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Home My WebLink About21410-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22621 Date SEPTEMBER 28, 1993 THIS CERTIFIES that the buildin~ ADDITION Location of Property 475 PIPES NECK ROAD House No. Street County Tax Map No. 1000 Section 53 Block subdivision Filed Map No. GREENPORT ~ N. Y. Hamlet Lot 6 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 10, 1993 pursuant to which Building Permit No. 21410-Z dated MAY i7, 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to ANNA PEKUNKA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N-283927 - JULY 26~ 1993 Rev. 1/81 l~O~t~ NO. ~ TOWN OF $OUTHOLD 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°-N.° 31410 Z Permission is hereby granted to~ ~ .... ~ ........... ~....~z~ ................................... ..... ~~<~.~........~7..:.../..z.~...~. ~... . . ~ ~, . ........ ~, .. . . , ~/~ ....... . . .~. . . . ~ . : ................................................................ at premises located at ............. ., .~...,~.....~,~,.; ........ ....~./..~2~,,..,.....~...'~.~.~..: ....................................... ......................................................... ~~ ...... ~./......r..~ ........................ ................................................... .(.'.~ ....... ~ ........... .~. ....... ~...J ............................................ Count,,, To~ ~ap No. ~0oo Section .... ..-~..~ ............ ~lock ........ ~/. ....... 'or No ....... ~ .......... pursuant to application dated ...... ....~.~.~..../.?. ........... : ........................ , 19...~...~..., and approved by the Building Inspector. ~ J~'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 "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 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 - Residential $15.00, Commercial $15.00 ?. ?. ........... Date .... i. .......... New Construction ........... Old Or Pre-existing Building ................ House No. Street Hamlet Onwer or Owners of Pro err ~.~.~ ~ ~t- P Y.. ~,.~. ~ .~....~ ...... .~-~ ..... ~ ..................................... County Tax Map No 1000, Section...9..~. ~. Block. .. ..~. ...... Lot .... .~. Subdivision ................................. . . . Filed Map ............ Lot .................... . . Permit ' ~ Date Of Permit Applicant Health Dept. Approval ........................ .. Underwriters Approval ....................... . . Planning Board Approval ..................... . . . Request for: Temporary Certificate ........... Final Certicate....~ .../..... Fee Submitted: THE NEW YORK BOARD OF FIRE UNDERWRITERS [ ~ ~ ~ ("~ ~ ~ BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date THIS CERTIFIES THAT o~y t~ electrical ~uipment ~ ~serlb~ be~w a~ intr~uc~ by t~ appl~ant ~med on the a~ve application number in the prem~es of in the foltowlng mcation; ~ Basement ~ Ist Fl. ~ 2nd ~7. OUT Section Bilk Lot u~s examlned on J [~ L Y ~, ~ ~ ~ 9 ~ ~ and found to be in compliance ~ith the Na~onal Electdcal Code. EIXTURE FIXTURES RANGES :OOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES 2 DRYERS FLUG~ESCENT OTHER SYSTEMS NO. OF FEET OTHER APPARATUS: E R V I C NO OF CC, COND A.W.G, NO. OF HI-LEG A,W,G, NO, OFNEiJTRAi PER ~' OF CC COND. OF HI-LEG OF NEUTRAL P.0,B0f 38 GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~OUNDA~ION --- {1st) ~OUNDATIO:; (2nd) ~OUGH FRAME & .FLUMBING INSULATION FER N. STATE ENERGY CODE FILIAL 765-~.802 BUILDINO DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING DATE FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y, 11971 TEL,: 765-1802 Disapproved a/c ..................................... BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ NOTIFY -~ .... ..... .... z/ MAIL TO: , . , (~ktilcl~g Ifispector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS : a. Tkis application must be completely filled in by Wpewriter or in ink and submitted to the 'Building Inspector, with 3 ~ets 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 lhyout of properW 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 what~ver 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 ~emoval 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. · '"iSigrl' '~ture'ot'"a~l}lic~t;' ~x~ ~d~d, i{dc'o;~o'rg~dn')' ' ' ...¢: .o.: ~e.~. p.7.6,./.Gv.e..e.~. ~¢.~.,..