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. , FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. CERTIFICATB OF OCCOPANCY No E-22906 Date MARCH 16, 1994 THIS CERTIFIES that the building ALTBRATI~ Location of Property 2600 YODMGS AVSNUB SOUTHOLD, M.Y. Hovee No. Street Hamlet County Tax Map No. 1000 Section 63 Block 2 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DSCSMBSR 5, 1988 pursuant to which Building Permit No. 17683-5 dated DSCBlIDSR 13, 1988 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate ie issued ie ALTSRATION TO MARS AS 8%ISTIMG ONB FAMILY DWSLLI~ HABITABLB AS APPLZSD FOR The certificate ie issued to DANIffi. KDJAWSKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL S/A UNDERWRITERS CERTIFICATE NO. A-137186 - JORB 21, 1990 PLUMBERS CERTIFICATION DATED OCT. 27, 1989 - PERFSCTIOR PLUM.&HSAT. NOTE: THIS UPDATES CO Z-18703 DATED JAN. 10, 1990 ui inq i epector Rev. 1/81 " ~ FORM NO. 4 t TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCOPANCY No Z-18703 Date JANUARY 10, 1990 THIS CERTIFIES that the building ALTERATION Location of Property 2600 YOUNGS AVENUE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 63 Block 2 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 5, 1988 pursuant to which Building Permit No. 17683-Z dated DECEMBER 13, 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 ALTERATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DANIEL J. KUJAWSKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. PENDING PLUMBERS CERTIFICATION DATED 10/27/89-PERFECTION PLUMBING & HEATING CU.IA Building Inspector Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18704 Date JANUARY 10, 1990 THZS CERTIFIES that the building ACCESSORY Location of Property 2600 YOUNGS AVENUE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 63 Block 2 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 5, 1988 pursuant to which Building Permit No. 17683-Z dated DECEMBER 13, 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 ALTERATION TO DETACHED ACCESSORY SHED AS APPLIED FOR. The certificate is issued to DANIEL KUJAWSKZ (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A uilding Inspector Rev. 1/81 TOBM NO.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 AUTHORIZED) N s G 17 6 8 3 Z Dote/~?~,~ I9.c~ ~ C o,d Permission is hereby grouted to. ~ G ~G~'L~ ~1~ , .,Y/..90 ....../.x.4...7/ Ito ~ ~~~.p ...'ylh.~1.•• ~~.~1~. .~..,....~-~..~C~~.t-.d~~.~1~ ct premises located at ..r~...~a..f? c............................................... ...................................`fir ~if',~':{' 7 ' County Tax Map No 1000 Section (G7..3. Block . Lot No. 2 pursuant to application dated . 19 and opproved by the _~Building inspec~r. ~'1 `Says !~G (/~e 5..,~aS.Q.O ,6~ooa OD ilding for Rev 6/30/80 TOWN OP SOUTIIOLD BUILDING DEPART2IENT 1 Yi.7W TOWN HALL SOUTHOLD, NEW YOEtK 11971 SBWN OP 80USii0LQ 7 6 5 - f 8 0 2 APPLICATION FOR CERTIFICATE OF OCCIIPANCY I ~r DATE _ . ! L k'.... . HEW CONSTRUCTION _......OL!/_D( O~R PRE-ESVISTING BUILDIHG..u~~.VACANT LAN~D(J~.._..._. Locatioa of Property... ~X+.~dY.......F.