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HomeMy WebLinkAbout20822-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20907 Date AUGUST 3~ 1992 THIS CERTIFIES that the buildin~ Location of Property 1200 THERESA DRIVE House No. County Tax Map No. 1000 Section 115 subdivision ACCESSORY Street Block 13 Filed Map No. F~tTTITUCK~. N.Y. Hamlet Lot 14 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 8, 1992 ~ursuant to which Building Permit No. 20822-Z dated JULY 13, 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 SHED IN REAR YARD "AS BUILT" The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 HENRY & JOAN ROMANOWSKI N/A FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPf~RTMENT Office of the Building Inspector Town Hall Southold, N.~. CERTIFICATE OF OCCUPANCY No Z-20906 Date AUGUST 3, 1992 THIS CERTIFIES that the building Location of Property 1200 THERESA DRIVE House No. County Tax Map No. 1000 Section 115 ADDITION Street Block i3 ~d~TTITUCK, N.Y. Hamlet Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 8~ 1992 pursuant to which Building Permit No. 20822-Z dated JULY 13, 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 "AS BUILT" TO EXISTING ONE FAMILY DWELLING The certificate is issued to (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED HENRY & JOAN ROMANOWSKI N/A Rev. 1/81 l~O~W~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°-No. 2082~Z Permission .~ ....~.. is hereby granted to: ...~.~..~.~......'.~L ............................................. d U~ ~ .~ .~ ~~. ~~, ~ ~ ~ ~ ~ ~..~ L.. ~L~.....~~..~..~..~..,.....,.~~~ of p~emises I~ated at ~~~-~.~ ........... ~.~ .......................... County Tax Map No. 1000 Section ....... .(./....~... ...... Block ...... /.....~. ....... Lot No. i ~ pursuant Building Inspector. Bl:lTlc[ing Inspector Rev. 6/30/80 Form No. 6 ~ ' TOWN OF SOUTHOLD BUILDING DEPARTMENT 765-1802 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 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: 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 July 87 1992 Date .................................... ... New Construction Old Or Pre existi g Building Location of Property 1200 Theresa Drive Mattituck, N.Y. House No. Street Hamlet HENRY & JOAN ROMANOWSKI Onwer or Owners of Property .................................................................. County Tax Map No i000, Section .............. Block .............. Lot ...................... Subdivision ................................. . .. Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept Approval .. . Underwriters Approval ...... Planning Board Approval · ... Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ .... .2.5:.0.0 ................. .' ' .' .~~ .~...~t ............... -Z 07 PLICA T Form No. 6 TO OFSOUTHOL /~/~j ~/~ BUILDING DEPARTMENT z? , 7C/ TOWN ALL APPLICATION FOR CERTIFICATE OF OCCHPANCY 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 topograph±c 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 Hnderwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of lg 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 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 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 - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date July 87 1992 . New Construction ........... Old Or Pre-existing Building ................. of Property 1200 Theresa Drive Mattituck, N.Y. Location ......................................................................... House No. Street Hamlet Onwer or Owners of Property IIBNRY & JOAN ROMAN~WSKI 115 ~ . 13 14 County Tax Map No 1000, Section .............. ~±oc~ ................ Lot ...................... Subdivision .................................... Filed Map .......... [.Lot ...................... Permit No Date Of Permit . . Applicant Health Dept. Approval ....................... Underwriters Approval .............. Planning Board Approval ' Request for: Temporary Certificate ......... .. Final Certicate ....... . . .. Fee Submitted: $.. 25.00 ' · ............ ¢o rOUNDATIOI! ( 2nd ) IOUGH FRAHE & ,PLUMBING iNSULATION PER N. Y. STATE ENERGY CODE ADDITIONA'L CO IENTS: TOW~I-~'$OUTHOLD '- FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ..~..1..~., 19c~.z. Permit No..c~..0..~..'~r~'. · · .~:" Disapproved a/c .... . .......................... ......