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HomeMy WebLinkAbout14310-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z.1.4.2..9.8 ......... Date .M. ~..~,c.h..2,] ....................... 19.86.. THIS CERTIFIES that the building ...... t~ 5).o.~...a .nj.. f...e .n.c.q ......................... Location of Property ..... .1.0.q Q..C.c. q a. r. P. ~. $ Y.e ................. .~.a. ~..c. ?.a. ~..J- .o.n. ........ House No. Street Hamlet County Tax Map No. ]000 Section 2.2 ......... Block ...1. ........... Lot ...1.2. ............ Subdivision g.~qa.y.i.e.u.. ?.a.r.k. ............... Filed Map No. 5621 .Lot No. 8 conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... S. e. p.t.... 6 ........ , 19.8. 5. pursuant to which Building Permit No...1 .4.3.1. 0 ~ ............. dated ........ ,S.e.p. ~.:..2.5. ..........195.5.., 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 ......... ?ool and fence. The certificate is issued to ........... 2~im. 2.... Dze.nkow~.ki ........................... (owner,~,~ erg~l~) of the aforesaid building. Suffolk County Department of Health Approval ........ N ./.A ............................... UNDERWRITERS CERTIFICATE NO N.. ? .2.8 1 3...0 Building Inspector Rev. 1181 ~TO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. NO BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 14310 Z Ooto ............................................. ~9... Permission is hereby granted to: .......... ....... ......................... .... ~.t......~!.?..~.~ ...... ~.,...k.,.... ,o ........... ..C. .......................................................... ~. ....... ~.o.~ ........... ~......~ ........................................ County Tax Map No. 1000 Section ~'-~'~' Block ~ Lot No. pursuant to application dated ................... Z./..~....~... ....................... , 19.....~.~:and approved by the Building Inspector. D-£oo Fee $ ........................ Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Ao Bo Instructions This application must be filled in typewriter OR ink, and subn~itted in dup{icate 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 peoperty 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, ~.~-Certificate of occupancy $5.~.~ 2. Certificate of o~upancy on peTe-existing dwelling or land 3, Copy of certificate of occupancy $1,00 use $5.00 Date.. 20 .~A 86 New Building ............. Old or Pre-existing Building(X) .... .~. _- =/Vacant Land ............ 1000 Cedar Dr, East Marion Location of Property .................... House No. Street Ha/n/et Owner or Owners of Property Kim T. Dzenk~wski T 1000 S ti ~ 1 L 12 County ax Map No. ec on ............. Block....,..,. , ,.. ot ' i~[~ A,~Ua~.iew ~k Fil d Map No 5-~ ~- I Lot No ~ Subdiv .................. e ......... Permit No...1 .. Date of Permit .......... ~pp~mant ............................... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. 3O Underwriters Approval ........................ Planning Board Approval .................. ~ , · ~ Request for Temporary Certificate Final Certificate , - Fee Submitted $...[~. 0~ ...................... Construction on above described building and permit~ meets~all aPPl-~cable~codes and regulations. ,~pp an[ . ~>;..~_. ,:~ .... ~ r. v ..................... Rev, 10-10-78 ,, ..... . .... ~,~ ~,..,~.,;'~,-, ..... . ., . ~' ... ~ .. . /1ELD INSPECTION ?OUNDATION ~(lst,) COMMENTS VOUNDATION (2nd) i~OUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY V 85 JOHN STREET, NEW YORK, NEW YORK 10038 T. iS CERT,mES T.^T ~,~:~4~[ o~ N 7 2 813 0 only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of in the ~llowing locatlon; [] Basement [] 1st Fl. w~ examined on D~©~ ~ g ~ .~,~ o ~ outside [] 2nd FI. Section 2~ Block 1 and found to be it~ compliance with tke requirements of this Board. rot 12 FIXTURE INCANDESCENT FIXTURES OUTLETS SWITCHES RANGES COOKING DECKS AMT, K. W A~ UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DRYERS OTHER APPARATUS: FLUORESCENT MERCURY VAPOR FURNACE MOTORS FUTURE APPLIANCE FEEDERS H.P. AMT NO, A W,G S iPECIAL REC'PT AMT. A~P. R EXHAUST FANS DIMMERS NO, OF CC. COND A W.G. PER ~ OF CC. COND V I C E NO, OF HI-LEG A, W. G NO. OF NEUTRALS OF HI-LEG OF NEUTRAL (,~3wi~mning Pool) This ' '"' ' only/, Because of %u~us~a], environments it is advisable to have freq~xent [;.~s'f and/or repairs 'made by a q'uvtif~jed person, K~m '2, Dzenkov~ska. ].000 Cedar Dr. East Ma~ton~ ~;.y., 11939 GENEI~AL MANAGER this certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors ma), be identified by their ~redeptlal$ 'I=ORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7654802 Examined ............... Approved ..... .~./..~..~.--..., 19.~.(.~ermit No' · ~' '~'%?'/'~ · ~'27' Disapproved a/c ..................................... {Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. This 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 promises 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 iss.uance 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 necessary insp, ections. ..... ............ (Signature of applicant,/~r name, if a corporation) · ! 597>. ? J.2 . ?. (Mailing address of applicant) State whether applicant, is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Name of owner of premises ..... I~J-~ .~,. Dz. enRD.w, ski.& .W~£.e ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) 144 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 done...I.000. ~ed ar. ~, ~.. fg&~C..M~r i~r~ ............... 1000 Cedar Dr. East Marion House Number Street Hamlet 22 I 12 County Tax Map No. 1000 Section .................. Block .................. Lot ................... Subdivision Aquaview t~ark Filed Map No. 5621 Lot 8 (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... 1..;~6.rn.... d. ~.~]. j_¢g ................................................ b Intended use and occupancy s mmim oo t ,'~3~ ,, ' Swimming pool ~., 3. Nature of work (check which pplicable): New Building ..... ' .....'Addition xx Alteration ~lJ~t O '~'' Ren oval ....... Demolition Other Work.. ' (Description) 4. Estimated Cost .... $900.G.q0 ....................... Fee ..... ~SD.o.00 .......................... , ~' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. Number of dwelling units 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. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w~th alteratmns or additions: Front ................. Rear .................. Depth ~ Height Number of Stories Dnnens~ons of enttre new cons~ructmn: Front ............... Rear ............... Depth ............... He ght ............ Number of Stories ......................................... f. ~ .. ......... Size of lot: Front fl 7.6.: ~5 Rear ~ ? 5.00 Depth .2.5.7.: 38 10 Dati of Purchase ~ Name of Former Owner 11. Zone or use district in which piemises are situated ..................................................... 12. Does propos, e_d construction viglate any zoning law, ordinance or regulation: .... no ........................ 13. Will lot be re,faded .... .ye ~ .................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises . 'i' S.a, n30 ............ Address ................... Phone No. 47.7.-:2.455 .... Name of Architect ' Address Phone No Nam i Same Add Ph am. ' e of Contractor ...... .................. tess ............... one No... s e 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. See survey STATE OF NEW YORK, COUNTY OF .............. S.S being duly sworn, deposes and says that he is the applicant (Name of individual si ning contract) above named. He is the ........... d /. ,~' (contractor, agent, corporate officer, etc.) of said owner or owners, and is doly authorized to perform or have performed the said work and to make and file this application; that all statements cogtained 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 N0g~V 1~.~ ~{m ~18m Wt .......... ' ~, 4707~78, ~ 129~/~ '/ + c.- (Signature of applicant)