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HomeMy WebLinkAbout14271-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17724 Date JANUARY 31r 1989 THIS CERTIFIES that the building. ADDITION Location of Property 4895 PECONIC BAY BLVD. LAUREL, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 128 Block O1 Lot 017 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 23r 1985 pursuant to which Building Permit No. i4271-z dated SEPTEMBER 12~ 1985 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 CARPORT ADDITION TO EXISTING ONE FAMILY DWR3J.ING The certificate is issued to JANET PASQUALINA,EXEC.EST ASSUNTA ROSE LICO (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEPu~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 14271 Z Permission is hereby granted to: .... .l.~....~..C.....~......~~ ..................... ,o .~.~......~.....~-..~..~..... ~.~...~..~....~~....~ ot premises located at ....~ ................ ~..~...~...~..~.~....~..'~,...~....o. .................................... County Tax Mop No. 1000 Section ....... /...~...~.. ...... Block .......C~.J. .......... Lot No .......~.J...~ ........... pursuant to application dated ....~.~,4~.~.......~,.~ ............. , 19..~..~.~., and approved by the Building Inspector. Building Insl:~ector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD 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 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 property 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: Add£tions $25.00 ?OOL$ $25.00 ALTBRATION $25.00 1. Certificate of occupancy New Dwe[ling $25.Q0, Accessory ,$]0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ lO0.O0 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 .. November 4, 1988 NewC°nstructi°n ...... Old or Pre-existing Building . ,.X.X ........ Vacant Land ............. Location of Property ..... 4895 Peconic Bay Blvd. Laurel House No. Street Ham/et Owner or Owners of Property JANET PASQUALINA, as executrix of the estate of ASSUNTA ROSE LICO County Tax Map No. 1000 Section...............128 Block 01 Lot 017 Subdivision .......... 7777.-7 ................. Filed Map No. - ..... .Lot No... 777 ........ Permit No.., 1417.1.. Date of Permit . .. 19D.5...Applicant ..... : .E.s.t..a.t.e..o. ,f..A.S.S..U.N.T.A...R.O~.E..LICO Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approvai ........................ Planning Board Approval ................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ 25.00 /B. Construction on above described building and permit meets all applicabl~ codes and regulations. Applicant.. ~ .~.~ ........................ JANET PASQUALI~A, as executrix of the estate Rev. 10-10-78 of ASSUNTA ROSE LICO TOWN OF SOUTHOLD BUILDING DEPARTMENT In the Matter of the Application of JANET PASQUALINA, as Executrix of the Estate of ASSUNTA ROSE LICO, for a Certificate of Occupancy STATE OF NEW YORK ) COUNTY OF SUFFOLK ) ss.: JANET PASQUALINA, being duly sworn, deposes and says: £ am the Executrix of the Estate of AssUNTA ROSE LICO, and am very familiar with the structure(s) located on property known as 4895 PECONIC BAY BLVD., LAUREL (SCTM~ 1000-128-01-017), situate on the westerly side of Peconic Bay Blvd., as shown on the survey of Young & Young, dated October 24, 1988 (copy annexed hereto My mother, ASSUNTA ROSE LICO, and father, CARL E. LICO, had owned the property since 1980. Both have died~ with my mother surviving my father. The original Certificate of Occuapncy was issued to Elsie Gerred on May 2, 1972. A dormer was added in 1975~ for which a permit was issued (no. 7820) and a C.O. A carport was installed in 1985, for which a permit was issued (no. 14271), but no C.O. I am hereby requesting the issuance of a Certificate of Occupancy for the installation of the carport. The structure has been continuously used as a resi- dence, since at least1980. I made this affidavit knowing full well that the Town of Southold will rely upon the facts as stated herein to issue a Certificate of Occupancy for the addition of a carport to said struc- ture to JANET PASQUALINA, as Executrix of the Estate of A$SUNTA ROSE LICe. Dated: November I~ , 1988. JANET PASQUAL~NA, as Extecutrix of the Estateof ASSUNTA ROSE LICe Sworn to before me this 15 day of November, 1988. Notary Public AFFIDAVIT JANET PASQUALINA, being duly sworn deposes and says: I am the Executrix of the Estate of ASSUNTA ROSE LICO and the daughter of ASSUNTA ROSE LICO and CARL E. LICO. My father died3.~.on~*~l[IrY~ /~73 , a resident of A~U~L , County of S~F~0£~ and State of ~/ ~0~ At the time of his death, he was married to my mother. No probate proceedings were instituted for my father's estate as all property was jointly owned with my mother, and therefore passed to my mother by operation of law. Dated: November I~ , 1988 Sworn to before me this of November, 1988. day [JANET PASQ~LINA, as Execu- trix of the Estate of ASSUNTA ROSE LICO ANNIE LAU NOTARY PUD[ lC, State of New York No. 31-48.97657 Qualified in New York COUnty Comm~ss~o~ [xp~res Jutxe l, 1989 ,'iELD IN$1~ECTION COMMENTS OUNDATION {1st) ~OUNDATION (2nd) OUGH FRAME & ?LUMBING ~NSULATION PER N. Y. STATE ENERGY CODE FINA/ ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~- ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [~FINAL REMARKS: IY~71 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION AND [ ] IN~JLATION [ ] FRAMING [//]~INAL REMARKS: ~ DATE /[/~//~Y, INSPECTOR CONSENT TO INSPECTION JANET PASQUALINA, as executrix of t~e Estate of ASSUNTA Owner(s) Name(s) do(es) hereby state: ROSE LICO ., the undersigned, That the undersigned (is)~m~xthe owner~kof the premises in the Town of Southold located at 4895 Peconic Bay Blvd., Laurel which is shown and designated on the Suffolk County tax map as District 1000, Section 128 , Block 01 ~, Lot 01.7, That the undersigned (has) [~R~) filed, 'or caused to be filed, an applica- tion in the Southold Town Building Inspector's Office for the following: , _ Certificate of Occupancy for addition 6f .