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HomeMy WebLinkAbout21138-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22097 Date JANUARY 11, 1993 THIS CERTIFIES that the building Location of Property 2715 KENNYS ROAD House No. County Tax Map No. 1000 Section 59 Subdivision ACCESSORY SOUTHOLD~ N.Y. Street Block 7 Lot Filed Map No. Lot No. Hamlet 2 conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 4~ 1992 pursuant to which Building Permit No. 21138-Z dated DECF_/~BER 11, 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 ACCESSORY GARAGE "AS BUILT" The certificate is issued to JOHN & LUCY FUGOSICH (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL INSPECTION NO. 2072 DATED DEC. 21~ 1992 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 Building Inspector FOII, M NO. 11 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT CfHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°-N,o 2113 Z County Tax Mop No. 1000 Section ......... .~...~...... Block ..... .~'... ........... Lot No ..... ~ ............. pursuant to application dated ..... /..~.../...,~.... ................................. , 19.~Je~, and approved by the 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: I. 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 Vpre-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. Fees i. 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 New Construction .......... Old Or Pre-existing Buij~ding .............. Location of Pronertv...~.2~/.J~. House No. Street Hamlet Onwer Owners of Propgrty County Tax Map No i000, Section .............. Block .............. .- Lot .................... .. Subdivision .................................... Filed Map ............ Lot ...................... eermic No.~ ............. Dace Of Pe~ic ....... ~ ....... ApplzcanC...~ ....................... Health DepC Approval ' zla~niu~ Board Appro~ai ........................ ~ee Submitted: ~'~ INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wleczorek Ordinance Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 DECRHBRR 23, 1992 JOHN FUGOSICN P. O. BOX 423 SOUTHOLD, NY 11971 RE:: ESTATE OF LUCY & JON FUGOSICH To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xxx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is k~not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT ~ 21138-z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. OUNDA~ION (1st) 'OUMDATIO:_~_I., (2nd) :OUGH FRAHE & .PLUMBING i1;SULATIOM PER N. Y. STATE E~ERGY CODE FI:;AL ADDITIOMA'L COMME~;TS INSPECTORS (516) 765-1802 VICTOR LESSARD, Principal CURTIS HORTON, Senior VINCENT R. WlECZOREK, Ordinance ROBERT FISHER, Assistant Fire Building Inspectors THOMAS FISHER GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD SCOTT L. HARRIS, Supervisor Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 December 15, 1992 Mr. John Fugosich P.O. Box 423 Southold, New York 11971 Re: Building Permit ~21138-Z Premises 2715 Kennys Road, Southold, surf. Co. Tax Map %t000-59-7-2 Dear Mr. Fugosich: Enclosed is the building permit for the accessory garage off Kenny's Road. A fee of $25.00 was required for this permit. An additional fee of $25.00 will be required for the Certificate of Occupancy plus any inspection and underwriters certificate for the wiring. we have scheduled an inspection on Friday Dece~er 18, 1992 as you had requested. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. TJF:gar Thomas J. Fisher Building Inspector encl. 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 loss 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. Foos 1. Cortificato of Occupancy - New dwelling $25.00, Additions to dwolling $25.00, Altorations 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 ~ $i00.00 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 ...~...~.. f/gl..~. .......... New Construction ........... Old Or Pre-existing Building...~..~.~.~.~.~. .... Location of Property...~g~.. /~/~/J/Y~ ~ 9~.~.~..~..~.~./T. P. ~../~...~. House No. Street Hamlet County Tax Map No 1000, Section .... ~ ..... Block ....... ~ ....... Lot....~ ............... Subdivision .................................... Filed Map ............ Lot ...................... Permit No ................ Date Of Pe~it ................ Applicant...~k~.;b~h...