~"J ~ ~p~ ~ (Building Inspector'-" v_ )  APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD Of' HEALTH ......... 3 SETS or PLANS .......... SURVEY ........ ~ .......... CI~ECK .................... SEVT~C ro~, ....... -: ...... ~,'o?~¥, ri - qlq~'2' . C^L~ . 3..~ ....... H^ZL TO: 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 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 R4gulations, 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 necessaryj~sp,~ctions. .~ .. ............. --' (Signat~e of applicant, or n~'~ if a corporation) .... .... (Mailing address of applicant) I / ~ ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ~. ~,~..~. ~,-~ ............................ . ........................................... Name of owner of premises ........................................ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly auth~orized officer. (Name and title of corporate officer) Builder's License No ....................... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be' done .................................................. · ........... ....... /odd ...... ......... ........... House Number Street Hamlet County Tax Map No. 1000 Section ..... /~..J~.. ...... Block ...d~. ........... 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 ..................................................................... EXISTING DECK 4, ACCY SHED . - , , :.~ b. Intended use and occupancy .. 3Mk2B" .......................... ................................. 3. Natur. e of work (check which applicable): New Building .......... Addition ~ Alteration .......... Repair ...... i ....... Removal .............. Demolition ...... ~J~ther..XVork .. _a,, i · . 4. Estimated Cost G*..~. . rt,~,~_~/~"~-jlr',l~ ~ ~ ~- o ~ ~J ~ .... .... ,~ / (to be pa~d qn~flhng't~s application) If dwelling, number of dwelling Number of dwelling units '6~ 5. Cnits ............. each floor ................ . If garago, number of cm ..... .] ................................................................... 6. If business, commercial or mixeg occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure's, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stores... D~ensions of same structure with alterations or additions: Front ........ Rear .......... Depth .................... ].. HeiSt ...................... Number of Stories ........ ~ entire new const~ction: Front ............... ' .............. 8. Dimensions of Rear ............... Depth ............... Height Number' of Stones' Size of lot: Front : Rear Depth Date of Purchase ~ ' Name of Fomer Owner Zone or use district in which pr~mises are situated ....................... Does p posed co tion violate ~ny oning law d[da' ' egulatio ' '" ......................... ' Will lot be regraded ......... 1 ................... Will excess fill be removed from premises: Yes No Nme of Owner of premises ... ] ................. Address ................... Phone No ................ Nme of Architect ........... i .... ~ ·...........Address ................... Phone No ............. ... Nme of Contractor ......... ] ................. Address .. Phone No Is this property wtchtn 300. feet of a ttdal wetland? ~Yes........ No ......... ~If yes, 8outhold ~own Trustees Permit may bo required. PLOT DIAG~ .Locat~ clea~y ~d distinctly ~1 ]bulldogs, whethe~ existing or proposed, ~d. indicate ~1 set-back d~ensions from prope~y ~nes. Give street ~d block number or description accord~g to deed, and show street nines and indicate whether 10. 11. 12. 13. .14. 15. STATE OF NEW ya.~v..... _ C ~'j ~. S~S OUNTY OF.[}_ ....... t.~.~....~:..,. ......... .u~.~',/.q.~/... >.~...,...c~.. i.W~ .a..~O..t!O.~. ~-.' ~ ..... being duly sworn, deposes and says that he is the applicant (Name df individual signin'g contract) above named. He is the .~..~. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 3uthorized 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 majl.ner ~et forth in the application filed therewith. Sworn to before me this . · tary Public ............ , -2'..'k"~.. C'ounty '' ... '~'i' a,~r~h'/i ~:.~-,, ,,..~2: (Signature of applicant) ..... PLOT DiAGRaM Locate clearly ond distinctly oil buildings, whether existing or proposed, ond indicote oll set-bock dimensions from property lines. Give streef ond I~lock number or descrlptior~ e¢¢ording to deed, ond show street homes ond indi¢ote whether interior or comer lot.