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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22869 Date FEBRUARY 10, 1994
THIS CERTIFIES that the building ACCESSORY
Location of Property 2600 YOUNGS AVENUE SOUTHOLD NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 63 Block 2 Lot 2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 24, 1991 pursuant to which
Building Permit No. 19642-Z dated JANUARY 29, 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 ACCESSORY GARAGE WITH ATTACHED 12' x 24' WOOD DECK
The certificate is issued to DANIEL KUJAWSKI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-233734 - APRIL 29, 1992
PLUMBERS CERTIFICATION DATED N/A
Mm
ui.ding Inspector
Rev. 1/81
FORM NO. 3
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)
.
W 19642 2 Dote o 199,1
Permission is hereby granted to: n
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rya
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at premises located of
.
Lot No.....
County Tax Map No. 1000 Section Block
pursuant to application dated 01~ 19c.., and approved by the
Building Inspector.
Fee o~2°~••!
4. / uildi Inspector
Rev. 6/30/80
r
• Form No. 6
/'d
"TOWN OF SOUTHOLD
BUILDING DEPARTMENT
FEB 4 ; TOWN HALL
765-1802
p'
APPLICATION FOP CERTIFICATE OF OCCUPANCY
A. 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.
B. 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 shall state the
reasons therefor in„writing to the applicant.
C. 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 $[1/5.t0~0, Commercial $15.00
Date .j-
New Construction....... .n~.../ Old Or Prey-/existing Building
Location of Property ....oSE~.UU........C0.4 ~S...f!.........Jp.~rfk4l
House No. Str et Hamlet
f O 6
Onwer or Owners of Property .....G:'l.....1~
County Tax Map No 1000, Section.... Block Lot
Subdivision .Filed Map............ Lot...........
/ c ~ / q u o
Permit No. c~ c.6. _.Z..Date Of Permit...... Applicant..L.__~..~~4~fk?S~
Health Dept. Approval ..........................Underwriters Approval
Planning Board Approval
1
Request for: Temporary Certificate........... Final Certicate... (;?x
Fee Submitted: $..,)--C)
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TCANT
IELD it:S:'ECTION 11DATF COMMENTS
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FOUiJDATION (1st)
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FOUNDATIO14 (2nd)
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ROUGH FRAME & 0
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PLUMBING
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INSULATION PER N. Y.
STATE ENERGY \
CODE
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FINAL
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ADDITIONAL COMMENTS: x
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THE NEW YORK BOARD OF FIRE UNDERWRITERS enGE 1
1195112 BUREAU OF ELECTRICITY 1
I BS JOHN STREET. NEW YORK. NEW YORK 10038
Date APRIL 29,1992 Application No. on file 76901392192 R 233734 i
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of
DAR KUJANSKI, YOUNGS AVENUE, POLE #2600, SOUTHOLD, R.Y.
i
in thefollowlnp location; ? Basement ® /st f7. ®Pnd Pl. GAR /OUT Section Block Wt
unsesaminedon APRIL 23,1992 andfoundtobein compliance with the requirements of this Board.
FIXTURE FIXTURES RANGES COOKING DICKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS TANS SWITOM INCANDESCtM PWdIELCLNT OTHER MAT. K. W. MAT. K. W. T. K.W. AMT. K. W. AMT. H. P.
7 7 7 6 1
DRYERS MENACE MOTORS FUTURE APPLIANCE FEEDERS SFSOALRIC'FT TIMECLOCKS FELL UNIT HEATERS MULTI.OUTUIT Glimmers
SYSTEMS
MT. K. W. pl X. P. OAE N. r. AMT. ND. A. W.O. AMT. AMP. AMT. AMPS. TRANS. AMi. H. P. NO. OF MY AMT. WATTE
SERVICE DISCONNECT No. OF S E R ppV I C E
MIT. AMP. TYPE ~ I ATM t / tW T X tW ] / AW MO' OYERC*CON0. OF C WCOND. NO. OP HI-lEG Oj NIAEG HO. OP NEUTRALS OF . W. G-
OTHER APPARATUS:
PANELBOARDS:1-4 CIR. 100
G.F.C.It-1
I
x~ V
i SAGE III LADENARN INC. LIC.#4141-E
P.0.B01 1768
SOUTHOLD, MY, 11971 BOOM MANAGER
11 ~y
Per.
This certificate mutt not be alknod in any monner; Mum to the office of the Board if incorrect. Inspectors may be identified by their credentials.
2W~WFY FM BUILDIM IMPARTMENT. THIS COFT Or CIEKTIFICATE MAT NOT BE ALTERED IN ANY MANNER.
pp~
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765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH. PLBG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING [ FINAL
REMARKS:
4-4 4
I
DATE I- o INSPECTOR
u
1 z
M-18.02
BUILDING DEPT.
INSPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS: `-e-e-`~l
--,ewe, 0-4
DO A47-
DATE ,~o INSPECTOR
r
lo~
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ( ] ROUGH PLBG.
FOUNDATION 2ND ( ] INSULATION
Vj--FRAMING [ J FINAL
REMARKS: -
DATE INSPECTOR
Slog-
(rL tsf 01s'
" P,,ao ,~t7X-~~~'nw.
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FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL f
~ Date t !1'!ti?"
To ck"f... K~.(,,.~ •~(~'a. J ~Y .
w w~.PVV~-+ R0L,. !a. ..!!.91.(
PLEASE TAKE NOTICE that your application dated + 19 %o.
