HomeMy WebLinkAbout19052-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19590 Date DECEMBER 18, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 1075 INLET DRIVE GREENPORT, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 36 Block 2 Lot 21
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 21, 1990 pursuant to which
Building Permit No. 19052-Z dated MAY 29, 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 GARAGE ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to MARIA R. GRZESIK
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N-156592 - OCTOBER 19, 1990
PLUMBERS CERTIFICATION DATED N/A
Bu lding Inspector
Rev. 1/81
ZPOIB~M NO. A
TOWN OF SOUTH®LD
BUILDING DEPARTMENT
TOWN MALL
SOUTH®LD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N s ~ U ~ Z Date .................~..~!a... ~ 19.9
Permission is hereby granted to: U
.....l.~s~.X...':~:.~? 5
G . y ~ .
..i~.........
of premises located at ..I.l.2.~. .....~9C1.l.SLt.KC~~J`~!'::•°•'::'.........°!
..........................................................................................................a.....................................................
County Tax Map No. 1000 Section Block ......4.~-...... Lot No...5~:~
pursuont to application dated )9.1.b., and opproved by the
Building Inspector.
Fee S..:~.~......
Budlding Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD n
BUILDTOWNDHALLTMENT ~7 ~ ,
tt 765-1802 ,1 Gtl~'~
DLD £r' i ~i2^ U Ll~
~O~r
;,~-nLt> d APPLICATION FOR 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 17 lead.
t 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 $15.00, Commercial $15.00
Date ...f i~{ ~,1.? ~ .
New Construction.. v..... Old Or Pre-existing Building .
Location of Property..../.d..~J...~<`:.~:~./...~.iztl~..'....~'~.~;~~.Y~~~.~'~/`
House No. Street Ha let•
Onwer or Owners of Property... ~:4:~?!.~/7 Z 2 s~,~,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
County Tax Map No 1000, Section.s~ ~,.........Block...-:~...........Lot...:~~
Subdivision ....................................Filed Map............Lot......................
Permit No...~.~r.Q.~.~.-...Date Of Permit ................Applicant.............................
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
cc~~ -
Fee Submitted: $....~.~7;:~:~ ~ ~
tae, wl 013 ~ . ~ .
~i APPLICANT
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December 6, 1990
Maria R. Grzesik
Box 485
Greenport, N.Y. 11944
To Wham This May Concern,
toe trre unable to co;npl~te your Certificate
' of Occupanr_y becau~c,of the following reasons.
I_t!J 11n n~plication for Certificate of 4ccul~ancy
/is not nn file. (SNCLOSSD)
/~~~`Io Under•.aritcrs Certificate on file.
/^?I `1't~e check .i:;(d(~~c~~P(~c~J(not o:i file.) 825.00
t:o !!ealth Dept. Approval on file.
t:o final inspection hae> been made.
P]enr;r, contact our office on this matter.
Thank yorr for your. cooperation.
IIuilcling Permit II 1 9 0 5 2 2
IIuilclir.rl UcpL-,
No Plumber Solder Certificate on file.
( all permits involving plumbing being
:LS:;uec] afL•cr April 1,19II4 ) -
i
rl=~^3 IGS:'ECiiU;7 ~IUAi1; ~ COMMENTS
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II7SULATION PER N. Y.
STATE ENERGY
CODE
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ADDITIOP7AL COMMENTS: ~ '
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BUILDING DEPT.
NSPECTIC~N
[ FOUNDATION 1ST [ J ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~ .lv, ~,n~j ~c._ 7.~
DATE ~ INSPECTOR
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BOA6D OF HEALTH
3 SETS O~PL.INS
FORt/l NO.1 SURVEY
TOWN OFSOUTHOLD cllecr .?.~5a.f
BUILDING DEPARTMENT SEPTIC t'oRrf .
y TOWN HALL
$OUTIiOtD, N.Y. 11971 NOTIFY I
TEL.: 7G5~1II02 CALL ~ •I•~Q•~ .
y 19p~ P1ALL T0:
EXallllnld '~7A~~"- ~q•' ! .
Approved :,J.::p. ~.1., 19~~ Permit No..~~90?.'~1.Z. • • .
Disapproved a/c • ~ a ~ ~ ~
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. ?~-o'~:-,...... ~ MAY 2 11990
g.
(Building Ins ector) 1#
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APPLlCAT10N FOR BUILDING PERMIT ~ 13S.Dta. C'~a"i. ,
Date I5.-.
INSTRUCTIONS
a. Tltis 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.
