HomeMy WebLinkAbout18196-z Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19496 Date NOVEMBER 8, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 235 PEQUASH AVENUE CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 103 Block 7 Lot 31
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore i
filed in this office dated JUNE 7, 1989 pursuant to which
Building Permit No. 18196-Z dated JUNE 12, 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 ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to CHESTER ORLOWSKI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-107453 - DECEMBER 14 1989
PLUMBERS CERTIFICATION DATED OCTOBER 29, 1990-HENRY J. SMITH & SON INC
Bui ding Inspector
Rev. 1/81
msas< 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)
N ~ 8 9 6 Z Date ...........~.,c~-~.n...t..z 19..x. q
Permission is hereby granted to:
.~.IS,,,.....~.,.~.......~.r.9 .s.~..
ro ..~'~4`.:4 tfi'....s~.......GL.aQ.rA
.~t'.an...Y..u.... ~...:4~
~.Is~ii.~:!:t.~.....~'...... R.u~.:~.~......
at premises located at .,ct~:~J....... ~g:~..... .:......~.,.'..:t~;!~9-,-
.................................................................................................................................11...............................
County Tox Map No. 1000 Section .......I. ~.3...... Block ......Q-I......... Lot Na....~.~
pursuant to application dated .......~.Art^.'!?4... ~ 19~.~.., and approved by the
Building Inspector.
Fee 5
Building Inspector
Rev. 6/30/80
r ~
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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 1% 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.
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
yew Construction........... Old Or Pre-existing Building,^ x,,,
.ocation of Property....~..~.s;;,,,,,,,,,,,,,~?~, l~:~l:~~.. .~.d.~~?:~a.t~
House No. Street Ha~Yet
rower or Owners of Property... „ ~>F: Sx:~:~r`:.~ , : _ , , .
'ounty Tax Map No 1000, Section.. .'.D,,,j ,,,,Block....~,.,(,,,,,,,Lot..s~.I
ubdivision.........
G ..Filled Map.......... .Lot...............
ermit No... Q . p.,Datpe~ Of Permit.. , ,Applicant.,(/ ~s-~~;+:.; S;[1..; .
ealth Dept. Approval...~.•.`` .:................Underwriters Approval..l.x../..Q,/„y
lanning Board Approval
equest for: Temporary Cer't,-if)icate........... Final Certicate., 1
ee Submitted: $....~~'.Y.` ~J
~ • N oho ~ . f . ~X:
~x`.'~.:~GS-~.... .
POZ IYNY~ APPLICANT
THE NEW YORK BOARD OF FIRE UNDERWRITERS t1AC> .1 .'~~s
! 7~0~1071 BUREAU OF ELECTRICITY ~:"jy
85 JOHN STREET. NEW YORK, NEW YORK 10038
j Bore DECEMBER 14,1989 Application No. on file 65102789/89 N 707253
il~
j THIS CERTIFIES THAT
i
I only the electrical equipment as described 6elom and introduced 6y the oppficant named on the oboee application number in the premises of
'd;
CHET ORLOLiSKI, PEQUASH AVE 3RD ON EAST, CUTCHOGUE, N.Y. Vii,
in thefollouing location; ? Basement ® lat Fl. ? 2nd Fl. Section Block Lut li.
uns examined un DECEMBER 07,1989 aredfound to be in cunrplianre uirh the rerynirements q(this Board.
FIKTURF ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT K W. AMT. N. W. AML K W. AMT. K. W. AML. H. P.
3 5 3 3
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS REII UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. On H. P. GAS H. P. AMT. NO. A W. G. AMT, M1P. AMT. AMPS TRANS. AML H, p SYSTEMS AMr WARS
NO.OF FEET
SERVICE DISCONNECT NO.OF S E R V I C E
AMT. AMp. TYpf METER I q 7W 1 0W 3 9 KW K ~ AW NO. OF CC. COND. A. W G. A W. G ~ A. W G
EQUIP. 'e PER 9 OF CC. COND NO.OF NI-lEG Of HbIEG NO.Of NEURRAIa pf NEUTRAL
(je
OTHER APPARATUS:
WIRING FOR ONE ROOM ADDITION ONLY-1
d~5iii
G & S CONTRACTOR LIC.#578 E " C~j~
BO$ 215
SOUTHOLD, NY, 11971 , ' GE~NERA1 MANAGER '
. ~ Per~Y~ ~
This certificate must not be altered in any manner; return to the office of the Board~if incorrecf.~ Inspectors may be`.idelftified by their credentials.
~~t
HENRY J. SMITH & SON, Inc.
PLUMBING. HEATING 8 FUEL OIL
MAIN ROAD
SOUTHOLD, N.Y. 11971
(616) 765-3690
C_E_R_T_I_F_I_C_A_T_I_0_N_
.
Date_ Octobe~~q,~~94__
Building Permit No.__1 ~ ~ ~(G
Owner Chester Or~owski_____________
Plumber Henry_J__Smith_&_Soni_Ine_
I certify that the solder used in the water supply,
system contains less than 2/10 of 17 lead.