.
for permit to
Location of Property je t Ilk V.-? , , ~ ga t ~ or
v ...................Hamlet
House No. Sheet
County Tax Map No. 1000 Section Q.LP.3.... Block ....Q. ?r Lot
Subdivision Filed Map No. Lot No.
is returned herewith and disapproved on the following grounds
0
Building Inspector
RV 1/80
BOARD OF HEALTH
3 SETS OF PLANS
FORM NO. I SURVEY
TOWN OF SOUTHOLD CHECK
OtPT' BUILDING DEPARTMENT
0,4 Of tj7 SEPTIC F•ORrf
TOWN HALL
SOUTHQL.D.. L\t.Y_ 11271
/r TEL.: 765.1802 ALL
Examined
T0:
Approved l/......, 192> Permit No..~
Disapproved a/c
JAN 2 41991
. tst ~r 1
wild' g Inspector) E t~~
APPLICATION FOR BUILDING PERMIT n.4 , ` "C_al qq t
Date 0.~1..l.1..... I9
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
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 stree
areas, and giving a detailed description of la
} ca
cation. yout of property must be drawn on the diagram which is part of this app
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 perm
4 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 Occupanc
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 th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c
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 t(
admit authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant, or, name, if a corpcrarron)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
0 W.A .
Name of owner of premises ° G f -6
I v-,... ~J. ~ I t .
(as on the tax roll or latest deed) " "
If applicant is a corporation, signature of duly 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:
1..6.0- .YQ
liouse Number Strc
/ Hamlet
County Tax Map No. 1000 Section .......3
Block . . . Lot.
Subdivision Filed Map No. .
(N:une) Lot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
In 0
A. Existing use and occupancy... ke.S t C e
B. Intended use and occupancy C- C-
k
li
3. Nature of work (check which applicable): New Building Addition . } ation .
d 1
Repair' R~mo;val Demol'tion ....Swimmin. ool...........
Tennis Court Accessory Building ....Fence .......Other Work:
'
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 miser} occupancy, specify nature and extent of each type of use
7. Dimensions of existing structure's, if any: Front . . Rear Depth .
Height 44Mber of Stories .
Dimensions of satne stiV. c'ltiPd tyrI t alterations or additions: Front Rear .
Depth ....................1.. Height 11 Number of Stories 'iI........
8. Dimensions of entirFtnew construction: Front Rear t~a Depth • , , • • • • •
Height t~ ''Number of Stories .
9. Size of lot: Front 1 t~ Rear 11M • Depth ../~o• • •
10. Date of Purchase Rio.4..1.Y9 Name of Former Owner
11. Zone or use district in which promises are situated . • .
13. Will lot re raded IRA ate any zoning law, ordinance or regulation:
13. Does proposed constructi~n~v oP ~ Mll excess Fill be removed from premises: Yes 14. Name of Owner of pre ises P. tens . ...............Phone No.... _ .
Name of Architect Address . . Phone No............... .
Name of Contractor . Address . Phone No. .
IS-La this property located within 300 feet of a tidal wetland? *YES ....NO.
*If yes, Southold Tow4 Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly allll buildings, whether existing or proposed, and. indicate all set-back dimersior:
property lines. Give street and block inumber or description according to de, and show street names and indicate
interior or comer lot.
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STATL OF N V-YO S.S J
COUNTY F a~J / 1 II• C:kq5 being duly sworn, deposes and says that he is the applicar.
(Name of mdividuaCsimin, contract)
above named.
Ht is the (r~. 1 .
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tlu
application; that all statements contained in this application are true to the best of his knowledge and belief; and that th
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
p
.t...... day oif U V........ 19 4~
Notary Public, : County
CLAIRE G LE1ly r
ry IJO~ 4 79tgOf NOW York (Signature of applicant
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DERWRRl DERWRITERS CERTIFICATE
REQUIRED
o_ll!`~II ~1 tf~~l PR ED AS NOTED
DATE. 9 / B.R N 5
FEE: Z~ BY:
1.44 NOTIFY RUILDENG DEPART T
766-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
3. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE
SEE ILI I 1 Rp q~Cg ya~~F 2 ROUGH - FRAMING & PLUMBING
c~rIEE A-1 CUP) 6!' ~'"ky 1,J INSULATION
w ~,i , l ~ ~~yE~ yr _ 4. FINAL - CONSTRUCTION MUST
y~XION 7 it X~04 II 414 9E IS BE COMPLETE FOR C..
I 1~~B t IIE IS UNl.~ag~~°FUL ALIT. CONSTRUCTION SHALL MEET
1i Y OI THOU tl CERTIFICATE THE REQUIREMENTS OF THE N.V. STATE CONSTRUCTION & ENERGY
CODE& NOT RESPONSIBLE FOR
OCC ID~{~,pC I'IFSIGN OR C.ONPTRUCTION ERRORS
No < OeA
TITLE
GARB ETT A.1~' STRNC rani LOCATION ~Q11~1 ~ ~Y1I~~I
archi ttict
SCALE e REVISED
Main FRoad P.O. Box 1412 Southold N.YI1 J NMI onawlxc NO
DATE I A Y
516-765-5455 DRAWN BY
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TITLE IV.O `AGI
GARRETT A. ~TRAN PRANG 1~ w~ww i rV' 1
LOCATION
architect
SCALE A~OICn DEVISED DPLW ING No
Main Road P.O. Box 1412 Soutiold N.Y.11971 N.Y.11971 DATE YV P Ill'v
516 - 765 - 5451 DnnwR I
PROJECT 901,90
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