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HomeMy WebLinkAbout19503-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20321 Date OCTOBER 30, 1991 THIS CERTIFIES that the building ADDITION Location of Property 360 WESTVIEW DRIVE MATTITUCK N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 139 Block I Lot I2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 29, 1990 pursuant to which Building Permit No. 19503-Z dated NOVEMBER 7 1990 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ANTHONY SARZABKOWSKI (owner} of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-177287 - MARCH 5, 1991 PLUMBERS CERTIFICATION DATED OCTOBER 30, 1991 - E.F. SCHILLER 0 Building Inspector Rev. 1/81 soaffi rto. s 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° 19 5 0 3 Z Date ..f.1~~ 19~~.. Permission I~ ere ~ t~ r~Q -:36.......~..~..'.~?.,~r~:~ to . ' at~~ses located at c~..~?. ~~C'1...~~.41F. ~.~l~G~ ............................................~!~6fi•~............................................................................... County Tox Map No. 1000 Section ...~///..:~.f.......... Block .....yl..°............ Lot No...~-2-n......... pursuant to application dated .....1.:~/u"~.~ 19..~~-~., and approved by the Building ~In^spector. Fee S•x.=/•..~• ~ .......c~i.~r ing nspector Rev. 6/30/80 TEL. 7G5-1802 ,~OS~FF~u' COI,, TO'SS~N Or SOtJTIIOd.D ~:a' r~.c OFFICE OF IIUILDII4G INSPECTOR ter., o `:yi; P.O. QOX 728 cr' a.`mti' TOiVNHALL ~~~,~~,0`~- SOUTHOLD, N.Y. 11971 Cpl ~ y,'b C E R T I F I C A T I O N , Date 3LI 9 of _ Buildinng Permit No. ~ ~/S°o,~ Owner ,°7'nY'-T7-low`/ ~HRZFI•E3f~Cz~~SKI (please print) Plumber ,~,F=, Sc1~-l/LLI=F~ (please print) Z certify that the solder used in the water supply system contains less than 2/10 of to lead. (plumber s signature) Sworn to before""""m``~~e this ' ~'O day of ~[~-6`rti°ti~ ' 19 Ca / ~ /'t-rc~~~-~~ Notary Public tlotary Public,~~~L,.c..?-County MARY E. "1'LD•RkANDT Kt?tAt'! P{•e i.~s ~t New Y~xk . MARY E. N!LDEtRANDT : f Aflfa .l • 1VOTA~A.Y Pt:F; SkN'~F IVew XoLY ~ ~a~~t'iad NaS~aa 'arm. o.. ED 4f4U59 C«mnG.en Fin 4y '~i2,~ya" ~ Qu~slffied Nassau ~glll!}' THE NEW YORK BOA~tD OF FIRE UNDERWRITERS,, ~ ~r, ~tltli;f84 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK. NEW YORK 70038 Date ?gt~lff'N {"'fi, It9 Tlf APPlication No. on file f-f Sf 9; ",tQ~/r)1. t~ :!"f'~f2i') THIS CERTIFIES THAT only the electrical equipment as described 6ebw and introduced by the applicant Homed on the ohove opplication number in the premises of A107`iTt?PLY ~J~RZt3i'..CJki"F:1, ~ikii~fV9'TsF7 TI'er:IV[;, i~i~1T'1'2"t'€7€:~, ,t,y, in the following lnca¢'y , 8 e gn ~ Lct Fl. ? 