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HomeMy WebLinkAbout19736-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20329 Date NOVEMBER 7, 1991 THIS CERTIFIES that the building ADDITION & RENOVATION Location of Property 875 ALVAHS LANE CUTCHOGUE N.Y. House No. Street Hamlet County Tax Map No. 1000 Section I09 Block 1 Lot 26 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 26, 1991 pursuant to which Building Permit No. 19736-Z dated MARCH 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 NEW ROOF ADDITION & RENOVAE EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to EUGENLA KAPUSTKA BEEBE (owner) ' of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-209775 - OCTOBER 25 1931 PIAMBERS CERTIFICATION DATED N/A t .t e / t~2. ~4.~.-0 o.Ji. Building Inspector Rev. 1j81 It`OIBD[ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N°- 19736 Z Date 19.q.~. Permission is hereby grouted to: l.~,~:~...A:~?.... ..F:L1..... . r/ I .c.,.~:. .M:~, ...............y...... ~.%9.x.5... ~..1 ; . at premises located at..~7.a~......~:......4:aY.S:S_............att County Tox Map No. 1000 Section ~ ~9.......... Block Lot No... a.~............ pursuant to applkation dated ..~~.14.C.!!'J..........c~~a 19.x./..., and approved by the Buildintg~ Inspector. Fee 5...~.~.,.....~- Building Inspector Rev. 6/30/80 . Corm Na, e (~'.~y i ~ ~ 3~~i~ ~ yes ~7~V ~ TOWN OF SOUTlIOLD ~ ~ . r i BUILDING DEPARTFIENT T~ " TOWN !TALL ~I t yes-tBaz ~ z a 3 0199! 61~i~, ~~.~.~t. ' ~ APPLICATION FOR. CERTIFICATE OF OCCUPANC €tf_6_~~. lq~~~'-~`' •1. This application alust 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 of topographic features. 2. Final Approval from Health Dept.•of watec supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation fro,n Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains i less than 2/l0,of 12 1pad. 5. Commercial bUildingy industrial bu~,lding, multiple residences and similar buildings i and installations, a certificate of Code Compliance from architect or engineer responsible foie the building. ~ I, 6. Submit Planning Board Approval of completed site plan requirements. B. ~prepexistingbulandC,USeyprior to April 9, 19S,j) non-conforming uses, or buildings and 1. Accurate survey of property showing ail property lines, streets, building and unusual natural or topographic features. 2. IfpaoCertificateeoEdOccupancyiis deniedcothenBuildingplnspectordshallhstatelthent. reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling S25.DD, Altei:ations to dwelling X25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pte-existing Building - X100.00 3. Copy of Certificate of Occupancy - X5.,00 over 5 years - x10.00 Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy -Residential X15.00, Commercial $15.00 bate jj CC~~ G~ ::ew Construe ""da•~(°•~•?••%.?•~....... tiara..,,.::. .old • Or Pre-existing building.. Location of Property. a„7;~' ~ House No. Street a/ "'~'~~~'t•~` Hamlet Onwer of Owners of Propett % ~ ' County Tax Ma No P 1000, Sections „ ~,~,~,,,,,Block.....~.~.. „ ..,,.Lot... , Subdivision _ •,,,a,a,l,.:fi „ i „ ia.,,.i,a .Filed 4 Map.....,...,..Lot.. 77// ss Permit No. i .:iJi(.o.s~,.Date Of Petmit,'.~~rr„~; ,,,,A licant, t°.