(,1"Z:?~~.~.._/.fX:~...~~~::Y/1~2~C~,_.__... HOUSE NO. t`$ REET HAMLET Ovaer or Ovners of Proper[y...~S~.~+.e..#..,~~vQ~s.~`~ Couaty Taz Map No. 1000 SecCion Block Lot Subdivision......_._...~ Filed Map ........Lot...._..... / [ 1 Permit No. ~ ~.l?.0~~..Date of Permit 1 ~r .,v~ .Applicant Health DepC. Approval Undcrvriters Approval_............_ Planaing Board Approval Request For Temporary Certificate Final Certificate Fee SubmiCtcd: $._5:.(54............ ~ ~ APPLICANT..:X~.~:'•'='t!'....~'"~!;' :§7~".Z..~_._....... rev_ 10/I4/88 ~vc• 38839 / W FORM NO. 6 1` ~ TOWN OF SOUTf10LD ka ~ fir. BIIILDING DEPARTMENT TOWN HALT 765 - 1802 ~r APPLICATION FOR CERTIFICATE OF OCCUPANCY INSTRUCTIONS A. This application must be filed in typewriter OR ink and submitted to the Building Inspector 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 suppiy and sewerage-disposaltS-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that solder used in system contains less than 2f [0 of IZ lead_ 5. Commercial buildings, industrial buildings, multiple residences and similar buildings and installations, a certificate of code compliance from the Architect or Engineer responsible for the building. 6. Suhmit Planning Board Approval of completed site plan requirements. B. For existing buildings ~PrI.Or to April 9, 1957 non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property shoving all property lines, streets, buildings and unusual natural or topographic features. 2. A properly completed`~`appLication, a consent to inspect signed by the applicant and a certified abs[zacC of title issued by a title company which shall show single and separate ownership of the entire lot prior to April 9, 1957. if a Certificate of Occupancy is denied, the Building Inspector shall state Che reasons therefor in writing to the applicant. 3. Date of any housing code or safety inspection of buildings or premises, or ocher pertiaevt information required to prepare a certificate. C. For Vacant Land Certificate of Occupancy: 1. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued by a title company showing single and separate ownership of the entire lot prior to April 9, 1957 shall also accompany the application. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. D. FEES: 1. CERTIFICATE OF OCCUPANCY mew Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwelling~~5.00;, Swimming Pool, $25_00. Accessory building $10'{00 Addition to Accessory buildings, $10.00. - Businesses $50.00. 2. Certificate of Occupancy on pre-existing dwelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - over S years - $10.00 4. Vacant Land Certificate of Occupancy - $20.00 5. IIpdated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $15.00 ~ev_ )n i.. i.._ TOWN OF SOUTIIOLD [n~~ ~ v BUILDING DCPART}SCNT V ~ 1 y~y~ TOWN HALL } 0 SOUTIIOLD, NEW YORK 11971 BLDG DEPT. 765 - [802 TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY //!/l ~j/~ DATE.. 1 ~.(,4'.. _ . . NEW CONSTRUCTION .......OL/D OR PRE-E%TSTING BUZLDING..~.VACANT LA~NSD()_.._.__. Location of Property... ~Ss.~,......~.C^~V:+:L_Q`..S_._.._~S~`-~.