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Home My WebLink About21004-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21064 Date OCTOBER 7, 1992 THIS CERTIFIES that the building ADDITION TO ACCESSORY Location of Property 875 WELLS ROAD PECONIC, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 75 Block 6 Lot 2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 21, 1992 pursuant to which Building Permit No. 21004-Z dated OCTOBER 7, 1992 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 DECK ADDITION AROUND ACCESSORY INGROUND SWIMMING POOL AS APPLIED FOR. The certificate is issued to MICHAEL & GEORGINE ZANESKI (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 FORK NM 2 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°-1v°• 21004Z Date 1992 Permission is hereby granted to: `mar, . olf/ . ZVI. y of premises located at ....61 .........SZI .......f (rl... . County Tax Map No. 1000 Section ,7,7 Block ......6............... Lot No..2 . pursuant to application dated ..........0.2./ 19.~ and approved by the Building Inspector. Fee ~ . /moo Buil I r Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 12 lead. 5. Commercial building, industrial building, multiple residences ana 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. 3. 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. 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 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date q 'ew Construction..... Old Or Pre-existing Building....... p ocation of Property:... X//5......../<?EG~S 1P0~.Q.........L9r (L° no f, House No. q Street Hamlet )nwer or Owners of Property.... . 4.4(~ ,/Gip/ C _ , JX!`S~~ 'ounty Tax Map No 1000, Section...... ?.5..„ Block..... Lot. ubdivision ....................................Filed Map............ Lot...................... ermit No ................Date. Of Permit Applicant 'calth Dept. Approval ...Underwriters Approval....... lanning Board Approval equest for: Temporary Certificate........... Final Certicate........... ee Submitted: CG ~o~~O (Q [c APPLICANT~ 7 BOARD OF HEALTH FORM NO. 1 3 SETS OF PLAINS TOWN OFSOUTHOLD SURVEY 2 BUILDING DEPARTMENT CHECK....... ~ . TOWN HALL SEPTIC FORD! SOUTHOLD, N.Y. 11971 TEL.: 765-1802 NDTIFY:, q CALL : Z-. Examined 19 l.? PIAIL TO. n - . • . Approved 119laPermitNo.. Disapproved a/c /B ing Inspector) APPLICATION FOR BUILDING PERMIT Date ..~~-•Z/ q~ 19 72 INSTRUCTIONS 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. c . 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 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; t'ons' (Si ature of applicant, name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . 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 . Plumber's License No . Electrician's License No . Other Trade's License No . 1. Location of land on which proposed work will be done. . ..i .y..EL..S..4POR~ e7 //,GeGo~..!Pc1 ~ COA/'~........................... (louse Number Street Hamlet County Tax Map No. 1000 Section 7 ~ Block i(?............ Lot PZ Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy .....~7~~.5 l I ~1 • • /~GC•K , • „ • , • • • , • , , , . . 3. Nature of work (check which applicable): New Building , , , , , , , , , , Addition Alteration Repair • • • • • • • • Removal Demolition for Other Work............... 4. Estimated Cost O "02 /1 (Description) 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 t . . . . . . ' . . ' ' 7, Dimensions of existing structures, if any: Front , , YPe of use . • • • .Rear " ' Height Depth • • • • • ....Number of Stories . Dimensions of same structure with alterations or additions: Front • . ' ' ' ' ' ' . ' ' • Depth Height Number of Stories Rear 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear. Depth 10. Date of Purchase Depth """•'••••••••••......•••..NameofFormerOwner 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . ' ' ' • . ' . ' ' . • 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded • ' ' ' ' • ' • • • • • • Will excess fill be removed from premises: Yes No 14, Name of Owner of premises Address Name of Architect , • • • • • • • • • Phone No Address Phone No............... . Name of Contractor Address 15. Is this property within 300 feet of a tidal wetland? * " ' " ' .Phone No . *If yes, Southold Town Trustees Permit may be required. " No......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. t APP 0 D AS NOTED pgp DATE: B.P. # b U FEE: ~~a ~ BY: E NOTIFY BUILD G 5EPARTM&f AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2 ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOWC.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF Oil COUNTY OF........ S.S I • • • • • • • • • . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. "le is the (Contractor, agent, corporate officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the vork will be performed in the manner set forth in the application filed therewith. ;worn to before me this l~ .day of , 19~ lotary Public . \ ClA1RE L OLEIN County No Ncgcy Publle~ . Scats of New Yak t~ /I ..COY.. . No.4878bOb QuaROW In Suffolk County Cacanieebct E>gilres December 8,19 ~y (Signature of applicant) i l~ tii .tJr l ,V~Ytili A'r 10 for " 'f n i Guru . ` 9 '15' . ~r lit \ J r u a i tJ 0 i 4. i'y % rte' ( L119 G :~Y 6 6• oj- = j ; - -ter _ Ail k~+9 00 "'1710111 v/ 6 1 J' f y l r d4TE:Li B.P # / FEE. NOTIFY 6UILL'IN4 DEPARTMENT AT f AM TO 4 PM FOR THE ~]y+~~~Y• 7 r. ,E t *IL~IW/O REQUIRED -ETE r' F k:!Lai i-+ ~t; r\ 9S'.~. r?a PLUMBING ^r"N , i j yy9 !Pj} IlTlll MUST ALL'.;taK,1 .t In ,l ~"!r a•LL,c' F~T j % .:eNT`: t?' 1'M£ NN THE OEQUjp:~I r=` '-5 'lGZ1 l c7rt ~ : r r {,t/!~ c:'C t/ i r5TC_4jfY~"T~` ENERGY ! ~7 c . , i~r rUR i'~ ~ _~r,,.1s>•lC.ca ~ lL' y/~ / rCr~ ` ~ f r r ~f-r" OPSr: 7 -r "Ile aht'Y r - J•. ~ N ~aa zo`ozx z ooA n^o ~~n*ti I ~`1x n o rn w~ h O ho ROM FEAe6 1,3 - - T r it fZ7 0 o o h I-z lI h ' ,/~1 I ~ 1 HVPR 1 - i 1 1 g, lVJ c II rn O I~rC O 3 4:0 " e A r- o t G m O