~. :%: .0.~. ~.5'. - . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ .~., .I.~ ~ .~. ............................................................................ Name of owner of premises . ??). [d~.~, ~ [...~. :. ~..,?.~.~.~-~t (as on the tax roll or latest deed) If applic~ is a corporat~of duly authorized officer. ,~zdne and title of corporate officer) Bmld~r's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............ ' .... ....... ....... House Number Street Hamlet County Tax Map No. 1000 Section O~ Block ~ Lot Subdivision ..................................... Filed Map No ............... Lot ............... (Nmne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constrnction: a. Existing use and occupancy ~1 o~' I~ , b. Intended use and occOpancy ..... ~.~.~ ~.~ ,1~ .......... - ..... ........... . ..................... 3. Nature of work (check which apl~licable): New Building ..... ' ..... Addition ~.~--C$ .~ Alteration Repair .............. Removal .............. Demolition ............ Other Work ............... I (Description) 4. Estimatdd Cost ...,Q;.q.~.... ! ....................... Fee ~ (to be paid on filing this application) 5. If dwelling, number of dwelling dnits ..... I Number o f dwelling units on each fl~oor... [.. If garage, number of cars ..... i .................................................................. 6. If business, commercial or mixedI occupancy, specify nature and extent of each type of use ................ 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Num~>er of Stories ....................................................... Dixnensions of same structure with alterations or additions: Front ................. Rear ................. D epth .................... ~. Height ........... ........... Number of, Stones .............. ' 8. Dimensions.o~ntire new constrUction: Front .... I. (~. ~. . Rear .... '.2- q. ........Depth . .~;.e( .t ....... Height . ! .37.],~.~-9,~ Number,. __el Stories .~} ..................................... ' ...... 9. · · .>~ ~'¢.~.Y'. .... Rear ...................... Depth ..................... 10. Date of Purchase ........... [. ·~..~ ............. Name of Former Owner ............................. I 1. Zone or use dlstrzct in which premises are situated ..................................................... 1 2. ocs proposed construction vlglate any zoning law, ordinance or regulation: . .~. ~ ............ 13. Will lot be regraded ..... ~.~] .,}~. .................. Will excess fill .be removed from premises: Yes No 14. Name of Owner of premises ~'~,.~.%~.~. ?.. ~.o?. ~.~.. Address ~7~. ?.'~e~5..~. q .°1~ ~.Phone No .... "1: .7.'7;r.'[ .~... Name o Arc ' f hltect . .,. .... ~.. ·. [ ~. ............. Address ........ Phone No ................ Name of Contractor .t~..~. t.,~-... 15.Is this property located within 300 feet of a tidal wetland? · If yes, gouthold Towni Trustees .Permit may be required. ,' PLOT DIAGRA~ Locate cleariy and distinctly all ibuHdings, whether existing or proposed, and~indicate all set-back dimensions from property lines. Give street and block interior or coruer lot. umber or description according to deed, and show street names and indicate whether STATE OF NEW YORK~ -- ~ S .............. ~t ............................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named· He is the ................. .(?.O ~ff*.C~..%< ......................................................... I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui3 authorized to perform or have performed the said work and to make and file this application; 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 manne~ set forth in the application filed therewith. Sworn to before me this/~-'~ o Notary Public, .. county No. 47251~ ,9 Su~[k ~uptJf~/ ' ~ (Signature of applicant) Term Expires fday 31, 1~ .~.,'r 13.. (.'3~° · :~ o~ On~ n-~ z I 1 q Q I, cipc'A i O / LUCAS ¢ BELIS `474540EF SCALE G = av1Cn+UMENT r o j -- - r Q 0 4 i f w i 3 , v �S�q in Illy In I _ i GO' I i «arcN PL, Vii_ . tis l MAF' OF A tlN �1� ;;JB'�_lI /i�1 �N MADE POQ MI TICHELL A. � Mf-TEs AT a TOWNI OP SOUS r ' VtYMAI " 6—�— Mf'FCH�ELL A• 375 P PE5-,ME<%RQA n1O ,4—v. ' ' OF NEW k ? SC}F1bAY F+ 1F Gi S ! XQ 8( `t' 1�CG.b, lip __.I _ heocwvuvr`oy "3e- �q..„.. � `LJ' Lc 3' �'11:Q§?E1`dT�" !. 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