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Home My WebLink About13682-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi[icate O[ Occupancy No. Z15278 DateFebruar7 17, 1987 THIS CERTIFIES that the building .... .A.I.~. e..r .a.t.~. 9 .n ................................ L°catinn°fPr°pertY~/~Os~ 58'5hjoi DOGWOOD LAIqE, SOUTHOLD · ' ..................... 's't/e~i ....................... h~t~iol County Tax Map No. 1000 Section ..0.5.4 ........ Block ...... 05 .Lot 056 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 4~.n....2 J .... 1.9{~,5.., . .. pursuant to which Building Permit No..1.3.6.8..2.g .............. dated .... o. a..n... 2. 2. .,..1. 9. 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 ......... · ~a..k.e..s.t..r.u.c.t.u..r.a.1..q .h.a.n. ge...~.n..e..x.i.s.t.i..n g..r.o. 9.f' .a.n..d..i.n.s..t.a.l.!' .t.w.o.. s..k.y.l.i.g..h.m.s.. The certificate is issued to s. RAVE, W. TLOCZKOWSKI, & M. TLOCZKOWSKI ..................... / oYn'd-, ~ :!~ Y;/~) ...................... of the aforesaid building. Suffolk County Department of Health Approval Iq/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED: Feb. 16, 1987 LOFT Rev. 1/81 Ul .......... ' ............ FORM NO. ft TOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NB 1368;> Z Date Permission is hereby granted to: to at premises located at ~.~.... ....... ; ................................................ County Tax Map No 1000 Secton AC~...'~....~.. Block . pursuant to application dated '~'(~/'-- ............. , 19~...Tand approved by the Building Inspector. ~/' (/ Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 TOWhee Sb-th~OLD - APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~==~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. 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 al~ property lines, streets, buildings and unusum 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 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 ............. House No, Street Ham/et Owner or Owners of Property . .~., '' '~' '~' '~'t'' '~'~'' · · '~' '~' '~ '/'~' · '~' '~'~-- ~. .~'. . '~' '~ · '~'~'~ '~' · .~' · County Tax Map No, 1000 Section .............. Block .............. Lot .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No, /7 (~2- ~, Date of Permit t .Applicant ut~,, 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 aj3plicable codes an, d regulations. App cant ~..~. f~ ,,v.,o-,o.,e FIELD IN SP~CTIO~N COMMENTS .. FOUNDATION (~st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PE~ N', Y. ~.~ STATE ENERGY C,ODE FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ~/~ ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [~'~ FRAMING [ ]FINAL REMARKS: ~/~,,,, ~ .765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION AND [~ INSULATION [ ] FRAMING [ ] FINAL DATE INSPECTOR, 7654802 BUILDING DEPT, ~ INSPECTION ~UNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REM RKS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~- ~ Owner ~ ~3~3~ ~O~ (please print) Plumber '~0~3 (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this / ~ day of ~.~ 19 Notary Public, MADE[.YN M, ~ (plumber~X~nat~.e) _ Notary Public County TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 - ' TEL.: 765-11)03 TOWN OF sOUTH?LD Examined .~... ~f~.. .... 1~.>.-' ~ Received ........... ,99.... Disappro~d a/c ...... -.-. · 7~ ........................ : ! (Building Inspector) APPLICATION FOR BUILDING PERI~/IlT Date ...... ( ........... 19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 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~e,,gtioxkq~7-~/~/~ ~ L ! -~ ..... ............ (Signature of applicant, o~ name, if a corporation) .... ........ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, Name of owner of premises..~..~f./.f~.. ~ .~..(~..~.]..(.a~/.!!~h~e. ia:~l:} i:t.~de:' .L(,0.~.~/.~/.d).L~..~-. f~-4;: .. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~...~..~../~.~. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land ou which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000Section ...'~.7 ............ 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 ....... b. Intended use and occupancy . .:-' .~/.~. ~. TT~:.~ .~-~7-.~'../7-'..'~./.~> .... ~~-~. ............. 3. Nature ofwor.k/(che6k WH{c~: applicable): New Building .......... 'Addition .......... Alteration .. r'~ ...... Repair .,,.~ ~ ....... R'em~oval .............. Demolition .............. Other Work . . .(..'.. : (J~J" l[~_~,} ~: ~ -- __ ~o (Description) 4. Estimated, Cost ...... ~:~.~!f.5. ..................... Fee .2~...~...'.~.-: .............. .... ~" (to be paid on filing this application) 5. If dwelling, numbe~ of dwellifig units ............... Number of dwelling units on each floor ................ If garage number of cars" 6.. If business, commercial or mix6d occupancy, specify nature and extent of each type of use ..................... 7 Dimensions ' ' ' if any: Front Rear Depth · of emstmg structures, ............................................ Height ............... Number of Stories ... ~.~..~ ................................................. Dimensions of same structure ~ith alterations or additions: Front ................. Rear .................. Depth ................... !... Height .................... Number of Stories ...................... Dimensions of entire new construction: Front ............. Rear ............ ... Depth .......... . ... . Height Nufnber of Stories 9. Size of lot: Front .......... . ............ Rear .................... Depth ...................... 10. Date of Purchase .......... ~ ................... Name of Former Owner ............................. 1 1. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................. 13. Will lqt be regraded .... i ............. Will excess fill be removed from premises: Yes (~ 14. Name of Owner of premises: .!... j .............. Address ................... Phone No ................ Name of Architect ~C~. ff. (~../.~/: ?.~.~ ........... Address . 7ou~d;/~'x .~..~oc .... Phone No. ?$o~ ~.4(.~. 5. NameofContractor . ~. ~.,~.~-1-~ ........ Address ~.P~.9~¢~..gm:...PhoneNo..~/k).~.,q'r~/r.~(3 .... 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 Coruer lot. STATE OF NEW YORK, COUNTY OF ................ S.S .................................................. being duly sworn, deposes and says that he is the applicant (Name of individual sigging contract) abow~ named. He is the ..................... 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 mannkr set forth in the application filed therewith. Sworn to before me this ............ (~'( ' ' day °!f i '~,'tr '..~i ......... 19 ~' '~- Notary Public, i .~..~.~ .... .~' County '"'~'" HELEN K, DF. VOE '~"'- , ~OTARY PLJBL¢~ State of New Yolk .......... .... , ..... N0. 47078'/8. SLII[0[~ O0~lnt~r' (Signature Of applic~t) ~ ~esm Exp~es ~la*ch 30, I9~~ ' FEEl .... - -BY: 7,65-1802 9 A~ TO 4 P~ FOR THE ],.._FOU~ON - TWO REQUIRED FO~ 2CL]RcD CONCRETE ...... 2: ROb'C~ - FRA~iNG & ~P-LU~BING 3, INSLU &~?'~ 4. F[N.4L - COX:S~OCT~ON '~UST BE C E FOR C,O. ALL CONS,TRUCT~ON SHALL MEET THE ~EOU~REM~NTS OF THE N, Y. ~ N STATE CONS,RUCT[O & ENERGY CODES. NOT RESPONSIBLE FOR -DESIGN OR ~'ONSTROCTION ERRORS. r T