`~c1L[~,...... HOUSE NO. $ REST HAHLET Ovuer er Ovners of Property...~~:~.0~.(„A...~~!~:-da_^~1~~~__... V County Taz Map No. 1000 Section Block Lot Subdivision..._._..... Filed Map ..._....Lot.. Permit No. ~.~:1?.9_3..Date of Permit 1:~rf ~V..Applicant t Health DepC. Approval Undcrvriters Approval....__.__.._.. Planning Board Approval Request For Temporary Certificate Final Certificate Fee Submitted: $._y75...(zt1..__........ /~y1I D APPLICANT _ _ .~2~-.~ %~.".ti . _ C .~"'?~~Lfz., _ . rev. 10/14/88 c~c.sss3q ~o ~l&70~ ~A"L C Form No. 6 -r5~'a ~ ~ "7~~s"' ~lOy6 ~ ; TONN OF SOUTHOLD 1,~ BUILDING DEPARTMENT z, ~ ~9AFf i 5 i; TOWN HALL t; ;t a , 765-1802 3 t: 3- Te~~:.~..~ ' APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OF, 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 19, 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. C. 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 - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..~~lJ~.~~~ New Construction....... G~~ Old Or Pre-existing Buvilding..... Location of Property....oL4~Q~ ................../0~:-A~].~....~..-Sc"I~^-:~:':-4'~~............. House No. Stre t Hamlet dI~' v ~ ~ Onwer or Owners of Property...'-l.Ct-::~..... r-u.~/.R~s~1!.$ ~r 1 J r)) County Tax Map No 1000, Section.......-!.....Block .........Lot..~5................... Subdivision... .....................Filed Map,...........Lot............ pp ' it ~~G~$~~ ~ " t ryry f~ ~ o r Permit No..4~ :..Date Of Permit.l~~~~~~.lI...Applicant...V~'l. ~~:N~.C~a,/5:~:........ Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval n , Request for; Temporary //Certificate.........., Final Certicate.. M~~JCfi~: Fee //Submitted: $...:~.V I a ~,fl b(,~.Xs~, c o a.~ 9 a ~ APPL ANT -g~ THE NEW YORK BOARD OF FIRE UNDERWRITERS >r!!""` 11_a~;r.i r 99 BUREAU OF ELECTRICITY P'h;F1R11AHY i)ti, 7q~G'IONN STREET, NEW YORK, NegW YORK 1003H 5qN?.37 a N9 N 05f;95:t Dote Application No. on file THIS CERTIFIES THAT only the a/ectrieel equipment v dsacribed 6ekno and Introduced by the applicant Wonted on the abode opplicetion number Jn the promises of DA.N KII,IA,N'`zCCT, Yt}ISNa;S AYN;., lNIN,F: $t6, SOIPCHOLI), N.Y. n p..~ 6i t'1' in thefollouinq lorof~~1A.1,~Y' 7T; ~R~ ? /st FI. ? Ynd FI. Section Block lot lees examined un and found w 6e in compliance mitk the reyuirements of this Board. pRiUlE AC7ES lNi1TCNlS TURK RANGES COOKNi6 DECKS OVENS qSN WASHERS NAUST FANS WTLETS INCANDESCENT HUOIIltCENi OTHER AMT. K. W. AMT. K. W. AMT. K.W. AMT. K. W. AMT. X. P. DRYlB FURNACE MOTORS rUTUtl AMIIANCI RRDERS SHGAL ElC7i TIME CIOCKS EEII UNIT NlA7ER5 MULTI-0UiIR DIMMERS AMi. K. W. dl X. P. OAS H. P. AMT. NO. A W.O. NAT. AMI. AMT. AMrS. TRANS. AMT. R. P. ~ t)! FAT NAT. WATTS SERVIQ DLf00l4YCT NO. W S E R p V 1 C E AMT. AAV. 1'?E ~ I l tW 11 eW 3 / tW S f AW PRR eCONO. d CC. COND. d N4lEG Of' H ND, d NEUTRALS d ~LntAL t >.0ti (x 7 ~ 1 "1,10 I 2/0 OTIpR AlMRATUS: - SA(.N, & t,AAM;MANN CNC, snlrrfrnr,o, Nr, t 7 Uri arEBRU ER 7] I,ICF;NSF,' NO, i535N: Per Thit certificofa mutt not ba ol»red in any manner; rNwn to tM office of fhs Board if itlcorrM. Inspactort moy ba identified by Is. COPY FOR BUILDING AR BE ALT RED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS FAGF 1 195112 BUREAU OF ELECTRICITY ' 85 JOHN STREET, NEW YORK, NEW YORK 10038 lUN!