The URL can be used to link to this page

Home My WebLink About20141-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20360 Date NOVEMBER 19~ 1991 THIS CERTIFIES that the building. Location of Property 1070 VILLAGE LANE House No. County Tax Map No. 1000 Section 114 Subdivision ADDITION Street Block 6 Filed Map No. MATTITUCK, N.Y. Hamlet Lot 14 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 12~ 1991 pursuant to which Building Permit No. 20141-Z dated SEPTEMBER 13, 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 ROOF OVER PART OF EXISTING DECK ADDITION AS APPLIED FOR. The certificate is issued to FRED GROMADZKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HF~ILTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A //B~'ilding Inspector Rev. 1/81 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~ 20141 Z Date ............................................... , 19. County Tax Mop No. 1000 Section .......... ./..../....~.... Block ......... ~ ........Lot No .......~...,~.... ........ ........../~/'../.~ 19...~.../., and approved by the pursuant to application dated .. .~...~...... ................................. Building Inspector. Fee $....~...~ Rev. 6/30/80 TOWN OF SOuTHOLO , FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted aa -- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-{S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings, 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 ?OOLS $25.00ALTERATTON $25.00 1. Certificate of occupancy New Dwelling $25.Q0, Accessory .$ ]0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ I00.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $I0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date..~...' .L;l/.Z~. ~' NewCons t:ruc tion ...... Old or Pre-existing Building .. ~ ....... Vacant Land ............. Location of Property ...0..2.O. ...... ¢,,,:w-,-~...... ~t ~ House No. Street ...... Hamlet Owner or Owners of Property .. . County Tax Map No. 1000 Section . .[./..~. ....... Block ..... 6. ....... Lot .... f. y. .... Subdivision ..'~. Filed Map No Lot No -- PermitN°2~'/'Ci//'Z Date of Permit .~/./~.~..{Applicant ~-~~~.' Health Oept. Approval....~r,..l~.-;..............Labor Dept. Approval ..J2-.:.~..'; ................ Underwriters Approval...%' .t~ .~ Planning Boar roval Jg.../-~ .-. ., ................. d App .............. Request for Temporary Certificate .... ~ ............ Final Certificate ...~¢.~%...~:-. ........... Fee Submitted $.. Constructign on above described building and permit meets all applicable codes and regulations. App ~cant . . . ...................... Rev. 10-10-78 to the Building Inspec- A'/71 c o o?03t O 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [']' ROUGH PLBG. ] FOUNDATION ZND [ ] INStillaTION ],FRAMING, [,~NAL INSPECTOR FOUNDATION (1st) FOUNDATIO~U (2nd) 2. ROUGH FRAME & ·PLUMBING .. INSULATION PER N. STATE ENERGY CODE FI~;AL ADDITIONA'L COMMENTS _ 1. FOUNDATION -, TWO REQUIRED CONSTRUCTION SHALL MEET REQUIREMENTS OF THE N.Y, FOLLOWING INSPECTIONS: FOR POURED CONCRETE ROUGH ~ FRAMING & PLUMBING INSULATION FINAL CONSTRUCTION MUST BE COMPLETE FOR C,O. S~[ATE CONSTRUCTION & ENERGY DES. NOT RESPONSIBLE FOB :! StGi~ OR CONSTRUCTION ERRORS ?f~5-I802 9 AM 'FO 4 PM ~R THE FOL.t. OWiNG ~NSPECTIONS; '~. FOUhlDAT~ON '~0 REQUIRED FOR POURED CONCRETE 2, ROUGH - FRA~NG & PLUMBING 4. FINAL COHSTRUCTION MUST BE COMPLETE FOR C.O, CONSTRUCTION SHALL ME~ REQUIREMENTS OF THE N.~ STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS INSPECTORS Victor Lessard Principal Building Inspector Curtis Horton Senior Building Inspector Thomas Fisher Building Inspector Gary Fish Building Inspector Vincent R. Wieezorek 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 NOVl!14BER 12, 1991 CHESTER ORLOWSKI BOX 949 CUTCHOGUE, ~ 11935 HE: Fred gromadzki & Wife 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. XXX The check is (X~ll~&~/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT ~ 2014 l-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. 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 ..................... CHECK SEPTIC FOR~ ......... NOTIFY CALL MAIL Examined .......... , 19 Approved ....... , 1 .. Permit No.. . Disapproved a/c ..................................... ng APPLICATION FOR BUILDING PERNIlT Date ~* .