HomeMy WebLinkAbout13811-zFORM NO_ -~
TO~'I OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Souuhold, N.Y_
CORREC'~D
CERTiFiCATE OF OCCU~C~
No: Z-22335
Date: 05/17/93
· £~±E CERTIFIES that the building
Location of Property: 1000 MILL RD
(ROUSE NO.)
County Tax Map No. 473889 Section 74
Su~divislon Filed~ap No. --
ADDIITON
PECONIC
(STREET) (HAMLET)
Block 2 Lot 14.1
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 22, 1985 pursuant to which
Building Permit No. 13811-Z dated MARCH 22, 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 WOODEN PORCH ROOF OVER ADDITION TO EXISTING ONE FAMILY DWELLING.
THE SErFFOLK COUNTY TAX MAP I~tYMBER AND HOUSE I, UJMBER ~AVE BEEN CORRECTED 0N
THIS CERTIFICATE OF OCCUPANCY.
T~e certificate is issued to GEORGE SWIERBUTOWICZ & WF
(OWNER)
of the aforesaid building.
~3FFOLK COI~A~fY DEPART~EI~T OF ~IF~LTE ~PRO~%L N/A
ELECTRICAL CERTIFICATE NO. N 139340 07/06/90
PLUMBERS CERTIFICATION DATED N/A
AuUhorize~ture
Rev_ 1/81
~0~'~' NO. ~B
TOWN OF SOUTHOLD
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~ 13811~Z
Permission is hereby granted to:
..................
................................................................................ ~t
at premises f~ated at ...~.~.....~~...-~.~ ................................................
..................................... .........................................................
c~ ~ox ~ ~o. ~00o ~,o~ ..L~.~ ........ ~,~k .... ~..~ ......... ~o, ~o...~ ...............
pu~uont to eppltcation dat~ ~.....~ ........................ , 19~., ~nd opprov~ by t~e
Build~g Inspector.
Fee $.~
Building Inspector
Rev. 6/30/80
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO Z-22335
Date MAY 17~ 1993
THIS CERTIFIES that the building
Location of Property 930 MILL LANE
House No.
County Tax Map No, 1000 Section 115
Subdivision
ADDITION
PECONIC~ NEW YORK
Street Hamlet
Block 13 Lot 4
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 22~ 1985 pursuant to which
Building Permit No. 13811-Z dated MARCH 22~ 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 WOODEN PORCH ROOF OVER ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to GEORGE & CHRISTINE SWIERBUTOWICZ
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWEITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N-139340 - JULY 6, 1990
~Buildi~g
Rev. 1/81
Ao
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be figled in by typewriter OR ink and submitted to the building
inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 f~rm).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2½10 of 1% lead.~
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
Submit Planning Board Approval of completed site plan requirements~
For existing buildings (prior to April 9, 1957) non-~onforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, buildiag and
unusual natural or topographic features.
2. A properly completed application and a consent to 'inspect signed by the applicant'.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant~
Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00
4, Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction ......... Old Or Pre-¢~istiDg Buildin~ .............. ~
Location of Property.. i i.~ .' .~ .... ........ ~ .~..~mf~,~.. ....... i[i .~...~. ....
House No.~
t~eet Hamlet .
Onwer or Owners of Property../.% ..... U .... ~ ........................................... ~ ......
$ounty Tax Map No i000, Section ....... Block ...... Lot. ' ......
~u dzv~szon ..... Filed Map Lot
~ermit No..~ .............. Date Of Permit ................ Applicant ................. .. ... ...... .
{ealth Dept. Approval ....................... · · · Underwriters Approval....~..~... .?...~.~. ~O.
'lanning Board Approval ~
iequest for: Temporary Certificate ........... Final Certicate~ ........
ee Submitted: ~ .~.~. ~ ~_O ~/. . .~~ ~_~ /
f 'y ' .... '"'"" ........ v "" '¥ ..............
