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Home My WebLink About22172-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23088 Date JULY 8, 1994 THIS CERTIFIES that the buildin~ ~ALTERATION TO ACCESSORY Location of Propert~ 595 NEW SUFFOLK RD. CUTCHO(~UE, N.Y. House No. Street Hamlet County Tax Map NO. 1000 Section 102 Block S Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 21, 1994 pursuant to which Building Permit No. 22172-Z dated JULY 8, 1994 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 ALTEEATION TO I~'£~IOR OF FIRST FLOOR OF EXISTING BARN STRUCTURE (STORAGE AREA ONLY) WITH NON--CONFORMING LIVING QUARTERS ON TN SECOND FLOOR The certificate is issued to JOAN SLEDJEBKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N-317366 - JUNE 15, 1994 N/A Rev. 1/81 FORM NO.3 TOWN OF SOUTHOI. D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. No 22172 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: ...~~.../..~: ............ 's ~-- ...... ./..~,~ ,..~.~......~.~....~~.....~ ......... ......... .... to . . ~. . .~/Z ................ ~.~. .t~ .......... ~. X~. .......... ~. . . . .~ ........ . . .~. . .~ ........................... ........ ~.~. ~ ........ ./~ ~ ............ ~ ......... ~. . . . ....... ~ ........... ~ ~ ................. ...... ~. ~.~ .......... ~.~. . ....... ~. . . .~.~. ~. . .~. . . .~ . , . ~ ~ ~. . , ~ ~ ~. ~. ...... ~...~..,.~ ...... .~....~ ........ ~.~......~..~..... ~z..~ ~.........~ ~. ........ <'"' '"'- - 'I /'~"~,'r. ............................................................................ ,,?.,,.~.,4,~,/,, ............................................. at premises Iocoted of ............... ~,?...'~... ........ ~.-,~............~..~.././,~. ~/,~'......,.,...~......~..t..... .................... ...................................................................... ....~./..'~'.,~..~,~. ........................................................ CountFTaxMap,o. 1000 Seotlon,,../~,..,.~,., ....... Block......~....~... ........... Lot,o ....... .~...~... ............. pursuant ,o application doted ......... ~../~../.. ............... i ................. 19.....?.,~...., and approved bythe Building Inspector. Fee ~....~.~ ...... ~2il~speotor Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 !'l~.7..J' ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted 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. Submit Planning Board Approval of completed 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 dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existin~ Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ...... .~ [~'. I ~. ........................ New Construction ........... Old Or Pre-existing Building ................. Location of Property ......... ~ ................ ~ ......... House No. ~ Street HaMlet or Owners of Property .... ~gF~.~ .... ..~.~v~.~.~..%i ..................................... Onwer County Tax Map No 1000, Section ..... ~.~-. ..... Block....~. ........... Lot.?.' ............... % .... Subdivision .................................. . . Filed Map ......... Lot ............... Permit No ................ Date Of Permit ................ Applicant.~.~..~77. .... Health Dept. Approval ................... ....... Underwriters Approval ......................... Planning Board Approval ...................... .. Request~for: Temporary Certificate ........... Final Certicate.~ ........ Fee Submitted: $ ............................. ........................ o s"e" -- STATEMENT OF BILLS RENDERED The statement below reflects bills or credit; if this area is blank, a charge. For additional information contact: 5];5 HEW S UI::]= OI..K H A I I..: bills and payments to date shown. A (-) sign after CASH AMT indicates a Your account number appears on the first line following your name. LEGEND ELEC (0180) - ELECTRIC RATE CLASSIFICATION EMTR - ELECTRIC METER NUMBER GAS (0120) - GAS RATE CLASSIFICATION GMTR - GAS METER NUMBER DL - NUMBER OF DIALS ON METER X - CONSTANT. DIFFERENCE BETWEEN METER READINGS MULTIPLIED BY CONSTANT EQUALS CONSUMPTION. DATE - METER READING DATES #DA - NUMBER OF DAYS IN BILLING PERIOD INDEX - METER READING BILLED CONSUMPT - UNITS OF USE (GAS OR ELEC) RD - TYPE OF METER READING A - ACTUAL COMPANY READING C - CANCELLED BILLING D - DIAL OR POST CARD READING E - ESTIMATED READING F - FINAL READING M -METER CHANGED - READINGS BOTH METERS COMBINED S - SPECIAL OR REBILLED READING T - TURN-ON READING V - VERIFIED COMPANY READING USEF - DALLY USAGE. TOTAL CONSUMPTION DIVIDED BY NUMBER OF DAYS IN BILLING PERIOD. REC. DEM. - RECORDED DEMAND', COMMERCIAL ACCOUNT BIL. DEM. - BILLED DEMAND~ COMMERCIAL ACCOUNT Your LILCO Representative J)A I'1E=06/'2'2/'94 , T):Hb:=i i : !5 (~ ~ 6..- 962-, 2'/;..-,46'7(,). P, D C UT C:I..I 0 (3 Ull}] Telephone ~mber HY ii9Sf~; PPlV RES '/, '.