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Home My WebLink About24194-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No E-25140 Date JULY 18, 1997 THIS CERTIFIES that the buildin~ BOILER Location of Property 1465 PEQUASH AVE. CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 103 Block 7 Lot 17 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 2, 1997 pursuant to which Building Permit No. 24194-Z dated JUNE 19, 1997 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 INSTALL NEW BOILER AS APPLIED FOR. The certificate is issued to ROBERT KOSCUIBKO (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A Bulling 'Ins~ctor Rev. 1/81 24194 Z FORM NO.3 TOWN OF $OUTHOU) BUt[DING DEP~J~!TMENT TOWN ~ $OUTHOLD, N,Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ....~.U~E: ................ /,.~ ............................ 19..~:Z ..... Permission Is hereby granted to: ....... ~QBEFI.T... E.. ~O~C ,I.UE~KQ ................ , ..................... ....... P, EgU~SiH...~.V.E ........................................................ ....... CI.IICH~0UE,, ,N,Y., ,..tJ..9.;~.5 ~ .................................... to,,., ,I.N,~ ,T,'~ LL ** ,'~., ~O,I,LEB** .¢,~.. ~.P,P**L,I,ED,,. E. OI~ ............................................................................ of premises lc)coted of ............... ;L,4*A 5.**** .RE;~IU~E~..~,VE ..................................... CU.T, CM0~LIE ......... Counfl/Tox Mop No, .,..,4;,7.;5.8.8,~ ...... Section ..~,0.~ ..............Block ....0.0~,7, .........Lot No. O1,7., ................ pursuont to oppllcqflon dated ..,¢.L.IH.E ................. 2, ......................... 19...,.~.7, ...... ond opproved bythe Building Inspector, Rev. 6/30/80 TOWN OF SOUTIIOLD BUILDING DEPAP, THENT TOIIN IIALL 765-1802 APPLICATION FOIl CER'I'iIrlCATE OF OCCUPANCY A. This aPPiieattou must be filled in by typeuriter OR ltd< and submir~cd ~o t'he building inspector with thc [ollowi. ug: for ne~ buildi,g or ne~ use: 1. Final survey of property ~ith accurate location of ail buildings, property lines, streets, and unusual natural or topographic featnres. 2. Final Approw~l from Uehleh Dept. o~ water supply and seuarage-disposal(S-9 form). 3. Approval o~ electrics? installation from lloard o[ F~re U ~deruriters. 4. Sworu statemeot fro 'plumber certifying that the solder used in system contairs less than 2/10 of 1% lead. 5. Comnerc~al building, industrial building, multiple residence~ and simil and installations,la certificat-o ~r c~, c ,. ~ ar buildings k ....... ooe oompiial ce Iroln architect or engineer respousible for the building. 6. Submit Planuing Board Approval of completed site plan requirements. g. F~r existing buildiugs (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existi g' land uses: 1. Accurate survey of property showing all property lines, streets, buildi,g and unusual uatural or topographic featores. 2. A properly completed application and a consent to inspect signed by the applicant. i' If a Certificate of Occupancy is deuied, the Building Inspector shall state the reasons therefor in writing to the applicant. C~. Fees 1. Certificate of Occupaucy - New dwelling $25.00, Additions to dwelling $25.00,-- Alterations to dwelling $25.00, S~Jmming pool $25.00, Accessory building $25.00, Additioas to accessory buildiog $25.00. Businesses $50.00. 2. Certificate of Occupaucy on Pre~existing Buildine - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. l'e, porary Certificate of Occupancy - Residential $15.00., Commercial $15.00 Date ......................... . ,... tew Construction ........... Old O~Pre-exis/ting Buildin~ ................ llouse No. Street ~ ~t~ml e t ............. County Tax Map No 1000, Section..~ ...... Block... 9 .Lot. ~ ~ oubdmvlSZon ........................... FSled ......... Map ............ Lot .................. Eermit No ................ Date Of Permit ................ Applicant ........... Ileal th Dept App rowel ' ' ......................... Unde r~riters Approval ............ ?lanning Board Approval ...................... Request for: Temporary Certificate ........... Fin~] Certicate ~ . % ........... .... :.:.: ............. Town Hall, 53095 Main Roa, d P.O. Box 1179 Southotd, NewYo~k 11971 Fax (516) 765-1823 lelephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CE RTI F I C'AT I 0 N DATE: Buildin. g Permit No. (please prln ; (please print} I certify that the solder used in the wa~er supply system contains less than 2/10 of 1% lead.. -- (plumbe~i~ Sworn to before me this Notary .... ~-~--~ - ---6~ ! "~' KENN~H A. MIONE NOTARY PUBLIC, State Of New Yo~k No. 0~MI5040~74, Suffolk ,Te~m Expires Ma~c~ 6, , V-77 :'1 ' ' ~.. I,$~ 156 1~6 ii/ ; 1.6~ 191 166 143 :,' 1.90 221 192 166 8xBx 15 81,'1 6xBxl~ 81.3 9xBx 15 81,Z SxBx 15 81.5 8xTx 15 N/A 86.2 ® I~'' :' ~,i AMERICAS BOIII:R CONIC%NY ". f ' :~ BUF~IHAM CORPORATION 765-180Z BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING [ ]FIREPLACE &CHIMNEY REMARKS: [ ] ROUGH PLBG. [ ] II~SULATION [ I,~INAL INSPECTOR ~//~--'~ , . ~ !,..