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HomeMy WebLinkAbout17657-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219127 Date JUNE 8, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 2420 DUCK POND RD. CUTCHOGUE House No. Street Hamlet County Tax Map No. 1000 Section 083 Block 004 Lot 001 Subdivision WOODBINE MANOR Filed Map No. 8239 Lot No. 1 conforms substantially to the Application for Building Permit heretofore filed in this office dated NOV. 30, 1988 pursuant to which Building Permit No. 176572 dated DEC. 5, 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE. The certificate is issued to THOMAS & CATHERINE L. ANDREJACK {owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-17 JAN. 8, 1990 UNDERWRITERS CERTIFICATE NO. H015097 APRIL 2, 1990 PLUMBERS CERTIFICATION DATED PERFECTION PLUMBING NOV. 17, 1989 B ilding Inspector Rev, 1j81 f'OHM N0. f 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 AUTHOR{ZED) N Q 17 b 57 Z Dote ...t r.IR.cJd:.~n7ht~.......~e~ 19.A.~. Permission is hereby granted to: n .~,~....,n~~:q to .C~.^.r~n:!-~s~.-.sa.....A~1R... .~r...l.J.~ ~r..c~....R.Cr.~.~4!S~Q~S...... ,....4~.... .......~d!~-- . ~ I~ n ...premises located at ....r~..`~P~ d......!,.d-~ ~ ~~QL.. Qd : Cu~'ti!:Q-a Caunty Tax Map No 1000 Section .Block Lot No pursuant to application dated .~.....w3eQ... 19.80..., and approved by the Building Inspector. Fee 3b~ 7a ~ ~()-t, u ding Inspector Rev 6/30/80 1 THE NEW YORK BOARD OF FIRE UNDE#~1NRITERS PACE t Rt)1 l.l.b}, BUREAU OF ELECTRICITY BS JOHN STREET. NEW YORK, NEW YORK 10088 pore APR:C.C. 02,19'}0 AppUcotion No. on file 5f}990984/ 89 H 015047 THIS CERTIFIES THAT Doty the eleetried puipment ae deRCrihed 6eloto and introduced by the opplicsnt nerved on the shoos eppflation numher in the pnm4es q/ t 9'Ht)kAS ANllk1;.7ACK, 2Q20 CCUCK PAND kt)All, POC,$ 197, CUTCNOGUB, N,Y. ~ in thefollominq loeotion; ®Bmement ® lRt FL ~ Yrtd Fl. CAR/ATT;[C/OUT Section @loek Lot Eeaa examined on MARC;N 2"l.,'C,990 andfoundto 6e in contplionce withthe reyuirementROf thu Boord. ~ nxTUn RXTURRS RANORS CODKtt10DKXS OVRNS W BXNAUST FANS OUTLETS AOIRE fW1iCNB INCANDlbClNT F1U011lSGlNT OTNER AMT. K. W. AMT. K, W. - AMi. R.W. AMT. K. W. AMT. N. P. - r;0 '70 5& 50 ] F ~ DRYHIS IVRNACE MOTORS 1U7UM AMl1AtiCE RRDERS STEpAL RRC'?i iMAl C104tE UNIT INAfUS MUL140YTLR DIMMERS AMT. K. W. 01l N. P. GAS N. P. AMT. NO. A. W.6. AMT. AMI. AMT. AMP6.TRANS.