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HomeMy WebLinkAbout17307-z ~ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17338 Date SEPTEMBER 22, 1988 THIS CERTIFIES that the building FOUNDATION Location of Property 155 GOLDIN AVE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 135 Block 2 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application far Building Permit heretofore filed in this office dated JULY 29, 1988 pursuant to which Building Permit No. 17307-Z dated AUGUST 8, 1988 was issued, and conforms to all of the requirements bf the applicable provisions of the law. The occupancy for which this certificate is issued is FOUNDATION UNDER EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to FRANCES ADAMOWICZ (owner, ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A Buildin Inspector Rev. 1/81 Bossx 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) NQ 017307 Z Date 198 Permission is hereby granted toAA: , "~~f:~ Ali........ . -y; , ro ..~7~AflStr.lL.....~~-z9...~. l~~l~.....~.r~f......~.~~~'.......~.:~: yl /5`~~......~.... .r......r,~-r.. of premises locUated at ...5'?,"~, s.....s~~a"•4•• ...............................j......_...~......................................... ..........................................~J~ .k~....~.~~<.................................................................. .......................................................................2,....................................................................................... County Tax Map No. 1000 Section Block Loot No............~(o........ pursuant to application dated .........../..,1...'/'Z..-..9 19.~L1, and approved by the Building Inspector. ~ Fee ®v r .........r... uil ing Inspector Rev. 6/30/80 a 'c'lELD I::S: E'C:'_u:i ~~UA:a ~CMMENT° ~ -o ~ ca a 7. ~ ~ H FOUI7DATION _ (1§t) T c ti FOUNDATIOIJ (2nd) _ - - ~ 2 . ~ . z ~ o P,OUGH FRAME & PLUMBING ti H 3. x, rn IIJSULATION PER N. Y. y STATE ENERGY CODE 4. .-~y FI;JAL o ADDITIOPIAL COMMENTS: ~ :.a _ O~l"i ra ~ . x \ w H ?J H H O 2 . ~ m aa"~ x~ ry m -o H -~~o gC Y~ I FORM NO. 6 S~ - 5-_3 7 7 TOWN OF SOUTHOLD ~'"`~/L"~°~ / ~ 3 ~3 Building Department T ~ 7own Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~sr~~ to the Building Inspec- ` for with 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 property 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. pate of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling, $25.00, Accessory 10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50 , 00 3. Copy of certificate of occupancy $ 5.00 , over 5 years $ 1 0 .00 . 4.Vacant Land C.O. $ 20.00 _ p G 5.Uodated C.O. $ 50.00 Date .~6i,~9~Q,,,, New Construction,,,,,,OldorPre-existing Building VRac~arn>tLand Location of Property l ~OL06%1~, ~~/E7... ~p~/'Tt,~,QGI~, , . ; { • • . • • . • • . House No. Street ~ ~ ~ • ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Ham/et Owner or Owners of Property ~~/J~Y,?,CEj , , ~QR/j~,oCcJ( . . . . _ . County Tax Map No. 1000 Section , , , {,-3,J~, , , , , , , Block a.......... Lot ~f~ . Subdivision .................................Filed Ma P No. ..........L//~~ot,,No . Permit No.d~~,3Q,~, Date of Permit .