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HomeMy WebLinkAbout20026-z , FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20681 Date APRIL 27, 1992 THIS CERTIFIES that the building NEW DWELLING hocation of Property 720 ORCHARD LANE SOUTHOLD N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 89 Block 3 Lot 11.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 19, 1991 pursuant to which Building Permit No. 20026-Z dated JULY 25, 1991 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE & DECK AS APPLIED FOR The certificate is issued to FRANK E. & RARRARA A. CIEPLINSKI (owners) of. the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 91-SO-48-APRIL 21, 1992 UNDERWRITERS CERTIFICATE NO. PENDING - APRIL 27, 1992 PLUMBERS CERTIFICATION DATED APRIL 27 1992-HARDY PLUMB.&HEATING 0..t. u ding Inspector Rev. 1/81 11'OBM Nd. ! 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°- 20026 Z Date ...~s 191... Permission is hereby gmnted//ot~fo: I ~ti/G2GLl/~ sale QG ~sZyR.~~iz ..caj'./J~...~%. ~../././.9/~7,/~/. / , ro ...~.....~...G~r.~.. ~ ..an~N~ll~.t!'.'?~....kt~... of premises located of ...,1,~®f1®..... ...../fi.rf.~l.~.........~/~ .G `-DEC............~.o.'-..~'..~.~..-.-..~,.2 ~.a County Tox Map No. 1000 Section ........Q..,l........ Bloek Lot No........`/.c... Z j pursuant to application dated ~~,l 19.9, and approved by the 4 ~ Building Inspector. i Fee $..J~..~'J. 'c~l~ r~~i.. .F~7.A~~ B ing Inspector~~ i Rev. 6/30/80 ~ ~ . Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 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-4 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 t 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. C. 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 - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.100, /Co^mmercial $15.00 Date ..~~f?,1.~: New Construction... ~ Old Or Pre-existing Building.. . Location of Property.... ©~...L~~.~i .............................~'"G;~f~o~a,kl Gj...... House No. Street Hamlet J, L © / / O Onwer ar Owners of Property...,l:`h'!~/`.. ~:14~1!6~N~?~'!s...r~.'.. ~~'.~1.•~:w~!~! County Tax Map NoC~ 1000, Section.....~~.a.~.....Block... ~...........Lot.....~7..~:b[.b Subdivision..~/:y~!'~,1!i?,T.(. 3S: ~ ~8../iJ`i~°`~Feee~I'+~. ~rrG SV ...L t....,.'/..../.~.~.......... Permit No. .Date Of Permit ................Applicant.. K:: !':'.~.:•?:~:~~7r!~, Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate....G....., Fee S~ubom,,itted: /~~v, /-c%~~'~ v`r"~-' y~7~b ...........APPliICANT. /K . CO~.2D6Q'l TEL. 7G5-1802 o~~FFaU, ~o`~ Town or so~T~oa,~ o`- ~t OFFICE OF BIJILDIDIG INSPECTOR o ,r;'~' ~c P.O. I30X 728 y f„ TOWN HALL 0,.~~ SOUTHOLD, N.Y. 11971 , 01 ~ C E R T I F I C A T I O N • Dat~9 I Building Permit No.~~.1_L15XSL Owner~_ ~ , (p ease int) Plum',aer ~ ~~e. (pleas pr t) I certify that the solder used in the water supply system contains less than 2/10 of 1~ lead. 1/^~, , ,r /~,ss --.~L A ~ (plumber's signature) Sworn to before ,me tf~/his ~Gj~ day of ~~~J/L~ ~(~~~tic,oi /~CQ~e2 k~~°.