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Home My WebLink About23709-z s FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24698 Date OCTOBER 24, 1996 THIS CERTIFIES that the building ADDITION Location of Property 305 SMITH DRIVE SOUTH SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 76 Block 2 Lot 24 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 9, 1996 pursuant to which Building Permit No. 23709-Z dated SEPTEMBER 30, 1996 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 DECK ADDITIONS TO EXISTING ONE FAMILY DWELLING "AS BUILT" AS APPLIED FOR. The certificate is issued to ANDREW K. LUTKOWSKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Ins p for Rev. 1/81 FORM NO. I 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) 23709 Z Date � ..-?..Q.......................................... Permission is hereby granted to: ...... -��.. ................... �• ....... ...... ... :�wl�!� . to .. .......... ..�� `�T jl.. r,.tn......4.... � .... .�'j"1.. .. . . . ........ ......., .. ....�.... .................................... ............................ at premises I ted at ...... ..... ... ......... .. ....s............ ........ Kf ........... ................................................................................ ................................................................................ ................................................................................................................................................................. County Tax Map No. 1000 Section ......... 6?...... Block ......i2........... Lot No. ............... pursuant to application dated ...: ............................................ 19f!�, and approved by the Building Inspector. Fee $•••/- /•.r . .... ...... ,rra... .r.. .Vic.......................... ilding Inspector Rev. 6/30/80 TO tv1,' OF j 0 i,i 30 L.D / 3U,T 17TY1C DE?a12TMENT 7 "1 l� TOWN 1,yLL �St i OJ-190� SEP 1 II 1996 APPLICATION FOR CERT?=IC TE 0-7 OCCi1P aC`.:_� _1.- __j TOWN_BLDG GL;bT. OF ! A. This 3DDiic3t On must be filled in OV t:rDeTart tar OF, inkaiiQ ^9u11din1 inspector With the following: for new Juild=ng or new use: 1 . C_nai sur-7ev Ot 'JroDerty W4tll accurate location of all buildings, proDe=y 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. Sworn St3temeIIt from plumber certifying that the solder used in system concains less than ?-/-'C of 1.0 lead. 3 . Commercial building, industrial building, multiple residences and similar buildings and-installations, a certificate of Code ComDliance from architect or engineer responsible for the building. o. Submit Planning Board Approval or completed site plan requirements. B . For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1 . accurate survey of property showing ail o_ roDert7 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 CartiJ:car_e of Occupancy is denied, the Building inspector shall state the reaSoris therefor in writing to the applicant. C. Fees ? . Carti=irate of Occupancy - New dwelling 325.00, Additions to dwelling 323.00 , alterations to dwelling 323.00, Swimming pool 325.00, Accessory building 325 .00, Additions to accessory building 325.00. Businesses $50.00. - 2. Certificate of Occupancy on Pre-existing 3uildinQ - 5100.00 3. Copy of Certificate of Occupancy - .251(;. Updated Carti_ieate of Occupancy - 550.v^0 3. Temporary Certificate of Occupancy - Residential Si5.�0j0,�jCoommercial 513.00 Date . . . . . . . //!�f �` . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . Old Or ' e-emistinguildin . . . . . . . . . . Location of Property. . . . . . . . . . . . . . . . . . � . . . :. . . :. . . . . . . . . . . . . . . . . . . . . . . House No. • . Street Hamlet Onwer or Owners or Property. . . . .` ko W S./ r . . . . . . . . . . . . . . . . . . . . . Count-r Tax Map No 1000, Section. . . . . .7� . . . .Block. . . . . . . . . . . . . . .Lot. . . . . . .. . . . . . . . . . . . . . Subdivision. . . . . ,/•�G�,J�. . . ! . . . . . . . . . . .?fled Hao . . /4 3 . . .Lot. . Permit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . / / . . . . . . . . . . . . . . Hea'_th Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . ..finder-writers ADDroval. . . . . . . . . . . . . . . . . . . . . . . . . Planning 3oard approval. . . . . . . . . . . . . . . . . . . . . . . . 3eauesc for: Temporary Cartificace. . . . . . . . . . . '_-:al Certicate. .�� . . . . . dee Submitted: . . . . .�: .�. - . . . . . . . . . �� - z . . . . . . . . . . . . . . . . . 47 T65-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING 14 FINAL [ ] FIREPL E & CHIMNEY�� REMARK uc X DATE INSPECTOR 1- FIE1.0 INSPECTION REPORT DATE COMMENTS----------------- W if b O FOUNDATION OST) itII ---- --------------- --------- II II II _—_------------------------------------------ c FOUNDATION (2ND) ------------------------- ---------- II � ROUGH FRAME & II II - 1 II PLUMBING II II INSULATION PER N. Y. �------ p -- ------ ------ --- � . STATE ENERGY CODE �� l I II II - N-------if ------ - ----- FINAL ►I 0 ----ADDITIONAL COMMENTS: BOARD OF UEAL'I'll . . . . FORM No. 1 3 SETS OF PIANS . . . . . . . . . . . . . . . TOWN OF SUII'I'1I01.0 SURVEY . . . . . . . . . . . . . . . . . . . . . . . . SEP 1 1119% BUILDING DEPARTMENTAIECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL ;iEPTIC FORM . . . . . . . . . . . . . . . . . . . BLDG.DEPT. SOUT1101.1), N.Y_ 1 1911 TbVVS�bF SOUTHbLI? TEM: 765- 11102 NOT I FY CAIA. . . . . . . . . . . . . Ex:rnitx'cl._ .✓'D........., 19 � Alrprcrvcd...7. ........, 19.91 Permit No_ ........... ..... ...... .... .. . ..... . . UtsillymVed a/c .................................. JJJ ..... ..... ... . ..... ....... .. .. ..... . . ....... .. ................................ .......... . .1 Do APPLICATION FOIt IIUILI)ING PI?Iil1I'1' q �j' / Date. . . . . . .l._ !. . . . . , 19�p INS'TRUCT'IONS a. 'Ibis alldieaticxr oust be ccaulrlelely filled in by typewriter or its inlc atxl strlrtuifted to the Iktilding lnsp(ctor with 'I sets of plans, accurate plot plan to scale_ Fee according to scltedule. h. Plot plan :;Ixxairtg localiorr of lot aril of Ixrilditq;s ot) premises, relationship to rxljoining preinises or Ixtblic sheets or areas, and giving it detailed descriplicxt of layout of propii Ire dratnr cx) the dia};rm wlticlt is part of [his application. c. 'lite cx)rk covered by this appl icat ion tasty tK)t be ccaunetK:ed Ix-fore isacrance of Ikri lding Permit. d. tllxxr al>j)rrrval of this application, the Milling Tnslxector will issue a Ikrilding Permit to file applicant. Such Ix-rmiL shall be kept on 11)e premises available for inspeelicx) lhrcugh(AW the conk. e. No firstling shall Ire cx:cupied or used in whole or in part for any lionlx)se ubatever until a Certificate of Occul>inxy :;hall have trees granted I)y the Ikrilding Inspector. AI'Pl.l(NI'fON IS 111LAUly MNA's to the Ikrilding Department for die issuarK_e of a Ikrilding PenniL ptrrsuaut to the @rilding 'Lcx)e OrditkuK:e of the 'That► of &rutho[c1, Strffolk Gxrnly, New York, and other applicable Laws, Or'Ylinances or Regulaticros, for ll►e Coils Lnxaicm of buildings, FxkliCicx)s or alLeraLions, or for ramNal or dc-imlit-jon, as herein ekescrilx;d. 