Henry P. Smith
Sworn to before me this
_2~th day of _ October ,
Notary Public
Notary Public, Suffolk County
DERN~DEiTE L TAAIstIN
NOTARY PUDtIC k4844893
State of New York
Residing in Surtdk County
Commission Expires Sept 30,1911' L
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IIJSULATIOII PER N. Y. y
STATE ENERGY '
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Tel. 734-6782-Residence Office-734.6693
APPROVED AS NOTED CHESTER ORLOWSIC!
DATc ~ / $9 CiP l94`~ CONTRACTOR & BUILDER
NOTIFY RUILOIN r DEPARTMENT qT CUTCHOGUE, NEW YORK 11935
786.1802 ~ AM `'fp ~I ?M POR THE ~ C ~ ~ ~ r
FOLLOWING INSK~F:CTION5
1. FOUNDATION TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH -FRAMING & PLUMBING 4
8. INSULATION ~ # ~
4. FINP.1. CQN$TRUCTION MUST
;a
BE COMPLETE FOR C.O.
ALL CONSTRUC`,f10N SHAII MEET
THE REOUIREMENT$ OF THE N.V.
STATE CONS A ENERGY
cooES, tr>dl~~I~PONSIeLE FOR OCCUPANCY OR
DESIGN OR CON8TRIK:IION ERRORS 5
USE !S UNaAWFUt
w~rwour cE~riFrCArE ~ ~
OF OCCUPANCY S~~{~6•~'
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UhrJ)cN+rIRfTERS CERTiflCAi~
d?[t~.UIRfD
Andersen STURTEVANT MILLWORK CORP.
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® 75 N. INDUSTRY COURT
DEER PARK, N.Y. 11729
w~+oro..•A~pnoa, PHONE 516-667-8700
DATE 70B
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Airderse~ STURTEVANT MILLWORK CORP.
® 75 N. INDUSTRY COURT
DEER PARK, N.Y. 11729
w~m~•r~.bn~. PHONE 516-667.6700
DATE 70B
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~~FORM NO. 7
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
~ TEL.: 765-1802
Examined ,cv.~. 19?~.`~ Received........... , 19.. .
Approved w-Wt-.. l 19 ~ 9. Permit No. ~ . 8.~. ~
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT r~ q
Date ~-r4~!^'~:". 194 .
INSTRUCTIONS
a. This 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 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
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 building for necessary inspe~ct~i~~on~s~. n/~
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........'.e,' x.13-r~/~?~^-/-~....~... (.1 .
Name of owner of premises ~..1G.s-qx~^. ~W~~l.~~*j`.3-(~"' .
(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. ~ . ~.5~..~. ~ . ~'J .
Plumber's License No . .
Electrician's License No. ..~..~.4~.. E .
Other Trade's License No . .
3 s . .
1. Location of land on which proposed work will be done. ~
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot .
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 ...~'}'p: `.''t`; ~u~,,,.,,~Q. t
...~.//.f
_.'':n''~-~' .
b. Intended use and occupancy .~-?~"?^'°-~.`'..~c~'. .X.•!Lp?'."a"~.. ~?Lti^, .
3. Nature of work (check which''applicable): New Building
Addition n...... Alteration .
~ Repair Removal Demolition ..............Other Work .
,g~ ~ ~ (Description)
4. Estimated Cost .~.0'Ty Fee ....5.~.~............................. .
i (to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor .
If garage, number of cars x..~............. .
6. If business, commercial or misted occupancy, specify nature apd, extent of each type of use . .
7. Di ~ensions of ex~stin stru Nures, if any: Front ?c"/.` . `....`..Rear ...:?~.y...:: Depth .
Hei ht ember of Stories ~ .
DDimtehnsions o~ acme structure'iwith alterations or additions: Front ~ y Rear . ~ ~ .
' p ..Height ?r: , . Number of Stories ...?r.' .
8. Dimensions of entire new con$truction: Front Rear ...............Depth .
Ha;uht , I~T,lmhar of Stories . „ : ' '
9. Size of lot: Front 7. S ~ Rear ~ S' ~ ~ Depth ~ ?S~ ~ .
10. Date of Purchase 1. if.5-~
`j .....................Name of Forme Owner ?.~a...~?.R, 1~.,.,.?~1~,~,, .
11. Zone or use district in which premises are situated IZ :•ra--`~ .
1'2. Does ro oseg construction violate any zoning law, ordinance or regulation: . . .
p p
13. Will lot be re raded ~1-t'^ Will excess fill b removed from premises: Yes
14. Name of Owner of premises ~?~.s.o$r. ~nQ.ti,...Q,.`, ,Address Phone No. Z3`f. , b7 F! .
Name of Architect Address ...................Phone No............... .
Name of Contractor ~?~ax.~^-~T.~ ..Address ..~°^~:¢~-~-°',-....Phone No.7. ~ Y: b ~ p~ .
PLOT DIAGRAM
Locate clearly and distinctly i}il 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. /
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STATE OF NEW YORK, II S.S
COUNT F .
(Name of indi~vidual~sig • ~ ~ • ' ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant
'Wing contract)
above named~.~ ry~
He is the . ~.-!^;.,?Cil .U.'~^.'~,:'O.° .
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dyly 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 will be performed in the manner set forth in the application filed therewith.
Swom to before me this
........................day of.....................,19...
Notary Public . I,................. County
.••..•.•.•,•.~•.•••~..•....(Signatureofapplicant)