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Home My WebLink About22022-zFORM NO. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z23001 Date May 17, 1994 THIS CERTIFIES that the building Location of Propert~ 4735 COX'S LANE House No. County Tax Map No. 1000 Section 96 Subdivision ADDITION Street Hamlet Block 2 Lot 10 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 13, 1994 pursuant to which Building Permit No. 22022Z dated APRIL 25, 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 A DECK ADDITION TO EXISTING OWE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ALBIN PIETREWICZ (owner, lessee or tenant) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector / FORM NOo3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAL1 SOUTHOLD, N.Y. N-° 22022 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: ... ~..~..... ~.~..~.!.,¢....~ .............. ...... ~¥;~ ........ ~:.~.....~ .................. ....... ....... ...................... ,o...~~..<.~ ............ ~ ........ ~.~ ....... ~../..~7~ ........ ../...¢.. .......... ~ .......... ..... · ¢7..~.;~ ....... ~ ........ ~.~ ....... ~_~,<:~.'~ ....... ,~ .................... ....... ~.,,:¢./....¢...<.4.~... ,~,~. ~ premises located at ...................... ..~...~..-~..~ ............... ~., .................................................................. ........................................................................... ~______~¢.~..~~..~..~ ........................................ CounlyTax Map No. 1000 Section ........ .?..~' .......... Block ......... ..1~...,~ ....... Lot No......~..~ ................ pursuant to application dated ............. ..~..~..~....-~... ............................ 1~.....,~....~....., and approved by~e Building Inspector. Fee $.......2.¢...'?.~ .... Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY mo 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. Conmlercial 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 completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vpre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. ~. 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 1. 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-existing 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 .~'~5'..-~ .~.~'.~..?Y~ ...................... New Construction...~ Old Or Pre-existing Building ........... Locat o of Preper(F.7.3. ........ ~ House No. F' ~S~treet Hamlet/ / or Owners of Property. '~~' 'l'. i 5--__~~ '~"~-~' Onwer County Tax Map No i000, Section~.~.~ x,_fBlock .... ~ ........ Lot..~..~ Subdivision .................................... Filed Map ............ Lot...~ ............ Permit No..~..~.L?].~....~..Date Of Permit...~././.~../..~..Appliean~.~.~..)~..~.~. 7 Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... ~ ~P~PL I CANT 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [/INFLATION FRAMING [E~FINAL DATE*~-~ ~~ INSPECTOR~ FOU14DATION (2nd) 2. ROUGH FRAME .FLUMBING INSULATIOH PER N. STATE ENERGY CODE FINAL ADDITIONAL COM~i~ENTS: APR I 3 Igg l LDG. DEPT examlnea ...... ~-,;q~ Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 BOARD OF HEAL ._... 3 SETS OF PL,%NS .......... SURVEY ................... CI1ECK .................... SEPTIC PORH .............. CALL MAIL TO: APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 set~ 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 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, buildicg--e~Me,~xhousing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. -' - (Signature ot"at~licant, or name, if a corporation) /~ailing address of/gtSplicant) State whether applicant ist~wngr, l~ssee, agent, architect, en~neer, genera~/co.ntractor,~e!ectrician, plumber or builder. .................................................... ..... ...... · . · 'A PRI)VED, AS. NOT O Nmne of owner of premmes ............................... ~'/....'. ~,: ~ ~:: iF~E;':?,~ BY:.~'~-: (as on the tax r011 or i~,te~¥~0~./_~,~,.i~UiL~iNG, DEPARTMENT AT ~"..i~ !?~!~!,8P~ 9..~ ~O 4 PM FOR THE If applicant is a corporation, signature of duly authorized officer. FOLLOWING INSPECTIONS: (Name and title of corporate officer) Builder's License No ..... ?. ?.~..~l~...~....c~..C..'~.'~ Plumber's License No ......... ~. ~ ............ Electrician's License No ....... .~..~. ............ Other Trade's License No ..... .~(..~. ............. Location of land on which proposed work will be done. 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION' MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL" MEET THE REQUIREMENTS OF 'THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS · ..... House Nmnber Street Hamlet County Tax Map No. 1000 Section ........ .?..~. ...... Block .... ~ ........... Lot .... /...~ ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy / 3. Nature of work (cheek which applicable): New Building .......... Addition~. ~"'-~'//~ -' '~" ......... ' Repair .............. RemOval .............. Demolition ............. q Ofi~e; ~X~,,~}.! ;~ ....... 4. Estimat(d Cost c~ -, ~ rt'~i ......... ~ ....................... Fee .......... ~,:. ;,...:..A.'I .......... (to be paid on filing this appl, Lc.ation), of dwellingiu its Number of dw lilng its ........... ~( 5 Ifd elli numb .... ~-i ~.~,,~la · w ng, er n ............... e un oneacnnoor . ,a ,-:. . ....... If ga be of ~'~' ~:~ rage, num r cars ] ................................. ........ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures,if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... ~.. Height ...................... Number of Stories .............. ~ ....... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ....... ~ ....... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ........... i ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... ! ......... . ......... Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction vic!ate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... ' ................... Will excess fill be removed from promises: Yes No 14. Name of Owner of premises ..., ................. Address ................... Phone No ................ Name of Architect .......... . ................. Address ................... Phone No ................ Name of Contractor ........................... Address ................... Phone No ................ 15. Is this property within $00 feet of a tidal wetland? *Yes ........ No ......... *If yes, Southold Town Trustees Permit may be required. · PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-: ~ack dimensions from property lines. Give street and block number or description according to deed, and show street name~ and indicate whether interior or corner lot. __ .~_.~j ~/~_~ ,,, ..... , 9 ¢Ui NOYuNLAWFuLOR ,: WITHOUT.,GERTIFICATE " "' O'CSUP/ NCY :,-- (Name of individual signigg contracff above named. being duly sworn, deposes and says t~ at he is the applicant He is the ........................... O L(~.f~. '.fff ................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulyi authorized to perform or have performed the said work and 'o make and file this application; that all statements contalped in this application are true to the best of his knowleage an i belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this % I ,ff,~ .......... /<. :,./· · .~.,....day of ....... ,e..~.. .... (.., 19. f~ Nota Pub .. Count · ~CLAIREL. 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