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
,?~uthold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
TOWN OF SOUTHOLD · ?
in duplicate c
A. This application must be filled in typewriter OR ink, and submitted 'V~.. ~:~o'zhe 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.
B. 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 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 preoare 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
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
House No. Street Ham/et
County Tax Map No. 1000 Section // .~, Block /3 Lot.
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No./~.. ~../.}~...- .-~ate of Permit . ?..Applicant...~. ~r..~. o...~.~.~..t~. ("r~.~. · .....
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.
Applicant ...... ~.~-,~-~-~. · · ~..~. · ·
Rev. lo-10.7a
INSPECTORS
Victor Lessard
Principal Building Inspector
Curtis Horton
Senior Building Inspector
Thomas Fisher
Building Inspector
Gary Fish
Building Inspector
Vincent R. Wieezorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector
Telephone (516) 765-1802
SCOTT L. HARRIS, Supervisor
Southold Town Hall
P.O. Box 1179, 53095 Main Road
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
OFFICE OF BUILDING INSPECTOR
TOWN OF SOUTHOLD
April 27, 2993
Mr. & Mrs. George Swierbutowicz
930 Mill Lane
Peconic, N.Y. 11958
Re: Building Permit #13811-Z - (Porch Addition)
Premises: 930 Mill Lane, Peconic, N.Y.
Suff. Co. Tax Map #1000- 74-2-14.1
Dear Mr. & Mrs. Swierbutowicz
During a review of our files it was noted that the above
building permit has expired, and a Certificate of Occupancy has
never been issued. A final inspection has been made and all
that is required is that you fill out the enclosed application
for the Certificate of Occupancy and submit it along with your
check in the amount of $25.00 so that the CO may be issued.
According to the Code of the Town of Southold, Article
XXVIII 100-281 and 100-284 a building permit is needed for any
construction of additions, accessory structures or new
dwellings, and it is unlawful to occupy or use said structure
until a Certificate of Occupancy has been issued.
If you have any questions, please do not hesitate to
contact this office.
Thank you for your cooperation in this matter.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
VL:gar
Victor Lessard
Principal Building Inspector
FIELD INSPECTION COMMENTS
FOUNDATION (1st)
FOUNDATION ( 2nd )
ROUGH FRAME &
PLUMBING
INSULATION
FERN. Y.
STATE ENERGY
ODE
FINAL
;
ADDITIONAL COMMENTS:
THE NEW YORK BOARD OF FIRE UNDERWRITERS
'~ (i~r)[)) '~ BUREAU OF ELECTRICITY
85 .JOHN STREET, NEW YORK, NEW YORK 10038
~-Date ('~([~'~] (}(~* ' 1 ()~)0 ~pplication No. on file :~ ~07~/~) ~ 'l "~(~ ~(}
THI~ CERTIFIE~ THAT
o~y the electrical equipment ~ ~scr~bed be~w a~ interlaced by t~ applicant ~med on the a~ve application nu tuber in the premises of
in the following locatlon; ~ Basement ~ 1st Fl. ~ 2nd FI. (~1(? Section Bilk Lot
~s exa~nined on ~]l ~F'. ~ ~ ~ ()~0 and found to be in cotnpliance ~'ith the ~equ re,tents qf this Board.
FIXTURE
OUTLETS
f FIXTURES
ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER
I 1
DRYERS FURNACE MOTORS APPLIANCE FEEDERS TIMECLOCKS
RANGES ~OOKING DECKS OVENS EXHAUST FANS
UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT S E R V I C
OTHER APPARATUS:
OF CC COND
NO OF HI-LEG
A. w, G NO, OF NEUTRALS A, W. G,
OF HI-LEO OF NEUTRAL
GENERAL MANAGER
Per, ,~"~
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectbrs may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COP*/' OF CERTIFICA~TE ~$T NOT B~E ALTERED IN ANY MANb~ER.
~FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
~OUTHOLD, N.Y. 11971
TEL.: 765-180:3
Approved..'~...-,Z-'_~...,4'. ff...., 19 .~Termit No./
Received.
