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Home My WebLink About14637-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14846 Date Sept. 2 ~ ................................................. 19 86 THIS CERTIFIES that the building One family dwelling. , Location of Property R. O:W. off OLD NORTH RD. SOUTHOLD County Tax Map No. 1000 Section . . .0.5.5. ...... Block 2 . .Lot p/o 4 . Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Feb. 21 .8% 146.37Z ..................... ,19.. ursuant to which Building Permit No ..................... dated Me~Tqb..1.1. .................. 19..8.6, was issued, and conforms to aU of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is~ ......... .... 9ne family dwelling. The certificate is issued to JOSEPH SAWICKI t JR. to~,,'o;, .......... ~x~a~X of the aforesaid building. Suffolk County Department of Health Approval ........ ~i~pL~9 Aug. 21 ~ 1986 UNDERWRITERS CERTIFICATE NO #N760512 July 25, 1986 PLUMBERS CERTIFICATE 7/16/86 Building Inspector Rev. 1/81 ~OEM NO. ~ TOWN OF $OUTHOI. D BUiLDiNG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 1~t$37 Z pursuant tO appJicotion dated ~..~.....~..i~ .................. , 19..~..~.,-- and approved by the Building Inspector. Building Inspector Rev. 6/30/~0 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~Jamm~a 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 p~Coperty 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 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 .~/~./~. 5. Updated C.O. $15.00 Date ....................... NewConstruction ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ......... .......... · Ham/et Owner or Owners of ? roperty ................................. County Tax Map No. 1000 Section ... F-..2~.q.~. ...... Block .... ~. ......... Lot.,..~.1.~.. ~. ..... Subdivision ................................. Filed Map No ........... kot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ~",~0..' ~. f . Labor Dept roval ..... .................... App ................... Underwriters Approval .~,~;d 3'./. '~ ................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... ,5' oe Fee Submitted $ ............................. Construction on above described building 9m~permit meets a~l applicable.c, edes and regulations. ' -'~,, ~.s~4/86 N 760512 THIS CERTIFIES THAT -- FIXTURE / I ] FIXTURES I RANGES tCOOKING DECKS I OVENS I DISH WASHERS EXHAUST FANS ~8 ~ 49 46 58 , :1 4.8 DRYERs FURNACE MOTORS FUTURE APPLIANCE FEEDERS ~PRCIAL REC PT TIMECLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS I 4 ~ I I I z I ~o I I ~ / ~ I6°° sERvI~ DI~ONNECT ~ NO. OF ) S ER V I C 1 150 cb X 1 1 - 1 Smoke Detectors~2 ~eco ~lec. Corp. (Cliff Cornell} 325 ~illow Point Road Southold, N,Y., 11971 ORN~RA~ I~&GER 'his certificate must notbe altered in ar~y manner; return to the office o~ the Board if incqrrect. Inspectors may be identified by their credentials, copY FOR S~L~O ~PART~NT. TInS COP~ OF C~.eT~C~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERT I F I CA~I ON Building Permit NO, (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) ?~wo~ to befolfe me t~is Notary Pu~~///f ?~Y Notary Public FIELDINSI~ECTION FOUNDATION COMMENTS FOUNDATION 2. (2nd) FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ~'~'~ ADDITIONAL COMMENTS: /I O. 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ', TEL.: 765-1803 Examined ..~.Cl.&..C.~../,I .... , 198 (o . Approved, .~ {:~..c~ .I/ .... 19 ~; Permlt No., ! .~. ¢..~.7. ,'~ Received ........... ,19... Disapproved a/e ..................................... . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ets 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- ;ation. 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 ghall 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 ~hall 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. Fhe applicant agrees to comply with all applicable laws, ordinances, building cod,e, housing code,,and regulations, and to ldmit authorized inspectors on premises and in building for necessary inspectiT~. ~~ (Mailing address of applifiant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ~ .~..~. ~r~.. ~..~..~....&..~.3..~.' .~.~. ........................................... Name of owner of premises ... ?~.~.. ~,~h~,~.~/~. (as on the tax roll or latest deed If applicant is a corporation, signature of duly authorized officei'. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No. : Electrician's License No.. ....... x .............. Other Trade's License No ...................... I. Location of land 'on which proposed work will be d6ne ................................. 