~l~/,~~,Applicant..~R/!~~-,/?!/HMaZJIGZ. Health Dept. Approval ........................Labor Dept. Approval Underwriters Approval ........................Planning Board Approval Request for Temporary Certificate . . .Final Certificate , _ Fee Submitted $ . Construction on above described building and permit meets al/l~ap/p{icable codes and regulations. Applicant `~i'l'{,I~LC,~, ; , ~Ll~,~~;~yhf, Rev. 10-te-?B • ' • • • • R~~3s 7sq C e ~-1~73 3~ l "Z ~©'Z ~ 765-1802 BUILDING DEPT. lNSPECTiON [FOUNDATION 1ST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING E l FINAL REMARKS: ~ ~ ~ ~ - DATE ~ g ~ INSPECTOR ~G1 C> l \ ~g 98 3q' MS ~ ~ „ E r~~ es o2~ 50 N a N 0. N ~ Eg. N ~ O ' / A T ~ ~ i. c a ~ e.~ N FApN_. 6 of °A Np~SE m Q ~ m~ ~ e' - ~ N ~ Y~ e~P~ Z FS~yED ~e.a R3,1. ~ ~ $ o2i rjo 8 Z 'g 12~ ~ a, O vo E. \ ~5 ~2`' ~ ~6 ~ \ ~gl PO l~~ Prepared /n accordance wllh the minLmum \ "O rlandards for Mlle surveys os eslobllsned by !ha L.l.A.L.S, and approved snd adapled ` for such usa by iha New York Srola Land ~ `N• Tlt/s Associallon, w \'O i SURVEY OF i o rs » ~ ~8 SUBD/VISION OF PROPERTY OWNED B Y CERTIFIED TO' NATHAN G OL DlN T TLE INO. S 968666UARANTY COMPANY FILED NOV. 22, 1932F1LE NO. 1106 FRANCES ADAMOWICZ AT SOUTHOLD SNERYL ADAMOWICZ TOWN OF SOUTHOLD QLANDS SUFFOLK COUNTY, N. Y. 5~ A.Ih Gq 1000 - 135 - 02 - 16 ~~~o5``Pa" ~FGy`~".~. Scale = 30~ + Y.S. L1C. NO. 49666 June 1, 1988 ~ © 5 v ,r RS', P. C. SO L .Y. 1/971 88 - 352 BOARD OF HEALTH 3 SETS OF~PL.INS FORM NO. t SURVEY . TOWN OF SOUTHOLD CHECK ~~5:~........ . 6UILDINGDEPARTMENT SEPTIC r•otzrt TOWN HALL SOUTHOLD, N.Y. 11D71 NOTIFY G ~i TEL.: 765-1802 CALL 1~~6°.~<d~".~~.~,~. PZ . Examined . t~0• .f.G..~.(.., 19~~ .~y/' MAIL T0: ~J~,~ /,~'0~ Approved ..(R~ .1.4. 19 Pcnnit No. /.7J~ O ~ J~ Disapproved al/c •43• ~ • d BLDG. DEUTHOIb • •TOWN OF SO (Bu' no Inspect r) APPLICATION FOR BUILDING PERMIT s~ t~ Q Date r 154~.~ 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 plat 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 HERESY 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 com 1 with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorize ~~tg uses and in building for necessary inspections.. ~T,P,tg - ~w,,~,,,,,- ~ t3 (Signature of"applicant, or name, if a c p ration T#g tiA~' ~t$@I Y-iiT+?; .5 ~ ; Jam. ~ : (•r' /V 7, ~S~tt ~~'=!`f,g :s', i (Mailing address of applicant) • tiM[St'Ad3iA4lt"9't .f State whe er ap t6'I~F~9s's~ agent, architect, engineer, general,cgnt;gctor, electrician, plumber or builder. .......tat~~rs~ahi`~f~. r................................... • T~as!~ ~t~T:~c~~a~t~~a~.t ti, a: . Name of owner of p,~87i~~~1?.33.~9'~~'/1'~~' .U F ,n (as op„,the,Ia;c rgll or latest deed) If applica~~ a rp~~~„r~~~~ature of duly authorized officer.' ~ ^ ~ ~ ~ a-~ Y. ti{Fal ~.ll3t~ii1C'-~:S~i'i aGhA , ~ , f . v., i%~~'`ae an't~~i~~e of corporate officJer~.)-yam Builder's License No. , ~~.°1/, - Plumber's License No . . Electrician's License No . . Otter Trade's License No . . 1. Location of land on which proposed work will be done. ; , , , • • • • ~r.'lJ,~1~/~1J.L~I~y~......5'IJ,U~/~.