- AMT, n P. ~ O ~T AMT. WATTb' F 3 1 SRRVIOE dSGONNHCT NO.OS S E R V 1 C E AMi. AMI. TYPE t / tW 1 .e SM' S 1 TY 3 X AW Oi CC. COND. A. W.O. NO. Or NlilO A. W O• NO. O! NEUTRALS A. W. G. PER 8 OF CC. OND. OF 1KdlO Of NEUTMI 1 200 tJ8 1 X 1 A/0 7: 7/G 0711ER AMARATUS: i SMOKF; OKTk;CT(>R : -1 moo'{ 9'NOt9AS ANDkIs.TA('K 2920 DUCK PAND RUAD C.C}'t'CHOGUI,, PCY, o116Q? MANAOY t t:+-,r,? P.. This csrtifica» mint not ba ahsrsd in any manTror; rNUrn to tM offin o} the Board i} incorrM. InapeNOrs maylbo` dentifad by 1Mir credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTiFK;ATE MUST NOT BE ALTERED Bi ANY MAlr1ER. TEL. 765-i 862 ~o5`~FFa~-~o~, TO'WN OF SOUTHOILY? ,`c OFFICE OF BUILDI2~IG INSPECTOR o ~ ~ P.O. BOX 728 ' u' ~ TOWN HALL "O ~ ~ `r SOUTHULD, N.Y. 11971 ~1p1 ~ y`~p ' C E R T I F I C A T I O N Date /~/7 Building Permit No. /7~p~ owner DlJ7 ~,~C-rhtCv~ (p/J7lease print} Plumber~Qfz'[7~b~ Cl/~7~/~ U/~C.+? Q (please print) -tJ I certify that the solder used in the water supply system contains Less than 2/1a of 1$ lead. , ~ (plumber's signature) Sworn to before me this ~_day of 9})0-~'~ r r 14~. RVC-~a~- ~f. Notary Public l7otary Public,___~~ County HELEN K DE VOE HDNVpY PUBLIC, State of New Yotk Na 4707878, Se!(olk Cau Term Exptrea MamM1 3D, 19 . ivLD u;.5. EC:.U;i ~~llnin ~ ~C:`tMCUTS 1. FOUIIDATI0;1 st ) - - - FOU1dDATI0;1 (2~fd) ` - ~ 2. ROUGH FRAME & PLUMBING t 3. ~ i I1ISULATIOPI PER N. ` STATE ENERGY CODE 4. ' FINAL I ~ - f- ~ r ADDITIOfIAL COMhfENTS: l ~~~7 765-1802 BUILDING DEPT. 1 NSPECTI®N [FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ DATE / INSPECTOR / 7~S ~ 765-1802 BUILDING DEPT. INSPECTION [ ] F NDATION iST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ ~ - DATE ~ / INSPECTOR Form No. 6 ?'J~ BUOI DING DEPAROTMENT tD w 1 " ~ ~ ~ ~ TOWN HALL l ~ g 765-1802 r TO~r , , APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submiL-ted to the building inspector with the following: for new building or new use: 1, Final survey of property with accurate location of all buildings, progerty 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/LO of 12 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 applicanC. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. G. 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 S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..~7~:.~ (~(9C) New Construction........ Old OrT Pre-existing Building/ Location of Property. ^~!~!f~,~<3L~_, ~E,rcCe _ Cic{CILC~!(~„~,/~1~,/~~3,~,,,,,,,__...... .House No.• .Street. .Hamlet i , Onwer or Owners of Property.,~~i1~~~1 CC~~C4tx~L~ ~IIL~~CCG~ . County Tax Ma/p~N~o~ 1000, Section.~~3,'~~:.....Block...C:'~'~:~~.......Lot..C.'('~:.C'~:r.._........ Subdivision. G.~C.4~: ~;Z-u~„JIL!21~ ..............Filed Map..~~.~.~?9.. .Lot., r r~ C ii ' Permit No. .f7~J.(.......Date Of Permit. ~``?=7/~~......Applicantf::`~G~d~:~ ~Zl~c'~Ce"~CC.~, ~ J Health Dept. Approval ..................Underwriters Approval.fr Planning Board Approval.... Request for: Temporary Certificate........... Final Certicate..~:....... , Fee Submitted: $...r~.`r~.~.'L 3 9733 ~C~Y~hF, , ~1 ~l a ~C'((d,/ C^ dC~ . C ~ z iy~a7 _ l APPLICANT ' N~~ ' TEL. 7G5-1802 S~FFOtkc op t Opy TOWN OF SOUTIIOLD ' ~c OFFICE OP BUILDING INSPECTOR a `.s ti' z P O. BOX 728 ~ ' ~ .