` '21,1990 APPlicotionNo.onfile 68947140/90 N 1371$6 - THIS CERTIFIES THAT only the elertrlcol equipment oa deurihed hebto and introduced by the appliean[ Homed on the ohove application numher in the prenuaes of f?AM KU.JANSKI, Yr)UNIIy~~r~IS AVP., POD~--L~~yyE-16, 80UTHOLU, N. Y. in the follotcing hrcation; LJ Baxement LJ Ixt Fl. ? Ynd FI. Oli ( .Section Block Lot JONk" 11,1990 uos examined on andJound to he in compliance with the reyuirementx of this Board. FIXTURE RXTURES RANGES COOKING DECKS OVENS qSH WASHERS EXHAUST FANS OUTLETS ECEFTACIES SWITt)IES ~NCANDEaCENi~FIlIOI1E5CENT OTMEn AMT. K.W. AMT. K.W. Anti. K.W. Anti. K.W. Anti. N.P. 8 34 5 8 1 F DRYERS WRNACE MOTORS NTURE AFFUANC! FRDERS SFECIAI RlC'FT TIME CLOCKS ~U UNIT HEATERS MlKil-0UiIET DIMMERS AMT. K. w, on N. P. GAS N. P. AMT. NO. A. w. G. Anti. AMP. AMT. AMPa. TRANS. AMT. N, p. SYSTEMS AMT. WATTa NO.OF FEET 1 f SlRVICE gSCONNECi NO.Of S E R V I C E AMT. AMP. TYPE EOWR 1 / tW 1 d aW 7 H aW ] / AW ~ CC. COND. A. W. G. NO. OF NLLEG A W. G. NO.OF NFUTRAIa A. W. G. PER A OF CC. COND. OF n-LEG Of NEUTRAL OiNFR ANARATUS: G.t". C. S.-I SAC,E R LAOL""MANN INC, 1.1C,q:i635-E /9~j'Gc o'~ P.O,fiOI( 1768 SOOTHOL.D., NY, 11971 ~ 11,. Per / Thit certificate must not be altered in any manner; return to ihs office of the Board if incorretl. Inspectors may be identified by their credentials. y COPY FOR BUILDING DEPARTA~NT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 1 765-1802 BUILDING DEPT. f NSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND (~i]'INSULATION [ RAMING [ ]FINAL REMARKS: ~Q~.~ w~, DATE ~ ~ INSPECTOR ,,~2+~, 765-1802 BUILDING DEPT. INSPECTION [ FOUNDATION 1ST ( ] ROUGH PLBG. FOUNDATION 2ND [ ~ INSULATION [ ]FRAMING [ ]FINAL REMARKS: G DATE INSPECTOR 7 ~O ,O ,3 765-i8~Z BUILDING DEPT. INS~PECTiON [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ }FOUNDATION 2ND [ }INS CATION [ ]FRAMING [ FINAL REMA KS: ~ ~ L DATE ~ INSPECTOR -idLD I;.s:~~.~u:~ ~~u,,:E ccdKn~curs 1. ~ m w. H H FOUNDATION (1st) c FOUNDATIOiJ (2nd) m _ - \ 2, a 0 ROUGH FRAME & PLUMBING 3. ~ ~ m Ii15ULATION PER N, STATE ENERGY ~ CODE 4 , ~ y FI;IAL ~V ADDITIOilAL COMM EiJTS ~ D 4 , '9 H H O m > v~ m -c H TEL. 7G5-1802 S~FFQG`~~, TO'4VN OF SO~JTHOb,D ~O ~l% ''c OFFICE OF BUILDIPIG INSPECTOR a ~ ~ P.O BOX 728 T TOWN HALL 'YO/ ~ ~ SOUTHULD, N.Y. 11971 ~dl ~ C E R T I F I C A T I O N Date ~/c''-7 Buildin;~g Permi///t No. ~ 7 ~p q~ Owner /`fyl~7~/SiFi ,~~(/pJlease print)/ P1u.;.ber /C~~c~o.~ /~/rn.4~,r~ ~ ~1~eti7~ ~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of IB lead. , U ~ber's signature) Sworn to befor= me tkas oT ~ day of QC~_ 19~~. Notary Public Rotary Public, _County HELEN K. DE VOE huJTARY PUBLIC, State of New York Na 4T07E7E, Suffolk County Term E%Plres March 39,19..E-/ EOARD OF HEALTH '<< 3 SETS OF PLANS I ~ ~ 9 FORM N0.1 SURVEY 1 1t1~ 5 3 TOWN OF SOUTHOLD CHECK . . BUILDINGDEPARTMENT SEPTIC FORM TOWN HALL SOUTHOLD,NY.11971 NOTIFY ,l(~5,. `f0`{~ p TEL. 7G5-1802 CALL Examme,d~~,!' `3 . 