~~-Ga~~ 19 t'- Not/a-/r(fy Public Notary Publi County TEL. 765-1802 ooS~FFOCkcc~ TOWN 0~' SOL)TIIOLD a~~' ~ , ~'c OFFICr OF BUILDING INSPECTOR o ~~1 ~n P.O. BOX 728 p~~. TOWN HALL O'~~~ ~~Ot' SOUTHOLD, N.Y. 1 1971 April 27, 1992 Winds Way Building Corp. 1020 Glen Road Southold, New York 11971 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because of- the following reasons. An application for Certificate of Occupancy is not on file. No Underwriters Certificate on file. ~r/ The check is (~iadx3r.xf.~d/not on file. ) $25.00 No Health Dept. Approval on file. ATo final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit {1 2 0 0 2 6 Z Building Dept. ***/1CX/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) r'lELD i;:5:'ECiiU:J ~~llATc ~ COMMENTS p, •v O / - H U` FOUIIDATION _ (1st) ~ ~ - - - ~ cS" / ~ . _ FOUNDATIOtJ (2nd) _ _ 2. s z o ~ P,OUGH FRAME & PLUMBING H ~ 3. ~ m ra IIJSULATIOPI PER N. Y. • • STATE ENERGY CODE x r 4 . •v-! y~ FIiJAL ADDITIOPIAL COMMENTS: m U . cn ' x ~ ~ • ro p( H E H\ oYo e.ea 1 1L mlo ' ~ a TJ H O x t*7 \n A \ • r ) H - ~ ~ ry m -e ` • ~ t~ ~orrri No. ll xowrr or' oov'rxol,D HUILDINO DEPARTMirNx TOWN IiALL SOU4'FIOLD, NY DEVL:LOPMi:T19' I'ERM'IT _ 4 .ta NO _ F DAtO / J Yer:nlaalo~ is h©~~~~- tad to: ~ via` ~j~ ~ t c ~-i>_~,~ji~~„J" it _,~_~r~ GCI,G~~ ~j1_..~~~~~~ A ~iL ~1/ ~7' . at promiaea locatod nt _7'oZ0 ,d~q~~ ,~p~~p Cour+ty Tnx Mnp tio. 2000 Hootion ~ Block .3 I,ob ` ~_lJ~ a~ purnuunt to u~pliontion dntod ~9 19~, snd tipproved " by the Building Inopoctor. 'wilding Poxsnit IIo. ~ . z h _ uil nR Tnspoctor ~ ~ 4/eo nr, o- - y. c , . , ,.Qf. . r. z°°. y. t ~ _ t, ~,r r _ r .3~fsa?..,..gk" 765-1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. 4 [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REM RKS: c~~~ i f j G i e I DATE INSPECTOR i C f ' t r 765-1802 BUILDING DEPT. iNSP~CTiON E [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL i REMARKS: ~~/,7~~'' 4 P { P ~ EEIEE r~ n ~ ~ ) ~ ~ ~ E DATE INSPECTOR 4 a~~ 7'65-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T ROUGH ' PLBG. ]FOUNDATION 2ND [ ] INSULATION [~MING [ ]FINAL i E REMAR 5: CJ`" ~ - f fkf ttk F{oft € ~ DATE ~ ~ ~ INSPECTO i ~ - L~~ ~ T65-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION iST [ 1 RO H PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL I i ~ ~ ~ REMARKS: C 4 n v I ~M k C DATE tl'" l INSPECTO ~c~~ t ___lll G _ _ r- v v~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~.J~ DATE ~a ~ ~ INSPECTOR Application Received Disapproval Issued Permit # /,S/ ~ _ 7 19~ 19_ ~ 19~ FORM NO. 10 APPLICATION FOR DEVELOPMENT PERMIT _ IN THE TOWN OF SOUTHOLD ,5; , , :r - ~y:i. Type os Development Proposea: New Structure (including storage tanxs~ :'-Add~tion,;and/or Alteration_ ••a .Flood proof Below Base Flood Elevation gvk%~~su . ~<<,~.- . a Other (specify) 2. Elevation Data in relation to above mean sea leve of: ~ (a) Lowest floor ele~ration, including basement -feet inches ~'"'-`~~''(b) Ina V Zone, bottom of lowest structural member feet inches~~. 