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Home My WebLink About19660-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 8outhold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19759 DATE: February 25, 1991 THIS CERTIFIES that the buildin~ Location of Property 15805 MAIN ROAD House No. County Tax Map No. 1000 Section I15 subdivision ADDITION MATTITUCK~ N.Y. Street Hamlet Block I Lot 3 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 8, 1991 pursuant to which Building Permit No. I9660-Z dated FEBRUARY 11, 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 (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED RICHARD & SUSAN KUBIAK Rev. 1/81 / B6ilding Inspector · 0~,~ NO. ~ TOWN O~ $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO- 19660 Z Permission is hereby granted to: , , /...~..~.~..~ ........ /YL~........~.....: ......................... · .................... , ............................. et premises located at ...~,..~..~....~..?...~..-~......'.....[~.~.....~.., ............ ,..~.....~..~.... ............... County Tax Mop No. 1000 Section .... ~./....~.~.. ........ Block ..... ..~...( ......... Lot No ..... ..~.....'~ .......... pursuant to application dated .... .~..~~.....~. .............. , 19..~..1.., and approved by the Building Inspector. Fee $..~.....t ............ Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY ,A. This application must be filled in by typewriter OR ink and submitted to the bnilding inspector with the following: for new building or new use: i. 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, 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. 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 - $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 $15.00, Commercial $15.00 / · , w Construction ........... Old Or Pre-ex~st~ng B..u~lding ............... Location of PropertY ... ~ ~ ~---- House No. Street Hamlet 3nwer or Owners of Property ............. ~ .......... .~./-~/'~ .... .. ................................. County Tax Map No i000, Sectioe.. ~l 5.'~.. .Block. / --~ ......... Lot ......... Subdivision ............................. Filed Map ............ I~ag ................. Permit No ...... Date Of Permit ...... Applican .............. !{ealth Dept. Approvals. ~/./~ .Underwriters Approval. ~.../~.'/.~. Planning Board Approval ................... (equest for: Temporary Certificate ........... Final Certi£ate ........... zee Submitted: $ ..... .2% ............. r.:o i9 35 1 .... ...................... TO%VN OF SOUTtIOLD OFt'ICL: OF BUILDING INSPECTOR P.O. BOX 1179 TOWN IIALL SOUTIIOLD, N.Y. 11971 Mr. Warren Waldvogel P.O. Box 250 Mattltuck, N.Y. February 25, 1991 11952 TEL. 765-1802 RE: KUEIAK, RICH~".D & SUSAN To Whom This May CoRcer~ ~ ' We are unable to complete your Certificate of Occupancy because .of the following reasons. /_--//An application is not on file. /--/ No Underwriters /~./ '['he check /_-/ /-/ for Certificate of Occupancy (ENCLOSED) C,:rtificate on file. i:; (~x~/not on file. ) $25.00 No Ilealth Dept. Approval on file. No final inspection has been made. CC TO: PJease contact ()ur office on this matter. Thank you for your cooperation. lh~il(l(r~(j PermLt # ! 9 6 6 0 Z Building Dept. ***/--/ Ilo Plumber ~k)lder C ' ' -- erC~f~cate on file. ( all pernlits involving plumbinrj being issued after April 1,1984 ) RICHARD & SUSAN KUBIAK 15805 MAIN RD HATTITUCK, N.Y. 11952 FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & ~FLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: 7G5-'~802 BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: ]FOUNDATION XST [ ] ROUGH PLBG. ] FOUNDATION ZND [ ]INSULATION FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHQL.Q. ~I..Y. [[[171- TEL.: 765-1802 Dlsapp.rnvcd a/c ............ . ................. ::'::: .... ..... (Building Inspector) . APPLICATION FOR BUILDING PERMIT BOARD OF HEALTI! ......... 3 SETS OF PLANS s~:,-~,~ ~o~, .~..: .... :: HAlLTO: , Date ...... INSTRUCTIONS a. Tlfis pphcatxon must be completely filled in by typewriter or in ink itnd submitted to the Buildin-=/map.et. ar, sets of plnr~% nrruram plot plan to scale. Fee =c'~rrfing to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sire'. or areas, and -' ' - detailed description of layout of property must be drawn on the diagram whichis parr of th.is ap; cation. , ¢, The work covered by this application may not be commenced before issuance of Bu/Iding Permit. 