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Home My WebLink About20845-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22021 Date DECEMBER 11, 1992 THIS CERTIFIES that the building. Location of Property 725 PACIFIC STREET House No. County Tax Map No. 1000 Section 141 Subdivision ADDITION Street Block 4 Filed Map No. MATTITUCK, N.Y. Hamlet Lot 12 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 21, 1992 ~ursuant to which Building Permit No. 20845-Z dated JULY 22, 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 PORCH ADDITION ON REAR OF EXISTING DWELLING AS APPLIED FOR. The certificate is issued to JUSTYNA SLAGA (owner) of the aforesaid building. SUFF6LK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED k-~ilding Inspector Rev. 1/81 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°N? 3084~Z Date i 9.~....~- Permission is hereby granted to: ...... ...... ~:~..,.....!..L~..:~.~.~ ......... ,o ~ " II ~1 ,----~"~-,'~". ..... ~ ............. ~ ................. :: ....... ~' .................... at premises located at ......~....~...~....~..~...~?..c,W~...~....~ ...~.~ ..... Coun~ Tax Map No. 1000 Section ..... ]..~..I ........... Block ...... .C}.~ ........ Lot No......~..J....~m'.. ......... pursuant to application dated ....... ...~..~. ....... .'"~"l ................. , 19~...~,.=:~/, and approved by the Building Inspector. Rev. 6/30/80 (~'0 .(~'x~ ~q..~ Form No. TOWN ~LL 765-1802 ~PL~CAT~ON FO~ CERTIFICATE 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 I% 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. 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 Date .... Dggg.~.gg.10,.1992 .................... New Construction ........... Old Or Pre-existing Building ................. 725 PACZFIC STREET Location of Property ....................................... House No. Street Hamlet OIlSTIrNA SLAGA Onwer or Owners of Propgrty ................................................................ .. County Tax Map No 1000 Section ]41 Block 4 Lot !~ Subdivision .................................... Filed Map ............ Lot ...................... Permit No.. ?PP~PT[ ....... Date Of permit...~/¢Z/?~ ...... Xpplicant...d,.~GA .................. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ ~ Request for: Temporary Certificate .......... f Final Certicate ........... Fee Submitted: ¢ 25.00 -'~ .... ......... f. ~5~ ~ / APPLICANT ~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [-~MING [ ] FINAL REMARKS: ~ /~ ~ ~/~~~, ~"/'~-~ 765-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [~MING [ ] FINAL REMARKS, DATE~ IN, ,. / -~OUNDA'TION ( 1 s t) ~OUI{DATIO:! (2nd) ',OUGH FRAME & .PLUMBING ~NSULATION PER N. Y. STATE ENERGY CODE FI;;AL ADDITIONAL CON~_~M_MENTS: Examined . .~...~...o...., 19 ?..&- Approved..~_ d.~., .~:'..~.., 190/.~. Permit No ............ Disapproved a/c ................................... ............ . . (Building Inspector) APPLICATION FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CIIECK .................... S~E PT I C FORH ........... . .... ~L TO: ' ' ''' INSTRUCTIONS a. This application must be comt~letely 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 w6rk. 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 all applicable laws, ordinances,~building code, housing code, and regulations, and to admit aut hor/zed inspectors on premises and in building for ne?es!~ ~,~...~,.~;?,__~tf.,... --' ~XSignature offdpplicant, or name, if a c~oration) ...... (Mailing address of applicant) Date .5~..~..O.i., 19 .~..~. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. / (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 License No ......................... Electrician s License No., ...................... Other Trade's License No ...................... 1. Location of land on which proposed work will be'done .................................................. .?go7 ' ' ....... ¢/ ............. .a,. ~... :.. .-~.. ..................... llouse Number Street ! Hamlet County Tax Map No. 1000 Section .../..~../ ........... Block .... .O.t{ .......... Lot....~./. i)_ .......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 1. State existing use and occupancy of premises and intended use an~l occupancy of proposed construction: a. Existing use and occupancy .... d . .t.:q'. .~. (/l qram. ............ ' ............................ .... ,.. , . ..... b, lntended use and occupancy ..df,~.'~./~.'~.fi~ ....... ~.~...~.p4.;/:~?-~.~,~/,}..~.. ...0,~7~...' 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Remoyal .............. Demolition ............. Other Work .............. ~' i , ~' ~ (Description) 4 Estimated Cost ] ~,~,,e.Y'O .l a,~...?..,~.~. .........· ''' - q ........................ Fee ............. (to be paid on filing this application) $. If dwelling, number of dwelling ulnits ............... Number of dwelling units on each floor If garage number of ears ' ., . .:. . 6. If business, commercial or mlxed!occupancy, specify nature and extent of each type of use .,...:· ........... 7 i · · . i.f F · ures, 1 '' 't)' pfh'..... Dimens OhS ot existing struct any: ront ............... Rear ...... '; .L . e ...... Height ............... Numl}er of Stories ......................... Di i of itlh ti dditi ............................... mens ohs same structure w altera ohs or a OhS: Front, ................. Rear .............. Depth ................ ,. Height ......... Number of Stories 8.. Dimensions of entire new construction: Front ............... Rear ............... Depth ...... J i ...... Height Number of Stories , 9. Size of lot: Front ............i .......... Rear ......... ~ ........ . ..... Depth .... 10. Date of Purchase - ' ................. ........ ~ ................. Name of Former Owner ............................ 1 I. Zone or use ..... district in which premises are situated ..................................................... 12. D°es proposed construction violaie iiny zoning law, ordinance or regulation: ................................ I$. Will lot be regraded ....... ,..:.............I ..... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ....................., Address ................... Phone No ................ Name of Architeqt ........... i ................ Address ................... Phone No ................ Name of Contractor ' Address Phone No Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... · lf yes, Southold T~wn Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from deed, and show street names and indicate whether 15. property lines. Give street and block nlJmber or description according to interior or corner lot. STATE OF NEW YO_Rlt;w--, COUNTY OF ..... lw.... '? ........ ....... (Nam~of individual signin~/contr~c} .... being duly sworn, deposes and says that he is the applicant ~bove named. Ie is the ........................ ~ ....... ~~ ............................................. (Contractor, agent, corporate officer, etc .) ff said owner or Cwners, ~d is duly ~uthorized to perform or have perfo~ed the said work hnd to m~e and file this Pplicafion; that all ~tatements contained ~ this application am true to the best of his knowledge and belief; and that the york w~l be perfome~ in the~ner set forth in the application filed therewith. ;worn to before me this ~ / i ' ........... ........ ~ ~Y~'~ ~ ~ (Signa~e of applicant) GREENPO ' Greenport. NPf. 119~ ~. FOUND/~r'ION '~O REQUIRED FOF~ POORED CONCRETE 3, INSULATION 4, FINAL CONSTRUCTION MUST BE COMPLETE FOR C.C. ALL CONSTRUCTION SHALL, THE REQUIREMENTS OF THE N.Y. STATE CONSTRUOlON & ENERGY CODES. NOT RESPONSIBEE.,~ FQR- DESIGN OR CONSTRUCTI~ ~ t:} 0__ rZ ~ i'~ ~. ~:~, MATTITUCK LOCATION BOX 1440 North Road· Rte. 48 Mattituck, N.Y. 11952 (516) 298-8559 FLOORING (~ENTER JUL 2 I <o, 0CCL~PA~O¥ /VT S