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Home My WebLink About21243-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22170 Date MARCH 1, 1993 THIS CERTIFIES that the buildin~ ACCESSORY Location 6f Property 645 GAGENS LANDING RD. House No. Street County Tax Map No. 1000 Section 70 Block 10 Subdivision Filed Map No. SOUTHOLD, N.Y. Hamlet Lot 33 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 24~ 1993 pursuant to which Building Permit No. 21243-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 ACCESSORY ABOVE GROUND SWIMMING POOL WITH DECK "AS BUILT" The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED EDWARD & LINDA FASZCZEWSKI PENDING - MARCH 1, 1993 ~ Buildihg Inspector Rev. 1/81 FO~ NO. ~ TOWN OF $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT trills PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~N°. 2i24~Z Permission is hereby granted to: ~~~. ...... ./~ ~.~.~.~....~....~:~~.~ ~....~z.~..,....~.z/...~ff-z/ ...... ....... ........ .................. at premises Iocate~. ............ ~..,.~,..w~....~...~~....~-~..~~ .................. ................................................... ~~/_.~.~...zz_~/... ................... County Tax Map No. 1000 Section ...... ~......z~... ....... Block ..... ../....Z~... ........ Lot No...~.....~... ............ pursuant to application dated ....... ..~........¢~.. .......... .~.....~........, 19.~.~.., and approved by the Building Inspector. Fee $ ...~.~....~./....~...~... Building Inspector Re~ 6/30/80 2 4 1993 FEB TOWb~ ',? ': ' 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 topograpkic 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. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: i. 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, Swin~ning 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 - Residential $15.00, Commercial $15.00 Date .... ~./.~,.~/~ ........................... New Construction ........... Old Or Pre-existing Building... ~ ............ Location of Property...~. ~.~.~. ........... ~.. ,~. 7.~.Z~t/~-~'... g ..~. ,~ft~..~:).fl .~'/.~-~...... . ...~.~.~...'~../~.~.~. ,~. ...... . House No. Street Hamlet Onwer or' Owners of Property ...... ,~.~.. T~ ...... ,. ................... .. . County Tax Map No 1000, Section...7..O. ....... Block../.D. ........... Lot.J7 .................. Subdivision .................................... Filed Map ............ Lot ...................... Permit No.~Z~.~3~..Date Of Permit~/~/ Health Dept Approval ' Underwriters Approval Planning Board Approval ..... Request for: Temporary Certificate .... ~.... Fihal Certicate.~ ....... Fee Submitted: $.. ~ ......... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY BS JOHN STREET. NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT o~ly the electrical equlpmen~ ~ ~serlbed be~w and introduced by the appg~cant ~med on the a~ ~pplic~tion number in the premlses of in the followlng h,catlon~ ~ ~s~men~ ~ Is~ Ft. ~ ~d a. O lt~ .~io~ ~l~k DRYERS SYSTEMS NO. OF FEET torero co~pJ, la~ce aL the dale of eavironmem~,s iL made b~ E R V I C E pER ,~' ,CO~D OF HI,LEG OF NEUTRAL GENERAt MANAGER Per2L~ ~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by~¥t~ir credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7654802 ItOARD' OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CI1ECK .................... SEPTIC FORH .............. Examined ., 19... Approved ~.'~: ~.:., 19¢~. Permit No. &/¢,~.,...Q(.ff-~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS NOTI PY ~ CALL ................... HAIL TO: Date, .~.~?. a. T~ts applicati~n must be c~mp~ete~y ~ed in by typewriter ~r in ink and submitted t~ the Building Inspect~r~ ~vith 3 sets 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 gb(ing 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 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 Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bnilding 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 necess~a,y~ inspections. /9- ............ - :.. ara m or ora ion, · ~ .~. 5...~:. e/~. &... ~2~/~. ~/. ~c~ ............ , (Mailing addr?s of applic, ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 't .................................................................................. Name of owner of premises 6q..~..64./].~... / .//./(/. ?)..,~. .... F~..:J..~..~.Z _~':~.fi~..~./.</t.:' . .................. (as on the tax roll or latest deed) If applicafit is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License.No ...................... Location of land on which proposed work will be done ................................................... House Number Street Hamlet County Tax Map No. 1000 Section .... '~. ¢). .......... Block ..... ./.? .......... Lot...~..;~ ............. 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 .~F/(..~/~..~ .... D...~...~. .~.~.~?.~4./.~..~. ~../~..~;~.~./,/.~..LT.' ..... -- ..... ~ ,, ?~ ~, -~ ............ b, Intended use and occupancy O 3. Nature of work (check which applicable): New Building ..... ition . 9~. ...... Alt~ation/k/ ..... Repair RemOval Demolition Other Work 4. Estimated Cost . ,. t/.o.i.. Fee .~.t~. ................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling finits ........ /. ...... Number of dwelling units on each floor·.. ~. ............ If garage number of cars ' .'7 If business, commercial or mixed, occupancy, 6. ' ' ' ' specify nature and extent of each type of use ..................... 7 Dim ions ofe itingstructue~ ifa y:Fr iR. Depthl · ens x s r , n ont ....... ~. ....... ear ........ , ................... Height ................ Number of Stories ............. ' ....................................... Dimensions of same structure wiih alterations or additions: Front ........ . ......... Rear .................. Depth .................... i · Height ......... t ...... Number of Stories : 24 ...................... 8. Dimension.~. ~f entire new constn4ction: Front...~7.¢.. , Re'ar-. .............. Depth ........... Height .......... N tuber of Stories ...... ,: ........... Size of lot Front i ' R~r ................... .... .' ] ....................................... Depth .... 10. D~ate of Purc~as, e ... 6,.. ~ ~.~. ~ ........ . ......... Name of Former Owner ........................ 12. Does proposed construction viola{e any zoning law, ordinance or regulation: ..................... 13. Will lot be regraded ' .i · ,, , · .... ~,','t ~ ......~ ........... Will exce,ss_fil,/,be removed from premises: Yes 14.. r~am e of Owner of premises ~'Ar t'. ~./.M...' .~ .~P,~..~.C:,~. ," ,~d d?ess ~, ~...~.,g~,.~'.'.'.'.'.'.'.'~Y. ~..~ .~.~.~,'/l~'ne No ~ .~'A-.-- ~ ~.. NameofArchitect ~,,.,,qn~ ~,~,~reoo I t '" ~h,-,,,,~ w,,' ' ,,t ..... Name of Contractor ....... .~q~ .......... Address ..... /. t ............ Phone No .... ~ t' ........ 15. Is this properfiy within 3~0 feet of a tidal wetland? *Yes ........ No..~. · If yes, Southold T~wn Trustees Permit may be required. ' .... PLOT DIAGRAM Locate clcai'ly and distinctly all buildings, whether existing or proposed, and, indicate all ~et-back dimensions from property lines, Give street and block nfimber or description according ~o deed, and show street names and indicate wh~ther interior or corner lot. ! -. STATEOF NEWaYO~.K, t S S ....... · _ (Name of indivtffual ~/gning ~ontract) above named. ~ being duly sworn, deposes and says that he is the applicant He is the ......... ~ ...... · ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly aulhorized to perform or have performed the said work and to make and file this ~pplication; that all statements containedi in this application are true to the best of his knowledge and belief; and that the ,york will be performed in the manner set forth in the application filed therewith. ~worn to before me this l .......... NoteW publlo, State o! New york No. 4879505 i-/~ -'r' (Signature o f applicant) Qual fled In SuffOlkDeoemberCOUnW ' Contmlsslon Expires