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• FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19292 Date August 14, 1990
THIS CERTIFIES that the building ACCESSORY
Location of Property 1315 BRAY AVENUE LAUREL, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 126 Block 8 Lot 7
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 10, 1989 pursuant to which
Building Permit No. 18027-Z dated APRIL 12, 1489
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 ACCESSORY ABOVE GROUND SWIMMING POOL FENCE & DECK
The certificate as issued to PAUL S. & SIISAN M. MASESKI
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. H-017345 - AUGUST 1, 1990
PLUMBERS CERTIFICATION DATED N/A
ilding Inspector
Rev. 1/81
roan xa 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)
. q
N°- x.8027 Z Date .......l..a 19.~.J
Permission is hereby granted to:
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to ...~%1.~-srs,,.i$~:...bra......~'-~-aue..Q.....1.~o-+-P ~cl`j..ce o.~ ~p~~ ~p
ct premises located at . ~.r~~~........s......:Yn
.
County Tox Map No 1000 Sectionn...~.cZi ~R.. Block ..L3.?7.........pLot No .Q.~]......... .
pursuant to npplication dated ~ 19.~..{.., and approved by the
Building Inspector.
Fee S .
.
B ding Inspector
Rev. 6/30/80
. Form No. 6
.
- TOWN OF SDUTHOLD ~ 4
BUILDING DEPARTMENT ~
TOWN HALL AUG - 31990
765-1802 j``
l 1 F ~
APPLICATION FOR CERTIFICATE OF OCCUPANCY `~µf` ~ NCB
- -
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: far new building or new use:
1. Final survey of property with accurate location of all buildings, property Lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
~ less than 2/10 of 1$ lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsihlP for the building.
6. Submit Planning Board Approval of completed site plan requirements.
' B. For existing buildings (prioz 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 Lu dwelling $LS.OU,
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 S years - $10.00
L'puated Certificate of Uccupancy - $50.00
5. Temporary Certificate of Occupancy - Residential(~$ 5.p00, Commercial $15.00
? Date .....QL ~~1~
..cw Construction......././/.. Old Or/~ Pre-ex~ilsting Buil/ding../........
Location of ?roperty..L7..3~.~14L~~.1:[~r~....../~:~{~~:L
.
House No. Street Hamlet
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Onwer or Owners of Property... ~4U:~,ec.J.../..: 11.1.:1ni
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County Tax Map No 1000, Section... ~~.~....B1ock.....~Q ......,Lot....
Subdivision ..Filed Map.......... .Lot....
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PcrmiC No. J.~Q~' ~ ..Date Of Permit. ,T. ...Applican~~9il,(~.
lfealth Dept. Approval ..........................Underwriters Approval......................
Planning Board Approval
Request for: Temporary C~e}rtificate........... Final Certicat ,
Fee Submitted: $......~ti1
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THE NEW YORK BOARD OF FIRE UNDERWRITERS FAr,E ' ¦
nolvl8v
BUREAU OF ELEGTRICITV
85 JOHN STREET, NEW YORK. NEW YORK 70038
Date Al1GU>1' 01.7990 qq I'. ioI}~No. on//je 6957%69CI/90 H 191T:~K5
P~7 yQ. Ifil~?72
THIS CERTIFIES THAT
only the electrical equipment as described 6ekm and introduced by the ayy>licant nomad on the abode appNce[ion number in the premises of
r>AIJI. I. MAJ'ESKI, 1L'S BRAY AVtiNUF, 1'ULF N15, LAUREI-, N. Y.
in the ollomin location; ~ Basement 01_I f 7 26 (It3 0117
f p ? let Fl. ? Ynd F7. Section Blcek Lot
.T IJLY !ti, 1990
uoa a:ermined on and found W be in cantpliance Frifh the reyuirementa of thu Brwrd. -
NXTURE RXTURES RANWS COOKING gRCKS OVENS DISNW AUST FANS -
OUTLETS KBTACLES SWITCNES INCANDESCENT. FlUORESCENi OTNER AMT. K. W. AMT. K. W. AMT. K.W. AMT. ' K. W. AMT. N. P.
