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Home My WebLink About19970-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z20084 Date JULY 17, 1991 THIS CERTIFIES that the buildin~ Location of Property 51925 MAIN ROAD House No. County Tax Map No. 1000 Section 63 Subdivision ADDITION BOUTHOLD Street Hamlet Block 05 Lot 08 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofor~ filed in this office dated JUNE 18, 1991 pursuant to which Building Permit No. 19970Z dated JUNE 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 DECK ADDITION TO F~ISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to THEODORA CZARTOSIESKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED / ~uilding Inspector Rev. l/B1 IPOR]d[ NO. 0 TOWN OF SOUTHOLD BUILDIH(~ DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N_O BUILDING PERMIT (THIS PERMIT MUST BE KEPT' ON THE PREMISES UNTIL FULL COMPS-nON OF THE WORK AUTHOR~ZEO) Date ~/~/~'~' 19970 Z .... =~...~. .......................................... , "-.-?/' / County Tox Map No. 1000 Section .......... ~....~...... Block ......... ~ ..... Lot No ....... ~ ............ pursuant to application dated ........... ~,~../../.~.. ............................ , 19...~./., and approved by the Building Inspector. Feo Rev. 6/30/80 Forth No. 6 TOWN OF SOUTIIOLD BUILDINO DEPARTMENT TOWN I~LL 765-i802 Ai°PLICATION 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 ali buildings, property lines, streets, and Unusual natural or topographic features. 2. Final Approval from tIealth 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 C~pliance from archiuect or engineer responsible for the building. 6. Submi~ 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 shaii state the reasons therefor in writing to the applicant. :. Fees 1. Certificate of Occupancy - New dwelling $25.OO~2Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $ 5.00, 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.o0 4.Updated Certificate of Occupancy _ $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Con~ercial $15.00 Old ......... ildi ew Construction ......... Or Pre-existing Bu ng ................. ocation of Property. ~/~- .~.~, ................ · ~ . .~ u'..~.~ HOUse No. Street Hamlet ]wer or Owners of Property .... ~rTL~j¥(7~l unty Tax ,ap No 000, Section .... ...... B uc ...J2. ...... ot.. Y ~bdivision ............ ......... ......' ............... Fil ,~mi~ ~o... · ..... ~ate o~ ~erm~t..?~.::,~/ A · ..~q~ - ' ' ' · .... Ppl~cant .... alth Dept Approval ' · ' ....... '' ' Uuderwriters Approval anning Board Approval ~ quest for: Temporary Certificate...~ / ~ .-., .... Final Certicate ........... 7 ........ ]..~ .............. ~oo~q ........ FOUNDATION FOUNDATION (1st) (2nd) ROUGH FRAME & .?LUMBING 3. INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTItOLD, N.Y. 11971 7115191 TEL, ,765- 802 To Whom This May Cogcern, We are unable to complete your Certificate of Occupancy because .of the following reasons. /~X An application for Certificate of Occupancy is not on file. ENCLOSED /5/ No Underwriters Certificate on file. /~X The check is(~m~not on file.) $25.00 /5/ No lIealth Dept. Approval on file. /5/ No final inspection has been made. Please co~tact Thank you for your cooperation. Building Permit tt I 9 9 7 Building Dept. ***/~/ No Plumber Solder Certificate on file. ( all perlnits involving plumbing being issued after April 1,1984 ) our office on this matter. 0Z DECK ADDITION OR IS UNLAWFUL CE~{flF]CATE OCCUPANCY 17:" t73' 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST I- ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION ~,.,.,.~~~,.~L REMARKS: ~'~~ ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined . ~.'./. ........... 19 ... Approved .... ~../Z/..?..~. .....19~/Permit No. ?.P?...7.~. ~ Disapproved a/c ..................................... BOARD OF HEALYH . SORv~-¥ .q'.~. ..... '"" '" CIIECK .................... SEPTIC FORH .............. ~ o .'." ............. HAIL TO: APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 6r 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 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 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 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 taws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspec~n~~-~ ......... . ./ ./ ?. ?4 . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner~ofprernises . .., ...... , ' (as on the tax roll or latest deed) If applicant ~,s a Corporation s~gnature of duiy authorized 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 .................................................. ....z-/. .............. .m. ............... .y?..,... .................... House Number Street Hamlet County Tax Map No. 1000 Section ~ -'~ Block ~ Lot 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 ..........~.~J¢ ...~..,~.. ['./~( .................................. .~..4/.~/t~q~ ~. ;.' ............... xb. Intended use\ and occupancy 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .... Remoyal ........... Demolition .............. Other Work.. ~. ¢~{'. ....... '~/..q'O O (Description) 4. Estimated Cost ...................................... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor ................ · If garage, number of cars ..... ~ .................................................................. 6. If business, commercial or mixedI occupancy, speedy nature, and extent of each tYl:le of use .................... 7. Dimensions of exisJ:jng structures, if any: Front..~.q./a..~.. ..... Rear ...~./4'. ~... ..... Depth.*?. ~'..:~./: ...... ' Height .... q~.~. fff ......Number of Stories ....................................................... Dimensions of same structure wi~h alterations or additions: Front .................. Rear .................. Depth .................... i · Height ...................... Number of Stories ............. ,. ........ 8. Dimensions of?ltire' new copstruction Front ~.O. ~.. Rear Height . ~..-~.~. q.b.o.~..~', l~aber of Stories ..... 9. Sizeoflot Front .... ~O.~., R~ar ~07~ ............ ~',,'~;~, .... ti~'/'L'/'5'~l'~' ...... I0. Date of Purchase ........... i ................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................. ~ ............... 13. Will lot be regraded ..... t~.~O. 4 .....;' 'x'.., .... ;. Will excess fill be removed' from premises: Yes No 14. Name of Owner of premises y&eq. dot~4, //. t~r~-~q~.ddres~ /S~x 7~! p 65-- :2 z_ . ............................ hone No..7.... 3. ~ .... __ Name of Architect .......... i ................ Address ................... Phone No ................ Name of Contractor ......... J ................ Address ................... Phone No ................ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No.~.. ..... · If 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 property lines. Give street and block r[umber or descriptio~ according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK. COUNTY OF ......... · ..... ! (Name of individual signin~ contract) above named. He is the ....................... of said owner or owners, and is duly application; that all statements contair work will be performed in the manner ~ Sworn to before me this ...... v- ..... f. ..... day of. Notary Public, .... HEEN K. ~ ~E ~ N~ PUBLI~ ~ ~ New y~ ~erm bpir~ U~rch 30 19 A I RO,VED AS NOTED 765-]802 ~ AM TO 4 PM FOR THE FOLLOWING iNSPECTiONS: 1, FOUNDATION TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C,O. ALL CONSTRUCTI.ON SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) authorized to perform or have performed the said work and to make and file this ed in this application are true to the best of his knowledge and belief; and that the forth in the application filed therewith. , ]9 .W .............. County ~ '~"' ~ (Signature o f applicant)