HomeMy WebLinkAbout18764-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 219817 Date MARCH 27, 1991
THIS CERTIFIES that the building ADDITIONS & ALTERATIONS
Location of Property 7035 ELIJAHS LANE MATTITUCK
House No. Street Hamlet
County Tax Map No. 1000 Section 100 BLock 04 Lot 09
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JAN. 24, 1990 pursuant to which
Building Permit No. 187642 dated JAN. 31, 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 ADDITIONS AND ALTERATIONS TO EXISTING ONE FAMILY DWELLING.
The certificate is issued to DONALD DEERKOSKI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N131057 MAY 24, 1990
PLUMBERS CERTIFICATION DATED DONALD DEERROSKI MARCH 26, 1991
uil ing Inspector
Rev. 1/81
sos>ti xa s
TOWN OF SOUTHOLD
lUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
18764
N ~ Z Dote ~:31 199.
Permission is hereby gwn~~~ 1~,~~~
...~~xs,~
sZ
of premises located at ...,~r..~(~.~yr./1....~..d!.
County Tox Map No. 1000 Section .......f~/d...... Black Lot No......f
pursuant to application doted ......./.~~:.`rY 19..~Q, and approved by the
Building Inspector.
Fee ;.~~~.e. 8v~~
.......~c:~~~ ~
IdInO..I or
Rev. 6/30/80
, ~ Form No. 6 D L5 C~~~, i ~i~'
i
TOWN OF SOUTHOLD ~
BUILDING DEPARTMENT ~ ~ 6
TOWN HALL
765-1802 ~
TnUJp~,
q..... _ .
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.
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 ,M\A2CN Zb; 1901 I
New Construction........... Old Or Pre-existing Building......7:.........
Location of Property..-l03S..o ...............~a_:Ja~a ~aY~,e.......... 1;~,~'a,
1T IT~n CIC .
House No. Street Hamlet
Onwer or Owners of Property...'o
~ ~ ~ Ctr~Iw~ILI,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
County Tax Map No 1000, Section......1.~ ....Block...... 4........Lot
Subdivision ....................................Filed Map............Lot......................
Permit No. .`g.~~4.~....Date Of Permit. ~.:3!..~~....Applicant!:~0~~`~. `Jgg2lc~e~~
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate..:.Yi......
Fee Submitted: $ „ a 5'O 0
N ~ ~
APPLICANT
r.:.,
zr.
r,~, ~ TEL. GS-181!'_
.`J,~F~Ck~C~~ To~rrr or souTUOi,~
}~j~,t; ~ 01'I'ICI? OF BUILDING INSPECTOR
1'%?~i'1~ y~ T04VN IIALL
Off, fit' SOLJl710LD, N.Y. 1 1971
~~l ~s r~ .
March 21, 1991
Donald Deerkoski
Boa 516
Mattituck, N.Y. 11952
'To 4)hcm This, May Concern,
4;e arc unable r.o complrte your Certificate
of Occupancy because ,of the following reasons.
/~1n application for Certificate of Occupancy
1s not nn file. (ENCLOSED)
/ / No Underwriters Certificate on file.
/'t'he chec:4: i::(~Etalgi$3E~~Enot on file.) $25.00
/ ( P:o Iteal.th Uept. Approval on file.
No final insl~ectiai hasfibecn made.
P]ca~e contact- our office on this matter.
Thank you for your cooperation.
Jtu.il~licg Pcrm.it'. If 1 8 7 6 4 Z
Duilc]inc cpt-. '
/ tlo Plumber Solder Ccrt.ificatc on file.
( all permits involving plumbing being
i~sucd aft.cr ,~pri.l 1,1984 )
,r _ _ T ~ -
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGi 1
t Utll. R i BUREAU OF ELEGTRICTTY
88 JOHN STREET. NEW YORK, NEW YORK 10088
Date MAY 24,199Q APPlicatlonNo.onfile fiRU1f459U/9O N i31C1'i7 ~
THIS CEftTIFIESi THAT _
Doty the alectried equipment os deecri6ed bebro and introduced by the epplkont homed on the ebow eppBeetton number in thapromieee of
DONALD DEF'.RKQ$KI, tiLTaAN~S L.AN@, PgIF. It56, MAT TT TUCK, N. Y.
in the folbwinR bcotion; ®Boeement ® lat FL ? Pnd Fl. G A N / A 7 7 I C /OUT Section Block Lot
ulaa examined on MAY l11 , 1 Y 911 and found to he in compliance with the reyuiremente of thin Boord.