19 aj,~~j MAIL T0: P 0 Y-~a~- ~ `/6 ppproved~'! '..3........, 19~'v Pcrmtt No ~~x~~ Disapproved a//c K~I~ ~ lid DATE: '2 `3 ~ ~ ~ (B dm~ s ctor) . ~E' hoc ~ APPLICATION FOR BUILDING PERMIT NOTIFY BUILONIO 786-t802 9 AM TO 4 PIN RDR THE Date De.c. 1 POtI_OtMNCx INSPECTIONS: i FOUNOATiON - TYMQ11EptJIAED INSTRUCTIONS FOR POURED ©ONClIETE ' 2. R S ~n~ic1af~on i sfbe completely filled m by typewriter or m ink and submitted to the Buildmo Inspector, v se~S~ ins, ac ~l~~ Fee accordtng to schedule. dUCation of lot and of butldmgs on premises, reiatronship to adjoining premtses or public s orA~rtea~,~~i~ e~td~r~tion of layout of property must be drawn on the diagram which is part of this o ~,QQU1R ENTS Of THE N Y S'fAT "CQ~'{''.~~ t~~l~cation may not be commenced before issuance of Buildmo Permit C ~1pop~ppr~E,pgt~pl~}on, the Building Inspector will Issued a Building Permit to the applicant. Such p sh~ldeg~~~rRfor inspection throughout the work. e No building shall be occupied or used m whole or to part for any purpose whatever until a Certificate of Occu; shall have been granted by the Building Inspector. APPLICATION IS HEREBY DSADE to the Building Department for the issuance of a Building Permit pursuant t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordman~ Re_ulatrons, for the construction of buildings, additions or alterations, or for removal or demohhon, as herein desca The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, a, admit authorized inspector on premises and in building for necessary i s ections. J er tubing is used ' ' • {f COpp (Signature of applicai or name, tf a c rporauon; for water distributing . • n fi!• ~J~X ~ S•A I /b • system; piping shall be J, U C) Td9 . Of types K or L oni (Mailntg address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bw C~w~.r.a.~r....... . a ~ ~ a b J Name of owner of premises D G.i'~ i. Q., 4.~-F Os~Q/S. .I• • • - - • . (as on the tae roll or latest deed) If applicant is a corporation, signature of duly authorized officer e ` ~~y~ 0R (Name and title of corporate officer) Builder's License No ~?~tilt~ . . Plumber's License No Electrician's License No :3 b 4 . J! m ~Gq t; ~~jrcj~~~~~+'~ ~f~ ~ V Other Trade's Lic.ensc No ~~~d'put4 . . 1 Location of land on winch proposed work will be done. ~~.V.(,t •Yp 1;.,~ti c,~$ ~ . . House Nmnber Street Hamlet y~ County T,w plap No ! 000 Scct~on ~ ~ Block ~ a, ~ • , , , • • Lot . S,-J Subdrv~sion Filed Diap No Lot . (Name) , 2. State e~istut~ use and occupancy of prem~ses~(a^nd i ten ed use and occupancy of proposed construction a. E~~stmg use and occupancy ~5~.~?+.v~•~ 0 ' 9~ oT c~~.. b Intended use and occupancy I~S~ ~~L'' _ """!may .____----__...r.--._- - \'CfUIW'S A11~l1lE w~. , , ~ ~ i; ~n ~ ~ ~ _ _ r N ls1,j~_Mfhi{TTA ~r i l ~ r ` ~ ~ ~ ~ ~ , ~ ~ ` ~ ~ ~q ~ C 1 `C ~ : s~~s 1 »a~ao { S F'?OR fy ~ }p s~x~ s3m~ G~a~ 1:~ 6cS°a?_e p m If' ~ ~ C w J•p3 Y? m (~1 H C7y 3R F, ~ ~ +.1 b.C ~ fig' ~ Ga~M13 ~ 5~.~ e~,,. yy~_ a~7q #~w_