HomeMy WebLinkAbout19798-z 4
~ FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office o€ the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20518 Date FEBRUARY 5, 1992
THIS CERTIFIES that the building ADDITION & RENOVATION
Location of Property 3015 WEST CREEK AVE. CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 110 Block 5 Lot 7
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit hereto€ore
filed in this office dated APRIL 19 1991 pursuant to which
Building Permit No. 19798-Z dated APRIL 23, 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 & RENOVATION TO EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to STANLEY DZIADOWICZ
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-220836 - JANUARY 17, 1992
PLUMBERS CERTIFICATION DATED JAN. 6 1992 - TIMOTHY HORTON
_,.~L_
B ilding Inspector
Rev. 1/81
>!08ffi 2i0. ~
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~ Z Date ..........`t4~:LS:T...~.r~.................., 19..1..
1979Q
Permission is hereby granted~toy-
' to ...~:?`~4:alL'l~M.G~' :....4!......P.~.-~s..k$....43,..~rsY~:^n..~:... x'::~4:....~:~-~ d:?:!?--
{ at premises located at ~d..~.~. w "-9.~' 4i ~
...........s...........................................
Coun Tax Ma No. 1000 Section 1. ~ ~ Block Lot No...~.~
: ty p
pursuant to application doted ~ .~...1 199.x..., and approved by the
Building Inspector.
Fee 5...~+.?~.:..
B ding Inspector
Rev. 6/30/80
i
_ Form No. 6
; ~
TOSJN OP SOUTIIOLD
BUILDING DCPARTC!ENT
TOWN HALL
765-1802
APPLICATION POR CGRTIPICATG OF OCCUPANCY
This application must be filled in by typewriter OP, ink and submitted to the building
inspector caith the following: for new building or new use:
1. Final survey of property eaith accurate location of all buildings, property lines,
streets, and unusual natural or topographic fua to res.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from L'oard of Pire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17, lead.
S. 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.
I. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. .lc curate 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
Updated Certificate of Occupancy - $50.00
S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
;+t .r
Date ~
'~ew Construction........... Old Or Pre-existing Buildin
s••• ? . _
!.ocacion of Property..3b1.5".... ~F?.~..(etnl)?~I~..~~r......~.~~'C'H(OG-~JF 11~~.
House No. Street " '
Hamlet
~:nvcr or Owners of Property....:~.~.~NL.,L'~Y,.~~,~ja~(3G<JLc,~....•.
~:uuncy Ta:< ;fap No 1000, Section...~~l~.......Block... d 7.••...••••••••••
.......Lot...
:ultdtvisiun... • ~ ~ •
qq~~IIpp~~Q .Fppiled h1:tp............Lot..
craLt :;0...~1!.1,$;;Z,,,,Date Of Permit.~'~.ld.~.,l,~, c•..•••••••••••••••••
.....Applicant..ST;gI'VLE~. _,~2iH,t,.i~f.ul~L
Eicalch Dept. Approval .....Underwriter:; Approval.............
.':.innin I:oard Approv:tl
•!e quest for: Temporatry Certificate........... Final Certicate.
..Ce Submitted: $~~d.~.~%.x
C'o ~ °'~5~~ APPLICANT
og~F f 0(h c~. TEL. 7t;s-1 soz
TOWN OF SOriJTHOd.D
- ~•1~ OFFICE OF II[IILDI?•IG INSPECTOR
~`.y , P.O. IIUX 728
-c TOWN HALL
0',~Ol SOUTHULD, N.Y. ] 1971
C E R T I F I C A T I O N
Date x/'02
Huildincg Permit No.O'748~
Owner ~~9~~e /~Z i~ ~ o c.~ i c
(pl~print)
Plumber ~j~~, /Soit~ic/
(pleas print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1g lead.
