HomeMy WebLinkAbout17271-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18681 Date DECEMBER 28, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 1371 ROW OFF COX NECK ROAD MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 113 Block 7 Lot 19.8
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 20, 1988 pursuant to which
Building Permit No. 17271-Z dated JULY 27, 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 TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to KEVIN & LESLEY MILOWSKI
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-090195 - SEPTEMBER 5, 1989
PLUMBERS CERTIFICATION DATED DEC. 26, 1989-PERFECTION PLUMBING & HEATING
,.G
Building Inspector
Rev. 1/81
roaar rto. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NO ~1.727~. Z Date l~~t.
Permission is hereran~ to:~ ~j , n
r ~ .
. z..9 . .
off ,
.......~~"'r~'1~.. .i
...~~......lr~ .
ct premises located at . .~.7~......~~..K~.
OG~-~.~.........................~...................
f."
Caunty Tax Map No. 1000 Section ........,.-,/~~.J........ Block .........7.......... Lot No....../..~/.r..T~.......
pursuant to application dated ............../.,1..~.............................., 19..~j and approved by the
Building`Inspector. ~
Fee $..c:l.~f.. Oo....
~Iding ect r
Rev. 6/30/80
.
1 TOWN OF SOUTHOLD
BUILDING DEPART?SENT
TOWN HALL
w SOUxHOLD, NEW YORK 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCIIPANCY ry szp
DATE c~O' _V J,
Add~~%on
NEW CONSTRIICTION .......OLD OR PRE-E%ISTZNG BUILDING.. ...VACANT LAND......._
LocaCion of Property.!371.~'~~!ve~K~cxrd......,._,-~11~;-a-~,:-fc~~.,,......
IIOUSE NO `J STREJEVT L HAMLET
Owner or Owners of Property..]5-~-.1~.))I.JJ~:F.~~.^.~~ ./.~_f!(,~`nl,,,,y~,,p,~,,,,,,,,,,,,,
County Taa Map No. 1000 Section C!~... Block ..7.... Lot /cU.._,
Subdivision Filed Map dd........Lot......../.y/~.
Permit No. .~~al~z.Date of Permit .~.-c2Q=gD.Applicant ~~~L~.i.!~.IQ~~~
Health DepC. Approval UnderwriCers Approval..............
Planning Board Approval
Request for Temporary Certificate Final Certificate
Fee Submitted:
APPLICANT. ~L-~C7`*.~e`~:~• - _ .
/ tiN~
rev. 10/ 14 /88 ~j~
dec. 38s6
CO ~-18Ge~1
TEL. 765-1802
o~pc~vFFOC/~~OG TOWN 0~' SOUTHOLD
~.ft OFFICr OF BUILDING TNSI'ECTOR
rn F.O. BOX 728
`'O~y~o~ ~~0~ SOUTI-TOLD NAY. 11971
DECEMBER 15, 1989
REVIN & LESLEY MILOWSKI
BO% 779
MATTITUCK, N.Y. 11952
To Whom This May Concern,
We are unable to complete your Certificate
of Occupancy because of the following reasons.
~ / An application for Certificate of Occupancy
is not on file. ENCLOSED
/J/ No Underwriters Certificate on file.
The check is (outdated/not on file.) $25 each
/J/ No health Dept. Approval on file.
/y/ No final inspection has been made.
Please contact our office on this matter.
Thank you for your cooperation.
Building Permit It ~ ~ ~ ~ ~ Z ADDITION
1 8 2 2 8 Z POOL
Building Dept.
***/g~ No Plumber Solder Certificate on file.- FoR ADDITION
( all permits involving plumbing being
issued after April 1,1984 )
PLEASF. FILL OUT THE ENCLOSED APPLICATIONS AND ID3TURN THEM TO US
ALONG WITH A CHECK FOR $50.00 and the PLUMBERS SOLDER CERTIFICATE
SO THAT WE CAN DO YOUR C.O.'s. IT YS A VIOLATION OF THE CODE
TO NOT OBTAIN A CERTIFICATE OF OCCUPANCY.
THE NEW YORK BOARD OF FfRE UNDERWRITERS 1
1(131 481 BUREAU OF ELECTRICITY
85 JOHN STREET. NEW YORK. NEW YORK 10038
Date u~;P`l'T7~R~';'i2 ~lcarl,`~~'S1 APPlicationNo.onfile 5~SJ4Ol~''81Ftf3 ~ t7~~~l~ixr
7HI5 CERTIFIES THAT
j only the elec[ricol equipment ax described below and introduced 6y the applicant Homed on the obaee application number in the premises of
I RFVI;Pl 3~i7a..t7WS1(,L, t."C)R %•3<:K }?7?. , t~t9?,~:-~75, kt?+`T'~~,'L`Ut:K, N~Y,
in the following location; ? Basement ~ lot Ft. ? 2nd F'1. ,Section Blrx.~k Lot
uwa examined an ~'~~"}1 ti~h ~',7 r I' 7 r' and fourzd to be in contplianoe frith the reyuirentents of Chia Board.
