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4
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24486 Date JULY 10, 1996
THIS CERTIFIES that the building REPAIR
Location of Property 51250 MAIN ROAD SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 70 Block 2 Lot 5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 8, 1989 pursuant to which
Building Permit No. 18358-Z dated AUGUST 8, 1989
was ieaued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
ieaued ie REPAIR E%ISTING PORCH TO ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is ieaued to MARY JANROWSRI & JOSEPHINE PLANZ
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inape or
Rev. 1/81
rosat xa s
' TOWN OP 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 18 3 5 8 Z Date 19.C7....
~
Permission is hereby granted to:
' ~i~~-X1,1`....
ro i .-.........>3..:~..:~.aC...~~r....
..........................`~e~~~:`~~Tl...~.~..../~....................... ~/~f
at premises located at ......~~.d..'~~..,.~..~JG
:~./...,.~~..f.'1......~,cl:~
.....1/..~..~.~i~l.•
. . . . . . . . . . . . . . . . . . . . . . . . . . .1. . r. ~
t l.... . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LL'\
County Tox Map No. 1000 Section .....~J Block Lot Na.......7...............
pursuant to application doted .....L~ 19.~~and approved by the
Bui lding[`I'nspecto~r.)
Fee $.~••~ir/..~.[/....
Building Inspector
Rev. 6/30/80
C7rm VC. b
k TOSv~i OF SOUTHOLD i~~
BUILDING DE°9RT:LEVT ~ t, r~-- ~ y { 1
TOCN EL1LL ~ ~ )
765-LSO2 JUL -91996
APPLICATION FOR C'cRTIFICaTE Or OCCJPaNCY pLDG.DEPT
~ TOUJlU OF SOU7HOLD
This application must be filed in by typewriter OR inic and submi*_ted to the building
inspector with the following: for new building or aem use:
1. Final survey of broperty with accuratz location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Hea1Ch Dept. of water supply and sewerage-disposal(S-9 form).
3. approval of electrical installation from Board o= Fire Under<ariters.
y. Sworn statement from plumber certifying that the solder used in syst _n 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.
o. Submit Planning Board approval of completed site plan requirements.
3. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
L. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. Apronerly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall statz the
reasons therefor in writing to the applicant.
C. tees
i. Certificate of Occupancy - New dwelling 525.00, additions to dwelling $25.00,
altzrations to dwelling 525.00, Swimming pool $25.60, Accessory building 525.00,
additions to accessory building 525.00. 3usinesses 550.00.
2. Certificate of Occupancy on Pre-existing Buildine - 5100.00
3. Copy of Cart ificate of Occupancy - .25~.
G. Updated Certificate of Occupancy - 550.00
5. Temporary Certificate of Occupancy - Residential 515.00, Commercial 515.00
Date
Vew Construction........... 01d Or Pre-existing \3uilding.r......\.\........ Q 1
Location of Property.r?~a~R.. ~a.1Q,1 ~UDi~4-. .......:?oJ~:o~O.j_ ~j~ ~1,\~,1,
House No. Street Hamlet
Onwer or Owners of Pronerty....~D~~.e~^.~ ..~~.1-ah~^ ~..~[4~`~. ~B?~:,~QIg~S~i , , ,
a,
County Tax PSan Yo 1000, Section... ~.~......B1ock....!~':.........Lot..~
Subdivision..*~..p
...................:~'........./r~igled `Lan............Lot......................
?ermit vo.IR 9tiS 0~....Date Of Permit..$ I$.~9.1.....:~pplicanc
iealth Dept. approval ..........................Underwriters Approval.........................
?lapping 3oard :approval
tzauest for: Temporary Certificate........... Final Car*_icata...........
'ee Submictzd:~5 ~~,,0~
1~~++pp~
QJGC. , S I J0~ ~ aPPLICavT •
~ o ~aY'f~~
~OgOFFOI~-C
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Town Hall, 53095 Main Road O • ~ Fax (51s) 765-1823
Southold, New York 911971 y~o! ~ ~aO~ Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
July 8, 1996
Ms. Mary Jankowski
C/O Robert C. Planz
52 Blauvelt Drive
Harrintgon Park, NJ 07640
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 18358-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
" ~ 765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ~ ] ROUGH PLBG.
[ ] F DATION 2ND [ ]INSULATION
[ FRAMING [ ]FINAL
REMARKS:
DATE 0 ~ INSPECTOR v~
IFID I=D AWN f0f9) Zt9 Q
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STATE EfJERGY
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ADDITIOP)AL COMMEf1TS: `
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BUILDING DEPT.
I NS~ECTION
[ ] FOUNDATION iST [ ]ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INS TION
[ ]FRAMING FINAL
[ ]FIREPLACE 8 CHIMNEY
REMARKS:
DATE INSPECTO ~
~ BOr\RD OF HE~ILTH .
FORM NO. 1 ~ 3 SETS OF PLr\NS .
SURVEY
TOWN OFSOUTHOLD CHECT;
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL
vOUTI10LD, N.Y. 11971 NOTIFY ~7r a~~~j
TEL.: 7G5-1802 CALL .