> ~
( lumber's signature)
Sworn to before me this
day of ~G~~
19
o ry ~ lic
Rotary ~ ~ ~ ,
Iublic County
',!1S;.;3 J.S:~GY w York
Notary PuN~. ~g9o735 a
pua9f,od in S
eSO~ Y
26~9~
Commission tixw
, r. ~ ,~m._..,______~- _ _ -
-
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE ] E_
1185077 pUREAU OR ElECT1EICTTY
pp JOHN STREET. NEW YORK,.NEW YORK 10038
JANUARY ]7,x.992. 73555591./91 N 220836 {
flats Applicotion No. on file
THIS GERTIFIEp THAT
Doty she steetrtcet equlpewewt a dsari6sd fAtlow end introelrced 6y.the a~plicwt homed on the etASUe appliatioa netntbsr In thepremias of
STANLEY A2IAD03?ICZ, .3015 WEST CRERK AVENUE, CUTCHOGUF., N.Y. D=
~~77rr~~ GAR /ATTIC, /pUT
in thefollotetnR loeetien• L'7 Bas t ~ Ist Fl. ? Ynd FT. Sertiun Block Lot Gp-~
JAi~t1ARY ] 3.~~12
roes exomtned wt end found to he in compliance with the reyoirements of this Board.
e 10(i11Y ft10KR10l1EGR! OWt BfNMIST F
OUTlttt k~ S~T~t INCANDlSClNT nOOtItRNT OTNlR AMT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. M. r. a
28 43 36 23 1 ].2 F
k.
DlTRRS tYRNACE MOTORS IY11ME AlttlAllC! 1rERt teEClAt RtC/T TIMt tYACKt tqt t11Ri KItATEtS plltT}'~h~OYT1Ri RThttARRS
AMT. K. W. Oll M r. GAS N. r. AMT. NO. A. W. G. Apt. AAK. AMT. AAVS. TtANt. AMT. X. t. Of ~ NAT. WATTS K
F 1. 3 ]U 1 30 1. ] F fig
T ffRVK7RpCOttltRCt eq.p S E - R V 1 l: E E3=
AMr. AAe. rTre I,e zW 1 i aw t i sw t,e aw . a c. coNG. a ~ . No. a NFIlG of ~ G. No. a NEUTKN3 ~ F~riAt
~ 1 150 CB 1 X 1 1 1 ] t
oTtw /IrtrRitTUS:
100ANP. TRANSFER SW./MANUAL°t
NOTORS:1-0.33 H.P.
PANF,LBOARDS:1-5 CIR. 100
G.Ffi.I:-8
SMOKE DETECTOR:-3
TRACK LIGRTING:-12
ROSLAK ELECTRIC LIC./3677-E
~ P.O.BOX 164
CUTCROGUB, NY, 7.1935 BptIRAt ttRMMRR
.z 11. r
• Per
Thit nrtiRtats, mupept in Glty taaatsrl Mwn to N» oNkn of 111e 100 :N intprrM• Intp~ctort 6e ' ' ~ by -tMur cr~edantidt.
Ct1PY. WIF DEMR'N~ll'[. Tlri C'9IY QF!E~RT~l1~~_NO~f 11E AkT~:~FAMY . , x
1NSPECT0RS
Victor Lessard ~5,}; f13j;~ 9~
Principal Building Irupectrn ,~~~'3 ~ v~
Curtis Horton , ~("'•;<y~,~4 SCOTT L. HARRIS, Supervisor
Senior Building Inspector
~ 'i) t"'`Y . a ~ Southold Town Hall
Thomas Fisher ~ <<x+?~~
Buildin Ins ector ~ ~ ~ P.O. Box 1179, 53095 Main Road
Gar Fish ~'~%''9~ 5 Southold, New York 11971
Building Inspector Fax (516) 765-1823
:y-~_ Telephone (516) 765-1800
Vincent R. Wieczorek
Ordinance Inspector
Robert Fisher
Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR
Telephone (516) 765-1802 TOWN OF SOUTHOLD
JANUARY 3, 1992
STANLEY DZIADOWICZ
3015 WEST CREER AVENITE
CUTCHOGUE, NY 11935
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
RXR An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
X%x The check is not on file.)$25.00
No Health Department Approval on file.
No final inspection has been made.
ggg_ No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 19798-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
I
765.1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [~NAL
REMARKS:
~ ~ .
DATE l ~ Z~ INSPECTOR ` '1
~'1::W iJ:S:'FC.iU;J ~~U6.E ~ i;OMMEN7S
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FOUtJDATION (1st)
FOUNDATIOIJ i~
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P,OUGH FRAME &
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PLUMBING
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ADDITIOPIAL COMMENTS: ~
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: Inc f~,~Q-~~-(~/
DATE~~INSPECTOR GIL~
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- BOAFD OF HEALTH
FORMN0.1 3 SETS OF PLANS
E,i:~- ~ TOWN OFSOUTHOLD SURVEY
1 ~ ~ ~ g BUILDING DEPARTMENT CHECK
f99~ ~~,I~ TOWN HALL SEPTIC Fanrt~
uL~~.„.,~,,,,„_..,,,L.? SOUTHOLD, N.Y. 11971 _ • - • • • • • • .
t3€-D€;.tJt_4~T. TEL.: 765-1$02 t:o'FIFY: ~ L`/
TOWPJ CAF
~OU~TN()tCf CAL .
