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Home My WebLink About24251-zFORM NO. 4 TOWN OF SOUTBOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, CERTIFICATE OF O~CUPANCY No Z-25151 Date JULY 23, 1997 THIS CERTIFIES that the building Location of Property. 350 BROOK LANE House No. County Tax Map NO. 1000 Section 79 Subdivision ADDITION SOUTHOLD, N · Y. Block 5 Filed Map NO. Street Lot 16.6 Lot No. Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated J~-L¥ 8, 1997 pursuant to which Building Permit No. 24251-Z dated J~/LY 17, 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 DECE ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR "AS BUILT" The certificate is issued to LAUREN PEEESLER KRUEZESKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 l~ng I nspec~r FORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN I'IAU. $OUTHOLD, N.Y. 2~251 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date..., .~ ~.~.Y ................ 3,7. ............................ 19_9.7. ..... Permission is hereby granted to: ....... [,,~ L.IB EN.. P..EE~.S LE Et.~. K~IJ~ ZJ~ S.K I ..................... ....... P..EI..,BO.X..i~i ~, ........................................................ ....... S~]LI.T. EIJ3 L~.. ~ .~...1.[ ~.7. l.. ....................................... at premises located at .................. ~.50....~EIE.QD.I~..~. ............................................ ,~.[3~ .T. H[~I~ ............ CountyTa~ Map No......~.7.;~.B.~ ......Section ...~7..~. ............. Block ....O.O.Q.5 ......... Lot No. O£~.O.Q~ ..... pursu~lnt to application dated ...~I.IJL.Y. ........ ......... .~..u ......... . ........... 19.....~.7.. ...... and approved by the Building Inspector. Fee $ ........ 7, ~. ,. P.O. ..... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitt~ed to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form)~ 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 2/10 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. 6. Submit Planning Board Approval of c6mpleted site plan requirements· For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '!pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets~ building 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. C. Fees i. Certificate of Occupancy - New dwellzng $25.00.,~s to dwellzng $25'--00~ -~. . . Alterations to dwelling $25.00, Swlmmzng pool $2~7. U0, Accessory bu~ldzng $25.00~ Additions to accessory building $25.00· Businesses $50.00, '2. Certificate of Occupancy on Pre-existinR Buildin~ - $100.00 3. Copy of Certificate of Occupancy - ~ .25~ D. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15·00 Date . .... · .7 %~.2~'~Z ..... ................. ~...~. New Construction ........... 01d Or ?_re-existing Building... ~.. ~¢ ......... Location of Property ...... .~. f.O.., ~.~..0~f..~.~..~.~. .... .~..~. ?...~.'.~.~..~ .............. ~ .... ~ .... House No. Street Hamlet Onwer or Owners of Property .... ~.Z~.~... r.J~.'. ~,~/.Z?..~....~?. ?..~..~.~. ~..~..~ ....... ~...~ ..... County Tax Map No 1000, Section ............~. ~. Block .......... I~...~ ~ .... Lot ...... /'~'.--.~ ....... Subdivision .............................. ... . ~Filed Map ....... ~ .... Lot~,.~ ............... ~. Permit No ................ Date Of Permit .... Health Dept. Approval.~ .................... ........ .. . Applicant ...... ~..~..,~ ............... · .Underwriters Approval Planning Board Approval ....................... ~ Request for: Temporary Certificate ........ Fee Submitted: $. ~ .~. .................... .. Final Certicate ........ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [~4~NAL [ ] FIREPLACE &/~HIMNEY REMARKS: ~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] ROUGH PLBG. [ ] IN~JLATION [~I~NAL [ ] FIREPLACE & CHIMNEY · // DATE INSPE FORH NO. I TO$~N OF SOUTUOLD BUILDING I)EPARTNENT TOWN IIAI,L SOUTI1OI,D, N.Y. 1197 I TEl.: 765- lB02 ,,::,:7 D~ alt .................................. (Budding hm~peetor) ~ APPLICATION FOR BUILDING PERNIT I NS'FRIICTIONS BOARD OF llEAIA~! ............... 3 SETS OF PLANS ............... SURVEY ........................ CIIECK SEPTIC FORH ................... .NOTIFY: CALL ............... HAIl. TO: .................... Date ................ ,19 .... a. ~is application most be completely filled in by tyl~.ndter or in ink a~ ~itt~l to the ~fildi~ Ins~ctor 3 ~t~ of plons, oco~a~e ploE plan to ~ale. Fee occordi~ to seh~hle. b. Plot plan ~ing ]~ati~ of lot a~ of hlildi~s ~ ~mi~s, relati~sldp to ~jolning ~i~s or ~bllc str~ta or areas, ned givi~ a ~tailed tbncrlpt:i~ oF I~: of p~rty ~mt Im drmm ~ the dla~ this appl icati~. c. lira ~rk ~ by this ~licati~ ~ a~t Im cc~<~l lefore ism~e of ~fildi~ d. U~ a~al. of this application, the Ihildi~ ]nSlmCt:or .ill is~ a ~ildlt~ ~mlt to O~e a~lleast. ~ch ~mit ~mll le kept ~ tim ~i~s ~ailable for ins~cti~ thm~pfia~t the e. ~ la~ildi~ ~mll ~ <~ied or o~l in ~a)le or ia Inrt for m~ p~r~ ~mt~r tmtll a C~rtifieate ~< troll b~ Im ~ted ~ tie ~ildit~ In~ctor. ~'l~'rl~ I8 l~l~ ~E to tim ~ildi~ l~Dartmat for O~e ismm~e of a ~dldi~ Pemlt p~r~a.t to the Mildi~ ~ ~im~e of ~ ~ of ~:ttohl, ~fffolk ~ty, ~ York, ~ other a~llcoble I~, ~i~es or ~latla,, for t~ =,t~ti~ of Mildi~s, a~iti~s or alterati~a, or for ~al or ~litlon, as ~in eb~riM. ~m ~lie~t ~s W c~ly ~ith all a~llcable 1~, o~i~es, hfildi~ ~e, Imsi~ cede, ~lations, aM to ~hit mOmrir~ ias~tors on prmi~s aed in Islildi~for ~cesma~ indies. ~ ~ ~ .................. / ~ 7~/~*/ / L a ~,, j ................................................... State riffler a~plicast ia o~er, lessee, agent, ardfitect, engineer, general contraetO~t~.e.~,ctrj.dan, plt~lm, r or builder. .................. .O.W.~.e~ ......................................................... :.,~,~ ........................... (as on tim tw~ mi1 or latest deed) If applicant is a corporation, signature of duly mlthoriz~M officer. and title o} corporate officer) Buihlers License No .......................... Plmimrs License NO .......................... Electricians lJcenm NO ...................... Other Trade's License No ..................... J,J~,JJJ ALt, CONSTRUCTION 8HALL MEET TI~ REQUIREMENTS OF THE N.Y. STATE CQNSTR~N & ENEtlIGY I. Location of land m ~hich propo.~cl work ,ill ~ ~ ............................ ~.~.~~.~ .............. ~ ..... .~...0.o.P ~L~, ...................... ~....~.~.Po ...... ~.~~, ,= .... .... ..... aiMivisi~ ...................................... Fil~ ~p ~ ................ lot . a ............ State ~istlng ~ ~ ~ of ~mi.~s aed inte~l~ u~ mxl ~y of ~ c~st~cti~: a. ~fisti~ o~ ~ ~a~ ............................................................................. b. Int~l o~ n~ ~co~ ......................................... I ........................ frc~u propezty li~. 4. EsL iu~lt~l Q)S: . ~.. [ ...... 'j ......... lee .............................................. 7. I)JllelltlJ(~ls o~ exJstJll~ ~t~T~Lure~) Jif ally: Fr(~il ................. I~r ............... l~pth ................. 9. ~;J~ ()E Iol:J FF(~i[ ........ t ............ I~tlr .................... Jgpih lO. PI,OT I) I'AGIIAH ((k)],t r;~c~or~ ;[g. en~:, c()rqtx~rnle ofl[:icer, etc.) ~ ~, nxl it y tulh t iz t l lo IXtt o] u ?t h;iv(~ I~H'J()l]ll~(I tim ~mJ(I ~)i.k m~l lo [s~il(~ nixl fl l(~ ihl/i ~ll~l]i Jt:;~LJoll; Omi. Itl l ~L~tt~l~ilJ~ C )ilL,lifted il) IJlJfl nppl Jr:re'lot, ~ll'(~ I i1~ Lo I~le IKfflL o[ bib ~lK~[~J/~e ~iKI t~J Je[~ IJuII (lift ~)[Jt ~JJl I~ J~rJ()~ Jllj [Jl(~ li~llll~r fi~[: JolJh ltl Ihta all)l)lJc~il:lois filed tlmrc~iLh, .......... ..... ,,,,,X/ .....