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Home My WebLink About21242-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22169 Date MARCH 1, 1993 THIS CERTIFIES that the building ADDITION Location of Property 645 GAGENS LANDING ROAD SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 70 Block_ t0 Lot 33 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 24, 1993 ~ursuant to which Building Permit No. 21242-Z dated FEBRUARY 25~ 1993 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 ENCLOSE EXISTING PATIO & ADDING A 4' ~DDITION TO EXISTING DWELLING 2ND STORY TO EXISTING 2ND STORY DECK "AS BUILT" The certificate is issued to EDWARD & LINDA FASZCZEWSKI (owner) of the aforesaid building. SUFffOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - MARCH 1, 1993 PLUMBERS CERTIFICATION DATED ~F~i~ Bu~l~ing Inspector Rev. 1/81 ]i~wr NO. ~1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N-°N? 21248Z Permission is hereby granted to: , £ ~~..~...~~....../.~ ~...~..~.~....~....../..~ at premises Ye~ted at ~ ..... .'.~,)..,~..TT.X<I~..~ ......... .~ .................. ... ....... , ...................... .............................................. ~..~~....?~......./....:~ ....................... County Tax Mop No. 1000 Section ........ 7.....~.. .... Block ...... Z~.,. ....... Lot No...~.....~. ........... pu~uont ,o opp,,cot,o, dot~ ....... .~.....~.... ........ ~...¥....... ,,..~ and opprov~ ~ the Building Inspector. Building Inspector 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 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. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '7pre-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 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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4.' Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residentia~ $15.00, Commercial $15.00 New Construction ........... Old Or Pre-existing Buildihg..~. ............. House No. Street Hamlet Onwer or Owners of Pro ert ~/. County Tax Map No 1000, Section ........... Block .............. Lot..-., ................. Subdivision ............................. .. . .. . . Filed Map ......... .. . Lot ..................... . Permit No... ate Of Permit ..Applican .. Health Dept. Approval .......................... Underwriters Approva ...~._.~'. ........ Planning Board Approval ....................... . Request for: Temporary Certificate...~ .... Final Certicate...~. ...... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~'~ ~, ~]~):{8~3:~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CERTIFIES THAT in the~ollo~,ing loca¢ion; ~ Basement ~ Ist FI. ~ 2nd ~. Section Bilk Lot ~s exa,nined on ~ ~ C ~{ ~ ~ ~ ~ ~ 9 ~ a~td found to be ln complla~tce u,ith the r~q~irements Qf this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE OUT[ETS SWITCHES FLUORESCENT OTHER DRYERS OTHER APPARATUS: S E R I C A W O NO. OF HI-LEG NO, OF NEUTRALS OF CC. COND NO. OF CC COND PER ~ ~ GENER¢~ ~NA~IR must ~ot be ~ltere8 in ¢~y monner; return to the offi~ of the Boord i~ incorrect. Inspectors m~y be identified by their COPY FOR BUILDING DEPARTI4EHT. THIS COPY OF CERTIFICATE t4UST HOT BE ALTERED IH At4Y MAHt4ER. OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE ......... ~ ~ ~ - APPROVED AS NOTED ~'*'~ ..... NO. TIF~ BUILDING .~PARTMENT- AT ............................................ 765-1802 9 AM TO 4 PM FO~ THE - - FOLLOWING tNSPEC-TIONS: 1. FOUNDATION - TWO FO~ POU~ED CONCreTE ~. ~OUGH - F~AMING & PLUMBING ~, 'INSU~TION .............................. :,, FINAL - CONST8UC~ION .MUS~ ........ BE ~OMPLETE FO~ C.O. . P.~-L. CONSTRUCTION SHALL MEET .................... ..... THE ~EQUIR~M~NTS OF THE N.Y. /' :~.rA~ CONST~UCTION & ENERGY CODES. NOT ~ESPONSIBLE FO~ - ~-~N O~-C~N~T~U~T~N-E~OR~ FORMNO. 1 TOWN OF SOUTHOLD .BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOA'RD OF HEALTH ....... 3 SETS OF PLANS .......... SURVEY ................... ClI~C~ .................... SEPTIC, FORM .............. NOTIFY ~ CALL ........... , ....... FLAIL TO: Examined ................ , 19... Approved '~...d ~...~.., 19qZPermit No..~./..~.. l~isapproved a/c .... ' ............ : ...................... Z ' .... ~ '7'~ i ....... .............................. .............. ,'' APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a, This application must be compiletely filled in by typewriter or in ink and submitted to the Building Inspector, wittl 3 sets of plans, accurate plot plan to scal~. 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 descrip!ion 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 s?ll be kept on the p?emises available for inspection throughout the w6rk. 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 Buildin~ Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Towa 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 hll 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, engtneer, general contractor, electrician, plumber or builder. . ..................................................... Name. of owner o f premises//~w~..?../fJ~..... ~~.. ~....~.~ .-~4q-~,~. .................... . (as on the tax roll ol-/ate~t deed) If applicant is a borporation, signature ~f duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No ......... . ................ Electri.cian's License No : Other Trade's License No ...... ; ............... 1. Location of land on whichpropose~ work will be done ............................................. ...... House Number . Street Hamlet County Tax Map No. 1000 Section i ..... ."~. ~. ........ Block .............. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy o~premises and intended use and occupancy of proposed construction: Existing use and occupancy ~. - - b. Intended use and occupancy ' ....................................................... 3. Nature of work (check which applicable): New Building .......... Addition ../~. ..... Alteration . .~.....'.. Repair .............. Removal .............. Demolition ..... , ...... Other Work ...... . ........ 4. c~.,~ ' ~ ,_ (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... [. ........ Number of dwelling units on each floor ................ · If garage, number of cars ............... '2~. ................. : .................................... 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 ................ Num her 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 ...................... Rear ...................... Depth ...................... 10. Date of Purqhase .., .................. . ......... Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ... ~.~. ........................ 13. Will lot be regraded .... ' ........................ Will excess fill,be removed from premises: ..~Yes Name of Architect .......................... Address ............ i i ~j ' ' ' Phone No ..... " ...... 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No.~. ..... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate cleariy and distinctly ~1 buildings, whether existing or proposed, and. indicate ~I set-back dimensions from prope~y Hnes. Give street and block number or description according to deed, and show street names and indicate whdther' interior or corner lot. STAVe OF NeW O/9 S s · ~'Te~A~.. ~..~. ~.~ ............. being (Name of ifidivi~al~gning contract) above named. He is the ........................... (Contractor, agent, corporate officer, etc.) ')f said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e ~d file this ~pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the ~ork will be perfomed in the m~ner set forth in the application filed therewith. gwom to before me this .......... ~.% ..... day o~. '.. f~ff~ ~ ..... ,19 ~ota~ Publ ~.. · .... County__s. N~a~ Pub[io, St~e of N~w York ............ No. 4879505 ............ ~'''''~ Gualified in Su~olk Coun~ ~/~ (Signature of applicant) ~mm~Jon ~ires Oeoomber 8, ~9 ~7 duly sworn, deposes and says that he is the applicant