rnp
FIXTURE ECEPTACLES 5w1TCHE5 FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMi. K. W AMi. K.W. PMi. KW AMT K W AMi. H P y~
I
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BEII UNIT HEATERS MULTI.OUTLET DIMMERS
AMC K. W, Oll H. P GAS N. P AMT NO A. W, G AMT AMP pMT, AMPS TRANS. AMT H P SYSTEMS AMi WATTS
NO.OF FEET
s S}Jfl
SERVICE DISCONNECT NO. of $ E R Y 1 C E
AMi, AMP. TYPE METER 1 YW 1 R SW 3 $ SW 3 dW NO.OF CC COND A W. G
EQUIP. 'g PER 8 OF CC. COND NO Of HbtFG OF HI-LEG NO OF NEUTRALS aF NEU qAL
OTHER APPARATUS:
{i,R .C~. r..^.1
S'M~EtA; 1?F;T~~C9"GR,r~-9
:
F Lj!C~
3tiLUY 1'T3i~T}LI:CI ~
i:~'t ,~r,,3Q0..R
~ 1'A'P hANF.
)-"T~'i'T.'T,TCIr;Y,, IVY, ;1 '195h GENERA MANAGER
11 ~ r' '7
this certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING OEPAR7MENT. THIS COPY OF GER71F1CA7E MUST NOT BE ALTERED IN ANY MANNER.
TEL. 765-1802
oS~FF~f./~~Cp`~~ TO'G~1Y OF SO'U'TII4b.S~
' 'r ~c OFFICE OF BUILDING INSPECTOR
' ~ P.O. BOX 728 ~
y ~ ~ TOWN HALL ham,.
O `r SOUTHULD, N.Y. 11971 D
~~Ql ~~b~ ~ ~C2&1989
rr
r
~m~.rt._... _
r~~rr~i..o~ :~oui'wo~r~
C E R T I F I-.CAT I O N '
Date , / J~~
Building Permit ~/Nyo. ""/`L7~7~
Owner ~!/.~cl y//i/~uya ~
(~pl~ease /print)
Plumber P.C}at%/Oti ~`/~/~'`'9 °i
(please print
I certify that the solder used in the water supply system
contains less than 2/10 of 1~ lead.
- (plumber's signature)
Sworn to befo e me thislI ~ ~ 1
r
19 Notary Public
l/
Notary Public,~~°~'\County ~ CLAIRE L.GLEW
No#ery Pubic, S#ate of New Yo#k
No. 4879505
QuslNied in 5uNo{k County ~j
Commission Expires Docamber 8,19
'-1ELD I;:S:'~C;iUN ~~llnTE ~ i:Oa~iMENT° \1
'a V
h a
C V Fi
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r, 0~U,~t,1~fD~A
T I _ w (1st
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FOUNDATI011 i2ndl ~
2 ~ f
o
<o Leif
ROUGH FRAME ~4
/ d
PLUMHII~!
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CA O
y
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CT1
3. fi
IIISULATION PER N. Y,
STATE ENERGY ~ d
CODE x
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y . New
FINAL !7 'b '
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ADDITIONAL COMMENTS: x
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~~~71
rss-iso2
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION i5T ~ ) ~OUGH PLBG.
[ ]FOUNDATION 2ND [~j INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~-~~~Q~~
wit ~.rt.~ ~ ~~uv
E
E DA'T'E ~ INSPECTOR
1~L7/
rss-isoa
IERUILDING DEPT.
t NSPECTION
[ ]FOUNDATION i5T [ ) ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[~RAMING f. ]FINAL
REMARKS:
i
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTi~N
[ ]FOUNDATION 1ST [ !ROUGH Pt.BG.
[ ]FOUNDATION 2ND [ ] lNSULATtON
[ ~RAMING /~0 [ ]FINAL
REMARKS: aX ~ 7,B-~~ ~,,,-~.~f
- C
DATE 0 INSPECTOR
E
765-'t802
BUILDING DEPT.
[ ] FOUN ATf N 1ST ( ~ ROUGH PLBG~
[ ] ~U~I~~N 2ND INSULATION
[1
[ 1 FRAMING [ ]FINAL
REMARKS. _ G~'
DATE INSPECTOR
i
BOARD OF HEALTH
3 SETS OF PLANS
FORM NO. 1
SURVEY
TOWN OF SOUTHOLD CHECK . ~.o2Sb'9 .
BUILDING DEPARTMENT SEPTIC FORDf
TOWN HALL
SOUTHOLD, N.Y. 11971 NOTIFY Q
n7 ~i,~4 TEL.: 765-1802 CALL ..~gU.:~.rg.~~.-~ .