~".../..~.. INSTRUCTIONS TO: a. Tlfis 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 l~grmlt. 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 apy 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 authorized inspectors on premises and in building for necessary~ (Signature of applicant, or name, if a corporatxon) ...... .G~...~.-..h. :¥ :...~. :.~. ~ ~... (Mailing address of applicant) State whether, applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~,~..c~. ~x~ .~~.~ ............ If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... t. ?...~.-'~..-.-~...~...~./?.... Plumber's License No ~- Electncmn s License No ....................... Other Trade's License No "~ 1. Location of land on which proposed work will be done .... t..' .'. ....................... ...t .~...v..o. .............. ~...~..~x. £~. ......... ~.~., .~.,~ :.. House Number ~ v Street~ , } ' Hamlet -- ' ........... County Tax lVlap No 1000Sucton .//..¢ ........... B~ck .~. .... . ..- Lot..~..c~. ........ S~d,v,s,on..O.~..~V.. ~ .......... ~,,?dMapNo..3.~.*..q.. Lot../../. (Name) ........... 2. State existing nsc and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ./}~ ~.~,~L~- .--. ........ ...... , ........................... 3. Nature of work (check which aplplicable): New Building ..... ' ..... Addition .......... Alteration .......... Repair . ~i .......... Rem~wai .............. Demolition ............. Other Work ............... 57 ~.~ (Description) 4. Estimate'd Cost .(r'gT0 ............................. Fee .... ~. ............. (to be paid on filing this application) 5 ILd '- ' · welling, number of dwelling mits ............... Number of dwelling units on each floor ................ If garage number of cars ~ ... 6. If business, cmmnercial or mixed occupancy, specify nat, ure ,a,nd extent of each type~of use .......... ¢. · · t.~ .... . _ . . R . ' " 7. DimensiO'~$ of existing structured if any' Front ..... ear ~.: .~ _ . Depth .~,~.(t.~; ...... Hmght. ,...I,..~"' , . Numlber of Stories ~ ~ ................ D~men~s,.ons of same structure with alterations or additions: Front -- Rear ...":- Depth .... ~g$;'e '~-~m&; ..... ,,.. Ilmght ............. Number of Stones .-. ...... 8. D~mens~onsi3f~ntirl~h%Wconstruct,on Front ..."~-. . , I~*nr *'-' Hmght ............... Num'ber of Stones .............. ~ ...................... ~ .... 9. Sizeoflot'Front. /.~r-.?).. ~] . . Rear O-~-/ :~F' ~ .~ '-h''e:Z~-_' ........ · '-,t ',~,' · · . . .,.,..,.. ~.~ .'o ..........l~epIn . . o,<..~ .0. ......... 10. Date ofPurcimse . .~r/.2...3./(.~.~ ............... Name of Former Owner Oq.~t4..~.~ 11. Zone or use district J.,{ which pr~mises are situated.../~..~ .~.. i::~.~' - .. ii Jill J ii ill i.~ '"~'" ' 12. Does proposed construe[ion violCte any zoning law, or'd~nance or regulation: . .°i i i~.. 7' ............. 13. Will lot be regraded ·...164v,. hFv... :.;.. ............ ,.. Will excess fill be removed from premises:~ No 14. Name of Owner of premises t~t,,t~ ~ .,,.,,o_,},0.o 12address 'lo~N. oL,-~ t ~,, t/, m,~,,~o ~,, ' rqame ot Architect .... .~ ...... l .......... , ....... Address ................... Phone No ................ Name of Contractor ~. {l~o~ . Address ~)~ .~..Phone No ?~ g.n ¢.~ ~..'~ . 15.Is th:ts property located ,a~.th~.n300 feet of a t~.dal wetland. *YES .... ~If yes~ Southold To*,nI Trustees Permit may be required. ... ] PLOT DIAGRAM Locate clearly and distinctly alllbuildings, whether existing or proposed, and, indicate ail set-back dimensions from property Lines. Give street ~and.block,numb~.r or.description according to deed, and show street names and indicate whether interior or corner lot. ,~ ~ .,,~T' STATE OF NEW YORK, ........ "' ~}'...~'.., k'~i~ '~'~¢ .~".. ~ I~'..I.C~. .~. $',~/being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. .e. He is the ..... ~ ..................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contalined in this appliciltion are .true to the best of his knowledge and belief; and that the Work will be performed in the manner set forth in the application ~led therewith. Sworn to before me this ...... ,.¥ ............ Notary Public,.. /// - c/ ROBERT I. scott, JR, · ~ ....... , · ,...,-,--.,x~.-~ .-.- ............. ~.01^~'~l~g~.~. b2~N~ (Signature of applicant)