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Home My WebLink About13926-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Plumbers Certification No. Z14893 Date September 18, .,19.8.6 THIS CERTIFIES that the building One family dwelling. 305 Smith Drive Southold, N.Y. Location of Property .................... 76 ' ...... County Tax Map No. 1000 Section ............ Block ............... Lot ................. Subdivision M/o Goose Neck Ests. 130 & 131 ............................... Filed Map No. 1663 .Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated May 1, 13926 Z ..................... ,19..8.5pursuant to which Building Permit No ...................... dated............................May 8, t9.8.5, 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 ......... ......... Q~..r.~ ro;Li.y.. Ow.e.~, J. ~.r~g ................................................ The certificate is issued to Andrew K. Lutkowski ..................... ioYn'o;, ~;,~-k~i,~;ei~ ..................... of the aforesaid building. Suffolk County Department of Health Approval 8 5 - S 0- 0 7 UNDERWRITERS CERTIFICATE NO. N 7 5 5 0 4 7 .... Dated: June 27~ 1986 Rev. 1/81 FO~' NO. II TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 13926 Z Building Inspector. ~ ,...4...~./...~ .... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec- tor with the following; for new buildings or new use: I. 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~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 occupancv on pre-existing dwelling $1 5.00 3, Copy of certificate of occupancy $1,00 4.Vacant Land C.O. $5.00 5.updated C.O. $15.00 Date .... -/~'-~ NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .... .~. ~ .... ,~ ~ ~T..~....~. ~.. .... ,. .., .......................... House No. Street Ham/et Owner or Owners of Property . County Tax Map No. 1000 Section .... ?,..~. ...... Block ..... ~,,,.. .... Lot./, ,~../, Subdivision., .~. ,o.%~% , ,~.~.cr ,J~,,, .~c'~$,~,~,~,~..~..Filed Map No, /,~,~C .',~.." .Lot No. /, .~,(~..'7 ./, ~./,. Permit No. /. ~,~.~-~..Z.. 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. ....................... Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. Ow~ler {please print) ~iumber ~,d qt-C~f~-,tgf)'~/ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. - - ' {plumber' s ~ature) Sworn to befores, this 19~'. ]~ ~ '- -- / Notary Public Notary Public, CommisSion ~ires Ma~ 31, 198~ IFIELD INS~EC~)N COMMENTS FOUNDAT:I ON ( 1 ,~ t) o~( ~ /,mb- FOUNDATION (2nd) 2 o ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL iooi~ia THE NEW YORK BOARD OF FIRE UNDERWRITERS B,,.~ June i8, i~ .~..f,..,,o.~o.o./,,~ a?ii~t/85 N755047 Andro~ I~lthowski, '~lth Drive South~ Southold, N.Y. i. the following location; ~, Basem,,e~n~ ~ Ist Ft. ~ £nd FL ,Section Bilk ~t . ~ i~, ~ andfou,d to b~ in cotnpl~ance u'ith the require,*ents of this Board. SERVICE DISCONNECT S E R V I C ,, )THER APPARATUS: ~-G. F. C.I. 2-~ke Detectors ~D1;ors: 1-111p NO O~ERCC~COND. A W O NO. OF HI-LEG A,W,G INa. OF NEUTRALS A.W G OF CC, COND OF H~-LEG OF NEUTRAL 1 ]. 