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Home My WebLink About19735-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19875 Date APRIL 26~ 1991 THIS CERTIFIES that the building ADDITION Location of Property I620 WEST MILL CREEK DRIVE House No. Street County Tax Map No. 1000 Section 51 Block 6 Subdivision Filed Map No. SOUTHOLD, N.Y. Hamlet Lot 28 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 25, 1991 pursuant to which Building Permit No. 19735-Z dated M~uqCH 26, 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 EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to ALAN CZELATKA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 ZeOJ,~ NO. II TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PIERMrr FI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°- 197.~5 Z Permission is hereby granted to~,~//~ /q . _ ~ .~/ ........................... ~..~..~........~. £ ............ ,. ~ ~.q, // ..-/ ~o~ ~,,-~ ,oco,ed o~ ./...~.a' ' .L...~.~.~....m.~'~ ~ ~..~.~ ....... ~~~. Counb/ Tax Map No. 1000 Section .... ..~..~...( ......... Block ...... .~b..~,. ...... Lot No......~....~.. ............ Building mnsp~tor, Fee $~.~...., ............. Rev. 6/30/80 Form No. 6 TO~N OF SOUTHOLD 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, 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. 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, .buiiding 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 i. 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 - $i00.00 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 $~5.00, Commercial $15.00 uate .~..~..; ....... ~ ......................... ~ew Construction ........... Old Or Pre-existing Buildin~ ............ ~'_~.~..gf~ House No. Street Hamlet ~nwer or Owners of Property ........................................... ooo. ...... ................ ................. ubdivision ............................... Filed Map ............ Lot ............. ermit No .............. Date Of Permit ............... Applicant .......... ~ .................. ealth Dept. Approval ............ ....... . . .....Underwriters Approval .................. . .... . . lanning Board Approval ..................... .. . equest for: Temporary Certificate ........... Final Certicate ........... ee Submitted: $ .................. C C-P_ / ~ ~ 9-~ ~- APPLICANT 765-1802 BUILDING DEPT. INSPECTION FOUNDATION XST [ ] FOUNDATION ZND [ ] FRAMING REMARKS: ROUGH PLBG. INSULATION [ ] FINAL DATE ~/~/~/~/ INSPECTO~~ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & .FLUMBING INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS: ~ ~-"76S-1802 ~ BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION FRAMING REMARKS: [ ] FINAL '<t' ] Examined .~ .o~.. ~.(~.., 19~.1. Approved . 19 .J. Permit No. Disapproved a/c .... , .......................... ......//~ (Building Inspector) APPLICATION FOR BUILDING PERMIT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH .......... ~ SETS OF FLA~S .......... ~-'SU RVEY .... SEPTIC FOKH .............. HAIL TO: Date ................... 19... 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 or .0teas, 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 c~mmenced 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 co~e~h~u~ing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspgctio . -- (Signature,:gff~pplicant, or name, if a cj~'poration) (Mailing address of applicant) :State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... : ......................................... (as on the t .w,l'roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ' '~ (Name and title of corporate officer) Builder's License No.../5~7..-.~.~. (.~.~. ............... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be don'e...z~..~,~" .~.~ ,/~f,5"/.~.~.tr~5:' 4/. . . . . q ................ . ./<. . .,v c .......... . .................. House Nmnber Street Hamlet County Tax Map No. 1000 Section .... ..(/ .......... Block ...... ~'. .......... Lot... ~..~ ............ Subdivision ..................................... Filed Mhp No ............... Lot .... ' ........... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy .... ~ ............................................................. property lines. Give street and block number or descriptiofi according to interior or corner lot. 3. Natureofwork (checkwh~chapphcable): New Building .......... Addition .......... Alteratior~ pai .......... Re r .............. Removal .............. Demolition ............. Other ~ ~.~.e~ ..... .'~. ~ .~..~9. ? mo~i, '" ~" O~l'o'Hption) 4. Estimated Cost ...... , ......... Fee ...... i (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. 1! business commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions et existing strncturesi if any: Front...~.o. ...... Rear . · ~..% . Depth .... ,/'7..0./. ....... Height ... fi',~./. ....... Number of Stories .... .~. ........................................ ; ......... Dimensions of same structurew'lth' alterations' or~a,dditions:' ' Front ..... ~.,,~,~..r .......Rear .. ~..,,r~..q.. Depth...,~j?~.,~:.. . ~ · ,3~ ........ .......... i' Height ..... ~ .......... Number of Stories... :,.~.-~.<'~.. ........ 8. Dimensions of entire new construction: Front . .~./'. -. F?..~.. Rear .... ~'..,(./..~ ~,gr... Depth ...~'~. '. 7. F. Height .../.~. ;4¢./,~ ..... Numb:er of Stories ........ .~..,~ ................................ ' ' ' 9. Size of lot: Front ....,-f~.~.' .... i .......... Rear ..... ./~2.~ ............ Depth ....,~?.~./. .............. 10. ~ Date of Purchase . .. F.~/~. .... i ................. Name of Former Owner . ...<~.~..~7~f...~?.....c,~-~.~..,-~ 11. Zone or use district in which premises are situated ..... ~¢j./.~q~./.~.~.. .................. 12. oes proposed construction wola~e any zoning law, ordinance or regulation . ~ .... 13. W' i . · ..................... ill lot be regraded ....... .,,A~.. ,.~,>,.. ,~. .......... Will excess fill be rem?ed from premises: Yes 14. Name of Owner of premises . .,~. ?.-,. ~.e..~/?.~,-~ Address ~,,~ ~,t ~,fi/~'/~f~' Ph~n,~ Mt, ?~F'-,-/ff2~ Name of Architect ....... ~.,.f.~.e ~..(q.~ ........ Address ................... Phone No ................ Name of Contractor... ' ~ ,,~,~-~¢ ' .... ~.,~.,7~ .............. Address ................. .~hota e No ................ Is this property within 300 feet of a tidal wetland? *Yes ....... ~ ...... · If yes, Southold Tdwn Trustees Permit may be required. .'. i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from deed, and show street names and indicate whether STATE OF NEW YORK, ?OUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signinglcontract) above named. ?Ie is the " ~ (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly atthorized to perform or have performed the said work and to make and file this tpplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the york will be performed in the manner se:t forth in ,the application filed therewitl~'~ ;worn to before me this ~'~ .~., da of.. i '~'~..., 19 HELEN K, DE VOE YOrl( .... NOT~RYPUBLIO, St~eof Nev~ or~ (Signature of applicant) No. 4707878, Suffolk Cou ntY,,~ ~, Term Expires M~rch 30.15.---.,~