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HomeMy WebLinkAbout17106-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17841 Date MARCH 13, 1989 THIS CERTIFIES that the building ADDITIONS Location of Property 1370 STROHSOM ROAD CUTCHOGtIE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 103 Block 10 Lot 28.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 24, 198$ pursuant to which Building Permit No. 17106-Z dated NNE 14, 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 & DECK ADDITION TO EXISTING ONE FAMILY DWELLING The certificate is issued to HENRY BOCZCK & wife (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PENDING - JANUARY 23 1989 PLUMBERS CERTIFICATION DATED MARCH 10 1989-PERFECTION PLUMBING Bui~spector Rev. 1/81 rows xo. s TOWN OF SOUTHOLD 6liILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Na 017106 Z Date ~ ~ 19.~ff Permission is here y granted to• mn~ ...../......7Q.....sf ..~~~.....~1.../~r........ U .1~., . .................~f..~... to ....AKA ......fr~4'r.F~l~~, ~~~y~~ ct premises located of ............~-3.7~..Si2~ .....41.Y ..............................................................................22................................................................................. County Tax Map No. 1000 Section ........~Q.J.... Block .........lo...... L~iot No..........~.~.° C pursuant to application doted 19.~~t, and approved by the Building Inspector. Fee $.ti1Sl ./,~,ry,.. ,77~~ J . . 6 Iding I for Rev. 6/30/80 .+R: _ ' ` FORM NO. 6 i4,~"~.°, ~s`~, .~e__. , TOWN OF SOUTHOLD t ~ Butiding Department ~7~ /t '~y . _ Town Hall F! by ~F~~ - 8 f,9~~ !I! (1 Southoid,iJ.Y.li97i 4Itr ~awt,._„ ._.n.~ APPLICATION FOR CERTIFICATE OF OCC PA Y, t'sj'-'c. i-~~=i`i ~S.dn1 C:F `.~`Ot17W0E0 Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- torwith 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 supply and sewerage disposal-(S•9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, acertificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements tivhere applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sveorn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare acertificate. / C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy S7.C0 / ate ~ , ~y . , New Building . ..........Old orPre-existing Sui./l_ding(X) . Vacant Land . Location of Property l:~ ~ , , S l ~ OHS UM- (2 p - Ct/TCJ~o House No.! {~~qq • • Srrear • . • • • • • ~ . • . •~Hamlet Owner or Owners of Property 1:'.~~ M~S (fL`~ ~oG7 E(L -.J~.-=. County Tax Map No.,1000 Saction - f ,3, , , , , - g!ock - ~ Lot Subdivision ............................/.....Filed Map~No. ./.:.......Lot Ne. Permit No. ~ 71 ~ Y Date of Permit ~~1~1 Applicant ~ ~ ,~~~;U~~' . Health Dept. Approval .............:..........Labor Dept. Approval , , , , , , , . , , , , , , , , , Underwriters Approval ~~~!b,l,~; ~ , , , , , , , , , , , ,planning Board Approval , • . Request for Temporary Cert'ficate .....................Final Certificate r- Fee Submitted S.G/.~.....~5~.~~, Construction on above described building and pe~~~imeets all p!{c odes an regulations. Applicant . Rev. 70~70~78 -1ELD i;;S:'~'~ilU.7 ~~UATE ~ C0IKMLNT° \ ~ 1. ?p " _ y ~ FOUt7DATI0N (1st) ~~p `~.