Disapproved a/c .................. ~ ...................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ................... ]9...
INSTRUCTIONS
a. This application must be compl6tely 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 descfibed.
The al:plicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorizedl inspectors on premises and in building for necessary[ .... inspections.~.~. ~~ '~a' i~~[''
(Signature of applicant, or name, ff a co p t'o )
..... z~. . .~ ¥ ?t. . .~. . . . . . ~. ~. ~ .. X~.
/ (Mailing address of applicant) ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
......... ....... ......
Name of owner of premises ....,~....'..-..5~.-~ .........................
(as on the tax r(ff~or
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. ;..~. ~'~1 ........
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
........ ~.y. ~ ............ ~_:...... ,~..~ ..~ ..................... . .~..~ .............
House Number Street Hamlet
County Tax Map No. 1000 Section ]/~- Block .../.~. .......... Lot
Subdivision ..................................... Filed Map No ............... Lot ........ ~' ......
(Name)
2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n:
a. Existing use and occupancy
2..
b. Intended use and occupancy .................................................
3. Natu~re of work (check which ~pplicable): New Building ..... ' ..... Addition ....... Alteration ..........
Repair .............. Removal .............. Demolition ..... ,~/- ...... Other Work...~...
I ~, (Description)
41 Estimated¢ost .... 'j7 '~..~'~.i .......................... Fee...f.~...~.f~...~.
!
~ *'~ (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 mixled occupancy, specify nature and ~xtent of each type of use .....................
7. Dimensions of existing structures, if any: Front ...... ' ......... Rear .............. Depth ...............
Height ........... Number of Stones
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ' Height Number of Stories
8. Dimensions of entire new cons'truction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ./ .................................................
9. Size of lot: Front ......... i ............ Rear ...................... Depth ......................
10 . Date of Purchase i Name of Former Owner
11. Zon~ or use district in which plremises are situated ........ ,O'... '. t .... r~.. ~. ~..~.,~..,~. T. ~..4~ Z-, ..............
12. Does proposed construction viglate any zoning law, ordinance or regulation: ...... .,~. ?. ......................
13. Will lot be regraded ....... " ................... #o~' ' Will~,~excess fill be removed from premises: Yes No
14. Name of Owner of premises**,'4 ............ .y swt~ ..... ~c~ress .. ~..'~o .... ~·.4.,. ...... ~-'~.~one No. ...............
Name of Architect .... ~ .................. Address ................... Phone No ................
Name of Contractor .../'~.~... ~'.~'.~.,~..C.,,/.Q.~(.. Address ....~?..'~. 4/~...,,,f...7' .... Phone No...~..~. ?..
property lines. Give street and blocl
interior or coruer lot.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
: number or description according to deed, and show street names and indicate whether
STATE OF NE~ YORK~
· · · ~ · · ~ ......~ ............ : .... ~ ................. being duly sworn, deposes and says that he is the applicant
(Name of individual sig~in~ contract)
abov¢ named.
(Contractor, agent, corporate officer, etc.)
of said o~ner or owners, ~d is ddly authorized to perform or have perfomed the said work and to m~e and file this
application; that all statements cont~ed ~ this application are true to the best of his knowledge and belief; and that the
work will be perfo~ed in the m~n~r set forth in the application filed therewith.
Sworn to before me this
765- ~ 802 D
9 AM TO 4 PM FOR THr
FOLLOWING
INSPECTIONS:
i. FOUNDA¥10N _ TWO REOLJIRE'~
FOR POURED CONCRETE '
2. ROUGH - FRAMING & PLUMBINg;
3. INSULATION
4. FINAL ~ CON'~TRI CT nkr
......... '~MUS1
BE COMPL:TE FOR C O.
ALL CONSTRucTIoN SHALL MEET
THE REQUtR~MEN'FS O~ THF N Y
STATE CONSTRUCTION & FN~Gw
CODEs. NOT R~SPONgiB~ F c~r~
DESIGN OR CONSTR[UCTION ~-~ ....