~ Health Dept. Approval .......................... Underwriters Approval ......................... Board Approval Planning ...................... Request for: Temporary Certificate ........... Final Certicate .... ~ .... Fee Submitted: $ ?~..~. · .~..z~. .... 1 5'ou 7'//~b,/v,Y /I??/ ,>.: t · o.J'I"HOLD ovER over RooF T B~ocK <, 17' 6" ~ 6uTL~T.S UNDI~RWRII'ERS CER]'IFICAt'E 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION AND [ ] INSULATION [ ] FRAMING [ ~FINAL DATE FORM NO. 1 ' ~ ': , ~ :\i~d, TOWN OF SOUTHOLD ' BUILDING DEPARTMENT TOWN HALL I}i'][~" ~ 1~9~' SOUTHOLD, N.Y. 11971 v/.~.~., ,~...~..~, TEL.: 765-1802 Disapproved a/c ..................................... · . APPLICATION FOR BUILDII~G PERMIT INSTRUCTIONS BOARD OF HEALTH ......... ~-3 SKTS 0F PLANS /.-SURVEY ................... ,~C~I~CK .................... SEPTIC FOR}H .............. CALL .......... HAIL a. This application must be completely filled in by ty?ewriter 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 coverOd 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 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 applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspecti . (Siona pli orporafion) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Nameofownerofpremises: .O'_7. O//-A/ ,/~//dOX/c// 4- I'~//~/~ · (7c/O r//~ff -/~/~,C. ~,q5 ~P) (as on the tax ro'~ or latest ~ed) If applicant is a corporation~, signature of duly auth~orized officer. (Name and~ ~[i~le of corp'0~ate officer) Builder's License No .......................... Pt mber s License No ......................... ; Electrician's License No ' - Other Trade's License No ...................... Location of land on which proposed work will b done. .-. House Number Street Hamlet County Tax Map No. 1000 Section ...... .~. ........ Block'. .... Z. 2 ...... Lot...~ ............. Subdivision ..................................... Filed Mhp No ............... Lot ............... (Name) State existing use and occupancy of premises and in tended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which ' ' .~.~)~/J~ Addition Alteration .......... apphcable): New Building ............ Repair .............. RemOval .............. Demolition .............. Other Work 4. Estimated Cost ........................ Fee ..................................... (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor .... If garage, fi~umber of cars ..... (~. P.~. O. ............ 6. If business, commercial or mixed occupancy, specify natgre and extent of each typ of use .............. 7. Dimensions of.existing stmcture~,ifany: Front ./.~/ .~.t,. . Rear /'7. t ~} m~,,*h ~,F'/ ...... Height . r. Num erofStories ...,. Dimensions of same structure wilh alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front ................ Rear ............... Depth ............... e~ght ............... Num bet of Stories 2 .......... ~./ ............................ 9. Sizeoflot Front ~ff../ n,,~ . ......... ... 10. Date of Purchase "/~"~ 3~ 'w.~ ..NamepfFormer,Owner :5~)... :~:~/'.7-~.." ". 11. Zone or use district in which premises are situated...~.~/.D. 12. D°es pr°posed construction violate any zoning law, ordinance.or reghlation: 13. Will lot be regraded ...... Will excess fill be removed from premises: Yes No 14 Name of Owner of premises ' Address · ' ...................................... Phone No ............... Name of Architect ' Phone No ..................... Addres~ Name of Contractor .......... . ............... , Address ......... . .......... Phon, e.~ ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No.. ~. ..... *If yes, Southold T~wn Trustees Permit may b~e required. .-'. PLOT DIAG I~M Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. APP, ROV, ED AS NOTED rATE: FOR POURED CONCR['TF 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRucTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRuCTiON & ENERGY CODES, N~ 'RESPONSIBLE FOR DESIGN OR CONSTRU~IoN ERRORS ;TATE OF NEW ¥^O,R/~ . :OUNTY OF... }'].L/. ......... (Name of individual signing !contrabt) bore named. being duly sworn, deposes and says that he is the applicant is the ' (Contractor, agent, corporate officer, etc.) said owner or owne.rs, and is duly a~thorized to perform or have performed the said work and to make and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner sei forth in the application flied therewith. a, orn to before me this .......... ........ ....... .