'file applicant agrees to curjily with all aplilicable laws, orditrxxces, Ixrilding axle, IK;rtsitq; code, mxl regtrlatiars, atxl to aduiC autlK)rized irMPeClors til premises atxl in Ixrildiog for rKe(' ssary 't ,lxcticx)s / .. .. ........... .. .. }itkapplicant, c - none, if n corlx)ral:iorr) (htri l in}; axkiretis o alrlil scant) Slate whether allAicartt is cxmer, lessee, agenC, architect, en};itteer, geireral contractor, electrician, )Itrti)et- or' Ixtildcr. O.".?6.e._�................. .... ... ... e .... .... .. . .. ................. ............ .. .. ....__......_.. R-11W of tinter of prcxnises ...... /`- ...................... .:.... .. ....... . ...k. ....... (as cxr the tax roil or latest d('ed) If applicant is a corporaLion, signature of duly A1,1010rizced officer. ... ...................................................... (R-mike atx1 title of (:orlx)rate officer) IkriIckers License a). ................ . . Plklib rs License No. ......................... Electricians License No. ........... ...... .... Other TnxW s license No. .................... I. I-cat icx) of larxl (x) which prnlx)s"I work will Ire dare......... .•-•••. .o- .....--.... �b . .S... . ... . .. .... ..... ....... Ikxtse Umber fitreel II rtileC Gxu)(y Tax L•j) >. IOW Section ._... :7.... ... Blcx-k 17. .... Lot ..... Sn,lxlivisiar oo ..l ..=........... . Fi tied t•ky No. ...�tQ ,3.._ Int (M-11e) 2. State existAlig use atxl occtlpaxy of premises a I inletKII use atxl cx.cul>aucy of prolxrsed coostrucaion: a. Existing use aril occulx:ux_y c yn.,, 1. �n�... 1 . ..... -....... ...... ,...... .................... b. lnletxkA use and occii miry ..._. 1. 1WIII I! of %Atilt (check %Ati(It .111Aic;IhIe): R-0 NIilIf inl, . . . . . . .. . . IV41i( iof1 . . . . . . .. . . Allf.ral ion .X- ��C�✓ 16!t>f l r . . . . . . . . . . . . Nilloval . . . . . . . . . . . . . Ik+Irt) i l ion . . . . . . . ... . . Ot leer 1k)llc C� D CJ (Ik!scriltl:i(xt) /1 . 1(:tt iuc11I'd Cost fee. . ... . fee . . . 6.1 0_0. . . . . . . .. . .. ... ... . . . . ... . . . . . . (lo lie paid or) 111 illi; Ihis '11110 ical ion) 1kA!11in1,, IKnl,er of: (k.,(!11in1, 1111i I's . . . . . . . . Iknlxr of (k.lrllinl, 1111il:t of) each floor . .. . . .t. .. . . . . . . . f 1,.1n11,e, 1t(n1x!r of cat tt . .. . ./ r/Z. . . . . . . . . . .. . . .. . . . . . . .. . . . . . 6, If kmilw•t;,, (xrinr!rcial or- mixed (wcolwexcy, slw!cify nalur(. rI1wI exte.1l of eelch I.ylx! of use...... . . . . . . (/.J Ilin�!nrticxls of exl:;l int; slnw_Une:;, if any: 11rcx11 . . . . . . . . . Itetlr . . .. . . .!. . . . .. . Dept 11 . . . . . . . . . . v Ik 11111 . . . . . . . . . . . .. .. . . . .. .... . U111x!r of S1 of : . . . /./. . . . . . . . . . . . Ilinr!nsio s of tumile c;tt%w!lure with alletell.io s or ;ulditions: P1oot . . . . . . . . . . . hear . . . . . . . . . . . . . . . 1~!11111 . . .. . . .. . . . . . .. . .. .. 1k!ig11r lknlw:r of 5l oriel . . . . . . .. f1. f)i1 n-iofm of (.111 its txa+ e(xlsl itwA i< Vr(w1l . . It Ik_ %111 . 0.44- �� - f6 S"6 . �j4i .4n - a'�i Ik!il,lll ... . . . .. . .. . .. .. .. . . . .. . . fknlwlr of of ien . . . . . . . . . . . .. . .. . .. . . 7. Nize of lilt : FI(Hit . . . . . IU. Iktle of 11111-Im se . . . .G -z �. . . . 11;.1x! of I'U4nr!r (krlK!r 11 . /A)fw! or use dist t ic( in %Atich Itrellikeh are shimled . . . . . .. .. .. . ... . . . . . . .r. .. ... . . . . . . . ... .. .. . . . . . . . . . . . . . . - 12. Ikx!:; Ino17(tsed c(xlslrlw•ti(xt violate fifty i(xtirll, Im.), oldillalw_e or relntlation: . ... . . .. . .... . .... 