l
DRYERS RJRNACE MOTORS lUilMf AMaANCE IREDlRS SHldAI REC?T TIME CIOCKS Yll U1Ni HEATERS MUlil-OUTIET DUAMERS
AMT. K. W. 01l N. P. GAS N. P. AMT. NO. A. W.O. AMT. AMP. NAT. AMPS. TRANS. AMT. N. P. STSTdAf AMT. WATiS
NO.OF FNT
SlRVICE DISCONNlCT fs0. 0t S E R V 1 C E
AMi. AMP. TYPE 1/tW t/tW ~,E ]W 3X AW NO.O~R COND. ACC
COMD. NO~~NI~LEG ~~H~~~G NO.OF NEU1RAt5 p{~EN
UTGNAI
OTHER AY?AMTUS: -
IRAM`iFf)RMER:1- y,VA ~
'1°,WIMMIN6 PElgt.l This, ccrtif Jcete
cnvarv, compliarre at the date of
7nspec:l ion only. Because of untl~suat
rnvlronmen[s it i~z advisreble ho
have frequent test andJor repwirr.
K~;y rle br a qua 7l Yied pr.rr,on.
t'AUI. MA.'tESKT t
1.435 PRAY AVE. _
LAUfts:l„ N't, 11948 O~ MANA~
17
Per
This certificate must not be altered in an manner; return to the office of the Board if incorrect. Ins sctors ~
y p may bi idenl7 i y their crodsntials. _
COPY FOR BUILDING DEPARTMENT. TIRS COPY OF IfICATE ANlST NOT BE ALTEREb- ANY MANNER. ~
D ~ ~ BOARD OF HE.ILTH
3 SETS OF PLANS .
FORM NO t SURVEY
t n TOWN OF SOUTHOLD CHECK . .
*'8~~ BUILDING DEPARTMENT SEPTIC FORM . .
TOWN HALL q o p
TOWN
UFS~ SOUTEOLD65- 8021~J71 NOCALL ~1~:
Q ~A.~........ .
MAIL T0:
Examtncd ~ Z..., 19 ~ Y
~~pProved '~'M~iI~X.. 19~~. Permtt No ~.~.~3:~.'~~.`.. / /~d~. J ~ C1~AN ~Ix/A~
Disapproved a/c l~/.S
.
~qu~2£,~ ~ //9~.~
~.c~'~!•~
(Building
Insp.
APPLICATION FOR BUILDING PERMIT
Date . l(/......, 15 .b
i
INSTRUCTIONS
a Tlus application must be completely filled in by typewriter or to ink and submttted to the Buildmo Inspector, wtth
sets of plans, accurate plot plan to scale Fee accordtn~ to schedule
b. Plot plan showtng location of lot and of buildings on premtses, relationship to ad~otmng premises or public stree~
or areas, and giving a detmled descnptton of layout of property must be drawn on the diagram which is part of this appl
capon.
c. The work covered by this appl~catton may not be commenced before issuance of Building Permit.
d. Upon approval of tlt~s application, the Building Inspector will issued a Buildmo Permit to the applicant. Such perm
shall be kept on the premises available far inspection throughout the work.
e. No building shall be occupied or used to whole or m part for any purpose whatever until a Certificate of Occupanc
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the tssuanc f a Bwldi a it pursuant to th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, other ap cab a ws, OrdinaBces o
Regulations, for the construction of buildings, additions or alterations, o oval or d o ~ i , as harem descnben
The applicant agrees to comply with all applicable laws, ordinances, d de, house ndtir ,ulattons, and t~
admit authorized inspectors on premises and in budding for necessa ns
' Sign ure onf~appliycyant, or me, tf a corporattonp)
• (Mailing address of applicant)
State whethE`r'yfa,~"~ali~can~is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budder
Name of owner of premises~~~~ . ~..1.~... ~ M . ~
(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 . .
Plumber's Luense No . .
Electrician's License No .
Other Trade's License No . .
I Locatcon of land on which proposed work will be done. . , ~ , , , ,
hf.?U.~~- ...l~.~..
House Number J ~Street Hamlet ~J
County Tax bfap No 1000 SCCt10? ld+~/• • • . • • • . Block ~ . , . , , , , . Lot ......1
Subdivision Filed ntap No . Lot .