1 :Famm.7~ Elec~t ric 18 Grahsm Road HmUpton Bay~, N.Y. 119~ GENERAL This certificate must nofbe altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their COPY FOR BU)LDING DEPARTMENT. THIS COPY OF CERTIFICATE. MUST, NOT. z BE ALTERED N ANY MANNER. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL REMARKS: 76.5-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [/?ULATION [] FRAMING I-~ FINAL , REMARKS: ~/~ '~'~x,/j 765-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND ~ INSULATION [ ]FRAMING [ ]FINAL .-.A.,~., DATE /~//~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,9OUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined. .-. Approved k'. · l .f?. Pe m't 7. · )isapproved a/c '-- ~ ~.. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Rece±ved ........... ,19... a. Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ts 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 ~r 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 tins 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [egulations, 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 code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections. . .7.o~ .~ .~3.~.~'.,..~.~.~ ~a.~ ~br,~.. ............ (Signature of applicant, or name, if a corporation) .'.3.~.x...C.9.1 ?.q :~..~4-: .;.4 .~.~. ~:~ !4. ........... (Mailing address of applicant) grate whether applicant is owner, lessee, agent, architect, enCneer, general contractor, electrician, plumber or builder· une of owner of premises f3r ¢1 d- .r'¢,-'0 ' (as on the tax roll or latest deed) 2d~aant is a corporation, signature of duly authorized officer. Builder's License No ..... /. ~./ .................. Plumber's License No.../.~.-f. t31 l~ ............ Electrician's License No. ~ ~ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. · ...... .~..o. ~'7. ................. , .&:.w.~., ~. c...¢.o., ............. .~??~ ?.,..~. .................. House Number Street Hamlet County Tax Map No. 1000 Section .... .~.?. .......... Block·....c~. ............ Lot .... ~Y.)?. ........... - ~ ~&~-/c.~4 Filed Map No..../'.(o [~ ·~. ..... Lo/t'~.6.4../.~./. ........ Subdivision...~ 04 C~. .... ~' ~'(iq'a~ ;) ............. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~.¢:¢ &~3 f b. Intended use and occupancy ...... .0D~.. t ........................................ 3. Nature of work (check which applicable): New Building ... ~/..... 'Addition .......... Alteration ......... Repair , :. Removal .. Demolition .. j~, Other Work . 4. Estimated Cost ~.0': 0'~ , . . Fee Z~.Z[ ~L""~. . (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ............... Number of dwelling units on each floor ................ If garage number of cars ' 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 of Stories 8. Dimensions of entire new construction: Front ... ~ ~... ~ ...... Rear ....,5'2...d, ...... Depth .. ?. '.~./ ......... ,¢.~. ' Nuinber of Stories Height .................................................................... 9. Size 0flot: Front /fiD' ~ Rear /.0'~) Depth 10. Date of Purchase ......... ~ ................... Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed onstmctmn vi01ate any zoning law, ordinance or regulation: .... DO. 13. Will lot be regraded ....... J .O~ ................. Will ex,.ess fill be remove~l from premises: ~Yes Name of Architect ....... ~ ...... Address .;Phone No Name of Contractor g-~l, ft ~.j~. ~.,>t../~x tl&qC..