11. Will lot Ix! tel,r;wk�d .. . . .Y1 Will et(ce,s fill Iw r(ylrived fr(tm�Incn)ises: YI?s 1.1) 1�1. tL�1■!:; of Owlw!r of I/re+nit;es : "' cklr(:r;•t i �Zlw ! � � �11wxw! . . . t1:r11c! of Atchilecl. . . . .y .. . . . . . . .. . .. . .... . .. . .. . . . . . A1kIIet;.,; 11unx! Tar. . . . . . . . . . . . . tl;.(1c! of 0)111 factor . . . . . ... . .. . .... . .. . . ... .. ... . . .... Ackll ess . . . . . . . . . . . . . . .. . ... . . . . . .. .. ..1'11.11x! Ilo. 15. Is Illis I7rr71x!rl.y Within _1(X1 feel of a I ill;][ (x!l 1111 7 * YES . .. . . . . . . . NO .. .. . . .. . . All, YI?s, 'Xxfliyxl) -Im" `11111SI1J s 1131trll.l. IIAY IUi Inigl1la.-D. j 1'1.OT DIAGRAM fix-al(! clearly .11x1 disfinwi ly all Intildinl;s, tAlelltor exi sl ing or Itrolx)sed, sex) irxlict)le till !el--Itnrk dimc!nsions f1(ru 1)101 !Ily lifw!s. Cive streel 1110 I)1(N'.I( tr■dler ov descriltli(xt according; to deed, mwl c:11ow street nmr!t; amyl irxlicale. %Aw!Illef inlerior or corrwr lot. �. !NAI1•: (W W14 Y(HtK, . . . . .... . . . . . . . . .`. . ' !.... . . . . . . . . . . . . . . . .Ix!i111, duly !inn n, (k•I)O,(•s a1w1 (;.ry:; Ill, If( i:; 1I T a1q/I is (Mvlw! ul ilwlividiml sil,ninl, coolim:1 .1Ix7ve 11.r1rd, rr� 1� n [/ Ik' k 1111! - - . . .Q W A!q_' . . . ... . . . . . . . . . . . . .. .. . . . . . . . .. . .. .. .. . .. . .. . .. . . . . . ........ . . .. . . . . ... .... . .. .. . Wontlaclor , ng,enl , corlxttale officer, etc.) of !;aid (1'.41x!r of ()k.xx!t:;, .11x1 is duly ;at111ori-r..(!d to Ix!rforla or l;av(! Ix!rfoollc!d Ilse faid "lilt texl to ectl(e ;sill File Illi!; :1111)1icni ion; 111;,1 .111 stnl(nwnls conlai;x!d in Illi:; .117111ical ion are ttlx! to (lie Ix!s1 of Itis luxx.rledg(! .110 Ix!livl; alxl 11;:11 111e (.,()14 will Ix! Ix!rfonlv!d ill Ilw t;c;u;x!r mA Icnill in 111e alrl;li(!al.ion filed lbelcvikll. S).nttn toll 1 2m! 11rt (1m; !.d�. .C.�. . .(I;ty of . ... . . . . .. . . . . . Fkt1.1t y 11%1%1 is `. .. ....... . ....JA-t,4_,_tA_N (Silg,n,Uure of AIg71 ir.nnl.) Bf Public t kto o MotarY Public State of YMic No.Q-32 O N ed In Sufw kramn y nO _ II 4,9 OL �� e . 3` �l dL Cf 14 -�-- Ael ri '►t�� C.C..�A j'2 �✓.�, -�P L�Vw.-�.�-. I ,�� l.�l �L �� `�.,�� -?��`.�' . >:,Al m � cc cry <' y ,• . % �" r } - 1< , a O z t cd, �xoCL Mloog tze+s� 1 wP 423 vi is r SUFFOLK CO.HEALTH DEPT.APPROVAL H.S. NO. 8 S- "0- ,. a ' f-�FaRTY I STATEMENT OF INTENT Ti -- --- ----- �NDk c I V y r <0WSK,l THE WATER SUPPLY AND SEWAGE DISPOSAL C, A7 SYSTEMS FOR THIS RESIDENCE WILL 1 CONFORM TO THE STANDARDS OF THE " 1d"7 OZ- J /DIY SUFFOLK CO. DEPT. OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH ! SERVICES — FOR APPROVAL OF 44 CONSTRUCTION ONLY DATE: rc s 14fr1Ce M - _ teff; H.S.REF.NO.: BS`SO-o7 hca/c APPROVED ','v_ // , [ �^ "s° SUFFOLK CO.TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. OF 4- OWNERS ADD .'' ESS•R Ar .� �'' :Vic, t`5/,6} :6•'�-559! 9�J F�L#C�COUNT"EALT4`1)EFAR MEN e f- ` T y' �; !/ t / DEED: L. P. SINGLE FAMILY DWELLING ONLY i " ' 'TEST HOLE. STAMP H.D.REF.NO. Si5-SO•D --,-.. —- - �— 4f". s atm ve«nw�.r.�.�n..rf ry' RIM,�Its r«!lore 1,6 r. .. DATE----� SGrPn vyr aer.wrrs - _ '. lhebne erww�r�t2erY�0 ernreyare erosr ed er THE SEWAGE DISPOSAL AND WATER SUPPLY FACILITIES FOR THIS LOCATION HAVE BEEN INSPECTED BY THIS DEPARTMENT AND ; FOUND TO BE SATI WY. f• I rsw..LwA hbmwwvw .� v tleeeeernw�wweeweedgr+eler/ Chief of Wastewater Management Section �,r: r - -J :i %eloe.0un IaerRtae�IneY�e r !_�r!l, C•' � rrer weYrY�sa Nwit - SEAL Of lie 5,19 t3 4 1401 RODER`IICK VAN TUYL.P.C. r LICENSED LAND SUR EYQRS 482S GREENPORT NEW YORK TRW"*rosT wless .