~j.r °~d FOUNDATION (2nd) _ - 9~8 2. ~ z o~ ROUGH FRAME & Gv -PLUMBING ,(A ~ H~ ~ ~ 3 . C° m ~o INSULATION PER N. Y. y STATE ENERGY CODE ro 4 . FINAL ~ ~ o ADDITIOP]AL C MMENTS: x~ 1 M ' x~ b~ r x d cn -o H TEL. 7G5-1802 c,~FFOC~f-C o ~ TOWN car Sr~YTTII~d,~J ,=y; ~ . OFFICE. OF BiJILDIi•IG ITISPECTOR o m P.O. BOX 728 u' TOWN HALL "OP,, ~ ~ SOUTHOLD, N.Y. 11971 . Cpl y,~ C E R T I F I C A T I O N Date a Building/P/ermit No. ©/7/C)6 Owner__ / ~OCZ~/~ (p ease print) Plumber .~.L'~rc~o.u /U/~7lJ~N/ c~~?d~%~ (please print I certify that the solder used in the water supply system contains less than 2/10 of to lead. l~~ " (plumber's signature) V Sworn to before ~m"e this /0 day of ~r/G~~-- ` 'mod , / Notary Public Notary Public, County HELER K 4E VOE ~No 47078TH, SufifulkfCaunttY~~a,r~~k term Expires March 34,19_0 ~,~~FOS ~ ~v~~ TEL. 7G5-S St„ ~ 0Pf'ICI:O[~ GUILD(NG iNSPI;C'I'OR u 1~ ~~~~ti ~ I'.O. BO?C 1 1 79 CT~~~i'~/ ~ TOVlN I TALL fit' S0U77IOLD, N.Y. 1 1971 ~yol ~,a . March 3, 1989 AWJ CONSTRIICTION CORP. DEPOT LANE CUTCNOGOE, NEW YORK 11935 Rg; HENRY BOCZEK 'I'o P7hom This, May Concern, 4.e arc unable r.o complr_te your Certificate of Occupancy becausc,of the follocving reasons. An application for Certificate of Occupancy is not nn fi].c. Flo [lnderwriters Certificate on file. / / 't'he checF: .i:; (outdated/not on file. } No flcal.th Dept. Approval on file. No final insl~ect.ion has been made. Plc;ase r_ontact: our office on this matter. - Thank you for your cooperation. Iht.ildtr,g Pcruti_h. 1f 1 7 1 0 6 Z Building Dept. Uo Plumbn_r ;;older Certificate on f-i1e. ( a].l pert:til:; involving plumbing briny ie;sucd after ,'1pri.1 1,1984 ) ~7~n~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T ( ] ROUGH PLBG. [ ) FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ FINAL REMARKS: 9-r , . DATE INSPECTOR . 7f5-1802 BUILDING DEPT. ~C/a~ I NSPECTIO ,N"~/~~ ~ FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: -~~8 (G ~ ~ ~ DATE~~ ~ INSPECTOR _V ~ / 765-1802 BUILDING DEPT. I NSPECTI®N [ ]FOUNDATION 1ST ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMAR. S: x ~ r _ DATE ~ ~ ~g INSPECTOR a /~r~~ 765-1$02 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND INSULATION [ ]FRAMING [ ]FINAL REMARKS: CJQ DATE 0 INSPECTOR y l ~~o ~ 765-1802 BUILDING DEPT. INSPECTION F UNDATION iST [ ] ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL 0.~r / REMARKS: ~~e~~_ DATE ~ ~ ~ INSPECTOR ri l2l0~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [~NAL REMARKS: DATE oZ , INSPECTOR w ^fv _ ~ ~ ~ 1~~ l~ L ~ i ~ l - - I ~ i - d, I ~ I - - - - - - - ' I _ - . _ a I----- k 1 I. ,,1 - - - 1 i 3X3 Ea~~~ ' ° sNcwtR ~ ~ ' q ` ~ - - - - - . i. 'J f I 1 I . 1 N i _ ~ ~ r".C, - ~-h.-L,Sia. ~ ~I ~ t ~h. r ~ ,~y - - - - , - ~ p2: o - - - _ ~ - - _ 5,-~ - - - /ra G.r i o i. - y ~?J_z ~ d-c~ ' c~C~ cY~~ ~ r c c I,~ \ , t- n e . V ~ ` .f~ ~C~~ Y" t~~.-arc ~~~(?'IQ GILY;P, Tu C;YtI: T. r , J , f~ ~ ~ ` t ~ ~ /-FC cam.. C %r7 ~ jt~ ~ \ - ~ ~4 / ~ \lY/ - ~ - ~I ` } i ' ` i _ _ a~ / I _ _ _ _ _ _ _ //J / ` PrW`u ~ 1 - ~ ~ a Z ` ,y / ~ (S 4 ~ ~ ~ r ~ - - ~ - - a i ~ ~ n z 7 - - , - i R 1 - - - r-t` - - - _ - - - - - r+ ~ - -l--- " - ~ ~ - c - - r~ - - - - - ~ i - ~ J - ~ 7 r - --f - - - 6 o~- - - - ~ ~ r --I- - ~ ' - - - - ~ . c.; s` G . Y 1 i ~ t ~ Q - ~ -9- Y_.. 