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Home My WebLink About17356-zFORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 217735 Date FEBRUARY 1, 1989 THIS CERTIFIES that the building ADDITION Location of Property 2110 COUNTRY CLUB DR. CIITCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 109 Block 03 Lot 2.21 Subdivision COUNTRY CLUB EST. Filed Map No. 6736 Lot No. I4 conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 15 1988 pursuant to which Building Permit No. 173562 dated AUGUST 25, 1988 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 ON GARAGE ATTACHE]I TO EXISTING_ONE FAMILY DWELLING. The certificate is issued to ED & SUE JERMUSYK (owner, xxxxxxxxxxxxxxxx) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N054374 7AN. 19 1984 PLUMBERS CERTIFICATION DATED N/A ~~ Building Inspector Rev. 1/81 8oaat 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 ° 017 3 5 6 Z Date ... . .........~rf!Q!!........ `~~..?~........., 19...O..g Permission is hereby granted to: ...::~:~::.... ~~. ~ :................~ G...... ..:~ d X...~..Q.37 ............................................ n _ _ (~ h .__ 11 at premises located at ..°.~(./. ....... Caunty Tax Map No. 10(00 Section ..~.Q..l....... Block .......Sa..~....\.~. ~t7Lot No......~.:.Z:.~..... pursuant to application dated ........~~•~•.•~.~•., 19~.R., and approved by the Building Inspector. Fee $..~..... ~..~ .... . ~.v'. "." ........... ............ ~...... Building Inspector Rev_ 6!30!80 xs~- Kam, ~ d' ~x ~-- 0. 1g~IG 37 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions `jMa-~ A. This application must be filled in typewriter OR ink, and submitted ~ _~~ 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), Nonconforming 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. Date 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 $25.00, Accessory -$ ]0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00 4. Vacant Land C.O. $ 20.00 /~ /,~ ~~ S.Uodated C.O. $ 50.00 Date .......~... .. NewConstruction,,,,,,OldorPre-existingBu/iDlding ...`~...... V~~aopcantL//and ............. Location of Property ..~~.flO.....L.ou.v/r~/.•~°(ub„~Y/!!t',,,,,, (:u /C~r•ri~JCPC„•,,,,,, House No. _ _ Street Hamlet Owner or Owners of Property .....~.°.~ . a Su@ /°r~*usy~ ................... .............................. County Tax Map No. 1000 Section ..... IA.~...... Block .... ,0. ~, , , • , , • . Lot ..... ~<.~~, ~ ..... . Subdivision .................................Filed Map No. ..........Lot No. ............ . Permit No. ~~7 3s.~ ~ Date of Permit ..gJ15.~/~! Applicant . Y:'a~, /t GCI~ ~' So~/ ~n~G ..................... 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 all applicable codes and regulations. Applicant ... (?vb Kac1~ ,t Soe/... ~~~. ......... Rev. 10-70-78 (~ `-~"/"~n /'~ /ltr.L~ (~~~r , ~~ti _3~ f~3 ill l~ `! G o z i ~?.jj' THE NEW YORK BOARD OF FIRE UNDERWRITERS ~nh~..I i U~ 1.(171 BUREAU OF ELECTRICITY BS JOHN STFIEET. NEW YORK, NEW YORK 70038 Date JANIIAAY 1Q,19Ry gpplicotionNo.onjile 59a;tR08R/RR N (15/4974 THIS CERTIFIES THAT only [he aleetricd puipntent ere detcriFAed helow and introduced by the appUcent nawssd on the ohooe application number in the premieee of ,rr.;tiMIJSYC. 211.Q COIIN'1'RY t",1,118 DRJ~VK, CiJT(JHcN;ilF„ N.Y. in thefollacireR location; ^ Basement ^ /Rt Fl. ^ Ynd Fl. GAH/l?137' Ser[ion Block Lot reae a:ermined on •XANUARY 1)6,1.489 andfoundto he in rnmpliernce with the reyerirementK OJ elite Boord. RXiEM! OUTtlTS AC IES EWNCN~ I R%TURK NCANOESCEM FLUOIIESCENi OTHER RA AMt. N6lS K.W. tpOKIN AMT. O DICKS K.W. O AMT. VENS K.W. DISH W AMT. ASHERS K.W. EXHAU AMT. ST FANS H.P. i 1 i DRYERS IVRNACE MOTORS tAET11M AHRIANCR tNOERS SFKIAI REC'FT 71FAE CLOCKS Rill UNIT IgATNS to ~E1t~lET AMT. K. W. Oll N. I. GAS N. P. MAT. NO. A. W. G. AMT. AMI. AMT. AMTS. TRANS. AMT. N. P. ~. ~ 1MT DIAUAERS NAT. WA1T5 fgVIQ DISCONNECT NO.OF 5 E R V I C E AMT. AAV. TrPE ~. 1q'tW 1/sW S/9W 3A.w NO. ~ COND. OF CC COND. ~.~NI{EG Oi~~~ NG.OF NEUrMlS ~NEUTGMAI O711RR ANMe1LTUS: (: & S C'UN"C12Af'CS1N Hi>1f 2i 5 Spl)T`HOI,D; NY, 11.9')1_ OMRAt 11 b1Ck;NSP, NO. 578 }; Psr This tertificaM mu[f not be akered in aLry manner; Murn to the offin of the Board if incorrM. Inspectors may be identified Moir etalsntiols. ^' COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT BE ALTERED IN ANY MANNER. r'1ELD I7:~~.C'k,40:7 ~ _ 7 ~llAiE ~ i:OMMENT° _ .. ~*\ RJ . / ',,/ ""~---- - ~ v 6 POUtdDAT20N ( 1 sue) _ ~ t ~ p• OUNDATIOIJ (2nd) ~ _ _ .~. ~~ ~~ z N ROUGH FRAME & 1 d PLUMBING 0 // ti y 3. ~ m IIJSULATIOf7 PER N. Y. •' `~ t STATE ENERGY P O C DE x a ~ y 4 . n ~ T2d~t FZiJAL • ~ ADDITIOfIAL COMMENTS: z ~ _ . ~ k -o N H -- ~' N N ,~ ` H ~- o a z ~ • a r y W ~(~ . d m v H c~~~-~ yt~-iso2 BUILDING DEPT. INSPECTION [ ] FOUNDATION i5T [ )ROUGH PLBG. (]FOUNDATION 2ND (] 1 ULATION FRAMING ( FINAL (] REMARKS: \ DATE INSPECTOR ~~:`y/ ~~ / ~s ~/ 765.1802 BUILDING DEPT. 1 NSPECTIAN [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [)FOUNDATION 2ND [ '1 NSULATION ,-- [ ]FRAMING [ ]FINAL REMARKS: c,~,7~ r~~C, DATE ~ Q ~ ~ ~ INSPECTOR r ~~ i~3~~ 765-1802 BUILDING DEPT. INSPECTION [l~OUNDATION i5T [ ] ROUGIi PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~~ ~ •~ DATE INSPECTOR ~~ --,,.