19~% MAIL T0:
[xamincd .~'~.t~J, ,7 n p~ ,
.\pproved G~~/~ 1~~Perrrti[ No. ,~~j ~ D ~ ~ ~ I1 V
Disapproved a/c
- AUG - 8
~2e!!~~U.:: BLDG. DEPT.
m 4~ .(O. 'rowN OF SOUTHOLD
(Building Inspector)
APPLICATION FOR 6UILDING PERMIT ~~jj ~y
Date ....Q~~ 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 stowing 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 m\tst 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 Buildin; Inspector will issued 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
Quilding 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 building for necessary i ec ons. ~ / j
-v..~ .~CJiI~,
(Signature of applicant, or name, tf a corporatton)
' (Mailing address of applicant) /~~y yr,'
Siate whether applicant is owner, lesseee, agent, architect, engineer, general contractor, electrician, plumber or builder.
\ame of owner of premises (I la~~ `~.~~5 ~?.........J V`1,4,~~ ~(~t.t~. ~ .
(as on the tax roll or latest deed)
IC applicant is a corporation, signature of duly authorized oCflcer.
(Name and title of corporate o/ffic11er/),
Buildci s Liccnsc No. . ~ J.~_....... •
Plurnber's License No . .
Electrician's License No . .
OtlterTrade's License No .
I. Location of land on which proposed work will be done. .
~~.~a.~o..... ......~a,.~....~-.~.......... sn~
~f~o~~
house Number Stree[.
- Hamlet
County Tax A1ap No. 1000 Section ~ - • • • . Block . , - , , ~ , Lot
Subdivision Filed t<tap No. Lot .
(Name)
State existing use and occupancy of premises and intended «se at d occupancy of proposed construction:
r
a. Existing use and occupancy ~t~1~~~ • • • ~ ;u?-Z,~! l
~ 'y.l~t,:.......
b. Intended use and occupancy ...................1. kl.{.'t!1.~......................................... .
u
~ P . }j ~.e ,c R`,applicable): New Building , , , , Addition Alteration
3• Retnirofcvor~•j~he(~,l.which~oval.......
. ~
• • • • Dcmolitioti Other 1Vork .
4. Estimated Cost .......L~Q~~~r~~, ~ (Ddscription)
Fee ..~iA.,~.~~.........................
5. if dtvclling, number of dtvcllin (to be paid on filing this application)
g units Number of dwelling units on each Poor . , , , , , , , ,
If garace, number of cars ~ , , , , , ,
6. if business, commercial or miffed occupancy, specify nature and extent of each type of use , , , , , , , , • • . • • ,
Ilcicltt 6.... Nures, if any: Front Rear .
mbcrofStorics.....,,,,,,,•,,, Depth
Dimensions of samet tructure with alterations or additions: Front
Depth. .Height. Rear.................
' 8. Dime ~ ~dr enClte new constntction: Front , ' ' ' ' ' ' • • • • Number of Stories .
Height ..?Nuinber of Stories Rear Depth .
m 9. Size of lot: Front'..,.... ti. Rcar•
• Depth
10. Date ofPurehaSe ~
...................NameofI=ormer Owner
1 1. Zone or use district in whic]t premises are situated ~ ~ ~ ' • ' ' ' ' ' ' ' ' ' ' ' '
1~. Will lot be re ~ constructton vip • • • • • • • . • •
p p graded late any zoning law, ordinance or regulation: ~ ~ ~ •
14. Name of Owner of premises , , ' ' ' ' ' ' ' ' ' ' • Ntll excess fill be rempved from premises: Yes Nc
Name of Architect " " " " " " • • Address ...................Phone No. .
Name of Contractor . . . . . . . " • • • Address Phone No... • . , ~ ~ • • • ~ •
IS.Is this propert loo •'••"'•••..Address phoneNo.
y ated within 300 feet of a tidal wetland? *Y);S....NO....~
*If yes, Southold Towp Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all, buildings, whether existing or proposed, and, indicate all set-back dimensions frort
property lines. Give street and block',number or description according to deed, and show street narri'es and indicate whether
interior or corner lot.
aJi l~
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STATE OF \E\V YORK,
COUP Y OF S
. ~1~;~' being duly sworn, deposes and says that he is the a
(lame of individual sip ;contract)
,~bovc named. PPlicant
. ~1~-f~'SM..f'~.?............
' (Contractor, agent, corporate officer, etc.) ~ ' '
~f said owner or owners, and is duly ;juthorized to perform or have performed the said work and to make and Glc this
PPlication; that all statements contain4d in this application are true to the best of his knowledge and belief; and that the
'~orp twill be perfortncd in the manner sut forth in the application fled thcrctvith.
^vorn to before me this ' ,
• .day
ovvf 19~.`/,
ry Public, , , , , :Q County
o t a ~ ~..~J`•1.~j
HELEN K. DE VOE . .
NBT~RY PUBLIC. State of Nqw Yak .
No.4707878,SuHolkCapnly ~ (Signat•re ofa• .hcanq
Term Expires M+reh 30,19... Pp