RXTURE RXTURES RANGES COOKING DECKS OW4NS OKFI WASNERS EXNAUST fANS
WTIETS AClES SWITCHES NGNDlSCtNT nUGRE3[ENT OTHER NAT. K. W. AMT. K. W. AMi. R.W. AMT. R. W. AMT. N. P.
c~ rL 4 I rT L
DRYERS IEIRNACE MOTORS RITYR! At7lIANC! IEwN15 SNYIAL EK'?T TIM! CIOCKS Eltl INpT MEATEK MU111.0UTlET DIMMERS
AMT. K. W. Oll N. P. GAS R. P. AMT. NO. A. W. G. AMT. AMI. AMT. AMPS. TRANS. AMT. X. P. SYSTEMS AMi. WARS
NO.Of iRT t
1 3U 5 6110 i
SERVK7E DISCONNECT NO.OF S E R V I C E
AMT. AMI. TYPE ~UNR 1 / ]W t p 3W ~ / 3W 3 / aw ~ ~CONa. Of CC
COND. D< NIAEG NO.O NEUT11AL4 ~ pAR
f
1 15u iaf 1 x 1 tlo 1 t!n
OTIIFR AI7ARATUS:
PANELROARD5:1-111 Ctk. 1511
!3.F.C.7:-2
SMOKE UEi7EC7OFt:-1
JULW (UMILLO LTC.R230U-~
t'AT 1ANt
MAT7IfU!:'K, NY, 11952 ORIilAIMAN R
11 ~ fj
Psr I,
This artificaN must not bs ahered in any manner; return to 1M office of the Board if iltwrred. Mspsttors may be iclsM'disd by their credaMials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MIR:T NOT BE ALTlR~ R9 ANY MANNER. -
~R
TEL. 765-1802
S~F~~L~ Cp TOWN OF SOYJTHOd.D
, l~
O ~ OFFICE OF BUILDIt•IG INSPECTOR
= j ' P.O, BOX 728 q ~ i
yE
~ ~ c TOWN HALL ~~L~l`rJ~~U\°JI~..'I~
O `r SOUTHULD, N.Y. 11971 q. ~ r-•~--"'°""'•
~~01 , f,' !MR 2 61891
C E R T I F I C A T I O N
Date ~1pP_t,14 Llo~lolril
Building Permit No. 1~j-llay ~
Owner~r.rY~c~ (~t.~~~cas~c,~
(p Lease print)
Plumber ~
L~n~r~ti~ btt~lwslc,~
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1~ lead.
~ ~ " ~
- (plumber's signature)
Sworn to befor^ me this
day of ~O/1 L__~. ~
-P~+c~
19~ Notary Public
Notary Public, County
NELEN K DE VOE
Nd01Rf WffiIC, SpRe of New YoA
No.470T878, SuHe~k Cau~Yp3
Term Expres Mueh 30.19---F
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FOUIIDATI0;1 (1st)
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FOU'IDATZO'1 (2nd )
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IIJSULATIO:! PE9 N. Y.
STATE EIIEEGY
CODE I _
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ADDITIOPIAL CO?1MENT5:
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ j FOUNDATION 2ND [ ]INSULATION
[ l FRAMING [ FINAL
REMARKS:
DATE ~ ~ INSPECTOR
~o / ~ / - 765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST f ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~.e,~e
DATE -3 ~ INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] F NDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMA S: :c~.,,~ .
DATE ~ O INSPECTOR
l 0 ~ (y ~ - 765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
[Ii]~FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
REMAR S: c~i~
j
DATE ~ a INSPECTOR
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BOr\aD OF HEALTH
~r- 3 SETS OF~PL.\NS
D ~ V'~ FORM NO. 1 $tlRYEY • • • .
l5 v'L, TOWN OFSOUTHOLD CHGCR ~.aSgQ...........
BUILDING DEPARTMENT SErTIC FOaPt _
T 4 ~ TOWN HALL
$OUTHOLD, N.Y. 11971 NOTIFY'o ~P~+-~~'
BLD DEPT. TEL.: 705-1802 CALL .a9F:S~PP: _~Y,(;', 1,30 , _ .
~SOUTNOLD MAIL T0:
Exami
Approved . ,~~/~'D......., 19~a. Permit No.,l~•F.~~`:.~ .
