HomeMy WebLinkAbout20509-z
FORM NO. 4
N
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22577 Date SEPTEMBER 8, 1993
THIS CERTIFIES that the building ALTERATION
Location of Property 1730 YOUNGS AVENUE SOUTHOLD, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 63 Block 2 Lot 12
Subdivision Filed Map No. Lot No.
conforms substantially to the Application far Building Permit heretofore
filed in this office dated SEPTEMBER 12, 1988 pursuant to which
Building Permit No. 20509-Z dated AUGUST 27, 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 ALTERATIONS TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to DOROTHY RUSKOWSKI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. H-033678 - MARCH 4, 1993
PLUMBERS CERTIFICATION DATED AUG. 27, 1993 - PECONIC PLUMB. & HEAT.
Building Inspector
Rev. 1/81
FORM NO. $
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N2N! 20509Z Date ....0 199
Permission is hereby granted to:
, L-0
to m . I . .
at premises located . t 01.le.................................................. 1-7 .
°..........s::5 7`:"........................................................
County Tax Map No. 1000 Section Block 4? Lot No..........r~.° -
i pursuant to application dated 19.6F9 and approved by the
i Building Inspector.
Fee !v .
Bu' ding for
Rev. 6/30/80
Form No. 6 '1 Qty _SCd .~""at•N!1
$aiRc aJ • i~g 7i
~~°lTOWN of soDTxoLD
~D a
BUILDING DEPARTMENT
'SEP "1j 1993 of
TOWN HALL
~_lr 765-1802
I-E E_= Ij f.
7O1R/N " 401 ~ 'APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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 19 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:
! 1. Accurate survey of property showing all property lines, streets, building and
y 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; Ad diticns-to-dwellin
g $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 $15.00
Date
New Construction............ Old Or Pre-existing Building..
Location of Property. l6.$O....YW06-z .fl~R NC-, 1. SQLt7_ Q.Z-b.
House No. Street c Hamlet
Onwer or Owners of Property.. wS.K
County Tax Map No 1000, Section Block Lot...,..................
Subdivision ....................................Filed Map............ Lot......................
Permit No.. n ........Date Of Permit-l9 ............Applicant TnK. y„',?(. . b,GJ,
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate..X......
Is 00
Fee Submitted: .
C)Zs~C. ,qq ~~~G 7ry~-PAD APPLICANT
C ~ da~J / / ~ - tai
S~FF[1LS'C TEL. 765-1 B02
TOWN OF, SOUTHOLD
j OFFICE OF DUILDIIIG INSPECTOR
u y P.0. L30X 1179
0\u\~ TOWN HALL
SOUTHOLD, N.Y. 11971
C E R T I P I C A T I O N.
D a t
Building Permit No. 20$_O9_Z
Owner_1OYO fh y R (ItS KOGJS k )
(please print)
S
Plumber ~LYII 14 IMAi !/~~/~~/I?~
(please- print)
I certify that the solder used in the water supply system
contains less than 2/10 of to lead,
/tee / v0Z
umberrs ignature)
Sworn to befor: me this
day of ~(4{
19 v~
Notary Publi
Notary Public,_
County
BARBARA S7EPNOWSK)
Notary Public, State of NOW York
Qualif ed In Suffolk County
Commission EVkes SaVt 30,1
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INSPECTORS
Victor Lessard ~$11FFol'fe
Principal Building Inspector pG
Curtis Horton SCOTT L. HARRIS, Supervisor
Senior Building Inspector CA Z Southold Town Hall
Thomas Fisher 15 P.O. Box 1179, 53095 Main Road
Building Inspector •
Southold, New York 11971
Gary Building Fish Fax (516) 765-1823
Telephone (516) 765-1800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
August 26, 1993
Dorothy Ruskowski
500 Smith Drive South
Southold, New York 11971
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
XX An application for Certificate of Occupancy is
not on file. (Enclosed) C+-"
No Underwriters Certificate on file.
XX The check is not on file. $25.00 rtl~
No Health Department Approval on file.
No final inspection has been made.
XX No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 20509-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
1 LA II:S:'EC;IuN JJDATc 1 COMMENTS
FOUNDATION (1st)
17-
c '~J
y n
FOUNDATION (2nd) _ m
2.
z
04 -
ROUGH FRAME F1' a
PLUMBING
H
3.
elf ' H
INSULATION PER N. Y.
STATE ENERGY
CODE
x ~t
4. ~
FINAL
o
ADDITIONAL COMMENTS: x
• x
.o
H
0
2
cam, ; i
a
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H
x y,
cn
-o
H
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
REMARKS:
DATE O INSPECTOR
i
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ I ROUGH PLBG.
[ ] FO NDATION 2ND [ ] INSULATION
RAMING [ ] FINAL
REMARKS: 4&_I.t)
- d
DATE u D INSPECTOR
ss-1802
ILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ROUGH PLBG.
