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Home My WebLink About14721-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. Z14955 October 6, 86 Date ................................. 19... THIS CERTIFIES that the build~g D o r m e r A d d i t i o n Location of Property 285 Private Road~ #6 (Huckelberry Hill) East Marion,lq.Y. House No. Street Hamlet County Tax Map No. 1000 Section 03 1 .Block 1 6 ..... Lot 0 04 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated February 2.7. ,.. 86 14721Z .................. 19... pursuant to which Building Permit No ...................... April 1 , 86 dated ............................ 19 ....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 ......... Dormer Addition to existing one family dwelling The certificate is issued to Robert J. Kamrowski & Susan V. Kamrowski ..................... io¥.'o;,'riOgo¥iYa, ' 'i .................... of the aforesaid building. Suffolk County Department of Health Approval ....... Iq / ^ UNDERWRITERS CERTIFICATE NO ..... N 7 7 1 4 3 7 Plumbers Certification dated September 8, 1986 .............'~~.~.... ~Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥o BUILDING PERA~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14721 Z Permission is hereby granted to~;. __ / .... ~ .~.~.....Z.~.~..~Z~. ....... ..... ~..../Z.~..~z-z....~.~.....~ ........... ..... ~~....~. ~.~.....z~.~o ,o ..... ~~~...~~...~. ~&...~...~ ..................... ..... ~.~.~t.....~.~/~.~ .......... ~ ............................. ~ ............................................. 7 County Tox Map No, 1000 Section ,,..~..5./.. ....... Block ...... /..~. .......... Lot No...~..(~.....~... ..... pursuant ,o application doted .... ~ ............. .~...ff ................... , ]9~..., and approved by the Building Inspector. Budd,ng Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANC' Instructions 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 natural 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 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p2"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. C. Fees: 1. Certificate of occupancy $5.00 U 2. Certificate of occupancy on pre-existing dwelling $[ 5.00 3. Copy of certificate of occupancy $1.00 ,,/ 4.Vacant Land C.O. $5.00 5.Updated C.O. $[5.00 Date....c~--7~..?.~ .......... NewC ohs bruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~--~>~'~- ~'~-'~Oc~ ~J ~:~.~. ~u~.~ .t~,~. House No. Street Ham/et Owner or Owners of Property ...% .~.'¢~.*~.....%~....~..~....~...-~..v~.'~...~.~.~.%..~.%-5. ?...~ ."jl~...~,¥¢..~.?.~\ County Tax Map No. 1000 Section ...C?.?.%, ...... Block .. ,~. ,k~?. ........ Lot... ~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........ Date of Permit ,~,': !: .~,,,. ,Applicant. ~ ~, ,~,,, , ,~,,,. ,~. · ,~, · ,~,-,\~, .~, ,% 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 permit meets all applicable codes and regulations, ~f, Applicant .............................................. Rev. 10-10-78 Zoqq3 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. / ~/7~7/ Owner~,,~~O~ ~ °'(~iA~ print) - (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ~(p~mb~er ,~s ~2ure) Sworn to before me this ~ day of ~ V 19~ · Notary Public, ~ County Notary Public THE NEW YORK BOARD OF FIRE UNDERWRITERS 100012}L BUREAU OF ELECTRICITY ~ 8,5 JOHN STREET, NEW YORK, NEW YORK 10038 o~y the eJectrlceJ equipment ~ ~scrib~ be~w a~ introduc~ by t~ applicant ~med on the a~e application number in the premises of ~ ~, Huck]e~r~W Hill, ~y A~nue, E~t ~:ion, N.Y. ~n the foJlo~'~ng location; ~ Basement ~ I.~t FL ~ 2nd FL Section Block Lot .~sexaminedon ~pt~n~r 22~ 1986 aadfoundtobel, compI.ncewththerequirementsgfthisBoerd. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 7 12 DRYERS MULTI-OUTLET SYSTEMS NO. OF FEET E R V I C OTHER APPARATUS: 1-Smoko Der ecr~3r Paul Burns 275 Toan Harbor Lane Southold, N.Y. 11971 ]~Ac. 282E GENERAL MANAGER 11 Per This certificate must not :be altered in any manner; return to the office of the Board if incqrrect Inspectors may be identified by their c~edentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FIELD I~SPE~TION DATE COMMENTS 1. -~ (1st) FOUNDATION FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING INSULATION FERN. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: 765.~802 BUILDING DEPT. INSPECTION .[ ] FOUNDA'rlON AST [ ] ROUGH PLBG. [ ] FOUNDATION :)ND [)]/~,ULATION [ ] FRAMING [/,-~FINAL REMARKS: ~~ 765-1~02 BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION :)ND [~]"~ULATION [ ] FRAMING [ ] FINAL REMARKS, DATE ~/~ ~/~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 '¢/. TEL.: 765-1802 Examined ........... (~'A 19o-~ ~ /~. Z .~.. -~ Approved . ...t... .......... 1,~..Permit No .......... Disapproved a/c .......................... 7~' ........ (Building Inspector) APPLICATION FOR BUiLDiNG PERMIT INSTRUCTIONS Received ........... ,19... Date ...~ ./.Z,.~.... a. Tkis 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 necessary inFpections. /~ - admit authorized inspectors on premises and in building for'~rq,~/.i ~e?...2~..."