4,y.n%?r..c~..~..a4,7,,' ..~.~ .~..~.~4 .aq.4¢q).~.~.~.~..~..~.<~.(a.,ff...~6.~?//.e: ~.,¢.~_F(..x'.. .......................... llouse Num her Street Hamlet County Tax Map No. 1000 Section ...~v~.~.. .......... Block ...~ ............. Lot................... Subdivision ....... .A//(~. ............ .~ ............. Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occnpancy ........ .ff'~C.~.A/'.T.,, .,~.A?~Z'. ,Z~..2't-./ .................................... b. Intended use and occupancy ' .~.~/~ ' 3. Nature of work (check which applicable): New Building ...~..' ..... Addition . Repair .............. Removal .............. Demolition .......... !.. Other Work ....... -~--~ i (Description) 4. Estimated Cost ................................. Fee ........ . ........................... ' (to be paid on filing this application) ./ 5. If dwelling, number of dwelling units ............. Number of dwelling unit on each floor ................ If garage, number of cars ........... ~. .............................. 6. If business, commercial or mixed occupancy, specify nature and extent of eacli typ~ of use ..................... 7 .... if any: Front Rear I Depth · Dlmensmns of ex~st~ng structures ....................... i ..................... igt b f St ' He it ............... Num ero ories ............................ I ........................... Dimensions of same structure with alterations or additions: Front ............ i .... Rear .................. Depth Height Number of Stories g. Dimensions of entire new construction: Front .... .g.,~. ........ Rear .... ~,,~ ....... Depth . .~.~.'.~.'[ ....... Height ............... Nmnber of Stories .... /.~. ................................................ ). Size of lot Front .... /.~'.*~.~. .......... Rear ./~ . ................. )e~th ............ ). Date of Purchase ....~.r/.4(.:~.~ ........ i. i . .. Najne of Former Owner . . 1. Zone or use district in which premises are situai;d ii .4qI~./~/'¢4~'~. ............................ '2.Does proposed construction violate any zoning law, ordinance or regulation: ..../ 3. Will lot be regraded ..... ex,/IQ. ................... Will excess fill be remover from premises: Yes No *. Nmue of Owner of premises.., f//~',F¢/..~ ........... Address ................ i. · · Phone No ...... Name of Architect Address Phone No Nmne of Contractor .......................... Address .................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. ind'icate all set-back dimensions from coperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~terior or corner lot. ~.TE OF NEW YORK, ,UNTYOF ......... ........ S.S .... .............. (Name of individual signing contract) )ye named. is the ................................... ..... being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.): said owner or owners, and is duly authorized to perform or have performed the sa}d work and to make and file this ,lidation; that all statements contained in this application are true to the best of his knowledge and belief; and that the k will be performed in the manner set forth in the.application filed therewith· )rn to before me this day of" ,:;:ary P/J/olic,../,...,..~. ......... /g~....~:5-County (Signature of applicant) Jo~,. z.], 195b. RODERICK VAN TUYL, P.O. LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO DEPT. OF HEALTH SERVICES APPLICANT SUFFOLK COUNTY SERVICES - For CONSTRUCTION ONLY DEPT. OF HEALTH APPROVAL OF DATE. ~ Z~-.~ ~"{ [-~ ~ APPROVED. ~ ~ s ~, ~ ~,., ........ ~.. ,T~_ l DIST. SECT. BLOCK PCL. OWNERS ADDRESS: T',~/. 7Z? - 1562 DEED: L 74 9E p. EO E TEST HOLE STAMP SEAL SUFFOLK CO. HEALTH DEPT. APPROVAL DE~,S. CF hEALTH 'FZ~ c~ ~Z~ STATEMENT ~ INTENT SYSTEMS FOR THIS RESIDENCE WILL ~ CONFORM TO THE STANDARDS OF THE .~O[J~N'~'n~ /~. ~ ~FF~K CO. DEPT. OF H~LTH SERVICES iJ APPLICANT I [ ~FFOLK COUNTY DEPT. OF HEALTP SERVICES -- fOR APPROVAL Of CONSTRUCTION ONlY DATE: APPROVED: SUFFOLK CO. TAX MAP ~SI~ATt~: UFFOLK ~UN~ HEALTH DEPA~MENT · ~"-.- % DIST. ~CT. BL~K PCL, . ,,~-: ............ : SINGLE FAMILY DWELLING ONLY afl I OWNERS ADDRESS: ' ' THE ~AGE DISPOSAl AND WA: ~ I suPf ~Y FACIU~B FOR THIS LOCATIO~ HAVE BEEN '4SPE~.~O BY THIS D~A~ENT AND r~UND T ~ BE ~TI~ACTQ~._ , I I I " Chief of Wastewater Manag~ment'~cti~ '%, ;o C£RT/FiCATION ,~ ~' : , SOLDER USEO IN WA ' ';" ~C~ED 2/IO ~ I~LEAD; : .~. , A pRO . . . . j ', ,: ~O,T[FY BUILDING DEPARTMENT AT . ,. FOLLOWING NSPECTIONS: ,' , t'FQUNQ~,TION 'I'WOF~EQUiREO'' ' '- r 4 '"~":"-~'""D~'''"'''''"?~-~-u~,uun~ ~,-,.,.?---~,~ . ...- , . ~.-' ' '. 'i ~. rr ' '',~2 ROUGH, FRAM NG& PLUI~IBING ' ' "' ' ~--r"¢ r" L~, ; ', ,;3; I1~1S 1'ION '" ' ; ~ '