~.c~. Address 3q-C. ~,) [op.,¢.{. ¢~. 1 ~' ~.~one No..'7~-L~/g-¢~. ...... 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 comer lot. , STATE OF NEW YORK, COUNTY ...... : s.s tB~.O~.. .. ~. · ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) above named. He is the .................................................................... I (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 manher set forth in the application filed therewith. Sworn to before me this ' NOTARY P(3[/(.IC, Statb of New '~'o (~ ..... ~ ........... Nd. 47078/8, Suf!0ik C0~mtf (Signature of applicant) 10~m ~xlmes Jvla,lh 30, 19.~7 ' '1 SUFF'OLK CO. HEALTH DEPT. APPROYAL Z , , ! j (~ ,, H.s. HO. i ~ ... ~.' ,~j~ ~ ~.'~ ~ ?, ~.,~ SERVICES -- FgR APPROVAL OF ", DATE: ...... ~ ~ , "~ ''¢ i',~* SINGLE FAMILYDWEL~NLY · / ~: ~ / ! - / ,,~ z. ,, . ~ ~.O~HoM~V/I~ ~ ~,._. ~.....-,'... . - · ~ , · ¢ : r~' ' f,~. ,"/ ' ~7' ' · . ~ ~ ' "- , -- , ~ ".,' - ,~, '~. :--:','. '.. ,, " · .~..~.~ ,~ ~!,-~" ~.~ ~lk.~:~ ~~ .~,,~,,~,~ . .... .. ,..:~ . ,_ . "~~e'-~ A~..~ ~x ~ ~ ~"' ' ' ~"~U~,''~' · ':, .... ' fi' : , ..... ' . '~ ~. - . ., . ./... ~ ,.- . ...... . . . .~. .~.~.. '.....':.: :::'. .... ' ~* SUFFOLK CO. HEALTH DEP"~a~.APieROVAL , , , ~ H.S. NO. T~E WATER $U~Y AND ~A~ [:' [ ~ ~'~ ~" SYSTEMS FOR THIS RESI~NCE WILL ~ .~ [ i~,~ .~ / CONFORM TO T~ STAN~ ~ I ~ SUFFOLK CO~TY ~. r ~ [~~ a~TRU~LY ~ ~ /'~ ~ ~T ;. , ~:~*:~ ~ DATE: ~, , ~,,, , . ~,c, o .. (r/ ~ I ~"' ~ ~ r t. /'~:/~) ',/~ ~ , ~ . ~. - ~.~/ SINGLE FAMILY DWELUN~ ONLY I , .. " ~:t, -'. ~/C~ ~. ~ ~:. . L. P. H.D. REF. NO. L~g~'~ ~ ' /' ~' ~ .... ~ .... , ....... '"~' DATE V ;, : :~r, ,,, ~ ; ""-.',:~ ~E ~ ~ ~ ~ ~ WA~R ~Y F~IL~ FOR ~ ~?~__ ~' "'-,~'~ ' ~ , ~ ~ .'~:~ ~ ~ "V ~ .......... , ~, ,. ' ' ' "' ~' ' ~ ~ ' 7~I~- t~ ~ //,'~' - ~'~ '~~ ~-. ~:~/d'* ~ ~.-,w2'd'~.~. . ~:.~ ~m. ~ t~ ~ , _'", ~;~[, :~ ~. , / ~/, /. ...... . '~' ~,"~;'c"~ '~ ~ :."?~ i -,- ,"~/~' ~ ~ o-,',,'~'/ / /,"~' ~' , , - , SUF FOLK COUNTY HEALTH ~,EPA~MEi-IT SINGLE FAMILY DWELLING ONLY H~D. REF. NO. LOCATIO~ ~NT AND H:TY /5:,4. %' L L- 12' o" FEE' ' ~NT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS' 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & pLUMBING 3, INSULAtiON 4. FINAL - CON'STRIJCTION MUST BE COMPLETE FOR C O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRO~ IF copper tubing is used ~:or water distributing system; piping shall I~ of types K or L o~!.~ ' 'PLUMBER CERTTFIC/JTION' ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYS~M CANNOT EXCEED 2/10 of 1% LEAD. FO UAID, TIO COoSE A &ID F vt/ 7'-I" 12;o" 'T J L. PST ~L LIVIM¢ -ir _ le. I FII?.ST F'LOOl2. PLA,L/ ~o9-7, z~ ,~ /vl/~. ~ iV D PE W L U T/c"O W,9,~I ~ O U 'T' t'I O L Z:~ M . y, C. wqsr-,.T T t::: L o o lC PL 4, tJ t U T~O WSk't ~OUTWOLD · FL oo L dTl~'O W,.5,~I E~OOTttOLP · Al, Y, EEL',= V.~ I t ELE V, Z,T'/ O /U_ PATE w5 ~I ~/DI--. E-VA T-/ !1]1 ~A~ E~VAT/O~I ~ ,1~ , .SOLITi-t o L I;> ¢ 1,,t,F. [LEV~, T~o~I ir2 I~ALL 1.o7' h~l /..or 13o - IO0.0 ~L o T PZ..A ,v ~OO~E ,~A Y ,,-~$TATE 5 .SOOTI-I oL D ., &Y F~L OT PLA Id,