••••~~••'t :~••••7 lfcalth Oept. Approval • • • ,Undetwritors Approval Planning Board A ' pptoval.,,,ii,,,,ai,a,,,. ~ •aj ~ . Request fnt: ,Temporary Certificate:,,.,.,,,,, Final Certicate.:...,'~ Fee Submitted: c~>u,ya9~~' a ' ~ co ~ a o3a~1 AFPLI ANT • , . I - THE NEW YORK BOARD OF FIRE UNDERWRITERS wi<.';h. e ).1.2,5065 BUREAU OF ELECTRICITY I- - ~ 63 JOHN STREET, NEW YORK, NEW YORK 10038 I~ OC"'OHRN 25,)99] 747707vi(ti) N 21)4'i95 = Date Application No. on file _ THIS CERTIFIES THAT _ only the elecer4al equipment as descrihed heloto and introduced hY the applicant named on the shoos app/icatlon numher in the premises of JRN KAPUS7`KA, ).90R ai,VAA's LANf:, PnLF;#9a&9, l;u'~CN<)c;1)a, ta.v. ~ry n..t~r in thefolbtointr bcotion; 4 t /xt Fl. LJ Ynd Fl. .Sertian Black Lut SEPTF;Mt3t:R (~¢ite~991 was examined on sndfound to be in complianre Trith the reyuirementx of this Beard. pXTUIE RXTURlS RANOES COOKING DECKS OVENS DISN WASNHtS lXNAUST FANS eHRIETS ACIB SWI7CNE5 INCANDESCENT FIVORE]ClNT OTNEP AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMf. N.P. ) ?.3 7 6 6 4 t' U!YlRS RlRNAU MOTORS ptTURE AMUANCE p!WlRS SFEGAI RlC?T TIME CLOCKS pLL UNIT NEATEK tMhTl-OUTI[T DIAAMERS AMT. K. W. Olt N, P. GAS N. P. MIT. NO. A. W. G. AMT. AAN. AMT. AMPS. TRANS. AMT. N. P. ~ Of AKT AMi. WATT] ~ SlRVIC! DISCONFIlCT NO.OF 5 E R p V I C E - AMT. AMP. TaS ~ I A ]W 1 l SW 3 A ]W ] / Aw ffN rCOND. Of C COND. OF N4LFG Of ~ NO.OF NEUTRALS ~ NEVlOW4 _ OT/NR AMMIATYS: G.f.C.Z:-4 SMOKE DETECTOR:-? s '3 i - LAKE F;l,fic"fk i C i, # 1.845 l//~/ " 17 FnRP;;'^' TRA; 1. R7DGF, NY; 7.196). p~~ _ ~t ~ Per This tMificab Mutt not ba alNred in any manmr; return to the office of the Board if imorrM. Impactors may be idemified by their credentials. e f s COPY FOR BWLDING DEPARTMENT. TFRS COPY OF CERTIFIGTE MUST NOT ~E ALTIRED IN AMY MANNER. cI~LD i::SPECT'_U:J _ (~U;,:3 I ::ONMENT~ ~-~-v m ,.o J • J y W c FOUIJDATIO:J ( 1st) = FOUtJDATION (2nd) 2. z o P.OUGH FRAME ~ v, PLUMBING y H 3. ra H IIJSULATIOPI PER N. Y, STATE ENERGY CODE x a /d . D m 4 , FI:JAL yC s z o~ ADDITIOPIAL COMh1ENTS: ~ P ' x "d ' J H a .V H ~ H O ~ Z m a~ r . - s Y o m "j 1 R H0.\RD OF HEALTH . LS ~ 'J-~-y r;,y 3 SETS OF PL.1:iS.•.•".-••.•. !y~ FORtANO.t SURVEY ~~d~ TOWN OFSOUTHOLD CIIECh BUILDING DEPARTMENT SEPTIC FORPI ~pQ,DEPT. TOWN HALL DUTHOLD $OUTIIOLD. N.Y. 11971 NOTIFY ; TEL.:7GS~1II02 CALL r1AIL T0: Examined °Z.~? l9 ~ 1 Approved !J a~O., l99 Pctmit No. I.9..~ 3 Disapproveda/e . c4 (Build[ g nspector) ~J APPLICATION FOR BUILDING PER~r11T //~~~~v~ L Date _ IS INSTRUCTIONS a. TI[is 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. e. 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 Pettnit 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 h1ADE 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 Re_ula[ions, for the consttvction of buildings, additions or alterations, or for iemovai or demolition, as herein described. The applicant agrees [o comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary pecttons. l i~ h . (Si a[ure of applica t, or name, if a corporatwn) .P~? X34 ~ 3lt.. G:,~:e-?71~. ~ 1.1q.~~:.. (Matling address of pplicant) State whether applicant is owne ee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of ownerofpremises ...~.4t.9'.L°Yltl4..~K/9~uS.~K!?.).....(3,~~ps.NOiED••••......... as on the tax roll or latest deed) DATE: B.P N . IC applicant is a corporation, signature of duly authorized officer. FEE: BY NOTIFY Bl11LDING DEPARTMENT AT 765-1802 $ AM TO n PIV FOR THE (Name and title of corporate officer) FOLLOWING INSPECTIONS. Builder's License No . . . 