3. FIRM--Flood Insurance Rate Map, Zone designations~~~ f fi'~ - ~ p r .4. Owner of Premises F ~iol~{i,.., ~ 9L - A , ;y. 5. Location of Property': H use # ~ } Stre t "'7"-'~- "O~~GI~~~~ Hamlet County Tax Map No., Dist. 1000, Section Block 3 Lot(s) Subdivision Filed Map# Lot(s) , ``~,6. Permission to be granted:Owner as above New Owner ~ - Under Contract Lessee Contractor ~ Phone # ~:e - - _ Name if not given abo a Mailing ad r ss ~S,~,.~~~-~f~'~ o ~ x'90 - . . 7. Approval from other(s) before Permit is issued: DEC /C7 g,~--/S ~6 o Wetlands (Town Board) r'1~~/9 Health Services 4~ SO- ~ ZBA _ ~,r,Z. J Building Permit Planning Board / - 8. I, ~~'~~'1~`4~~~-- ~ ; the applicant, am the Owner 1U ~ ~ \ - Co-Owner New Owner Under Contract Lessee A ent g Contraotor _ and agree to comply with all applicable sections of the Code of the Town of Southold; County, and State and to admit authorized inspectors to premises authorized 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 my knowledg~~~ryd belie and that e work will be performed in the manner set forth 1 _ therewith. ~ a~~ COUNTYOOFNEW~Y~ORK ~ /L,. SS ~ 3 , ~~i Signature > ~ , SW N TO THIS DAY OF 19 ~ ~ 1 (r,:~? Notary Publicggqq~~,_ F Apply ~ .ofgewYmk v t ~Lr E , addr 9~8 ^ ~ s ~ ~;r if ~i1?I~ ~~~dber $ 18 ~ ~'r~ -11/85 y~~£~$ n~~~1/}NS.}PTi Jilt \~`."YdYA.tYxl 5~~~~~ "1'i ~~AR~~~lub i~ ~~....~~t.'~ ..ax.-, v 2" ia.4aYf{ ~F~~m f f. hY~:. a ~~y~ rr~ ~ BOARD Of HEALTFt ~L: FORM N0.1 3 SETS OF PL \:7S ' 7'$~+ !i TOWN OF SOUTHOLD SURVEY . BUILDING DEPARTMENT CIICCh a . ty .q.._.... TOWN HALL SEPTIC foam . . . . 6LDG I~~,, fw.,._,.~,...~ { SOUTHOLD, N.Y. 11971 TOWN OF SOfJI-riilf..F) ; TEL.: 765-1802 t.o~ I FY ; CALL Examined . ! ~5....... 19~j CFA I L T o : • . _ . - • • • • • • . Approved.7. 19~PermitNo..~O~~ - DisapprovedaJc ~(Buil „Inspector) APPLICATION FOR BUILDING PERMIT Date .........'t.~~~4..., 19~~. INSTRUCTIONS s 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 Ordnance 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, buildin code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp -ons, ~ (Signature of appplican , or name, if a orpor ion) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . ................../.7'tf .f.~4~......P~Q....... . Name of owner of premises 7/:1H~'!?!~'!~Y1,r, , , O~!'!~ . C ,l NDk+ .o (as o the tax roll or latest deed) G''d ~f ~ l /d5 k~l If applicant ' cor ra -on sig ure o my authorized officer. ...........L. (Name and title of corporate officer) Builder's License No . . Plumber's License No. .L°~. 6~`.'~- Electrician's License No. ~ ~ Other Trade's License No . ss~~ _/a/~0 ~~~~=~-•Q~h l. Location of land on which proposed work will be done. ./:'~~..C ~,J.. , O{Y~L~if-~r? . f vn~Cr /fit . House Number treet Hamlet ~ , County Tax Map No. 1000 Section Block Lot ~.9. 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 ........................................:3"r~ : , . b. Intended use and occupancy _ , - , • , • , , . 4ry4'°s'?.ZV yr 2 .Yo- 5a 2'tq'rK> ! 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