'd. Upon approval of this application, thc Building Inspector will issued a Building Permit to the applicant. Such perrr shall be kept on the premises available for inspection throuzhout the Work. · ¢. No building shall be occupied or used in whole oran par[ forany purpose whatever until a Certificate of Occup=n: shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department £or the issuance of a Bu/Iding Pe.,'m. it pzr'xuant to t: Building Zone Ordinance o£ the Town of Sou[hold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations. for the eons[ruction of buildings, additions or alterations, or for removal or demolition, :a herein describe: aTdhC.~paplican.t .a. grecs to comply with 31[,applicab~e taws, ordinances, building code, housin= co~e, anu regulations, and t mz uthonz.d inspectors on premises :Ind in building for necessary inspections. · or ~;a~J, i: ........... .&:iiin/.':ddri~s o~ aCpi~c~8 State whether applicant is owner, lessee, agent, architect, engineer· general contractor, electrician, plumber or builder Name of o~vner of premises ...... (as on the tax roll or latest deed) [l'appllcant i~ a corporation, signature of duty authorized.officer. e o officer) Buildcr'.~ License No. '/~ '¥r .~A~..(-/. [ .... Plumber's License No ...................... Electrician's License No ..................... Other Trade's License No ' Location of land on which proposed work will be done; llous- Number Street ' ' ' ] ...................... · / · County Tax Ma o. 1000 Section ............. Block .. · · ' ....... ~... Lot ..... . ...... '.-.. Subdlvislon ..................................... F..ilcd Map No. (N:lme) .............. Lot ............... ~t2lc existing usc and occupuncy ofprcm/scs and intended usc and ncc. up.ahoy o£proposed constrnction: ,,. ....... .... ' · . .......... .... ..... B. Intended use and qccup y ' 3. Nature of work (check which aPPlicable): New Buildinc Repair .......... R~moval .............. ' ......... Additic, n .......... AJterat:on Tennis Court '.'.'.'. Dcmolltion .............. Sm~g- II~L..' ........ If dwelling, hum-' .................................... $' ocr of dwcllin, units ....... (ts bc paid on filing this appiicanon) Ifgarage. numberofcars ... o ..... :-: Number of dwelling nnits on each floor. ' .. If business, cOmmercial or mixed occupancy, specify ' ' ' ' nattr extent of each type of usc ........ 7. Dimensions of ex sting struCtUres if a Height . , ny: Front ..... Dirv~ . ' ............. Nu, ~ber of Stories .......... Rear .............. Depth .. D~:pth .......... ns or add,hens: Front . ' .............. 8. Dimensions ofe.o. ............ Height .......... ' ............... Rear .............. Hci ht .. ,,,,re new construction: Front ...... ' 'i~;;rNumbcr of Stones ..................... 9. Siz~Zorlet. l~idr~t'''~Z]r'NUmberorStodes .... '.': .... : ............... Depth ......... ,. '~Seutstnctmwhichpremise.._ ..'''': .... ms,me .Of Former Owner .L~/~z~F.,~) ~,,gtO~o~i~_ ..... 12. ~oes proposed COn,et ..... ;- - ,' ,re s~tUatect ...... ff~e,ft ~)..~_,.r~-r,~/_ .......................... 13. Willlotbe ...... '.~ .....~unvtolate.,anyzoninglaw or,~: .... - ................ .; ..................... 14. · -t9_2,' :2 7~': .......... Will excess fill be removed from r . ..... ~ .................... Address · - ....... Phone No. : : .... tS.JLa thio property lOCated withln'300 feet of a tidal ~eClaud? *YES .... NO..:]' · If yes, $outhold To~n Trustees Permit moy be required PLOT DIAGRAM ' Locate clearly and distinctly all buiIdhlgS. Whether'existing or proposed, and. indicate all set-back dL'nensions .- .Property lines. Give Street and block number or description according to deed, a.nd show street names and lateener or corner lot. - " TATE OF NEW YORK, 'OUNTY OF ........... S.S · ' (Name O£individual signiugcontract) ~ove nam'~.' ...................................... being duly Sworn. deposes and says that he is the applle::. e is the ................ · .................. ...... ; ;fi ; 'fi; 3 ...... ' (Contra t ,agent, co p e fice. . ' ......... ........... said OWner or owners, and is duly authorized to perform or bare performed the said Work and to make and file ti: Plicat;on: that all statements contained in this application are true to the best of his knowledge and belief; and that Il: ~rk will be perforated in Ibc manner set forth in 'om lo before me this thc application filed /herewith. · .r. ..... day o .... . tary Public, . ., .~ County HEL£N K. DE NOTRRY PUBLIC, ~:a~e o! New Ym'k No. 4707871~, Suffolk County.,~ · Term Exoims N~rch 30, 19.---~/ (Si~natu~'~ f applies.n: OWNmeR: .j 4~.kl iV[Ap oF' M~'T T I T CKi t~. I/ '7/ / / / TI~ST HOLM _ *'t'~°_q_._ loam SUFF. CO. DI~'PT. OF HEALT4 SI~RVICE~ FOR APPROVAL OF' CONSTRUCTION ONLY DATE: H.S. EEF. NO,: APPROVED: STATEMENT OF INTENT {S) ...... . A~PLICANT