1. FOUNDATfON - TWO REQUIRED NGy OR FOR POURED CONCRETE Plumber s License No . ...............QGCiUPp "I~~L 2. ROUGH FRAMING & PLUMBING USE., ~uG R~YIvF\CP~~ 4. FINALATION Electrician's license No . - CONSTRUCTION MUST ' ~Q~(~ NC~ BE COMPLETE FOR C.O Otltcr Trade's license No. QYCUPp ALL CONSTRUCTION SHALL MEET " " " " " " " THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY 1. Location of land on which proposed work will be done; ~ C DES. NOT RESPONSIBLE FOR SI NST UCT ON E O . .7.,? :...........~:L.v.a. h `.s ~ ~4. H e ,~'~atbec~ e ~ u.~'`, ~~i 3 I(oust: Number Street Hamlet ~ County Tax \fap No. 1000 Section ~ • • . • • • - Block ~ , , , , , , , , , Lot ~ / ,J1/I.~...... . ~ . . Subdivision filled tap No. Lot ..INamc) State csisting use and occupancy of pyr~emises an/d intended use and occupancy of proposed construction: ` _ a. Existing use and occupancy .....I~.eS[G~l.~.~C.~ b. Intended use andoceupancy `~~•rn"~~"" 3. Nature of work~(•chec • which applicable): Ne v Ouilding • • • • • • • • Addition . .Uteratton Repair ..`7r~. Rpmoval Demolition . • ..SW • . • Tennis Couft\.~........ Accessory Building..........Fence .......Other [fork.. 4. Estimated Cost s Fee , al (to be pair! on filini,~.~ 5. If dwelling, number oC dwelling upits Numb r of dwelling units on each (loot . Ifgaracc,numberofcars ..~:(~~.G!-,((.!`rCT.,.~.L;..O-1~..>~ei(•-,r/{~,,~ ,,i.•.., 6. If business, commercial or mixed I ccupancy, specify nature snit extent each typ~ of rue • . • • 7, Dimensions of cei~ting structures, if any: Front . ~,~d'..t~.: , ; Rcar Depth Height -j~......... Numbj;t of Stories . . . Dimensions of same structure with alterations or additions: Front ~ Rcar . Depth ......:..............1Height , , Numbcra• tonics . . S. Dimensions of entire new constnt tion: Front ~ Rcar . , ,Depth Height ~ ~a--'6t . . Number of Stories . 9. Size of lot: Front ! 1~ ~ ~ ~ • ~ ~ • :~s:-r~ ~f~_ Rcar .....,(,~7. tl/.`~:....... Depth . •"J •7'~ ~1 ~ I0, DatcofPurcase ,I, ,,,,,,,,,,,,NameofFotanerOwner 1 1. Zone or use district in which premises are situated . . P P ~N 4e any zoning law, ordinance or regulation: 13. \Vill lot be regraded Y•K a , , , , i Name of Owner of premtses viol?, • • • • • ' ' ' ' ~Vdl excess fill be removed om©emises: . Ycs No . . ..............Address ...................Phone No............... Name of Architect , , , , , , , , , , , , , , ,Address ...................Phone No................ . Name of Contractor ...Address .Phone No.. , , ; . IS.Is this property locat~',ed within 100 feet of a tidal wetland? *YES....NO.'... *If yes, Southold TownlTrustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from aroperty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~.a~rv-~v-2 3 o--J~•;s( /tom-o~--~c~ / ~^-~^-~-o"L'~ .~'~'l~ ~ r• [a.ra.fw^rr•cC 0~ 0 , ~ o-,~.,t~ ,.w10 a- II ~'~Q,.,~=,-g~.~ 6'~-ems. ~~~'h-e,~G-- w~•~-,•-k•-+k.. Q din a~ ; . ~ 7a ~ ~ , ~ ~-~-~-.z~y -rte. , ~ . 0..-a- Ie..~ STATE Ol~ \r E1 YOR 9, I S S ~ '~"~`~`Ay'" a 'Q`"'~' COUNTY OF • • • (A`amc oC individual si nit ~ ' ' ' ' • • • being duly sworn, deposes and says that he is the applicant • g ~tg contract) above named. Fkisthc (Contractor, agent, corporate officer, etc.) ~ • ~ ~ ~ ~ • ~ • ~ • of said owner or owners, and is dulyi :mthorizcd to perform or have performed the said work and to make and file this application; that all statements contained in this application arc true to the best of his knowledge and belief; and that the work will be pcrforntcd in the manner'',sct forth in the application filed therewith. Sworn to before me this ~ • a ~O.. .day or ??~a~.~........, 19 y?. Notary Public, , , , , , , , ./.t1:4 v.~-... , County~''~' ' NOTNn 4~U8a IC~~~ New Murk ~ e U ~ ~ untto~ (Signature of applicant) Turm Ezpires March ~0,19.~pJ ,