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HomeMy WebLinkAbout18695-z1 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18982 Date APRIL 23, 1990 THIS CERTIFIES that the building ADDITION Location of Property 875 ALVAH`S LANE CUTCHOGUE N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 109 Block 1 Lot 26 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 12, 1989 -pursuant to which Building Permit No. 18695-Z dated DECEMBER 13, 1989 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. The certificate is issued to EUGENIA KAPUSTKA BEEBE (owner) of the aforesaid building. SOFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED Building nspector Rev. 1/81 gosas xo. 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) No ~. 8 ~ 9 5 Z Date .~.1.Y..P.,~............I..,,~...o ............... a9.o~ °/ Permission is hereby granted to: / y' ~/...,~~. .. . .. ... ro .........li.~./.l~iC........~(,......~c~~'.~..~..........~~..., .. .......~ /~ ..... .... ......... e .............. ct premises located at .......i~.~~.......d! . .... ................... . ..............................~. .~:~,-r,~~.........~ . ...................................................................................................../........................................................... County Tox Map No. 1000 Section ...I.~¢. -dl........ Bloyck ....( ................. Lot No..~r4...~.......... pursuant to application doted ............6a.(.~.r~~.......[...,~........, 19..~~ond approved by the Building Inspector. Fee $..,.Jr~i..~1...r.~... i ~I~/~ 7 Building Irrs~ector Rev. 6/80/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- torwith the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, acertificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ..( ~~ .,/.~.~.Q.... New Buildin ... /.. . g ......Old or Pre-existing Building ............ Vacant Land ............ . Location of Property ..8'7.5.....~.~ ~/-J{7.;5.. ~..1~-.{"J. ~.......... ~.~:4-.~~e<i. J.r cl::~ . . House No. ~` Street + ~ Hamlet Owner or Owners of Property .. ~ ~ ~ JE', dP ~ ./.~ .. t .k.,:y: P.u 57,~~~J, , , ,~ ;~ P ;~ , , , , , , , , , , County Tax Map No. 1000 Section ....~ ~ .q...... Block ..... ~......... Lot .. ~:~......... . Subdivision .I.pp ...............................Filed Map No. ..........Lot No. ............ . Permit No. ! p, b.~,~..~-Date o,/f Permit ~~-/,/3~y~.Applicant .~~4~9.~°h.<:5? . ~~1`i9~clS~i~~), f5~~'6~ ~' Health De t. A royal .. N.,17. ~' P pp ................Labor Dept. Approval ........................ Underwriters Approval . ~:,t¢ .................Planning Board Approval ....... . Request for Tempgpary Certificate .....................Final Certificate .. !~.................. . Fee Submitted $ .. h !~. ~ t7 ................ . Construction on above described building and ermit meets affll //applicable codes and regulations. APPlicanty~i~~f~~-rwa...l.la~ ..,.. .. ............. Rev. 10.10-78 ak. ~f.~y8' Co ~.) ~ Yg-a `y - ~~ 1 ~ ~ II - y 'OUIIDATIO`I ( 1st ) ~~ ~ A ' c 'OUtJDATIO;J ( 2nd ti~ m -a - _. I o I ~` 30UGH FRAME & .PLUMBING N H 3. m rn IIISULATIOf1 PER N. Y. I ~ ~ ~ ~ STATE EfIERGY ~ CODE (~ s w FILIAL ( ~ • l o \ '^ ADDITIOfIAL COMMEgTS: Y ~ 6~ ~ ~ ~~ - _ ~ x w • ' • ~ H ~ t 9 H O \ =.