~ = FORM NO. 1 ;TOWN OF SOUTHOLD /'"!?? ,JUlx,~ , 2 I,~,~,)' BUILDING DEPARTMENT ; TOWN HALL ' '"-'," ;,U':~; ........ ~ SOUTHOLD, N Y 11971 ~ ,t, ,',,:3c..,~ .-, . TEL · 765-1802 .... rmit No.. Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF ?LAN$ ......... SURVEY CHECK ........ . CALL ................... HAIL TO: Date ................... 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 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 igsued 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 shallihave 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 inspecfi.~ns. . . ...... -- ;,~ (Signature of applicant, or narr~~ if a corporation)// ' .... i State whether appl~nt is o_3yner, lessee, agent, architect, engineer, general contractor, ~le~,}ei~:.Plumber or'builder. .................... ................................. - . ..... r ............ r · · . .... .. .' ' '~' ;; ' '; 'NOYI~'I~OILDING~DEPARTMENT 'AT .... tas on [ne tax roll. or la.~e6r~.~l§~)S AM ~0"4 PM FOR THE [f of duly authoriied officer. FOLLOWING INSI~ECTIONS; 1. FOUNDATION ~.- 'BNO 'REQUIRED ~ ,~<.¥ r .'-.~.-~,~ FOR POURED CONCRETE 3. INSULATION' 4. FINAL- CONSI~'RuCTION MUST Builder's License No .......................... BE COMPLETE FOR C.O, Plumber's License No ......................... ALL OONSYFiUCTION. SHALL TUE REQUmeMEUTS OF TNE N.Y. Electrician's License No. ~ ~>ff'? / "~-- ' STATI: C'~l~'~R~lOh~ & ENERGY ...................... CODES. ~OT RESPONSmLt FOR DEm_O~ OR_CO~Omucno~ eRRORS Other Trade's License No ........ ; ...... ~ 7/. ¥7Y . - ' /Q / ~ 1. Location ofland on which proposed work will be done /Z//~ ~-" /~-~/d'~st/), .~/~//~ ........ · .... . ................. : ..... .......... Itouse Number ' - -- ,.Street '1~, Ha/filet Cou'nty Tax MapNo. 1000 Section .'.:.Z?...~. ...... Block ..... 7' ' Lot / '/ Subdivision ' Filed Map No ............... Lot .... : .......... (Name) 2: State existing use and occupancy of premises and intended use and occupancy of proposed construction: / a. Existi g use and occupancy... ~ ........ /-~'. · · ·/..'-..~. ...... ~. v..,~ ................... /~ .....~-~ .... b. Intended use and occupancy _~.~.~ .//~....-x--//.. .....~..~.~..~. ~.¢ .~..,~.....~.?..~....~. ~1~.~ ~, / ..... ~//~) ~.~./~. .... '3. Nature of work (check whic t applicable): New Building ..... Addition .......... Alteratior ' pal R ........ Re r .............. ~,moval .............. Demolition Oth k · , i . .~ ' ' '': ......... er WoT .. 4. Estimated Cost.. . ,.,, ; ....... , (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number Of dwelling units on eac oor ......... Ifg b i . h fl ..... arage, num er of cars ~ ................. ' 6. If business, co,mmerciai or m/xed occupancy, specify nature and extent of,each type of use .................... 7. Dimensions et existing structt~res, if any: Front ............... Rear ...... De . pth .............. Height ............... ~umber of Stories ....... Di f h ~ ith ........................................ dditi ......... mensions o s me structur w alterations or a ons: Front ................. Rear ................. _Depth ~ [ Hight i . . 8 Dime ...................... e .......... . ........ : · · Number of Stories .................... ions of enti e new constmcti n: Font Rear ' ' · H ns r Nfimbero r ............ : ............... Depth ........ . eight ............... of Stories ...................... ' .... 9 Siz of lot Fr nt I ' Rear ' '" ............. 10 Date of P has I · ' 'I~a ......... Depth ...................... · UTC e ................ me of Former Owner 11 Z dist icti whi h ' ' situated ............................. prem . · one or use r n c ises are ................ . .................................... Name of Architect ........ ! ............ i .... Address ................. ,.. Phone No. .T7 4 ................ Name of Contractor ~:~.o ......... Addres~..d/~c/,t. ?4~..~i'/J~,~W... Phone No..d,.~. 7./.q..~.'-'.~. 15.' I.s this property w±th±r~ 300 feel: of a t±dal wetland? ~Yes ........ No ...... ' ...... ~If yes,' £outhold! Town TrusCees PermJ_C may be requJ_red. ''' [ ' PLOT DIAGRAM Locate clearly and distinctly all buildings, Whether existing or proposed, and, indicate ail 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, CO[/N~Y OF. ~ ......... , ; ' ·(Name ....... '. · · being duly sworn, deposes ~d ays that he ~s the applicant ~ of individual signing contract) above nam e~~ ~ ' Heisthe ~ ~~ ] ' of said owner or owners, ~d is dulYiaut~ohzed to perfom or have perfo~ed the said work and to'm~e and file this application; that all statements contained m this'application are true to the best of his knowledge and belief; and that the work will be perfomed in the manner ~et forth in the application filed therewith· ' Sworn to before me~s ........ Notaw Public, · County KENN~H A. MIONE NOTARY P~BLIC, State No, 01MI5040~74, Su~olk Co~nF