2nd F'l. Section Blork Lot N ~;h~SYtC31t,~ ~r ~ a'~"I. i uws examined un arzdfound to 6e in corrtpliancc with the requirerneatx of this Buard. FIXTURE ECEPTACLE$ SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FWORESCENi OTHER AMi K W. AMT K W. AMi K.W AMi K W pMi. H P !a ~ i 5 2 1, f1, 7 h' DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS AMT N. W. Oll H. P. GAS H. P. AMT. NO A. W. G. AMT. AMP. AMT, AMPS TRANS. AMT. H P. SYSTEMS AMT. WAitS NO.OF FEET i rj 58RVICE DISCONNECT NO.OF S ~ E R V I C E MIT AMP TYPE METER ~ RW I 3W 3 % ~W 3,e' 4W NO. OF CC. COND. A. W. G. NO OF HbLFG A' G NO OF NEUTRALS A' W EGUIP. PER % OF CC.COND. OF HbIEG OF NEUTRAL OTHER APPARATUS: 1C,.f1YY Ptf:M1t,J„") trt%.~~%'.;CfC#^.~, PA'1' ?,j~fii'; Nt~7"~'I,`1'tSCK, ICY. 7.'I95ft GENERAL MANAGER 7~ Per s.Y y , :.n This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST 1VOT BE ALTERED IN ANY MANNER. murz TE,I,. 7G5-1 SO'_ p~~~f.~CK o To~N Or SOUTIIOLD ~ y ""'"~3~ ~ OrPICl; OP BUILDING [NSPEC"1'OR o ;~M; ,:-j~,g+ ,zT, P.O. BOX 728 ~ ~~~~i'*' ~ TONN fIALL O~ol ~ ~a0'~- SOUT[IOLp, N.Y. 1197] ry / / To Whom This May Concern, We are unable to complete your Certificate oL- OOccupancy because of the fallo~oing reasons. /-i// J1n application for Certificate of Occupancy is not on file. ~^~-~"'-F~ / / No Underwriters Certificate on file. /?r The check is¢~~dateE3/not on file.} ~ 2S'_UO No flcalth Dept. l:pproval on file. No final i.nspccCion has been made. Please contact our office on this matter. Thank you for your cooperation. I3ui7 cii.nq Permit ik ~ ~ d ~ Z ~L~' Uu.ildi.n<I Dept. Dlo Plumber Solder Certificate on file. ~ . ( all permits involving plumbing being ,issued after ~~pri1 1,19flA ) "_Y Q~c~~~ /{~(~LCf'~~ l ri 9 sr'1 765-1802 l;UILDING DEPT. INSPECTION =s a [ ]FOUNDATION 1ST ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION ° [ ]FRAMING [FINAL REMARKS: DATE ~ INSPECTOR G _ f~ * H 11..•• ' H W UIIDATZON (lst) ~ - ~ v a UtJDATIO;J (2nd) m \ . y o w )UCH FRA;~iE & I O .PLUMBING ~ ~ ~ ~ rn n H NSULATIO?! PER N. Y. STATE E4IEROY I CODs I t . s t 0, m ~ H FI;IAL • I o M ADDITIOPJAL COMMENTS: S . • i~ Q ' . • x ro v N \ 9 ' H • ~ `17 f{ ~ . ~ S m } • r . a 'i`~\ -v H • a 1 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING FINAL REMARKS: ~ ~ 9ATE~1 INSPECTOR . 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ NSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ DATE a INSPECT ysS-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [v]A`itOUGH PLBG. [)FOUNDATION 2ND [ ]INSULATION [~.]"~~~RAMING [ ]FINAL REMARKS: D)"` ~~-r.~, E i DATE L INSPECTOR z 1~~~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ]ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [)FINAL REMARKS: DATE ~ 1~ INSPECTOR i"/ f .fi 1~U T65-1802 BUILDING DEPT. 1 t~-~~PECTION OUNDATION iST ROUQ~M PL®G. [ ]FOUNDATION 2ND [ ]INSULATION [ l I~RAMINt# [ ] FKfAL RtNiARKS= i DA71E r f ~ ~ INSPECTOR ~ ! -ao;' ~-.~a I ~ ~ ~ zi~;>~ .,P. ~l ti _ r ~i ~,ri ~ -ryi ` 0 ~ f cal - U7 ; p'- ~ ~A `-_.~.S vii ~ ~ X' ~ e 1111 (fx m I I ~ ~ ~ cr ~ x ~ ~ ~ ~ ; I Z , ~ O E i ~T` ~ ~ ~ Z i - ~,Y ~ f..._.._ ; \ h ~ ~ _ i o 3 f)t ~~~al i LL I ~1 "ro o u;~ 3~~E1~, ~ ~ ~ 1 Ul~~ O ~:~t 4 w J^ ~ W ~ ~'t~ ~ ~ I p u~ ~ ~'j O i ~ \ ~ I ~ ~ m °t $ w G , ~ W 3n41 ` . ~ ~ lit! ~ [ ~`Y ~ t ~~7 ; ~ 7i t11i tt~r ~ ~ ~ ~ ~ u~' ~ ~ w I j ~ ~ ~~a~t~~~•~ I ~ ~ ~ i i e. . - BOARD OF HEALTH 3 SETS OF PLAN ~ FORM NO. 1 $tTRV EY , , , TOWN OF SOUTHOLD _r~t3~cx • , , BUILDING DEPARTMENT Si:PTIC rORPi . . . . . TOWN HALL $OUTHOLD, N.Y. 11~J71 NOTIFY I TEL.: 765.1802 CALL ry MAIL T0: •~y~ S f~O~O Examined 1.......... 