HomeMy WebLinkAbout20403-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28262 Date: 03 OB 02
THIS CSRTIFIBS that the building ACCESSORY
Location of Property: 1915 MANOR HILL LANE CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 108 Block 3 Lot 8.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 21, 1992 pursuant to which
Building Permit No. 20403-Z dated JANUARY 23, 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 AGRICULTURAL BUILDING AS APPLIED FOR.
The certificate is issued to JOHN A & PATRICIA C ZURAWSKI
(OWNER)
of the aforesaid building.
SUFFOLK CODNTY DBPARTMENT OF HBALTH APPROVAL NIA
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATBD N/A
uthorized Signature
Rev. 1/81
1'Oif[ N0. e
TowN oP souTHOLD
~IiIIDINd DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
~UILDINd PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°_ 2 0 4 0 3 2 Date 191.'.?-
Pertniuion is Mreby pwnted to•
.
//pp J /
premiaea located at ...f../...~5 ~si?~..../.~....•~~.~....~~~ ......s3.....
. ...........................................................................Gi....................................................................................
County Tax Map No. 1000 Section ..../Q..IJ......... Block Lot No......~l..t.. Z:..
pursuant to opplicotion doted ....,~~~.1 19.'~1.~, and approved by tha
Buildlny Inspector.
~ d'~
Fes S.c:l.. ~.~.~G~
..8.
Rev. 6/30/80
r R p
Form No.6 ~r I~'~ ~ ri' Iti
TOWN OF SOUTHOLD : i r ~ , ~
BUILDING DEPARTMENT ~ i : S i
TOWN BALL r/~nR T ZO02
765-1802
- _ _ _._---._-.J
APPLICATION FOR CERTIFICATE OF OCCUP T"' ?r
iso:_o
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. 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 fonn).
3. Approval of electrical installation from Boazd of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I% lead.
5. Commercial building, industrial building, multiple residences and similaz buildings and installations, a certificate
of Code Compliance from azchitect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements:
B. For eriating buildings (prior to Apri19,1957) 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. Photocopy of Certificate of Occupancy - $ 0.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $1AA5.0//0
Date. /~CCGYC~ J~~ o7~Z
New Constrnction: Old'o/r Pre-existing Building: (/ch-ec/k one)
Location of Property: /9/S A~Annr H i / ~CcnG ~ ~ ~3 _(t 7
Gi7~l,~.
House No. Street ~ Hamlet
Owner or Owners of Property: JOti/1 Q. ~'+CL h~c'f'YIC1C3~- C• ZJ.c..YQlt)S'KI
Suffolk County Tax Map No 100,0","Section I ~ g. Block .3 Lot ~
Subdivision %4f`S rlc.-rG~S Filed Map. Lot:
Pemtit No. ~U~U3 Z Date of Permit. / a3 9 ~-Applicant~G)
Health Dept. Approval: Underwriters Approval:
Planning Boazd Approval:
Request for: Temporary Certificate Final Certificate: (check one)
cstl
Fere S~bmitted:
L 113 ~ Applicant i lure
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'OUJIDATION (1st) rl
_ ~ I TI~
'OUNDATIOIJ (2nd)
I Z_
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;OUCH FRAME & ~
\~Iv al
~PLUMHING
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:IlSULATIOf! PER N. Y.
STATE EfIERGY
CODE
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FIlJAL
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ADDITIOf1AL COMMENTS: m
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BO~1FD OF HEALTH ,
FORMN0.1 ~ SETS OF PL.1tiS
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT CIIEC:: . . . .
TOWN HALL sErrIC FDRt1
SOUTHOLD, N.Y. 11971
TEL.. 765.1802 r: or I F't ; . ~ 3 ~ ! /
ixamined.~~~~,..... ,19~~ CALLi ._7~~
~ l CinIL~ TO.
\PProved ~ 3 19/v-Permit No. ~~,Td ~ .
)isapproved a/c _ .
/(Bu' ~ng Inspcctor)
APPLICATION FOR BUILDING PERMIT
Date A n/ , "2 i......, 19 .9:
' INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
;ts 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
r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
rtion.
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
call 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
tall 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
uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
he applicant agrees to comply with all applicable laws, ordinances, building. code, ho g code, and regulations, and to
unit authorized inspectors on premises and in building for necessary inspection
(Signature of applicant, or name, i a corporation)
...~~.~GX 79 /~cGON-G N.~/ IIc/S~
(Mailing address of applicant)
tote whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
OWNC,e
Lame of owner of premises . , a oNn/ ~ e /~/~TR ~ LiA Zu /~Au-)S/~i
(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 . .
Plumber's License No . .
Electrician's License No . ~ ,
~ ~~N~I{ fl<<l >R
Other Trade's License No.
C>l1(~°tloGVr
Location of land on which proposed work will be done. ..~R: V TE /i~0~ ~ l.~
1~--~' .
L 7 A n ~ ~
.
ouse Number Street Hamlet
County Tax IVIap No. ]000 Section ~G Block Lot
Subdivision ~ GCT's L'.QC=S Filed Ma No.
02
P Lot...............
(Name)
State existing use and occupancy of p/r~emises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~S: ~.~!?!!/~C-
b. Intended use and occupancy ; ~.9MC . .
~
3. I~Tature of work (check which applicable): New Building ,
Addition Alteration . ~ .
Repair Removal Demolition • • • '
.......Other Work
(Description)
4. Estimated Cost U~ . Fee .
5. If dwelling, number of dwelling units , , (to be paid on filing this application)
• • • • 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 of existing structures, if any: Front .
Height Number of Stories ? • ~ • • ' ' ' • Rear Depth .
.
imensions of same structure with alterations or additions: Front ~ ~ • ~ ' ' ' ' '
Depth Height Number of Stories Rear .
8. Dimensions of entire new construction: Front .
Height Number of Stories , , • • , Rear Depth .
9. Size of lot: Front Rear.
10. Date of Purchase Depth
"""""'•••••••••••••••...NameofFormerOwner
1 1. 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
l4. Name of Owner of premises ....................Addressxcess fill be removed from premises: Yes
0
Name of Architect • ..Phone No .
.Address .Phone No.
Name of Contractor .Address ~ ~ • • ~ ~ • ~ ~ ' ' ' ' ' •
5. Is this property within 300 feet of a tidal wetland? * •Phone No. _
Yes..
*If yes, Southold Town Trustees Permit ma NO'S " " • '
y be required.
• 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
nterior or corner lot.
h
TATE OF NEW YO ,1'
OUN,T~ OF ....~u~0 ~4- S.S
...1.~?72~c~aU Zui2/-)Gels/~,
' ' ' ' ' ' ' • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
rove named.
is the .
......................>9 VW.~~"~.........
(Contractor, agent, corporate officer, etc.) • • ~ ~ ~ ~ ~ ' ' ' ' ' '
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
irk will be performed in the manner set forth in the application filed therewith.
~om to before me this
2 1
~ of.. • ~vQ~ 19.~~
tary Public, • • • , p-Ci?.u~. • ~ ~~~\~C.~
NOTRYPUBl1
~T~te~IV.C (Signature of applicant)
No. 4725089, Suffolk Coun~ttyy
Term Expires May 31.19 Y3- >
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