-'9 i S., 2S 46 ,. 6B 4t i 5 42 (i')6 i 2S ~)8 i89 '1~ 22(') 77; S'5 i '.36 i 8(.) 9(') CSH2 '10T AlklU'LAI','.S ., 0(~ Printed on recycled paper. ~ 0NSTANCE N.68'32' Z0" E. S. 6 8° ~'5' ~*0" W. NOW OR FOR~IERL¥ K o OVERTON -- I ~ 260.91 ~ ~ 0.9' ARBOR L_~ -- 282.95 ELLIS BILLARO I 0 0 MAP OF PROPERTY VAN IpELT TO BLASCHACK SITUATE AT CUTCHOGU E SUFFOLK Co.. N~. Y. ~'ITLE SCALE-', 50'=1'* GUARANTEED TO TITLE GUARANTEE E~ = MONUMENT TRUST CO. AS SURVEYED FEa. 27.1958 OTTO W. VAN TUYL & So~,l AREA: 0.672 ACRE '~. LICENSED LAND SURVEYORS GREENPORT, N. Y. No. 1222 859 FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SGUTHOLD, N.Y. 11971 TEL.: 765-1802 ^pproved ........ l f.. Pe=it No. Disapproved a/c ..................................... ./(P~ildino Inspector) ~- - APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ......... 3 SETS OF PLANS .......... BUR~VEY ................... CIIECK .................... NO?IPY ~ CALL ... 2~5= !.~a .~. .... MAlL 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 iets of accurate to scale. Fee to schedule. plans, plot plan according 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 inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) Builder's License No...~ .............. Plumber's License No ......................... Electrician's License No... ..................... Name of owner of premises ...'~..°.~K.. E L ~-i3 ~'~%~, ,(as on the tax roll or latest deed) APP~V~ If applicant isa corporation, signature of duly authorized officer. 766-1802 9 FO. mUS;= C~ 4. FINAL - CONSTRU~ION'MUST BE COMPL~E FOR C.O. oth~ T~'s Li~n~ No ...................... 1. Location of land on which proposed work will be done. ~q ................... ~'~ ' ' DESIGN OR CONSTR'b~TION ERR0~ House Number Street Hamlet Co..ty*ax 000 Section .. i. a .......... ...G ............. ............... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy .... . .~,14/). .... . .C:2~.....~..d~....a~.. ...... :," :','"Y;;". ..................... b. lntended use and occupancy "~"¢-~'-~-' ~ ~ ~"~''~~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alter . Repair .............. Remgval .............. Demohtion ............. Other Work ~,~-~... i (Description) 4. Estimated Cost .... '. ·., ......................... Fee ...................................... i (to be paid on filing this application) 5. If dwelling, number of dwelling iunits ............... Number of dwelling units on each floor ................ · If garage, number of cars i 6.. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7 Dim .... ' if any: Front Rea Depth · enslons of existing structures, ............... r ............................. Height ............... Nun~ber of Stories ........................................................ Dimensions of same structure wtth alterations or additions: Front Rear Depth Height Number of Stories 8 Dimensions of entire new const ,ruction: Front Rear Depth Height Num'ber of Stories -' Size of lot: Front ........... , ........... Rear ................. Depth ...................... Date of Purch.ase· . .,... ,... ~ ...' ....... Name of Former Owner ............................. Zone or use district in which pr.emises are situated ..................................................... Does proposed construction violate any zoning law ordinance or regulation: Will lot be regraded ~ Will excess fill be removed from premises: Yes No Name of Owner of premises ' Address Phone No Name of Architect ' Address Phone No Name of Contractor ~ Address Phone No · Is this property within 3.00 feet of a tidal wetland? *Yes ........ No ......... · If yes, Southold Tiown Trustees Permit may be required. ~ PLOT DIAGRAM Locate clearly and distinctly all ,braidings, whether existing or proposed, and, indicate all set-back dimensions from 10. 11. 12. 13. 14. 15. property lines. Give street and block interior or comer lot. .STATE OF-NEWYORK, COUNTY OF · tumber or description according to deed, and show street names and indicate whether ......... ............ ·,; ....... : .................. being duly sw6rn, deposes and says that he is the applicant · .(Name of individual signin~ contract) above named· . He is the .... i (Contractor, agent, corporate officer, etc.) of said o'.wner or owners, and is duly Authorized to perform or have performed the said work and to make and file this applicatioh';'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 manner sot forth in the application filed therewith. Swormto before me this ....... _ .... F'x .......uay of..i.,/'.; .'-7. ~ ........... ,19... ....... County ~, ~ · Notary Public, } E M. WILK NS Notary Public, State of NowYo~ ' '/~<-3.~ f ~ ' '~' ......................... N_o, 49_52.246, .8uffo.lk, C?.unt~ [ / ~ (Signature of applicant) lerm expires dune 1;~