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Home My WebLink About23502-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~ERTIFICATE OF OCCUPANCY No Z-24634 Date SEPTEMBER 19, 1996 THIS CERTIFIES that the buildin~ REPAIR Location of Property 320 (a/k/a) 319) CHAMPLIN PLACE House No. Street County Tax Map No. 1000 Section 34 Block 3 Subdivision Filed Map No. GREENPORT, N. Y. Hamlet Lot 41 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 13, 1996 pursuant to which Building Permit No. 23502-Z dated ~ 13, 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 REPAIR FIRE DAMAGE OF EXISTING ORE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to HENRY E. RUT~INOSKI, JR. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/~ N--384345 - APRIL 26, 1996 N/A Building Inspector/ FO~M NO. ~ 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.° 23502 Z Permission is hereby granted ~:~: . .... ~..-~~~ ........... ~.!.~.~ ,o..,~/~.....,...~ ....... ~.~~......~...~...~.~.::.~p~ ............................................. Co~n~ To~ Mop So. ~000 Se~.o~ ..... ~ ...... *,o~ ....... ~ ........ Lot.o ...... ..~./.. ......... pumuant to oppllcotion datod .... ~ ...................................... , 19~.., and oppro¥~ by ~e Building Inspector. Rev. 6/30/80 8I.DG. DEPT. . TOWN OF SOUTHOLD~.__~ TO%'N OF SOUTHOLD BUILDING D EP g-RTXE~YT ~OW~[ F~LL 765-~802 PPLICATION FOR CERT!PICATE O? OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or sew use: Final survey of property with accurate location of all buildings, properny lines, streets, and unusual natural or topographic features. 2. Final Approval from Reaich Dept. of water supply and sewerage-disposal(B-9 form). 3. Approval of electrical instaliacion from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system connains less than 2/[0 of i% '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. B. Submit Planning Board'Approval of completed si~e plan requirements. For ex~ting buildings (prior Co 'April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing al! property lines, streets, building and unusual naeurai 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 s~ate the re~so~s therefor in ~*riting to the applicant. 1. Certificate of Occupancy - New dwelling 525.00, Additions to dwelling S2B.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building 525.00, Additions to accesso~? building S25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildin~ - $I00.00 3. Copy of Certificate of Occupancy - ~ .25¢. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $[5.00, Commercial $15.00 New Construction ....... ,..... Old Or Pre-~xistinz Building.l ............... --,..- ~oeation of ~roperty.. Z.!.? ................ .C..~.~..~,.~.. ~.L.. ...... ..~.. ~n..W~ ~l .... ~ouse ~o. S~reet Hamlet Onwer o~ O=ers o~ ~ropert~.......We"~...~/............~ £.~ ~.~-On-{~.~. ... ~Z ~ .............. cou~t~ T~ ~p No [0oo, Section...~.t'/. ....... Bloc~...3 ........... ~ot..~l .................. Subdivision ....................................Piled Kao ............ Lot ...................... pe . _t ate hi,cantE, · ~ ................ ' ' · .... r,. ...... .. i ,qea_~h Dept. Approval ........................... nde_,~r,-e~s Approval.., -.-- Planning Board Approval ........................ / lequest for: Temporary Certificate ........... Final Cer:icata ........... I-4 FIF-LD" INSPECTION REPORT DATE COI~ENTS FOUN])AT ~ON ( IS'F) FOUNDATION (2ND) IIqSDLATION PER N. Y. STATE E~RGY ADDITIONAL CO~ffENTS: 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING [ ]FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] IN/SULATION [~INAL / DAT~/~ INSPE~ -FORH NO. I TOWN OF SOUTUOLD BUILDING DEPAR31qENT TOWN NALL SOUTDOLD, N.Y. 1197 I TEL: 765- 1802 Disapproved a/c ................................. . BOARD OF IIEALTH ............... ~..