Examined.~,$,,,,19~'1. / MAIL TO• ~/~~7
jjdd ~~i>; , f
Approved . . d ~ 19 9~ .Permit No. I 7 g,g.Lz. • ' • • _ • . • • •
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19 . ~ b
INSTRUCTIONS
a. This application must lie 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
of 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 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 i s ecti ns.
.~~Gt^:~ .
(Signature f applicant, or name, if a cor ration)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises . ><.J. Z.~o.4 p~ ~ C- ~ ( ~ ~ ~
(as on the tax ro or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. ~W n,1~.2,,, , , , , , , , ,
Plumber's License No. ~
Electrician's License No. f"'^~~ iti"''~~rlf`;
Other Trade's License No . .
I. Location of land on which proposed work will be done . . .
House Number Street Hamlet
7
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 ~~~1.~.~J~`{~~~ . , .
b. Intended use and occupancy . 4~:~St~~~~~.? , ,
~~r,
.
_ ,
to . - Px.. i ~ ~ . a -:`e? ,.+.x. , . ~ ,a.~.x ~..n.v.mv r&, x».aa.~ ~ ..Saa i7v„~.fYv„sa"~,~+'sC~.A _,xg4n~.4` kA 'fin. a~iS.A~Y
3. Nature of work (check which applicable): New Building , Addition Alteration
Repair Removal Demolition Other'Work ,
~(l~e¢cription)
4. Estimated Cost ~Q~ (~t~c7• ~ . Fee ~l;~t .
5. If dwellin number of dwellin u (to be paid on filing this application)
g~ g its , ~ Number of dwellin units on each floor . .
If garage, number of cazs . g
6. If business, commercial or mixed 4ecupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front ...yO . ~ ,Rear , , , Depth . , , ,
Height . . Number of Stories .
Depth sions of same structure with,, alterations or additions: Front . . . . . . Rear .
p ~ Height Number of Stories .
8. Dimensions of entire new construction: Front Rear ...............Depth .
Height . . . Number of Stories .
9. Size of lot: Front . S? , . , , , , , , , Rear ,.~!?r?~, , , ;Lt9o
Depth
10. Date of Purchase . , /,9,~¢"A, , , , , , • . , , , , , ,Name of Former Owner
1 1. Zone or use district in which premises ate situated . .
2. Does proposed construction violate
p S • ~ any zoning law, ordinance or regulation: . . .
13. Will lot be regraded ,h/C? . ............Will excess fill be removed from premises: Yes No
14. Name of Owner of remises ~./f9i~.QW.
<G:Z: ,Address .~Q. !4. ~.~T~ffone No. ~,3.Y. G ~r,7„~~.
Name of Architect ~ / , , , , , , , , , , , ,Address , , .Phone No............... .
Name of Contractor . , , ,q'~U',cyGU,l,G~; , , Address.3O.l.~. w~aST.e~~Phone No. 7.3!/.:~v,z73...
15. Is thislfroeSrtSouthold To0, feet of a tidal wetland? *Yes........ No.,.......
* y n Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buljldings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block nuzfitber or description according to deed, and show street names and indicate whether
interior or corner lot. I
rota; ~ ~~~s~~' 6~~=~:+~~' ~
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STATE OF NEW YORK,
;OUNTY OF . S.S
(Name of individual si pin co ~ ~ ~ ' ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant
g g ntract)
bove named. .T
[e is the ..........................f...............,.....,...........,..............,......
(Contractor, agent, corporate officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
pplication; that all statements contained jn this application are true to the best of his knowledge and belief; and that the
pork wIll be performed in the manner set fprth in the application filed therewith.
worn to before me this I
Sx . l ....day of . . C I/ a~-c~KCr...., 19
otary Public, /,1,•, I'w`:'•!t9~... County
~ _
NELEN K, DE VOE ~ ~ ~ x
NRTAAY 0 C ~~p of New YcrN ` ~ a ro o Pphcant) r~ ,
Na~47p7@~N~,AyI(ulk S!4 ~ ^.,~K ~ ' ~ ,f
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