Disapproved~ia/c
...............................cJ%%% ~f!. t~zv
(Bu' ding I •ector)
APPLICATION FOR BUILDING PERMIT
Date Jam' Zg 150 -
~
INSTRUCTIONS
a. Tlus 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 agproval of this application, the Building Inspector will issued a Building Permit to the applicant. Such pezmit
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 Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Re;ulations, for the construction of buildings, additions or alterations, or for iemoval or demolition, as herein described.
The 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 inspections. C~
(Signature of applic'a`nt, or 1name, if a corporation)
- }moo ~~'F 511, ~a~-t~~~c k. N., ~ IGS~...
.1.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
d N L YC
Name of owner of premises ~~°P: ~ ~ co s t~
.
(as on the tax roll or latest deed)
JCapplicant is a corporation, signature of duly authorized officer.
(Name and title of corporate /o~fFicer)
Buildei s License No. `1:~~`'}""4!
Plumber's License No. ~ .
Electrician's License No. N`.~~`: ~ ~ ~'k
Otltcr Trade's License No . .
I. Location of land on which proposed work will be done; C 1 ~ja 1~ s 1--arc, 'Ma 1-~,~~.
House Number •~0.3 S Strcet....L ~aN ~ Lama' • • „Hamlet M~ ~ z ~ , N ~ ~
County Tax Map No. 1000 Section • • ~ ~ • • • Blvck , 4, , , , , , , , , Lot 9 , ,
Subdivision Filed 11fap No. Lot
(Name)
State existing use and occupancy of premises and intended usernd occupancy of proposed constn~ciion: ,
a. Existing 11=~w• ~ l I~w t (v t,
use and occupancy . .
b. Intended use p y I r~w~:l..l..~we~l~r.t ..~.:4.'...........
and occu anc . .
3. Nature of work (check which applicable): Ne~v [3uilding Addition ~6. • • • • Alteration .
Repair Removal Demolition ..............Swimcring pool...........
Tennis Court Accessory Building..........Fence .......Other Work:...........
4. Estimated Cost ~O .a::°.... (q~, oa Fee ~ ~t ~
(to be paid on fling this application)
5. iC dwelling, number oC dwelling units . ~ . ~:'."::l.:'L Number of dwelling units on each door
ICgarace.numbcrofcars ~
6. iC business, commercial or mixed occupancy, specify nature a(td extent of each type of use .
7. Dimensions of existing structures, if any: Front~5~.~:~.l~U:7.~`1.:1?':~s-Rear . P~:.:".`'• `~a'~'-DePth L3•?• . .
Hei^trt Number of Stories . .
Dimensions of same structure with alterations or additions: Front ~ Rear s"i- ~ . .
Depth Height ....?.`t Number oC Stories
8. Dimensions of entire new construction: Front Rear Depth .
Hci;ltt Number of Stories ~
9. Size of lot:. Front DSO. rp~............ Rear Sy. Depth .
,
lU. Uate of Purca:,;e -1. ca ..........Name of Permcr Owner C~.~?:. ~ .k~sl:'..... .
i i. ?one or use district in which premises are situated . . .
12. Does proposed construction violate any zoning law, ordinance or regulation: ..lV ~ . , . .
13. Hill lot be regraded Nill excess ('ill be removed from premises:. Yes . ; No . .
14. Name of Owner of premises~?s~: ~'?..7ce~k°~4 ..Address S«:/~:'.!-:':-.r:":~~'~`~^Phone No..,~~~ :4s~L. , , . ,
Name of Arc}titect .~??a~LI?, ~G~'.'.5 .......Address !~d ~~,~he1~1k`:.. Phone No..:l~Z ._.35~!.... .
Name of Contractor ..........................Address ...................Phone No..... ;i,......:... .
15.Is this property located within 100 feet o£ a tidal wetland? *YES....NO
*If yes, Southold Tovn Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly ail buildings, whether existing or proposed, and. indicate all set-back dimensions from
property Gnes. Give street and block number or description according to deed, and show street names and indicate whether
interior or comer lot.
II n
c1rC1~.~~-ce~v.a~ ~rv~~v~q
CE55t'QOL G:CtdaTit'<°;,j'+:
CEIIARCDItiS'Hei~»»-,~'"`///~.-~
STATL• OF NE~V YORE, S.S
COUNTY OF .
being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
Hcistltc
(Contractor, agent, corporate officer, eteJ
oC said owner or owners. and is duly authorized to pccform or ltavc performed the said work and to make and tle 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 performed in the manner set Corth in the application fled therewith.
Swom to bciorc me this
Notary Public, ,l~~U~....... County + n
1 ,
1101M7n~
swr~te.wt ' ~ • - - • • -
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ (Signature,oC applicant)