~~ r • ~a 0..~~~< W / /pry ~~''~ .. ~ '1~~ t /'f.~ ,t`• r.+-- __._.._. --._.~._._~._.----~_. r "'-• ~.. . ' .~ ,~~''" 'a~. r i ~ ~ .••\ } \ .. . '- \i. '` CP '~C ` ~: i ~ /~ i63J ~Y~ o ~._ b J9./'-aSf! ~ _..~~. ~ iii' c f a. i• $ A 1' a +s r' r ~. , Z z~ ~r_~~r ti ~ e• ~' ~ ...,, r.,c. 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I 1 j ' i i ~ I l ~ i~ i l R f I ~ ' ~ !I I ~ ~ I I ~ ~ I i i ' F I i ~ ~ I i ~ ' / ! , I I ~ ; i FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL °OUTHOLD, N.Y. 11971 TEL.: 765-1802 Exami .....?wQ: 2a. ., 19~.. i Appro .... ~'~:°.?-. ~'~• ., 19 ~~ Permit No. ~ 7. 3 no. . Disapproved a/c .................................... . ....... (Building Inspector) APPLICATION FOR BUILDING PERI411T INSTRUCTIONS 3 ,Q.t.Co 0 ~ ~ s3 z Received...........,19... e.~. -2 9 ~ ~ ~ ~.G 5~ Date /r........, 19~'fp 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 ba 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 Depaztment 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 inspections. c---"" (Signature o applicant, or name, a corporation) rl~a dress of pplicant) State whether applicant is owner, lessee, agent, azchitect, engine general contract r; electrician, plumber or builder. ..........................................,..{.''................................................... Name of owner of premises . ~~. ?`.. ~u.tr .... /,?-,k-~. !a1''K,1. f!.~ ..................................... . (as on the tax roll or latest deed) If applicant is a~o~r~pora~ti/o/n,/s/ign~ature of duly authorized officer. (Name and title of corporate officer) Builder's License No. . !"r?..S~??..~{~ • Plumber's License No . ....................... . Electrician's License No . ..................... . Other Trade's License No . .................... . 1. Location of land on which proposed work will be done. .. ~` ~ ~.~....~-~~.?~ .. ~!Cc,~ .. ~/ :Y......... . House Number Street Hamlet County Tax Map No. ] 000 Section ... ~.°..~ .......... Block ... ~.3............ Lot ..~.~.'~ `. ~ ~• • • . • . Subdivision .~?"n~~ . ~'.^:~" . I:~-~• • • • • • • • • • • Filed Map No. ,d. 7 .3.6 , . , , . , . Lot ..:! ~t`. (Name) 2. State existing use and occupancy of premises and intended use,,an~d®oc>cupancy of proposed construction: a. Existing use and occupancy ....d~~ p. G~~... ~A~.~ ................................. . b. Intended use and occupancy ...~~"°~-~~:'t~ ...~...°~(:~¢n-G~<G-~ .............:................. . 3. Nature of work (check which applicable): New Building .......... Addition ~.... Alteration ......... . Repair .............. Removal .............. Demolition ..............Other Work .............. , ,,// (Description) 4. Estimated Cost3':~®~.5~... ......................... Fee ....................................-.. (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 ...1 .................................................................... 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 ...............Number of Stories........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ................. . Depth ................. ..Height ...................... Number of Stories ..................... . 8. Dimensions of entire new construction: Front ............... Rear ...............Depth .............. . Height ...............Numberof5tories...............................................,........ 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 ]aw, ordinance or regulation : ............................... . 13. Will lot be regraded ....... : ....................Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . ,' ..................Address ...................Phone No............... . Name of Architect ........:..................Address ...................Phone No............... . Name of Contractor .......:..................Address ...................Phone No............... . 15. Is this property located within 1.OO feet of a tidal wetland? * Yes ..... No,1~.. * 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 lines. Give street and blocjz number or description according to deed, and show street names and indicate whether interior or corner lot. r~ STATE OF NEW YORK, 5.S COUNTY OF ................ . (Name of individual signing contract) above named. He is the being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dµly authorized to perform or have performed the said work and to make and file this application; that all statements cori,tained 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. Sworn to before me this Notary Public, .......!-:~...N.~(!~vv.... County N6TARY P 9LiC, 3Sd~e M New Yak Term ~Exp~rea MerSch~Blk~ou_ `y (Signature of applicant)