....~.~.~.~~ ..... ~~......~.:~.**......L!.~.~"..~. ......... ot premises Iocoted at .,'~,-~,,..,,,,~,,, .~ ........ .,,u~, ,~,,.,.~...,,,,~,., ............................................... County Tax Map No. lO00 Section ...... .(~...~....'J. ...... Block ...... ..~.....']. ....... Lot No ...... ..~..~)~ ......... ..~..'~...~.....~,.~. ........ , 19,t..~,, and opproved by the pursuont to application dated Building Inspector. ~ee ,.~.,...!..0. ...... Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date April 14, 1987 Building Permit No. Owner DAVE CICHANOWICZ Plumber (please print) ROGER MC CARVILL (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to before me this //~day of ~ , Notary Public,~County ~...~/ No~ry pUbiic ~ FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall 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 fo{lowing; 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 p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 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. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date.~,q,~,6, ... ,~,-..'<---~,.. ,[~ ?.'?... New C on str uc t i on ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property...g..OT...~..~.. ...... ' ......./~../.~..~...Z..~/.~. ................. Hou,eNo. S,,ee, Ham,e, Owner or Owners of Property . . .~-.~ .c./~.~O~V~'~Z~ .............................. County Tax Map No. 1000 Section ...... ~.Z .... Block ...... ~. ....... Lot,....~.. .......... Subdivision ................................. Filed Map No./..~..~.E~..~...Lot NO..~./. Health Dept. Approval. ,~,~:'.'.'?,?,':,"~,, ,~ ......... Labor Dept. Approval ........................ Underwriters Approval'./~. ~f~..~2~..~. ............ Planning Board Approval ...................... Request for Teq~orary Certificate ..................... Final Certificate ....................... Fee Subm tted $ ~-.~,, ................... Construction on above described building an.~q~ermit meets all applicable codes and regulations. Rev. 10-10-78 TION ~DA_.T ION (ls~) COMMENTS ~DATION (2nd) FRAME & ?LUMBING JLATION FERN. Y. STATE ENERGY CODE FINAL ADdiTIONAL 'COMMENTS: 76S-1802 BUILDING DEPT. INSPECTION []FOUNDATION IST [ ] ROUGH PLBG. []FOUNDATION ZND [ ] INSULATION []FRAMING REMARKS FINAL 76S-1802 BUILDIN6 DEPT. INSPECTION [ ] FRAMING , RF. MARKS: [ ] FOUNDATION XST []ROUGH PLBG. [ ] FOUNDATION 2ND []INSULATION []FINAL L 765-X~02 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] RouGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [] FOUNDATION 1ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [] INSULATION REMARKS: */-~ ~~ ~. BUILDING DEPT. INSPECTION [ ] FOUNDATION XST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMIN(a [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~ DATE X¢///.~/"c~c~ INSPECTOR ~~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~AL DATE TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR ?.O. BOX 728 TOWN IIALL SOUTItOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of tho following reasons. An application for Certificate of Occupancy is not on file. /5/ No Underwriters Certificate on file. /~/ Tile check is(outdated/not on file.) No Health Dept. Approval on file. /5/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit # Building Depto I _,5_2~ 4._Zg No Plumber Solder Certificate on file. ( all permits involving plumbing beln3 issued after April 1,19B4 ) Examined .~~ Approved~. ~. ~.~. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 0OUTHOLD, 'N.Y, 11971 TEL.: 765-180:3 ., 19~. Permit N)~..~..~ .~ .'~..~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN O,F 80UTHOL~ Received ........... ,19... Date September'. 26, ...... 19 86. INSTRUCTIONS a. 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 schedhle. 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 necessa~tion~~ (Signature of applicant, or r~me, if a corporation) . .1.65..~oocl. Lane.,. Peconlc,. N.Y...1.1958 ............ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. .Owne~ .......................................................................................... Name of owner of premises Dav. i.d .Ci.ctl&rto. w.i.cz ......................................................... (as on the tax roi1 or latest deed) If applicant is a corporation, signature of duly authorized of tiger. (Name and title of corporate officer) 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 dofi~e0. .M£ami..