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 issucd'a Building Pcrmlt to the applctnt. 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 Zane Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Rc;ulatiofis, for the construction of buildings, additions ar alterations, or for removal or do olition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, b ~ d' g code, housin e, and regulations, and to
admit authorized inspectors on premises and in building for necessary ons.
atu a or a 1 ant, r me, if a corpor ;wn
(Mailing address of ap Leant) •
State whether applicant is owner, lessee, agent, architect, engineer, General contractor, electrician, plumber or builder.
Name of owner of premises ...../!:.l.~lJ . ~/.'l..... ' ~ • • • .
(as on the tax roll or latest deed) -
Ifapplicant is a corporation, signature of duly authorized officer. '
• • • • • • • • (Name and title of corporate officer)
~~tu ,
Builder's Liccnsc No. ...~l.~h~
Plumber's Liccnsc No .
Electrician's License No. . • ~/.M.... ~~l~.e::.•
Otllcr Trade's Liccnsc No . .
1. Location of 1 n on w ich p J work tvi d ne;
house Number beet. Hamlet •
fuck ~ Lot 1/ t;,
County Tax 1`tap No. 1000 S¢ction i ,
Subdivision . Filed Map No. Lot .
• (Name) • _
• State existing use and occupancy of pre ises and intended use and occup ncy of proposed constnlctioti: -
a. Existing use and occupancy , . • .
b. Intended use and •T••.... ~
occupancy
3. Nature oCwnor~jJ~'t,~c~7whiclh
a icabl • ~~e~w~,DuyJdin~/• • • • • • • • • • Addition .UtetaUOn'~~
t~r~~
Repair ./y~.~!:L:'":~1ipmovnly~~l'~,y:rC~-'Demolition i:anin; pool.::'•',~:
.Tennis Court 1~ Accessory liuilding..........Fence .......Other IJork............
~4. Estimated Cos/.Ct//• Fcc
(to be paid on Tiling this application)
5, 1f dwelling, number of dwelling units Numbet oC dwelling units on each Cloor
If garage,numbcroCcars •
6. [f business, commercial or mixed occupancy, specify nature and extent oC each type of use .
7, Dimensions oCexisting structures; if any: Front ....ll.Q. j Rear G.O, , Depth y/......... . .
Hci;;ltt Jt.~a :
F g`ft Numhcr o f Stories QN, . .
Dimensions of same structure wit~t alterations or additions: front • Rear . .
Depth , .G. ~ 1Icigttt . 13.'.'y-:h.r........ Number of Stories ...~r.-.~.. •
S. Dimensions of entire new constriction: Cront ~.°1.~....... Rear ~k•`• . • • • • • • Depth •.a`l::l
Hc~;ht /O, ;Pas; ; Number of Stories ...r:11.o;v,-P .
9. Sim of lot: Frotf~, Q.~.. Rear Fd Depth ...2„7.x1. i!7..~ .
10. Date of Purchase . . .Name of Former Owner . .
11. Zane or use district in wlticlt pretPises arc situated • . • • • • • • • • • • • • • • •
•••d
l Docs proposed construction violate any zoning law, ordinance or c attar: ....a! • • • • • • • • • • • • •r•~•
• •~•y~•
13. Will lot be regraded .......f/,Q ill ex c remove'~~~hpremises:~l.:~.7C/.4... . •
1.1. Name of v er f premises ress 7 _ hone No.
Name of '9 ~ 3~'~A:?«'... {;11 Address . Phone No. !t/.2?:": r•
b~~ L' .~w~ n ~ ..Phone No.f~'.7TY• 3
Name of Contra for nc GN.~-.:........Address . L.`N sr{x~, s
IS.Is Chis property located within 100 feet of a tidal wetland? *YGS...~O-
*If yes, Southold Town'Trustees Permit may be required.
PLOT DIAGRAIvS
Locate clearly and distinctly all buildings, whether existing oc proposed, and indicate all set-back dimensions from
property lines. Give street and block r;umber or description according to deed, and show street names and indicate whether
interior or comer lot.
I
STATC OC' NEN YORE, $ S
COUNTY OF
• • • , , • • , , • , , , being duly sworn, deposes and says that he is the applicant
(Name oCindividual signiiro contract)
above named.
Flcisthc......•.....•........
(Contractor, agent, corporate o(ficcr, etc.)
oC said owner or owners, and is duly, authorized to perform or have performed the said work and to make and tilt 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 manncr'isct forth in the application Glcd therewith.
Swom to bciorc me this
Notary Public, • • . . , ~ • • • • County ~ •
K, t1E VOE'' _
A]
7878, Su~itolN~_
t>t~! . , • • . • • • . • • -
TermEx~reshletch30.1 --•rr (Si; ure of applicant)