...'~.. '.~.~. ¢.~...~.. '~ (Signature of applicant, or name, if a corporation) · (Mailing address of applic, ant) State whether applicant is 9.wne_r. lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ................................. Name of owner of premises . .'~..(~J~.~' .... .~..'..~..~:~{~.~.~. ..... ~ .IQt.'%.W~..t~..~ i~.'J ....................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer· / .... .: .................................... (Name and title of corporate officer) Builder's License No. ~J~.~/~lok0.1h .t{~..~i.&...~./IT.)*..~ Plumber's License No...~. q.I ..~ ................. Electrician's License No, [Jt~0~. (~, ~.., .~.~.e/l~~' Other Trade's License No .... tQ].t~ .............. h se ork w]ll be done *"~4~~ 4~ (~ ~i[~ ~ ~l 1. 'Locationoflandonwhic propo dw ' · ...... · .... ~... ' :q[ .... ~. ............... '~' · ..... .............. ltouse Number ., ~---/ ~'C,~ ,,/ Street Hamlet County Tax Map No. lO00 Section . i' ' .0~ .~ ......... Block .... l~. ........... Lot... 7 .~.~-~.]--...~. ..... Subdivision ..................................... Filed Map No .... ~q.q.I..". ,~.. Lot (Name) 2. State existing use and occupancy of premises ahd intended use and occupancy of proposed construction: a. Existing use and occupancy ....~I[~[,~ ~.~[~'.~. ~'". b. Intended use and occupancy ..' .~J~',~,~ .~. · ................................................... i [ [ 3. Nat ure. o f work (check which applicable): .Nms~gu-i-lding Addition .. ~.~lll~l~t~io~ ~ Remov~rl~ .. . I~me~i~-ien ........... :.- Oth~r-~Vork.. 4. Estimated Cost : ............... Fee ...... · .................... ' , . .x (to be p~id on filing this application), 5. If dwelling, number of dwelling_~it,i~ts . . .~f~ ...... Number of dwelling unitsl on each floor...~{~1~. ....... If garage, number of cars t~.l.~. ........... ! . 6. If business, commercial or maxed ~Ccupancy, specify nature and extent of each type of use . .[~[~ ............. 7. Dimensions ofexistlng structures, if any Front ~ . ...... Rear Dentl{ Height .,~ , Number of Stories ............... ].; . ! ...... Dimensions of same structur9 with alterations or additions: Front ..~. ~.[.! ........ ~ ....Rear . .~. ,/. } ............. Depth ~3~ ) ................. Height .~.1... ~ ............... Number of Stories .. :*~.c~'..,3 .............. 8. Dimensions of entire new construction: F[ont... ~ .......... '. Rear ..... ........... Depth ............... Height 2. i'. ........... Number of Stories ......................... . .... i ......': ....: ........ ....... 9. Size of lot: Front .......... Rear ...................... ?evth ................. 10. Date of Purchase .~:::¥~: ............ :...NameofFormerOwner ~..~}.~.~.~a ..... 11. Zone or use district in which premises are situated .......................... : ........................... 12. Does proposed construction violate any zoning law, ordinance or regulation: I~} ........................... 13. Will lot be regraded ....~ ...................... Will excess fill be_remover ~ 'ses: Y No .................. 14. Name of Owner of prl}mise' _s~!~,~.;.~l~l~l~n~.lAddress l~lf[l,.l~..~. ~h~o"~e~, Name of Architect .~II~.~.`; .I~...: .~. [1'}1~..~ .... Address ~1~.~.. Ir~. ~/~.. [,~t~hone No.~."/?.~,~...~I~'~ Name of Contractor ~ ]~...~.~! [~,1~1%~=~ ....... Address ~'0..~,~.. }I.... Phone No.~[0. 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 show street names and indicate whether interior or corner lot. STATEO~ ~.,,~ xOr, K, COUNTY OF ................. S.S ................................................. being duly sworn, deposes and says (Name of individual signing contract) ~bove named. that he is the applicant ~Ie is the .............................................................. i... i ....................... (Contractor, agent, corporate officer, etc,) j >f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements containe, d in this application are true to the best of his knowledge and belief; and that the ~vork will be performed in the manner set forth in the application filed therewith. ]worn to before me this ........ ........... No. $0-4844789 .......................... Qualifisd In 'Nassau County ~ (Signature of applicant) Commisslon'Explras March 30, I087 i Z OCCII? ,HC¥ OR ,~,¥~,r dislribL~ting ~/~!gmt piping shall be types K or L only SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 of 1% LEAD. PLUMBER CEI~TIFICATIOST OH LEAD CONTF~NT BEFORE C~I~TIFICATE OF OCCUPANCY 76~1802 9 AM TO 4 PM FOE THE FOLLOWING INSPECTIONS: J. FOUNDATION - ~O REQUIRED FOR POURED CONCRETE 2. RO. UGH- F~MING & PLUMBING ~. INSU~TION 4. FINAL - CONSTRUCTION MU~ BE COMPL~E FOR C. O, ~L[ CONSTRUCTION SHALL MEET ~E REQUIREMENTS OF THE N.Y. ~ATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERROr, S. EDWARD E. WLLt_/AMR BUILDING CONTRACTOR 150 SEAWOOO DRtVE \o° L Main Road- ,¥ 'T tVJ t" ~'r;: ,AL- Ft F: S?- CL(%(t: Phone 477-0400 ~ Mare Road GREENPORT, N.Y. 119:44