1 ~ ~ ~ ~ ' r _ H n b ~ cr- -o ~ S er tubing Is used If cope fot Water distrig all be -s--3-- ~-a~- - of tYPe$ K --=-,---------T - G l 5 - ~ - - S - - ~ - - - -~Z{ ~j-- h I sir ICY _ -ii _ _ l/ ~'19~YV1~ ~ )~17 - - - - _ ON_ DENT R,EFQ}~---- - - = CERT/F/ OF OCCUPANCY ~ SOLDER USED IN WATER - - - - - - - - - - -SUPP~,~! ~YSTE-l4f Cy4NN+UT f ~ EXCEED 2/10 of 1 % LEAD. - ' lVJ?ZG~- -SldlNG~.----~ ~ APP D AS N ~/~6 - - - DATEr -ikl!N.~..- ALtaL~IMIIABtE- t~11MM16N iJlI~R Ir1Rdf - - - - - 768TINGBEF#~RF CONERMIQ - NOTI ICOING -DE AT 78b-1>~2 9 AM 'tip 4 PM R THE" - - - - - - fOUAWlNG~NSPEGTION&a - - t. FOUNDATION - TWO REQUIRED - - - - --FOR-POURED-CONCRETE . - 2. ROUGW -FRAMING PWMBING - - - - ~d _ t - - - _ _ - - 3..lNSlILATJON - ~ 8 ~ 4. FINAL - CONSTRUCTIONMU$T '~J _ _ BE_CQMP4ETE FOR C.O. ~ .ICJ _ - THE RE_nUiREMENTS O~TWE N~Y V U~ S7ATE CONSTRUCTION $i ENERGY ~ CODES. NOT RESPONSiBI.E FOR ~,,,t - - DESIGN OR CONSTRUCTION ERRORS - - J ~orrnerly Mary Wetter 1 , - - - -~---T----- - -e - I 9 ' U M ~ ~ ~ ~ Y N .L M. Seaman ~ n ~ u W i c 5.84' S4' i, 0"E . 16 .50 y o mow o .o po acv ~ ~ d ----1 -1~' - r V 'p wen ~ a ~ ~ IY ~ c n4~p I ~ i- ~ d ~ I ~ w 0 v\ C Yi V O ~ N I;a~ .a ~ 2 iUt O ~ ti7- a j a j ~O o , 'ac 9 ~ s ? IIl ZpKe y ~~N` £ = N~ s Y o -sb - a>t•e v ,J O r 6 i C m L, Po~esney L 33~ , MAP OF YROpERTY ( SURVEYED FOR ~.~2AYMOND N~NRY A. ~EalTN A. Bt'~CZEK • - iron pipe PECONiC Q canc. Monument' AYTH00.12[D ALi[RATION OR A9D~ ~ FS, LK GO., N. Y. fN12 SURVEY IS A VIOUYION 01 STtON 7202 Of THE NE,V YORK SYAn E ucATIONLAw. GE.Egra+~teed -t'o iHa~ L1.5. =Tie RI,ES OC THIS SURVEY Mqi NOT SfApWO TItIe IH SVYq HCB CO. f iH~ f\AY1YIr+P_ f ELAND SU:.VEYOR'S iN!:.D S'µ O0.: kO23ED SEµ SHAH hCT BE WNSI0ERE6 Mld ~GYd ~fll' keY Nalt_ia% n ~ C3ar:c ' BJ A VALID il;UE CORY• ~ d4 '3 LtYYN:'c.o L`~+C Yi1H Vey! .3. ~ I9TS. i ARANTLES INDICAi:p HfRSON SHAH RUN S C A L g : S O ~ C ' (~gpgE,l CK VAN Tt.lh'L E p. C, 1 LY 70 THE JE; SQ: FOB 1'I'r.CAf THE SURVEY '//y/~,/{¢y('y}~~'p.~/~ I REpgR(D, A::D OPI H,S B:EiALF i0 THE /T/' Y E f>•.~.~~-~'ti~ ~ COM9ANT, GOVE:i<iGLNlgI AGENCY AND i ? LC DING INSiiiUilON LISTED H. R:ON, AND ~ ~ ' THE ASSEGNEES OF. THE LENDING INST4 LiGen$ed Land Surv yOrS - ~ ION, GUARANTEES qRE NOi iW1NSFERAOLE'. ADDITIONAL INSTIfUYIONS OR SUESEgUHf7' 6 roe n ~ Q r'f 1 ~ , 2 . NERSi -'f{?LE N0. ' BOARD OF HEALTH 3 SETS OF PLANS FORM NO. 1 SURVEY TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL ~ .ZJ.t{.:.S~(,~.-, . t~ MAIL T Examined . 19~R Approved ..C?~/.s~........, 19 f/r/. Permit No% ~~8.~~. ~ I,~ ~ ~ ~1 G~%rO 1 Disapproved a/c 7~~6 LI I ~ a~ 4 ~~~'fr f (..h!.. . p. p ~ BLDG, L",~r uildii%""" ector) TOWN OF g0UTy0LD APPLICATION FOR BUILDING PERMIT ~,Z ~ Date......----...., 15 U.. 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- caxion. 