~3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORH ................... NOTIFY: CALL ..... o .AiL TO: ~ ~t~ ........ APPLICATION FOR BUILDING PERHIT INSTRUCTIONS , a. 3his application mast be c~ple~e.,~fj~l~_l_e!l- ip _by tyl-~'--~flteE2r iRink,~t~v~e~hfilOing_ ...... IOs~tor with G~~ pi~, ~at'~* plot-~ [o ~ale. 'F~-~}:o~-i~"~ ~,~fe~' -'~ '-= b. Plot plan ~ l~ci~ of lot ~ of ~ildi~s ~ ~i~a, relation~ip to ~joini~ pr~i~s or ~lic str~ts or ~eas, ~ givi~ a ~tail~ ~scripti~m of l~t of ~r~ uust ~ dr~ ~ ~e di~ ~{i~ is ~rt of . this a~licati~. c. ~ ~ ~ ~ ~is a~licati~ v~ ~t ~ c~ ~fore isle of ~ildi~ Pemit. d. U~ ~al of ~is a~licati~, tl~ ~ildi~ Ins~ctor will is~ a ~ildi~ Pe~t to the ~licat. ~mit ~mll ~ ~pt ~ ~ ~i~s ~ilable for ins~cti~ thm~t tim ~rk. e. ~ ~ildi~ ~all ~ ~pi~ or ~ in ~la or in ~rt for a~ ~ ~at~er mtil a ~rtificate of ~ ~m[1 h~e ~n ~t~ ~ ~ ~ildirg In--tot. ~I~ IS lg~f ~ to t~ ~dldi~ ~nt for the isae of a ~ildi~ Pe~t ~t to tim ~ildi~ ~ O~i~e o[ ~m T~ of ~t~ld, &lffolk ~, ~ Yo~, ~ other a~li~le ~s, ~i~es.or ~lati~s, f~ t~ ~t~ti~ of ~ildi~a, ~iti~a ~ alterati~s, or for ~al or ~liti~, ~ ~rein &~ri~. ~ ~li~t ~s to c~ly ~th all ~lieable l~s, o~i~os, ~ildi~ e~, ~i~ ~, ~ ~lati~s, ~ to ~t ~ri~l in--tots ~ ~i~s ~ in lmildi~ for ~es~ in~ti~s. (Si~mre o[ a~lle~t, or ~, ii a co.ratio) ..... C~ < .. .~ ..... (~ili~ ~reshof ~l'ic~c) State whether applicant is (m~er, lessee, agent, ard~itect, engineer, general contractor, electrician, phraber or t~dlder. ~ of ~r of,~i~s .. ~ ......... Z....~S /~, a~szo~ tim tax roll or latest deed) [f aqFplieant is a corporation, sigrature of duly am~thorized officer. (Nan~ ~ title of corporate officer) Plmlmrs License No ..................... .. .. . Electricians License No ...................... llouse ltmtmr Daml et Street ~ (~) 2. State ~i. sti~ ~ ~ ~a]l~y of prml~S ~ mte~ u~ a~ ~cu~:y of ~ c~stmctxon: if 8arage, ~dmr of earn ...~ ................ ~ ............. 6. If I~mi~mss, ~m~rcial or mi~l ~culmr~, s~ei~ ~t:ure m~ extent of each ~y~ of u~e ............... ~ ...... l~pth .................... I~i~t .................... Kmtmr of glories .... ~. ........ 8. Di.ermi~m of enLi~e ~ (:{~mtn~l 1~: lq'~C ................ l~ar ....... [Mi)th .............. . .......... , .... ................. n~ ...,,....~...~.~ .... ~ ....... ~ .......... PI.OT I)IAORAH l~ate clearly m~ dlsti~tly n~l I~dldings, ~mtl~er exi$ting or pro[~l, m~ it~llente 8ll ~t-I~k dh~nsioa9 fT~n prolmrty li~9. oi~ at~t a~l] bl~k n}dmr or (~eripti~ acco~Jng to ~1, a~l M~ sLreet ~a m~l i~llcate ~6mllmc interior or conmr lot. AP~O,,V~D AS NOTED . NO?IF¥ t'~Jll~DING IDEPARTI~II~-'~T oLLow,.G ,.SPECTIONS: ,. ou, .loN ' OREaU,RED O.R O CONCRETE 4, FINAL CONST,UCT, ON MUST B~ COMPLETE FOR C.O. ALL CONSTRUCTION SNALL MEET THE ~EOUIRL:MENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN 0}~ CONSTRUCTION ERRORS m.~Jrn, (lelxme,,; a~xl nay,,; tlmt he is the apl)l ice,iL . ((~x~ rnctor, nl~.e r; <:orlx~rnte ol:[icer, eLe.) naid <~mr or ~r$, mKl la duly ~.JthorlM to ~rfot~n or h~e lerl:onfnd the .altl m[k atKI to ~ke atxl file thin the ~}rk will I~ l~rfon~l In th9 n~ln~mr ~t forth ill the nlq~l icntJon flied l~)ro Lo I~[~)~'epe Lhls ~ i ........ .... CLAIRE L GLEW Notaw Pubiio, State of New York NO. 4879505 [ Qualified in Suffolk County Commission Exp res December 8~ 19...