~ m ' ~ ~ ~ a d• m -o a f ~ ~' ro ;~~,C~ ~~ ~ ~ ~'~~~ -" ro 't" `~' ~» ` ~ c e j 4 `^~, ~M ~~ ~ ~`' ^_~ ~ ~ ~, ~ -r ~ n ~. °~- `~ l r~-^-. ~i~ ~7 ;~ u ~ ~ ~. ., ~ ~~~ ~ s ~ .. ~ ~ 4 ~~ ~ q~ y } ~d ~4 t';~a ~~~ ~ , w.~ ~~^^ ~° ~u~ ~ 'C~ema+ ,~.?,eR us.~, l ES u r7 ~ ,P (~ ' ~ y~ Vla '~ pr.~~~~ "iy e. G % ~A "e ~ 9 * n t u ~. u~ M ry 5Y fi ~~ r~ ~ a X1-,1 ~~ -~ ~~a~~ '~' ~ ~, T st N p~ O rt n ,-~ N'~mUa`~rP~pt9Y2usc`. ON'QN ~ ?~~2t~t1 'y.~ ~~~}m0 T~h m ~' tnjmt~°~2gpt~tr'.'22 ~+~n ~~~~~~~ p~~2 7 pN~p ~p ~ Gm ~.. p R.. W~ tt1 'L r ~ may, C, ~ A ~ ~ ~ ~' ~ ~ ~~o 5 ~.r' ~ ,_ '~- M: THE NEW YORK BOARD OF FIRE UNDERWRITERS PArf , a' lt~sllns suREwu oR E~ECTRICm OE JOHN STREET,NEW YORK. NEW YORK1009f pew IrF.CI~MNt:R 13,19$9 ApplicetionNo.onfile 6510'ltil19/A9 - N 1CI71H6 ~°: TMIO CERTIFIES THAT "- oaJr tM eMetripi puipwtsnt N deecrtbed 6ekno end iwtroduced 6y the epplicent horned on the oboes oppWeotlow narnber in tM proetieee ~ Ji::N KAI'lP.i1KA. R75 ALVAH'S LANp, P'01_C'tl9A, f, 11C1;N0i;UF:, N.Y. in tluJolloteinR kuetion; ®Boearnent © IAe FI. ~ Pnd FI. tl ll7 Srrtlou Mock Lot uw a:emined on OE' Y; [~. M H k. R l14 , t'1>l9 end found to 6e in aromptiann with tke rcquirontentr q(thu Baerd. COPY FOR BUILDING DEPARTMEWT. THIS COPY OP TI ICA ER. ~ /Ift11Mf t,'ppIEM g4NCltf O VWt ~ T fl{titnf ~ ~~ nCANOliClNT tlUOtHClM aTNEn NAT. R. W, AMT, K. W. AMT. LW. AMt. t. W. AMT. X. r. la <~ za In ~ r _ o- ORYNIf RJRNAn kwtats wron At1YY1gR~ er-r rwtaoas pLL utmttuttrs. O1kIk1Nf _ - - ,~iMT. t. w. at X. r. OAS X. r. AMr: n0. A. w. a AMR AAV. Arr. AAYt: TRMi4. +iMr. X. r. 1~:0-- Aur. wArn s r 1 ^levlca eaeoHewcT ta.a s e ^ v 1 c s _~ AMr. AW. rrre ~ / tw t / tw t i tw t,e /w ta. or cowo. w. o. ea. or recto A. w. uo. a.auttus oi'twei~ut - 1 10(1 C1S 1 x 1 E 1 h OiNM ANIk1hTUk ~ n SMOKE' 1>E.1E f:l OR: -? y / ~ V 1 -' I ~ _~ t~ ~ ~ ~ ~~ IAKl E,LCCI"RtC L.TC .I1Cid8 ~ / 1! t(rRF::~f 'IltAll ~ NTI?GE, NY, tl'abl ~u~ t l Pa Thit wt(&eb mutt not bo ok~nd ks aay nwmwrs M b fM o ' of: tM bard if incorrect. ...: ittr . . tlr& cndenHak. FORM N0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .//~??-~G.. r.~....., 19~~../ Application No . ................. Approved .kf~ . ~.,~ ....., 19 ~~Permit No.. ~,?.~~~~ Disapproved a/c ..................................... ................................. .f .. .. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date . ~-?u:.. ~.~-....., 19 ~:;1 a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue a Building Permit to the applicant. 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 Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or 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 to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) /.`111 „i1.~c4.S4i:{.~-s~.~):~,1,~,~,~. ~.C<a.?.C~~.^~sw/ N:~. (Mailing address of applicant) /! y~g -- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................~a..........y.-.....,1............................... Name of owner of premises .....~G4,~~yj.l.~?.....1•~. r.!~:~.~:E.-~1..~`.,'7 :.............................. (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. ./. 3.~. ~~T..~1......... . Plumber's License No . ....................... . Electrician's License No . ..................... . Other Trade's License No . .................... . 1. Location of land on which proposed work will be done ~~ T t House Number Strc~eet Hamlet / County Tax Map No. 1000 Section .... ~..