~1•k~ ~ TONN f[ALL Dy~O! ~ ~~0~- SOUTEIOLT), N.Y. 1 1971 Sune 8, 1990 THOMAS 6 CATHERINE ANDERJACR BO% 349 Ci1TCDOGDE, N.Y. 11935 To 4Thom This May Cohcern, We arc unable to complete your Certificate of Occupancy because of the following reasons. An application for Certificate of Occupancy / is not on file. (ENCLOSED) /_//No Underwriters Certificate on file. T}ie check is(/not on file.) $25.00 No ]tcalth Dept. P~.pproval on file. No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit f( Z Building Dept. / No PLumber Solder Certificate on file. , ( all permits involving plumbing being issued after npril 1,19II4 ) f T65-1802 BUILDING DEPT, INSPECTION [ ]FOUNDATION 1ST ~ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ 1 IN CATION [ ]FRAMING F~INA/L REMARKS: -rZ ~-C~~ t _-!?-~"4 DATE INSPECTO 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [INSULATION [ ]FRAMING [ ]FINAL ` REMARKS: ~ ~ ~C , DATE ~ INSPECTOR • ~ R 2 URA SMt7H j ~ ~ a N/~/F RICHARD EBOZS~vn A^rt' QUA ~c~ ~,s' ~.`E ~~h T 2gp.p0' w ~ o T ~ ~r o ly5!° pp'O(J~~E Ia x~ o a m n ~ b O ni s c w ~ 4 ~ ~i ~ ~no K D ~ ~ `~~n I A c ~ 4~ ~ ti c ~ ~ ~ ~ ~ n ~ 7$ ~ ~ (2 t n y ? ~ ~ y_ i D r 1 ~ p 1 a o o m z 1 -t t ~ ~ O R --~c~ ' ~ h W 1 D ~'i ~ ~ ~ m m t i^ o, © 2 ~ _ _ ~ ° _ ~ 1 z ~ e-~MENY _ ~j lh _ - ~ v ~ o ~,L.I ~ ~ O G ~ ~ b t~.+ n o O~ IN % ~ ~ m ` A s M $ I 51 ~ 4 ~ f ~ ~ ` n t « ~ m (v[~~ ~y N 9 Ul V !'~f v N O ~ M oN ¢ ~ % ~ ~ V ~ t,~ OD m ti ~ 'x ~y r. v OL I VJA LANE 1, ~r CQ q se ~R i~ .:,ADO ~ 3~p40~ h ~Ar ~ °~~^3g Fes; Zacoy mir,wQ()Z mmO"'1~ J~ ~ $s eY v.b~ Dcti hc~n p'm O-Q~O1~1 OD Z. 3 ~ zn-ic _2 N O h ~ ~ O W Q r ` o h z , ~ G1 ~ r~ n n 7 ~ Q ~ (A W m m _ 'N x 2 / rn ~ 5M)TN j ~ Y Q. N/QfFR~CHAR~ ~ Bazs~vA q„rfl ~ LRURAp c~ / . wn• ' x T L5O.0~ ~ lD r r ID ~tNO o rT1 ~ z ~M X Q_ v~ r1 `~j 1 X151°~;~~~ o_ r ° ' ~ < e'er 1a, 2 aj~o ~ i y _ o ~ t ~ ° 1 1 i K~N~.o ~ n }x O i ~ e ° O <'6" ' a Q z ~ " ~p ~ _ (~q ~ h ~ M 83 ~ ~ ~ r> r s ( } `n k < - m vs ~ n ~7 ~20 G", ti rr~ t l a_ z o h1 2i.4' a ( ; ~ ~ y 1 ( ~ ~ a 832' ~ ~ ~ A _ _ o ~ ~ ~ ~~N b ~ ~ ~ Ql ~i ~ 'pN AiNA i/-' _ 2 5 , A ~ V ~ ~ b ~~et+ ~S~oQD'0~ ~ ~ r ~ Z m a ~ f p q a I of y m M Q u N 3' A L` q~ ~ z D "3mr ~ a a L Or m ~ sm Y ar ~ C, ~ ~ Ql h 3 - ~~ti~ ~ ~L1VlA LANE m ~ O .r ~"ssy.:: Ri C~ 'n o i '33 ~ : ' ~s~ ~ h -i fi ? ~ ~ ~ m p cry ~.,e s rka 1s x& sE Yx o -~i Q C n rn ~ cn O ~ q n `•1 QJ 3`. ~ g~ ~!'A mb~Qy z~DD~~-~y~~~pQ< ~ cn "i s s sgt cn b ~ m a•° ~ ~~°a Zipih z 3`~ O a O ~ a, boa $y~~ b cbiZv., ~ w n1 ro Z x ~ z a n cA 4 ~ ~ ~e w C) o eb 'Q` ~ ~ '2 b o o vo S~ m "o ~ Ls z ~ R ~ rn iN ;KO o< 3 h oa ~ ~ ~ V ~N q~,~ Z r_ a Q .a m . ~ t~~ ~ ~ ~ ~ " ~22~1 ~ . , , i C~ b z BLDG DEPT' ~ O ToW~ aF SounioLD ~ & LRURA SMl1H m a+ ~ z RICHARD E BOZSNYAK J a~ O