(Name)
State c~is[mg use and occupancy o(nf~pppre~~mises and intende~~'~d ))))use and occupancy o,f/~p`roposed construction
a. Existing use and occupancy ..V.L~C~ ~ m~•~.y• • • • ~~C7U. ~ .
b. Intended use and occupancy sr~:me Bo Y~....~~Q u~~.... ~ Q,~.,,, , , , , , , , , , , , , , , , ,
3. Nature of work {check «htch applicable) New Budding Addttton AlterauQn .
Repatr Removal . Demohtton O~ie{ Work .
i
,,e/ t (Descnpiton
4. Esumatcd Cost ~°•S.~QD • • • • • Fee ~ -
Ito be patd on tiling thts apphcahon)
5. If dwelltng, number of dwelling untts Number of dwclltng untts on cach floor .
If gara;e, number of cars .
.
6. If business, commerctnl or mt~ed occupancy, specify nature and ceient of cach type of use . . . .
7. Dimensions of extsttng structures, tf any' Front Rear Depth ,
Height ...............NumberofStoncs....-......
Dtmenstons of same structure with alterations or addtttons Front Rear -
Depth lletght Number of Stones .
8. Dtmenstons of enttrc new consttvcttan. Front . Rear Depth .
Hctgltt umber of Stones . . , , ~ . .
9. Size of lot Front . Rear ~S Depth .~~t?Q , . `
10. Date of Purchase ~4 .~~g . Name of Former Owner l ~ i. ~ ~~V...... .
1 1. Zone or use dtstnct m which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation: .N.a . v
13. Ndl lot be regraded Will excess fill b removed from premises Ycs
14. Name of Owner of premtses.,l. f. ~tiSyN.j}1. A~tpd&&~ . I ~ls.~i~ y.~ 1~.. ~l{~IAto. s~9~-.~~.Z..
Name of Architect ..............Address Phone No............. .
Name of Contractor ..........................Address ...................Phone No........ .
IS.Is this property located with in 300 feet of a tidal wetland? *YES....NO~..
*If yes, Southold Town Trustees Permit may be required.
_ PLOT DIACRAhI
Locate clearly and dtstmctly all buddings, whether extsttng or proposed, and.tndicate all set-back dimensi ns frc
property lines. Give street and block number or descnption according to deed, and show street names and ind}~e
wheth
tntenor or corner lat. „p'4£t'~y1
~ r~~ t~ L
i + T,,4~i.
APPROVED AS NOTED ~ x G-''
OATS ~ Y S P, 1f ~ g O.17 1y + ° r + C~'~4t~
FEE ~ X73' ~ BY ~ 'I•' Lo` ~ POOL c~ OCCUPANCY OR
NOTIFY BUILDING DEPARTMENT AT + ~ p t tISE IS UNLAWFUL
785-1902 9 AM TD 4 PM FOR TtiEZz q ~ WfTHOUT CERTIFICATE
FOILQWING INSPECTIONS J 1
I, FOUNDATION TWO REQUIRED 1 Gf pGC(jppNCY
FOR POURED CONCRETE +
2 ROUGH -FRAMING & PLUMBING ~O' _16+_ ~b~ - .
3. INSULATION ~
4 FINAL - CONSTRUCTION MIjS,T ^ `SidiMEDWTEI.Y"
BE COMPLETE FDR C.Q. ! ~ ;aCLD5E POOLTO COGR
ALL CONSTRUCTION SHALL MEET fly`" UPON COMPL6T10N
THE REQUIREMENTS OF THE N.Y. 1 "FORE "WATER"
STATE CONSTRUCTION i ENERG`! t
CODES. NOT RESPONSIBLE FDR tf~
DESIGN OR CONSTRUCTION ERRORS r ~
~~.7, f 1'' V,
~N
STATE OF i\EW)'ORIi, S.S
COUNTY OF ..c~IIF.FOL~..yy.~.
~~~IV ! t 1•-• . S being duly sworn, deposes and says that he is the appiica
(Name f mdtvidual signing contract)
abo.e named.
~Iietstlte........(~(/v.n.Prr......
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authonzed to perform or have performed the said work and to make and file ti
apphcahon; [hat all statements contained m flits application are true to the best of tits knowledge and belief; and that t
work will be performed m the manner sci forth to the apphcahon filed therewith
Sworn to before me this
...CO.......day of 19~~.
\otary Public, ~ !}'.¢:Y.~•:.... County
.
NOTARY PUBLNjC,KSU~M~tdewYak (Signature of appltcat
Na 4703878, SuBolk County
Term Fxpua Much 30,19_.~~