Examincd.~ry..........,190~Q/ MAIL T0: may..
Approved ..~2.7........, 19f~1J. Permit No. ~ 7 ~ ~ ~l~{R,Lff/`
Y~
Disapproved a/c
x(988 ~
(B ddi nspector)
APPLICATION FOR BUILDING PERMIT TOW
pFSpU7li0Lp
Date . 19 O.C~
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 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. T}te 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
Reeulations, 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 insp ctions. ,
.GEC.. ~~E~G~ cag'I~ .
(S'gnature of applicant, or name, if a corporation)
' (Mailing address of applicant) ) /G5~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .~2'/<C~..~~..~C~~C:"~.. ~!~t~f3.~ .
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. ...4~Lln4R!~! .
Plumber's License No . .
Electrician's License No. .~R,Ga;~'; • • • • • • .
Other Trade's License No . .
- ,
1. Location of land on which proposed work will be done. . ~/,Z2./%G!$,T~; • • , ~~~j',~,~'r;7~~; . •~`tf~~~~~fa
House Number ~ Street\ ~ • • • • • • • ' '
' Hamlet
County Tax Map No. 1000 Section . ~ B~bck ....7. Lot 9, C~ • , . , • • , , • , , •
Subdivision .....................j Fled Rlap No. Lot .
(Name i
State existing use and occupancy of premises~a^nd intended use and occupancy of proposed construction:
a. Existing use and occupancy . ~I/1~.~~T~Y1.~.Y.~~...fe~.~d•L•ne~ •_..Pt,.mA~~..f~s•!d~=.n~~........
1 ,
b. Intended use and occupancy L~ «
~5 i~~.l~-. ..~^.e.:..P~~i~~:r~ . r~s,~:~~nc~...:. .
i
3. Nature of work check which ' 1~'~ Alteration . .
( applicable): New F3uilding , . Addition • • • •
Repair Rcrhoval , , . , Demolition Other 1Vork .
~ ; (Description)
tiz
4. Estimated Cost . 02, G, UC~U : . . 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 ~ . . .
6. if business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions o existing s[ructu~es, if any: Front ...J`",~~/ Rear . Depth ~s~ ~ .
Height . ei(~`. , , jnber of Stories ...1Jo~ . . . . .
Nu
Dimensions of samC
sta1!oture with alterations or additions: Front ~ Rear ,~J.3 ` .
( `!p„~p.Th~d. height , . .........Number of Stones ..off.... , .
8:';1~',,,..~t~o....•.. CW construction: Front , . ~Q.'t-~ , Rear .1q~y.'~........ Depth .1.~:(p.i~........
Height +c~~ ~ , t.`t; Nujnber of Stories ..aZ . .
9. Siz~',ta(1,~:~,'y~ :QI , Rear ,a7~Ct~.c~(Ra Depth Fi,3q. y~lN,~.~S~s~.~~.~ .
10. Date of Purchase . ......Name of Former Owner Wil~idtYfl.G,hVs~iCi,~... .
1 I. zone or lrse•Qis,p;ic ,,{{n w ich premises are situated . ~?~.iC~'°.~~".~A.~-.~.~(r ~.~U~~'I.~(CZ ~ . ~Q1'l~......... .
12. Dpes.pras~~,~fruction violate any zoning law, ordinance or regulation: . NQ .
13. Nill~lot be regraded . . ..Will excess fill be removed from premises: Xe ~ No
14. Name of Owner of premises ~yi p: ~1C,s.~C~ M! j~~~Address ~`JO]<~1'7q .~R7`:i7~44~Phone No. e?g~': • •~J..•~..
Name of Architect ................Address > ..................Phone No............... .
Name of Contractor .
IS.xs this property loci',,,,,,,,,,,,,""•Address ......,...........,PhoneNo...........
ated within SOD feeC of a tidal wetland? *YES....NO.
*lf yes, Southold Towp Trustees PLOT DIAGRAM a required.
Locate clearly and distinctly alb buildings, whether existing or proposed, and, indicate al] set-back dimensions from
property fines. Give street and block, number or description according to deed, and show street names and indicate whether
interior or corner lot, I
i
,
• ,
i
i
i
STATE; OF NE1V YORK, ~ S
COUNTY OF .
. , , , • . . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signijig contract)
above named. ~
He istfte
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly, authorized to pgrform or have performed the said work and to make and file this
application; [hat all statements conta%ned in this application are true to the best of his knowledge and belief; and that the
work wd! be performed in the manncr'isct Forth in the application filed thcrcwitlt.
Sworn to before me this
A' ~
Notary Public, 1:';`.".'.`~..~•~e"v4~C((//••,••, County .
i tL~'~16 . .
41E1E?I K OE VOE
NoTARPFU8t1C.SbleotNewYrAr (Signature of applicant)
kna
E+~dros M~