~1.. 1........ Block ....~ ............. Lot ...~~ .E~,. Subdivision ..................................... Filed Map No. .............. Lot .............. . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... G .i~: ~'... ~cl.,(~.r. ~ ~~~ 4-~r.P. r~ ~ ~. JZ ..................... . b. Intended use and occupancy . (~ ~-...... [~{I. CN. < .~y... ....... ~. / . / , , , (,,tl, y ~~?, , , r/ , k , , , ... . 3. Nature of work (check which applicable): New Building .......... Addition ..~:'''..... Alteration ......... . Repair .............. Remgval ..... , ........ Demolition ..............Other Work .............. . ~ (Description) 4. Estimated Cost .. ~~ 4'~::d. ~''' .Cr. t) ..................... Fee ...r U.. ~. ~ ............ . /• ~ (to be paid on filing this application) 5. If dwelling, number of dwelling pnits ............... Number of dwelling units on each floor .....:,......... . If garage, number of cars ........................................................................ . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... . 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. . Height ...............NumberofStories........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ................. . Depth ....................L.. Height ......................Number of Stories ..................... . 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. . Height ......::.......Num'berof5tories........................................................ 9. Size of lot: Front ....................... Rear...................... Depth ...................... 10. Date of Purchase ...........i .................. Name of Former Owner .... , ....................... . 11. Zone or use district in which premises are situated .................................................... . 12. Does proposed construction violate any zoning law, ordinance or regulation : ............................... . 13, Will lot be regraded ...... ......... .........Will excess fill be removed from premises: Yes No 1.4. Name of Owner of premises ~uT9 ~e n.~ H:. ~:A:Pc<57•~'A Address . G~aT.`Gii d ~. u~ x:...... Phone No. ~.3 4.. Ea(n f,J... . Name of Architect ..........I ................. Address ...................Phone No............... . ~ ~'.t/e.~ rv.. i3.k%/~rcS. Address ..G:,t"y:c.{I.o. q.ca.~p... Phone No. ~.3 4/-(c.W.d;~ .. . Name of Contractor a Yh ..!tf , I PLOT DIAGRAM Locate clearly and distinctly all, buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. I ~~vf F ~t , ~,~ , I _ ~~~ ~ STATE OF NE1~Y RK, S.S CO Y OF ~ ~~~~ ~/• •(•Name of mdtvtdual st n ~ ~ g ng contract) above named. SHeisthe .....................G~2~'L/'L~!~..~ ..............,............ ............................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work wilt be performed in the manner set forth in the application filed therewith. Sworn to before me this ,~~ Y ..............7~'t : , ~:4 ......., 19 . Notary Public, ......d~~ ~ .. ?~~ ....... County n SYLVIA~'K. ROUSE ~i.~ty~~a.ds. ~/L[. ..... !i-~ .~ .i!4~~~4~-~!`^•-~'. . Notary Public, Mate of New York o No. 4674306, Suffolk County (Signature of applicant) Commission Expires, July 3t, t~G.. ~', I f`.. . ~~ ~s being duly sworn, deposes and says that5te is the applicant