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HomeMy WebLinkAbout19223-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27962 Date: 09 24/01 TNIS CERTIFIES that the building ACCESSORY Location of Property: 26565 MAIN ROAD CUTCHOGUE (HOUSE N0.) (STREET) (HAMLET) County Tax Map No_ 473889 Section 102 Block 5 Lot 20 Subdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 17, 1990 pursuant to which Building Permit No_ 19223-Z dated JULY 23, 1990 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 ACCESSORY SATELLITE ANTENNA AS APPLIED FOR. The certificate is issued to H ALBERT ORLOWSKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTN APPROVAI, N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATBD N/A Authorized Signat re Rev. 1/81 IP01311[ NO. • 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) Na ~2~~ Q Z Dote ..........:~3 19.1.a Permission is hereby granted to:~~ ~Q~f~ ~ .~fal.... ~ a 3..,...`~,,1.~....~~.. ....L.A~ i~ .............................pp.........................................;....................................................................... of p miles located of ...rrl..(J..~~.~... ..Ci~%~~~~j.w.~~~ . ..~.1.~...`.~. . County Tox Map No. 1000 Section .....~i7...2..... Block Lot No.....'~~..'d............ pursuant to application dated .........~~.7 19.rl..~(~., and approved by the Building Inspector. s9 Fee S••er~.~ / Iding I fo~ Rev. 6/30/80 Form No: 6 , i.----; TOWN OF SOUTHOLD . BUILDING DEPARTMENT TOWN HALL I d 765-1802 ~ '''i APPLICATION FOR: CERTIFICATE OF OCCU NCY'" - A. This. application must be filled in by typewriter OR 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 1~ lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Complianoe 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 Buildine - $100.00 3. Copy of Certificate of Occupancy - .25~p 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00,C,o/m//mercial $15.00 Date ~ ~~~of New Construction........... Old Or Pre-existing Building~.~./. Location of Property..~.~Jr.~t~ .................~.gNCJ.~}/?:............... House ,Nyo.n n Street{ (J~ ~ _ /f~ , DHamlet . Onwer or Owners of Propertyd,:lT.LJJ~RT.`~:~Y.•~/13A*:~^!~N7:'j.TtW.w......... County Tax Map No 1000, Section...~~~.'~d...Block.....C~rS'.a.~....Lot....~.a,A..dd~....... Subdivision .Fled Map ............Lot............. Permit No..!.!.~.°~",>...Date Of Permit..[./°~':~?.~~.~...Applicant Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate...V ~5=c Fee Sub tted: . _ m~J ~ a. ~IC~ C D APPLICANT =1c:LJ i:::::~C:'ti;:i j~9A:E j~ ~J:`iMtNT° -o m a` 7 . ''C,,11 ~ W H FOUNDATION (1st) N FOUNDATION (2nd1 _ - m 2 . ' a 0 P,OUGH FRAtiE & C~i~ PLUMBING y H 3. m II7SULATIOPI PER N. Y. y STATE ENERGY 1 CODE r m 171, y FI;JAL I ' o ADDITIOIIAL COMMEIJTS: m to \ ' ~ x w ' ~ W1J H (U A ' y M\ O N 1 I x m\~'C' a r H • Z v- i m v H BOAFD OF HEALTH ' 3 SETS OF PL.1NS FORMN0.1 SURVEY •sd TOWN OF SOUTHOLD CHECK •t ~•r•~- BUILDING DEPARTMENT SEPTIC FORhf . TOWN HALL $OUTHOLD, N.Y. 11~J71 NOTIFY; TEL.:7G5.1302 CALL Examined . 19 MAIL T 0~ . /f qrs. Approved 7/~.~ 19~~ Permit No. ~.'3~ .l..~t-X~~....... . z Disapproved.~Jc D LS L71"~~ ~tt3l. 1 i :~ti;~ ~Buil g Inspector) • - • - ,_.,.._n,;,_..- BLCCi. UcFT. s APPLtCAT10N FOR BUILDING PERPi11T TOWN OF 501.~Tf't)Lt7_ • Date ~Z< 7• 19 9.~ INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets of plans, accurate plot plan tUscale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 hall 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 ha;l 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 tuilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or :c_ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ~he applicant agrees io °eomply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmi[ authorized in3pectgrs, on premises and in building for necessary inspections. . - _ / (Signature of applicant, or name, if a corporauon) (Mailing address of applicant) :ate whether applicant. is owner, lessee, agent, architect, en ;ineer, general contractor, electrician, plumber or builder. ~7, ame of owner of premises ..5-GC:~L.