The URL can be used to link to this page

Home My WebLink About20645-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPA~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21054 Date SEPTFRMBER 29, i992 THIS CERTIFIES that the building Location of Property I015 ROBINSON LANE House No. County Tax Map No. 1000 Section 98 Subdivision ADDITION PECONIC, NEW YORK Street Block 5 Filed Map No. Hamlet Lot 5 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 15~ 1992 pursuant to which Building Permit No. 20645-Z dated MAY 21~ 1992 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 WALTER SUSKEVICH (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 FO~.M NO. ft TOWN OF SOUT~OLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PEPJ~AIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N°N? 20645Z Date ......,,.. .............. , ...... / Permission is hereby granted to: .... .............. County Tax Mop No. 1000 Section ..... .~....~.. ........... Block '-~ Lot No. pursuant to application dated .~...'~........//..~... .............................. , 19...~.., and approved by the Building Inspector. Rev. 6/30/80 ' SEE 2 I/ D2 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 w'ith 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 '¥re-existing" land uses: i. ·Accurate survey of property showing all property lines, streets, building and unusual natural or topographic ~eatur~s. 2. A properly completed application ann's 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. 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 o~er 5 years - $10.00 '- 4. .Updated Certificate of Occupancy - $50.00 5. T~mporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .... , .................................... Construction .......... Old Or Pre~-existing Building .... . .... House No. Street Hamlet er 0 ners of ............................................. :ounty Tax Map No ~000, Section...~...?.~ ..... Block ...................................... ;ubdivi-sion ' · ' ' Filed Map Lot 'ermit No...............~CP~ L/ ~- .Date' Of Permit.../....l .... Applicant {ealth Dept. Approval .......................... Underwriters Approval ........................ .. 'lanning Board Approval ........................ :equest for: Temporary Certificate ........... Final Certicate ........... 'ee Submitted: ........ ~, ~,'.- '~; , ~.- JUL ~- 1978 ~,~.~. /[~/ the sewage dtsTnm'.~ e.n¢~ ~f.l.~p ....... ' D~ED~ ~/~ ghiof Of Geu¢~al '- ...... ~0.0 ~ ~ cort~t% ................ M~P OF LOT ZZ TF-~T HOLE SUFF. CO. DEPT. OF HEALTH SERVICES STATEMENT OF INTENT K~', ) DATE: DISPOSAL ~YSTEMS FOR THIS R~I- 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [ ] FRAMING [~FINAL REMARKS: DATE INSPECTOR FOUNDaTIoN (1st) FOUNDATION (2nd) 2. ROUGH FRAME & -PLUMBING e INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: ':,~' ~/~¥ I 5 1992 Examined ............. Approved ........... , 19 e~it Ho. . Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180;3 · (Bui~i% Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLAHS .......... SURVEY ................... CHECK .................... SEPTIC FORH t;OTl FY ~ ; a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 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 ;hall 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 appticant 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) (Name and title of corporate officer) Builder's License No. dg&;/~-M£'/~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. APPROWD AS I~OT~D ........................ .... ................ Nameofownerofpremises FY.~ z~ ~OS'ICEVIGt7 ......................................... .' ay:.' .... _ (as on the tax roll or latesN ~ DEPARTMENT AT If applicant is a corporation, signature of duly authorized officer. 765-1802 9 AM ~ 4 PM FOR ~E , FOLLOWING INSPE~ONS: 1. FOUNDATION ~O RE~IRED FOR POURED CONCR~E 2, ROUGH - FRAMING & PLUMBING 3. ~NSU~TION 4. FINAL CONSTRUC~ON MUST BE COMPL~E FOR C.O. ALL CONSTRU~ON 8H~ ME~ THE REQUIREME~S OF THE N.Y. STATE CONSTRU~ON & ENERGY CODES. N~ ~ RES~NSIB~ FOR DESIGN OR CONS~U~ON ERRORS 1. Location of land on which proposed work will be'done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section . .Q.?~ ........... Block .... { ............. Lot Subdivision..&q~.t¢;, ~. ¢~ .............. Filed Map No. (Name) L 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 ~ZC~ ~trzo 3. Nature of work ' ' ' (check which applicable): New Building .......... Addition ..~/ ....... Alteration .......... Repair .............. Removal, .............. Demolition .............. Other Work ............... 4 Estimated Cost /,5190 ,'Od~) ! (Description) .... i Fee (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 c~s i ............... 6. If business, commercial or m~xedloccupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures~, if any: Front Rear ............................. Depth ............... Height ............... Numl~er 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 Num her of Stories ............................................. 9 Size of lot: Front ' Rear ............................................. Depth 10 Date of Purchase , Name of Former Owner 11. Zone or use district in which pre ' ises 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 No 14, Name of Owner of premises .... ~i ............... · Address ............... .... Phone No ....... Name of Architect ~ Add Pho N ......... ........... 1 ................ ress ................... ne o ................ Name of Contractor .......... ................ Address ................... 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 clearly and distinctly all §uildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block nhmber or description according to deed, and show street names and indicate whether interior or corner lot. 3TATE OF NEW YOILK,rc~ ,~ S o SOUNTY OF ....... ~:~-~..~.~;ab~... '? sgev c ' . .......... ........... ~. ·;, ~ ...... being duly sworn, deposes and says that he is the applicant (Name of individual signin~ contract) :bove named. ~ [e is the ........................ ] ...... ' ...................... . ................... : ........ ' ' '~ ! (Contractor, agent, corporate,officer, etc.) ,f said owner or owners, ~d is duly ~uthofized to perform or have perfo~ed tbe said work and to m~e and file this pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the /ork w~l be perfo~cd in t~ner sdt forth in the application ~ted therewith. ~wom to before me this ~ J ] ................ ..... ....... ¢otaw Public, //1~~ ~ ~. ~ Couh[~~ N~ 47~ ~,