1~c~yy~~,. cc Approved 1~~.........., 19'!x. Permit No..`J.~v~.~ _.r..g,: . ~7 rry h DisaPProved aic D ~ LJ L".-~ { ~1 ~ ~ ' ~ ~'~~Q ~i 1 uildi nspectorl 8~-D~~~-' TL1VdN C)S ~ ,..,m,.,~., _ - ~ i APPLSC TiON FOR BUILDING PERfv11T / Date ~ ~ (,2 15 ~Q INSTRUCTIONS / a. Tltis application must be comp]etely filled in by typewriter or in ink and submitted to the >~uilding Inspector, with 3 sets of plans,accurate plot plan t6^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. c. The work covered by this application may not be commenced befoze 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 throwout the work. e. Na 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 3uildin~ Zone Ocdinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or tc;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Clie 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 'nspecticans. - (Signature o~fjQapplicya/~nt, o~~r-,na-me, if a corporar~to/n) ~.`~:..rJ®x..%gt.j?I/9.-~r/~i~, ~;.Z.l,'~;zjj•.~/,`~,f2- (Mailing address of applicant) ;rate whether applicant is/o~wner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. :ame of owner of premises !!~'4~ ~...:1::. ~?'~:~Ye:~...3?'1-.....~.~ l~t?!'~ Sk..f........... . (as on the tax roll or latest deed) "appl' is a corporatio , si ure f duly aut'hyor~ized officer. ' (Name and ti le of co ate officer) • Builder's Liccnsc No. .,....2.~f ~ ~~.L Plumber's License No . . Electrician's License No . OtltcrTradc's Liccnsc No . Location of land on which proposed work will be done; ' house Number Stregqet Hamlet j County Tax 1,tap No. 1000 Section ......I S r• , Block , , , , , , , , , , , , , , Lot .Z-'.... Subdivision Filed t1lap No. Lot , . (Name) State existing use and occupancy of prcmj;es and intetn~ded use and occupancy oC proposed construction: , A. Existing use and occupancy.......L~:.~•~(/~G'?`:T//~Zr.: B. Intended use and occupancy...........f• : ~~•rJ~7.~/~~•-• • • • , • • • • • • • • . , , Nature•oCwork (chccl. which applicable); New Uuilding Addition ...l.` . • • • • • • . . Repair , , , , , , , Removal; , , • , . , Demolition . .Swimnin ; pool Tennis Court Accessory Building..........Fenre~n~•ti,.. ..Other lJork........... Estimated Cost ~ d ~ Fee , (to be paid on filing this application) Jf dwelling, nurnbcr of dwcliing units Number a(dwclling units on each floor , . If garage.numbcrofcars If business, commercial or mixed occupancy, specify nature and extent of each type of use . Dirttcnsions of existing structures, iC any: Front . Rear . Depth . . Hei~ltt Number,of Stories . . Dimensions of same structure with alterations or additions: Front Rear . . Depth Jlcit;ht ......................Number of Stories . Dimensions of entire new constn+ction: Front Rear Depth Hci~ht ~ Number of Storks . Size of lot: Front Rear Depth Date of Purchase . , ,Name of Former Owner „f2u,`/, • , ~,l7,cf',e ~vy,,3,„ " • Zone or use district in which premises arc situated 2 L=~~(..?c`t~rT:~~4-.... , Dacs proposed construction violate;any zoning law, ordinance or regulation: 1Vill lot be regraded tiVill excess fill be removed from premises: , Ycs .Dj, • No Name of Owner of premises .~E~.Z~}Kflcut,, Sk,f, , , .Address C(C... Phone No. • . Name of Architect ,Address ....Phone No. • . Name of Contractor 1~~(LL yr •~ol'~-S• • . , , ,Address .~1.~2T• (~r~ .Phone No. `~ff.'cg::~o . . ..Is this property located within 300 feet of a tidal wetland? ~YCS....NO..?~ • ~If yes, Southold Town Trustees Permit may be requited. , PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from ~perty lines, Give street and block number or description according to deed, and show street names and indicate whether crior or corner lot. S ~ j jt-!"jj~Gf~f~J . .~L! 12'vG~J j~ /9NS '+TG OF 1E1V Rj~ UNTO1~q/F..S00O'~~z'~:(~S.S', c, ~Q74-~~ (if• • • ~ • • t ~ ~L ~ ~.!S being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) lvc named. ~7-7~ ~ IS l11C ~~t ~4k'~~: (Contractor, agent, corporate officer, ctcJ. ;aid o+vner or owners, and is duly autlwrizcd to perform or have performed the said work and to make and file this lication; that all statements containcdi in this application arc true to the best of ltis knowledge and belief; and that the, k will be performed in the manner sct,forth in the application Glcd thcruwith. t lm to bciore me this ary Public, ;`:'::b.~.4~. County //U// eATRICIA f. AlLiis`,7 • • • • • • • • • n~ornav ruf+l.lc, >rd,L ew (Signatu pphcant} 114 7909 6 2, Suffolk ~f/,uia , "=:Ym. Expires Fj?~rjx„~/,•(. ~ • ~ oJ4' ~01 7~p~ Form No . 6 ~ ~ 4`'7 I.~°i LI ~l„~I;;w~ t~{ v 1 ` TOWN OF SOUT[IOLD ~1 ; 3 i fi BUILDING DEPARTMENT ~ 4 0 N HALL ' T W 765-1802 gl.DG, IsES~t. Yf2~J(~1 C~§~,4fl!!"iPdt7LC3 X41, APPLICATION POR 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. :l. 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. L. 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 $15.00, Commercial $15.00 Date ......v~.L`:~:.~~.°1'y~.-~-/.. Sew Construction........... Old//O-iri Pre-existing Building.'~l•(~,apQ/,-~.%-*y:-.+~:-- Location of Property..:i6~ W,-a:°!~~:ti':~.. ~ti••••"•r•/•..°~.. Rouse No. t,'.~('~Street ' / ~ ~ Hamlet unwer or Owners of Property... ti~I~ ~.~:i°C~`":: ~''!`.'~.....ee.~~ bounty Tax Map No 1000, Section...I ~ ~.......Block.....~..........Lot....I.44 :subdivision ....................................Filed Map.........QQ...~L"ot°.~.'...p.~_............... Permit No.~7S.Q~~.....Date Of Permit.~~I.~19©........Applicant.~J:7VC.txry.~°{~`!:~ !Iealtli Dept. Approval ..........................Underwriters Approval... a 8 7 Planning Board Approval Request for: Temporary Certificate........... Final Certicate...~..... +-xJ Pee Submitted: L o ~ n o2 APPLIC NT