^v. enue,..P, ecard.c,..NY...1.1.95B. ................ House Number Street Hamlet County Tax Map No. 1000 Section ...... 67. .......... Block ...... 7. ........... Lot ..... 3 .............. Subdivision .................................... : Filed Map No. ' 1.0.,.1.0.5. ........ Lot . 3 ............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy vacant. 10t ............ , ............................................... b. Intended use and occupancy J.family.re$i~e0¢e..., ............................................... 3. Nature of work (check which applicable): New Building .K...' ..... Addition i Alteration ' pai ' Oth Re r .............. Removal .............. Demolition ........... ~. · · er Work ............... (Description) 4. Estimated Cost $65,000,00 ............................ Fee ....... ~ ' (to be ~oaid on filing this application) 5. If dwelling, number of dwelling units..one .......... Number of dwelling units on each floor ................ If g b f ' arage, hum er o cars .rlQrle ....................................... ~ ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear ....... [ ....... Depth ............... Height Number of Stories ' Dimensions of same structure with alterations or additions: Front ............ ..... Rear .................. Depth ...................... Height ...................... Number oflStories ...................... 8. Dimensions of entire new construction: Front 44: .0'I Rear .44'..O't : ~' '- °3' 0" ......... ~epm t, ........ · 0 ...... Number of Stories 1~/~ Height 24'. " : I 0I ' I Size of lot: Front 200.00 ................ Rear .~QQ..Q ................ Depth 66..1.0. ................. Date of Purchase 1 ,/31 ,/86 Name of Former Owner $.~.e.v.e..l.e.n.e. dio s ........... Zone or use district in which premises are situated .~esidential/.ggr. iqqlg~r.~. ! ............................ Does proposed construction violate any zoning law, ordinance or regulation: .Il0. i ........................ Will lot be regraded [~0 .......................... Will excess fill be removed from premises: Yes i N'~o Name of Owner of premises David Cic~ano~icz... Address~§5 WQQcJ I,~ PeconJ~,~ ~ 734-6986 Name of Architect sa~le ....................... Address ............... ~... Phone No ................ Name of ContractorS0r~¢ Address Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate 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//Y0,R.K,, , S S COUNTY OF.~ .... ' , ·.. ~. z~)../.~./'-t/~'~'.. ~..~.~?.~e~i4.d~ ~./..(~. ~ ............. being duly sworn, depos,es and says that he is the applicant (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have ,performed the sa!d work and to make and file this application; that all statements contained in this application are true to the best of his 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 NOTARY PUBLIC, State of Now Y01~.,zx ........................................... No. 4787124, Suffolk C0un~d(l ], ~ - ~/ ~ ~-/~7" e of applicant) ~ouu~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY  B5 JOHN STREET. NEW YORK, NEW YORK 10038 796008 D~te Applicant ion No, on file N THIS CERTIFIES THAT ~s exami~ed on ~'8~ ~8~ ~ ~ ~ ~ and found to be ln complia~ce with the requlrements ~f thi~ ~oord, $1X~URE FIXTURES RANGES OVENS DISH WASHERS i EXHAUST FANS DRYERS DIMMERS NO, OF r~ET OTHER APPARATUS: AWG OF l-Smok~ J25 W~low Poi~%~ This certificate m~t not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be id~ftfied by their DEPARTMENT. THIS COPY OF CERTIFICATE,~ MUST.~ NOT, BE .ALTERED N ANY MANNikin. / PLEASE NOTE .~ ! It is the app!icant's responsibility to maintain adequate s~mtary dmtance between all water supply a~qd sewage disposal facilities. DRAWN BY Af/"~'. ~ · The water st~pplj,, and sewage disposals, system for this resitleace will con- ~%rm to the standard al th- S- ~- SURVEYED z' :~,~c. / ~9 ,~F,~F' BY WILL[ M R. SIMMONS -,'/,~ - ~,/,~,,,~'~ o~,~ L. I., N.Y. LOCATED AT/~C"c::3~,-*",,~'~, "~,t~,4." ~ ~.~'"~'.~'~t:-,~/ ..~'~-,-/,~'.~',~.~' ~;. ~'~/-~. SCALE ~"= ~ ~ .~' A, ql,4 MI ~oo -C ',USE I$ UN~WFUL ,, "; WITHOUT CERTiFiCATE OF ,OCCUPANcy NOTI;~Y BUILDING DEPARTMENT AT ?{,5 '~802-~ ~,1~ TO4 ~ ~fl THE ' , , , ; FOL;O~ lNG INSPEC~ONS; - FOu~DA~O~ ~fO ~Q~RED ,, FOR ~O~JREO ,' ,r.": "'2 .ROUGH ~RAMING A )LOMBNG ~' FINA'L ~ONSTRUC~ION ~UST ', ':. A~ ¢ON~TRU ITJON S~L MEET ~: NOT :~8~NS~E ~R If ~P~er tub..tng, l'- used forwaterd,strbufing :"." ',' ':, , ' ' sy~t~m; plpln~ ~h,.!l b~ '