[ j FOUNDATION 2ND [ j INSULATION
[,I'FRAMING [ j FINAL
REMARKS:
DATE CIS INSPECTOR -
L
i 413S
Q C~ G0 N~~a
m23an i'
BLDG. DEPT.
TOWN OF SOUTHGLD
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROU H PLBG.
[ } FOUNDATION 2ND INSULATION
FRAMING [ ] FINAL
REMARKS:
:
DATE INSPECTO
FORM NO. S
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No 017435 Z Date .....Y/zl~ 19le
Permission is hereby gro to t0/G~_..'/n,/Sv',..('.r.®Y•~~~~Gtet:,..A..G'Rt`:/.w'!YI..A y ..............G .'~.`X~~..`~...~~+.............
...::KKI.TitiwM! v.....`: -e ......4 ~p.?.IKe ~....../.A ................................i......................
Gya ~ p
at premises located at ~..a..0........G% 4 .
County Tax Map No. 1000 Section n........ Block 9= Lot No....... Z
pursuant to application dated .....`~/1-2. 19.1e and approved by the
Building Inspector.
a~
Fee
ildin nspector
Rev. 6/30/80
rORK NO. S
TOWN OF SOUTHOLD
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 42 Z Date .......,lol 19..1Q
Permission is hereby granted to: e:2
l
..fir.....
....V~.....
to...... Y~2c........ 4
4*0
at premises Iota ed at ........Q ...................../t....................................................
County Tax Map No. 1000 Section ......4.n;~ Block Lot No....
pursuant to application dated v 19.i , and approved by the
Building Inspector.
Fee S••4••1~~
for
/Puildin',
Rev. 6/30/80
i
7 1-13 5- 2-
I
1~23~ '
BLDG. DEPT.
TOWN OF SOUTHOLD
n (LEPGACG F~on/Y` J- !NT£,'?~ol,~
15OCK PpRGH a -I' Doo2S SAS? S/2E
. , N~kl PGylvooA ~b~ ~ram2
UIRED
KiTCN#N ;
N
a
pCU
3
' i
~awN !PLUMBER CERT/Jn?CAT/ON
ON LEAD CONTENT BEFORE
- CERTIFICATE OF OCCUPANCY
SOLDER USED IN WATER
SUPPLY SYSTEM CANNOT
- EXCEED 2110 of I% LEAD.
uP
Llwm~ Room
~LooR
N poppet tubing is used
for Waer disttibuting PLUMBING
.PLUMBING W/A$TE
Bystan piping, she It be WATER LINES NEED
Of"" K or L only ~ ;TESITiNG BEFORE COVERING
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BOARD OF HEALTH
3 SETS OF PLANS . •
a 14 FORM NO. 1 SURVEY
ra.. TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765.1802 CALL /p
MAIL TO:
Examined . 19fe,
010 Approved 19 4 Permit No. ~ ~KI~~
Disapproved a/c D
/
1
DG. DEPT.
.
TOWN
( OF pector) SOUTFIOLD
APPLICATION FOR BUILDING PERMIT
Date .........~/s~ 1
INSTRUCTIONS
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 plo4• s4pNt'~gt1:iR~ICt1 of buildings on premises, relationship to adjoining premises or public streets
or areas, i#l`vm etIB$,giotcA layout of property must be drawn on the diagram which is part of this appli-
00 cation. i lE (;t7Y1c1Wp jjC11N ' b1 t3C*A
c. Ty w
s~tk oil,~,t~otjt~~ilktip111$ttrk9ia' may not be commenced before issuance of Building Permit.
d. Up p p &8'&q) AwaIiVRaA' iokjh i4 Building Inspector will issued a Building Permit to the applicant. Such permit
shall be keptt n tjl}p4gf # rpisp
k) v~ikdble for inspection throughout the work.
e. No byte ~tg shaglt~pjQ0. ttrsp}d`&bf'4 e8 in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have to na gpqwlj~ y the Building Insppector.
s p,{'(tYUklw
A~ t~ DE to the Building Department for the issuance of a Building Permit pursuant to the
BuildiPngPLZ~C o11 UcRo .{;fxthold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulatiotis t
ri t c~ip,of buildings, additions or alterations, or for removal or demolition, as herein described.
The appliba~t a ~cowli h ikap.Pticable laws, ordinances, building code, housing code, and regulations, and to
admit authdriz~
t ~3tF ~+oPv d building for necessary m ections.
a s '
UV y - '91; 0 Signatur of plican , or name, if a corporation)
.Hy..7.!...
(Mailing address of?apoplic~vft)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
(17~!?!or1~
Name of owner of premises'16.120.'o-l Y... WXS.k a 4C!SS= .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. . 00, F!? .
Plumber's License No. .494W4 .
,
Electrician's License No. .0.el)We4.
Other Trade's License No . . .
1. Location of land on which proposed work will be done. .
O... -y4&.Ny. X.. A&Al'. k .........4~o er. ai....
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot. e~~ . . , , , , , . , .
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 - • . • .
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