p 250.00' u ~ ^ r0 N 51 ° 00' 00" E ~ti m T o t 9r ° < a max--~-'~"r--~._ O ~ O ~o fiFAVEi RRlVEWAY IU ~ i% O ~ ~``Rj O w ~ ~ 4 ~ ~ _ . a E 0 ~ I 2~ r• ~ m m ti 'v ~ a 1~ < q ~ w Y .C ~ m O h V h ~ Y - » ~ D m s • m e m + I 2 Uf ~ S 7 9 p C O O m 8a.2' t~ s ~ ~ ~ 2 O - a Stl I ' O D y ~ o u UI A ~ I IN ~ ~ _ ~ a ~Al Q Y O _ I O • ~'J ~ ~ - I EASEMENT + w b RRA7NARE w y e~ 250 00` ql ~ h i v ~ C7 D y I X r2 ~ ~ b ~ Ri ` m Mo,ai ~ y ~ ~ ~ b ~es:pq to ro ~ z~o.4 ~ to z s,.a ~ ~ ^t asna, h,a .L~'1~ V ~acn o~A~ ~ 4 h ~ O ~ ~ pLIVjA ~J~NE ~C• ~ fw 0 r a r er y '~.i J ~ :n 7' m 0 p,h~ o.aa~st4Ch~ D~ e n t T~ "'1 ft'f~ y ay o w`c cp oo ~ ~ as ~ ~ 70 ( ^ q y y0 ~ ~ ~ pp ...h to ~ "0 Rl y~ vq o>yZ aco d ZQ m~.,h 4 ~ W ~ ; C7 to a 00 .p =C„isOcQ'n m~x~ tic sv ~ '^.t ~ ~ om o ZO I't~ o~j Oo ~c~tis o sus Fa~~c c~us~v ~f~a~rt~aaa~! ~ r~€,u.rsi ~ V Jy ~py~ y cn?o,~s i C`f.,,LF gN, 34~ 4'}~+~~i Nti VRK•+ Q ~ ~ , a v i ,-JAN A S i99 ; s REF f~) ~ ~ Z i3F, c x r°p' m p < ip., guy , •os.a ar,d tiasFr suppiY faat';hsss hr t~,~s ~ ~ .V`~ y iJ ' i~ ibe• `Y ~Ii5~iL.LW~ f ~ Zfi~ f~}ra~fiTfiEfiT 81~t t Cf CD 0~.,,4 ac ua;•al ..,;;=I a ~,~a itrund *o~fe sab~tkt'sn . + ; Ch3e, of Eareau of 4Vastewa;at l~It?s'e"}ezt4 _ nn~ n ~ J BOARD OF HEALTH • . (~jX,(- ~-G~ ~ 3 SETS O F PLANS - • - FORMPtO 1 SURVEY - - TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY SOUTWOLD, N.Y 11971 TEL.. 765-1802 CALL MAIL TO Examined t.kcea+,,~t•u. S• , 19 $ g I' ~ Lc ; 1-~~ ~ ~ c_ ~ ~ J ( c-'~~ Approved ~,•,.aieom~wt S~ , 19~~ Permrt No 7 ~ ~ 3 01986 Disapproved a/c ''t L„_ ~ r TOV'. ' (.F SCUFF,, i d (Building Inspector) ~5(6~ ~ - S APPLICATION FOR BUILDING PERMIT ll Date .~.~F' 19 ~ INSTRUCTIONS a T}us application must be completely filled in by typewriter or m ink and submitted to the Building Inspector, wrtk 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 ad~oinmg premises or public stre or areas, and giving a detazled description of Layout of properly must be drawn on the diagram which is part of this api cation c The work covered by this application may not be commenced before issuance of Building Permit ` d Upon approval of this apphcatron, the Building Inspector will issued a Building Permit to the apphcant Such peri shall be kept on the premises available for inspection throughout the work e No building shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnb. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in building for necessary i~~ctions /J ` ~.lil7t&~~ ~/~kG~ (Signature of apphcan , or name, if a corporation) Po acx ~u/c-~ct~, ~z~ ,i93,~ (Mailing address of app scant) Sta//ti~e whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build• Name of owner of premises ~l'(L'7KQti ~i?U"~ r u/-t~-~- l u'uj~-~ (as on the tax roll or latest deed) If apphcant is a corporation, signature of duly