-c~rport That the undersigned do(es) hereby give consent to the Building Inspectors of the Town o~ Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: November 4, 1988 (signat~/r'e) JANET PASQUALINA, as executrix of the Estate of ASSUNTA ROSE LIC0 (print name) (sifnature) (~rint name) 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 19 .~.. Permit No ............ Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 stxeets ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :at, ion. 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 hall 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 ~ 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 ~uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws. Ordinances or Legulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing co.¢/e, and regulations, and to dmit auth°rized inspect°rs °n premises and in building f°r necesi~7, iyy~~.../.~/....~//..~ ......... (Si~gn~r.e_~ofap~plicant, or na~,~f a corporation) // .... -~.¢. _~/.~.~.47'¥ :. ~ ~.~..~..~..~... (Mailing address of applicant) ;tale whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ¢.',~,~. ~/...(~.~. ~..?.~...~r..e~.~ ........ ~ .............................................. ~lame of owner ofpremlses...~fi~.O..~.3. '7~* .~>.....~..,/..~..(2~ ......................................... (as on the tax roll o~ latest deed) I f applicant is a corporation, signature of duly authorized officer. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ....... ,t ....· ................... ,~ .................. ...... ' /. House Number Street Hamlet County Tax Map No. 1000 Section ............... Block .................. Lot ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: ....................... ~.,~,~,~,n~ o~,~an~ .0 ...... $e ..... ~'. ~ ........ :..,,?. .. .~,.. 3. Nature of work (check which applicable): New Building ..... ' .....'Addition ......... Alteration ........ :. Repair .............. Rem6vai ............ Demolition .............. Other Work ............... i (Description) 4. Estimated Cost .......................... Fee ...................................... ~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling!~nits ............... .Nu.m.b~r o.f dwelli, ng units on each floor ................ If garage, number of cars .... ~ .......................................................... 6. If business, commercial or mix6d occupancy, specify natule and extent of e~tchty~e of use .............. ,., ...... 7. Dimensions of, existin structures if an · Front 2~.,~....~.. Rear ~..~ ~-~ . Denth ~ "~' ~.. '--r g , ' Y .................... ~' ''/ ........... Height ./~. ........... Number of Stories../..[~ ............................................. Dimensions of sarape stn, cture with alterations or aCditions: Front .~.~ ~3. Rear .~..5..~. Depth.. ~-..c~. x .~. ........ i... Height.. o/c?. ..... , ........... Number of Stories ..... /'. ............... Dimeflsions qf er)tire new construction: Front .... /. ~'. ....... Rear .../..~. ~. ........ Depth . ~., .~.,..~6 ...... Halgh* ~ umber of Sto~o~ ! -- 9. Size' of lot.' Front ...... ~.~.u__,.~ ........... Rear .... ~(~. ~.. ............ De~th ... ~...~. ............... 10. Dati of Purchase ................ ~NardoofFmmaerOwner ..(~]-t~h.~...~-itP./&.cl.C~7 ..... 11. Zone or use district in which premises are situated.. ~.~'r.~. ?.tr. '.-//..,:~. t~ ...................... .~'..... 12. Does propos, e.d constructk~n violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ../~/.6_9...~. '- .... ~:..,, ..., ..... Will exce~s fill be ren~oved from premises: Yes No 14. Name' of Owner of premises .ff~'.o./d../.~...t~z~.O.. Address . .~..c'.~.q-.l ....... Phone No. ,~t~..~./. ~..(¢. Name of Architect ......... [ ................ Address ...~.~.~. .... .~: .......... ...]. Phone No ....... Name of Contractor. .~.ql .~sS:.. . "i ..~..q ?.~ ~e/~. .. ........Address . ~..~.. .~'~,m~'... ....Phone No..?.2~..~'. PLOT DIAGRAM I,ocate 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. STATE OF NEW YORK, , S.S COUNTY OF ................. ' ........................... , ..................... being duly sworn, deposes and says that he is the applicant (Name of individual" ' s,gmng contract) above named. He is the ................... (Contractor, agent, corporate officer, etc.) of 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 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 .REW~IONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: dOHN LONGO ~ CAROL L. LONGO LAUREL TOWN or SOUTHOLD ' ,~.r~LOI~GO~ ~ ~...LO~;(:T*~ SUFFOLK CO., N.Y. sGAL£: ,,,.: 30' ';;U?ANC¥ OR - IS UNLAWFUL ;HOUT CERTIFICATE OCCUPANCY