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Home My WebLink About20265-zFoRM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22606 Date SEPTEMBER 22, 1993 THIS CERTIFIES that the building. ALTERATION Location of Property 4255 DEPOT LANE CUTCH~UE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 96 Block 5 Lot 7 subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 4¢ 1991 pursuant to which Building Permit No. 20265-Z dated NOVEMBER 7, 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 CONVERT EXISTING SEASONAL DWELLING TO YEAR ROUND ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. SUFFOLK COUN~T DEPARTMENT OF HEALTH APPROVAL STANLEY & ROSALIE SAJNACKI (owners) UNDERWRITERS CERTIFICATE NO. H-029409 - JUNE 18r 1992 PLUMBERS CERTIFICATION DATED MAY 21¢ 1992 - S. SAJNACKI Rev. 1/81 lrOlt~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. NO_ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2 0 2 6 5 Z ~,o .................. ~.....7. ......... , ,~.~.. Permission is hereby granted to: ~~.....~...~ ......................... ~... ..... ~~_...~:.~.~..~.~...~..~.~ .... ,o ......... · . ~ at prem ses ocated at ....~...~....~...'~.~. ...... ,~ . ~ ..~ ~ County Tox Map No. 1000 Section ..... ..~...~....~. ........ Block ....... ..~...~. ...... Lot No......~...~. .............. pursuant to application doted .... ~.~.......~.~. .............. ~ ................ , 19..cJ..I.., and approved by the Building Inspector. Fee $....~..~...:..~ ..... Re~ 6/30/80 FOUNDATION (lst) FOUNDATION 2. f2nd) ROUGH FRAME & .FLUMBING ® INSULATION PER N. Y. STATE ENERGY . CODE FINAL ADDITIONA'L COMMENTS: '~F:INNW¢ ANY NI G::I~t:I/"I¥ :IG J.ON J.snw =lJ. VDl=llJ.~g3 dO AdO:D $1H1 '.LN=IWJ.ava:ga ONIO'llng ~O=1 'sj~!$uepe~ ~!eq~ Xq p.!~.!$uep! ect Xinu s~oi~edsuI '~.~e~o~u! J! p~olt eq~, :to e~!J~o e,.J$ o~ u~n~,e~ .'~euu~u~ Xuo u! Io~e$1o ~q iou ssnm e$~)!~.!i~e~ s!qJ. S~IOLOW BDVNIII~I SII~JAIIG N¥,I iSi~IyHX~ SB~HS'~/~ HSSG SNi~AO SBQN~'B S31J~IXI:I ~o7 - 7(J5- 1802 "' , FO~ POiJRLO t3F: COtY PI FI'E FC~F~ C ~'.~ THE Rf'QL Form No. 6 TOWN OF SOUTtlOLD 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 less than 2/10 of 1% lead. 5. Commercial building, 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 '.'pre-existing" land uses: 1. industrial building, multiple residences and similar buildings~~ April 9, 1957) non-conforming uses, or buildings and 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 - $10.00 4.Updated Certificate of Occupancy - $50.00 5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Uate ;ew Construction ........... Old Or Pre-existing Building ..... .~ ......... .ocation of Property...~...~g.~ ~ .... A~ ~.r~.~.~ ~ Uouse No. Street Hamlet nwer or Owners of Property. ~f~ ~a~Z..{M~P~,.'~..~.~=,~ I' ounty Tax Map No 1000, Section,¢.~ ......... Block.·.~". ........... Lot.. ~ .V ............... ubdivision .................................... Filed Map ............ Lot ...................... ............... Date Of Permit.. ....Applicant .~ ~2.~ g .~f~,~i< .~'~ Xg~c/~ ~ - ~alth Dept Approval · ' ......................... Underwriters Approval .................... · arming Board Approval ....................... 'q~est for: Temporary Certificate ........... Final Certicate...~.. ...... e S~bmitted: ~ ~7~/p FEE: _~_--~. _~ ....... ~'~' .-~, _6_. X.; NOTIFY I~l,~ll.J'.')l[.JG DFP/-'*,FW~VtENT 785-1802 9 AIV! '¢('~ ~:~ ¢,~ {:O~ 1. FOtJND~BON tWO REQUI~'ED FOR POURED CONCRETE 2. ROUGH . FRAMING & PLUMBfNG 3. INSULATION 4. FINAL CONSTRUCTION MUST 8E COMPLETE FOR C,O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE STATE CONSTRUCTION & ENERGY CODES. NO~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. ~0~----~ P1 um~ber .......... (please print) I certify that the solder used in the water supply system contains less' than 2/10 of 1% lead. Sworn to before me tkis NOtary Public~/~ County ,, (plumb~'s si~ature) Notary Public Examined . .~.~. Approved . /0...&J-~...~.. 1., 19 ?/]. Permit No. ~...o.~..b..~'..~... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-180:~ Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... CHECK .................... SEPTIC F O Rl'l .............. CALL ................... ............ f, .,.. a. Tkis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot 151an showing location of lot and of buildings on premises, relationship to adjoining premises or public streets )r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appH- :ation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hail 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 hall 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 /uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or {egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Fhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulaJ;mns, and to ~dmit authorized inspectors on premises and in building for necessary inspe~,~/ · ......... ( ignatur~o,~4:2~plicant, or ha ~me~ f//a yot~,~ration) .. .... (~ailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Wame of owner of premises ................................. (as on the t,ax roll o~,~test deed) applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) Builder's License No. (<~4,,,~-~O%._ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... '. Location of land on which proposed work will be done .................................................. House Number -- Street HamleL/ County Tax Map No. 1000 Section .... ~.~ ........... Block ....~. :~.. ......... Lot .... ~..7. .......... 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 .... .~q~ ~.-~. .... b. Intended use and occupancy .... ~. ..~~ ~~~;~,, b,??C f,~.' 3. Nature. of work.(check which appllicable), New Building ....... .. A/dditirm.v.... .... · ... Alteration Repmr . . . ~ ........ Removal .............. Demolition .......... .... Other Work -,,'¢~. (Description). 4. Estimated Cost .... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ..... ./ ......... Number of dwelling units on each floor ................ If garage number of cars ~ ' 6. If business, commercial or mixed bccupancy, specify nature and extent of each type of use ...................... 7. Dimensions of existing structures if any Front. ' ~ Rear Hight Nu b[e fSt ries .................. " ................. e ............... m ro o ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... . Heigh~ ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height Numb'er of Stories 9. Size of lot: Front ............. i .......';.. Rear ' 10. Date of Purchase ..../.~'//. .]. ......' ......... Name of Former Owner 11. Zone or use district in which prergises are situated.. ... ' ....................... 12. Does proposed construction violaie any zoning law, ordinance or regulation: .................. ~ .............. 13. Will lot be regraded... ......,.........~.° .... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... i ................. Address ................... Phone No ................ Name of Architect ........... ................ Address ................... Phone No ................ Name of Contractor , · . , · .................................... Phone No ................ 15. Is /:his proper/:y xalth~.n 300 feet: of a t±dal wet:land? *Yes .... · If yes, Sou/:hoid T~wn Trustees Perm±/: may be requ±red]'' · No..~ ..... ... I PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block n~mber or descriptioh according to deed, and show street names and indicate whether interior or corner lot. ~/ 7, "/ ..'~,. :oux%,Y OF.. . .... ,A... ...... ,ein, duly sworn, deposes and says th,t he is the applicant (Name of individual signin~ contract) t bove named. le is the . .. ...................... ~ ................................................................. i (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this ' pplication; 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 s~t forth in the application filed therewith. worn to before me this ', eMIt .Ou. ellfl_ed I.n Suffolk COuI~J ,~ ', / ; (Signature of applicant) minion ~xpire8 DecembeI 8, 19-~ : L