authorized officer (Name and trtle of corporate officer) ALL CONTRACTOR'S MtT. S_7;,BE SUFFOLK COUNTY LICENSED Builder's License No GU/'~J Plumber's License No Electrician's License No Other Trade's License No 1 Location of land on which proposed work will be done Ilouse Number Street ~ Hamlet County Taa Map No 1000 Section UD Block Gig{. Ob Lot ~O~' u ~j~i Subdivision ,/"~~~'~'~~~'e' Filed Map No 3q Lot ~ (Name) 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy ~CL~Qnf b. Intended use and occupancy !-'u9n.Q,2G~f- ~-~'d'~~~'t'~~•: . 3 Nature of work (check which applicable) New Building 1/~ Addition Alteration Repair Removal Demolition Other Work h (Descnp1ion) 4 Estimated Cost $ / 5 _ UC)~ Fee . . . ` (to be paid on filing thzs applicatron) 5 If dwelling, number of dwelling units ~ Number of dwelling units on each floor If garage, number of cazs . 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use 7 Dimensions of existyig structures, if any Front Reaz Depth , Height Number of Stones . Dunensions of same structure with alterations or additions Front .Rear Depth Height Number of Stones . 8 Dimensions of entire new construction Front G'~-~ ~ 8 " Rear fie? ~ Depth :3rj ~ • Height -33 . Number of Stones . 9 Size of lot Front ~~~.~3 ~ Rear ~(aQa j3.~ De th a`-~~'~~~`~ 10 Date of Purchase '`j~ ~9~7 Name of Former Owner nr cPl~cga q~rc,~rx~-'''~' - ~/c~tv 1 1 Zone or use distract in which premises are situated . /r?Or'~ . . 12 Does proposed construction violate any zoning law, ordinance or regulation 13 Will lot be regraded Will excess fill be r moved from premises Yes ~o 14 Name of Owner of pre irt5 ses ~N'r°•~~/14r1'~~arh. Address P~/3rx3~9~ih-ht~uc;• phone No ~~1 / 3a"f. Name of Architect ..Address Phone No Name of Contractor Address . , Plione 15. Is this property located within 300 feet of a tigidal wetlands *Yes *If yes, Southold Town Trustees PermitPLOkI'DIAGKAMed. Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dunensions from property lines Grve street and block number or descnptron according to deed, and show street names and indicate whether intenor or corner lot r STATE OF NEW YORK, S S COUNTY OF being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ' above named He is the (Contractor, agent, corporate officer, etc) 2 ~ , of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tkus application, that all statements contained in this application are true to the best of his kiiowIedge and belief, and that the work will be performed in the manner set forth m the application filed therewith. Swom to before me this p?fa d-a~y/of /~~4/ , 198 Notary Public, •!`~~x~! . Y°~ • . K!:e. t!~'?-. .County 4"" ~ C HELEN K DE VOE 'itl~ d! NOThBY PUBLIC, State of New York • • • • ' No 4767818, SuftalkCau ~ ~ (Signature of applicant', Term Expires March 30, I9~ -