~~~..~.~~.•. {1~`7/ I{ouse Number i Stree~ ' ' ' ' ' Hamlet ~ / l County Tax Ivlap No. 1000 Section ..,1. Block • , , , , . , , , _ Lot n~ y~ y/ /o Subdivision ..!G.'~~/!~!`:.... SS':~L•'lir/~ Filed tap No. ..~~Q,(t'r...... Lot . ~C.:f . j8 . (Name) 'Y State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....~st-...~.,~~1~-'H^:+'-Q~..,~,~Q~ b. Intended use and occupancy • • • • • • • • • • . ~ A ( «a,~.Rt4 ~tE~1t ~ sr~it~a#rr:r~Ft~', 3. Nature of work (check which (',applicable): New Building • • Repair . • Addition Altcra 'on • • • • • • • Re(rtoval Demolition Other }Vork.~?t~.4.p~!~!tiS-c. 4. Estimated Cost ..7 •OQC~, ° ~ ~S- (Description) / Fee ~ 0.~........................ g ~ lto be paid on filing this application) ba g units Number of dwelling units on each floor . If ~ ra_e, number of cars 6. If busmless, cots mer ~aldor mix . ed occupancy, specify nature and extent of each type of use • 7. Dimensi a'thy: Front . ' Height rAl~tSt'~Storics . . . • . Rear Depth . Dimensi Carrie s(ructure wit t~rations or additions: Front ' ' ' ' ' ' ' ' ' Depth. j................. Rear............. 8• Dimensi ~~t~ i 4i Front Number of Stories . Height ~ Rear............... Depth 9. Size of 1 :Fro YY t. ~ >ti~ Stories . ~SRfY'C:t"+,.`tLTt•~`~.Y?7• • . . • • Rear . . 10. Date of ,acritase.,:.;•. . ~ D~~th 11, Zone or use district in which ' ' ' ' • • • • • • Name,of Former Owner ..~.cf /Y' /,~/t~C/r(/,r*, • , j~~/1/TE' ' Pccmises arc situated . 12. Does proposed construction vi 13. Nil( lot be regrade P Mate any zoning law, ordinance or regulation : . . Nill excess fill be removed from premises: Yes No 14. Name of Owner of remises . • , , • , • • • • . • Address . Name of Architect •••••••••••••••••PhoneNo Name of Contractor . • • • • . • • • • • • • • • • • ' ' ' ' • • • Address ...................Phone No........... . . ...........Address . IS.Is this pro ert locl'~ted •PhoneNo......... P Y a with in~00 feet of a tidal wetland? *YES....NO...: *If yes, Southold Town Trustees Permit may be required. . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property Bnes. Give street and blociS number or description according to deed, and show street names and indicate whether interior or corner lot. /yj ll~ l G Q %/.t/~r , _ ~o ~eg•~eaa a ~ to a ~ f?Mr FoL~oinnNp IN$~;IIQIA; 1. Wt?NI1~1M1N lYWN~b OCCUPANCY OR x• 3. INBULATIQN USE IS .UNLAWFUL a. FINAL . CON$TR1lC11pp Mu>n BE COMPLETE hpp QQ, ALL CON8TptICT1ON I~NALI MER WITHOUl~ CERTIFICATE STAtE OUNRS NUC~j(1N a p1i DESIfiN OR CONSTRUCTIONfRRp11g STATE OP NE1V RK / I COUNTY OF... Q .S ~.4~ • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant (Name, of mdrvidual si^nii,rg contract) above named. [ie is the L,..... ..........4?LtJY~ t° I'. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly', autitorizcd to perform or have performed the said work and to make and file 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 mannerSCt forth in the application filed therewith. Swom to before me thiGs~ /~~;ip~ 194 P. Votary Public, .l,_~.. County ~r~ M (Signature o • pplicant) ~OAnIrN G~~~