~~2~L.%-t? . (as on the tax roll or latest deed) • applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. .~:':~:~!'::~!~-G Plumber's License No . " Electrician's License No . . Other Trade's License No . • Location of land on which proposed work will be done; - ~11: Y't-:~:L.. ~l ~e O; f' F~: ~G ~i` ~;C,~;r.~ Zj, :71.' j`. ~f 9 ii.' ' . ' •r house Number .:2 S•G ~ ~ S//f~reet. Hamlet ~ ~ • County Tax \lap No. 1000 Section ....'©•O``......: Block Lot " , ' •r Subdivision Filed Map No. Lot , (Name) State existing use and occupancy of premises and intended use gad occupancy of proposed construction: " . v,~~. A. Trxisting use and occupancy _ B. Intended use and occupancy - , Nature~of work (check which applicable): New [3uilding , Addition ~Uteration • Repair Removal Demolition ..............Swimnin; po~o~l ~ , Tennis Court Accessory Building..........Fence .......Other WorK:~~~L:L.~~.~f'. Estimated Cost Fee ~(-C~~~ (to be paid on filing this applications IC dwelling, nucnbcr of Swelling units Number of dwelling units on each floor . If garace, number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use . • Dimensions of existing structures, if any: Front . Rear Depth . . Hei_Itt Number of Stories . . Dimensions of same structure with alterations or additions: Front Rear . Depth IIeight ......................Number of Stories . Dimensions of entire ne~v constntction: Front Rear Depth . . Hci~ltt Number of Stories . . Size of lot: Front Rear...................... Depth . Date of Purchase .............................Name of Former Owner . . Zone or use district in which premises arc situated . . . Dacs proposed construction violate any zoning law, ordinance or regulation : . . . . 1Vi11 lot be regraded tiVill excess fill be removed from premises: Yes , No!~ Name of Owner of premises ....................Address ...................Phone No............... • . Name of Architect ...........................Address ...................Phone No............... . . Name of Contractor .................:........Address ...................Phone No......... ' . S.Is this property looted within 300 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 operty lines. Give street and block number or description according to deed, and show street names and indicate whether tenor or corner lot. G^-~•~ 1 AP ~0 D AS NOTED _ DATE: 7 ~U B.P. # - . Li'L~t ~ ~ 1 NOTIFY gU1LDlNG DEPART NT AT 765.1802 9 AM TO 4 PM FOR THE ~""~+PA1 YCY ~R FOLLOWING INSRCCTIONS: ~ ` V 1. FOUNDATION TWO REQUIRED cc~.LC ~ FOR POURED CONCRETE ,.~1 V~~'• 2. RO:1GH - FRAI411NG & PLUM9ING \~i ~~t 3. itJ~rULATIQty ~ u (:~~~~C~~1/I'j'~ FI?~!~.L - CONSTRUCTION MUST ~ ~ A~~~'~?+~~~ (~H j BE COMPLETE FOR C.O. ~ ~(„t' ALL CONSTRUCTION SHALL MEET ~ ~ ~ z THE REOUIREMENTS OF THE N.Y. ~ c STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR ~:C-~o ~C DESIGN OR CONSTRUCTION ERRORS ~ ~ c~~ ~ ~ ~ _ L~-E/~C J //'7/ LATE OF NE1V YOR1:, S.S OUNTY OF . • • • • • • • • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant • ~ • • • .(Name oC individual signictg contract) rove named. :istltc. (Contractor, agent, corporate officer, etc.) ~ ~ ~ • said, ptiync:1 of 'owners, and is duly authorized to perform or have performed the saiS work and to make and file this 'PiicStion; that all Statements contained in this application arc trot to the best aChis knowledge and belief; and that the ~rl; tivill be perfom~^d in the manner set forth in the application filed therewith. ' porn to before mn~7this , ,1:/.~`1 ..dayof..:-~.C.l~y........ 19.1. • • - nary Public. ~U . County . iy. . . . . . . . Not?ry Pair„ Stan of A~at York R~, 4~ i2j3 (Signature o C applican t) Cvarisd in SuE-mot Y~ y, . Conmis:>vi: F.~~89 l~ .