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 shed 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 cod/e, housing code, and regulations, and to admit authorized inspectors on.pzemises and in building for necessary i~~°e.:«- (Signature of applican , o a` a corporation) . , ~ ~ - ~ 0 7- L~>~ ~~t~ il/ t~~ y.......y (Mailing address of applicant) 3.~ State whether applicant is owri~r, les§ee;`agent, architect, engineer, general contractor, electrician, plumber or builder. s : ~ . Name of owner of premises ; . t4....!"/........ / . (as on the tax roll or latest deed) If applicant is a corg~ration,'sign~tttrB of duly authorized officer. - ,.x , p a, -r.. .;...3...:5. (Name and trtle'o'f odrporate 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. , , , , , , , , , , , , , , , , ~UhZ...1.~~ . e/ t . /t0/~ ~ . House Number Street Hamlet c~, County Tax Map No. 1000 Section ...I.O3........... Block ,1 Q.. - , , , , , , , , Lot ~ C=/?.I.......... , Subdivision Filed ~1ap No. Lot . (Name) 2- State existing use and occupancy of premises and intended use and occu ancy of proposed construction: a. Existing use and occupancy • ~ ° b. Intended use and occupancy ...~a~ Re air , , , , . ( Re applicable): New Building Addition Y Alteration , . 3. Natpure of work check whiclmoval . Demolition Other Work . ry ~ ~ (Description) 4. Estimated Cost p .0. ~ . ! . . Fee . 5. If dwellin number of dwelli (to be paid on filing this application) g>ng units , Number of dwelling units on each floor . If garage, number of cars 6. If business, commercial or mijCed occupancy, specify nature and extent of each type of use , , , , , , , , , , , , , 7. Dimensions of existing structures, if any: Front , , , , , ,Rear . ~$'y , , , , , , , . Depth Z r , , , , , , , Height , , , , , , , s Number of Stories f . ~ s with alterations or additions: Front • .7~:a, Rear y . Dimensions of~same structure Height (,Z, , , , , , , , , , , , , , , • ,Number of Stories J................ , , P 8. D mgensi ~ ~ e • new c ~n'sttuction: Front Rear ....y .L Depth . ~ a, , , , , , , , Hei ht Amber of Stories . . 9. Size of lot: Front .~+69Z3... . . Rear ...l 0.'1. (c) ............Depth I. . 10. Date of Purchase , , , i Name of Former Owner . 1 1. Zone or use district in which premises are situated , (Z r~! ~ L 12. Does proposed construction violate any zoning law, ordinance or regulation: , /V~? . • . 13. WIll lot be regraded ! Will excess fill be removed from premises: Yes No 14. Name of Owner of premises l~f K.~.l!71e3, /f ~ t'3p~?rA`ddress S. , or•1Sah . (~?a • , • phone No... Name of Architect , pp , ,Address . !Z~; f.--~, , , .Phone No. . Name of Contractor .(.V.r,~~l i~ . ,~~)-GA.nr.$ ..Address ,57.~?QT: ,~,gvE , ,phone No.Z?7..7.: 15.Is this property loc *If es Southold To ated within 100 feet of a tidal wetland? *YES....NO.... Y . wn Trustees Permit may be required. PLOT DIAGRAM Locate cleazly and distinctly ~Il buildings, whether existing or proposed, and, indicate all set-back dimensions !j'om property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. , ~~T AP R VED AS NOTED,,., ~ _ i DATE~a%~~~ B.P. q ~ BY: FEE: AT - NOTIFY ILDING DEPA 766-18D2 9 AM TO A PM OR THE FOLLOWING INSPECTI~OVNOSREOUIRED 1. FOUNDATION FOR POURED CONCRETE MBING 2, ROUGH -FRAMING 6 PLU 3. INSULATION 4. FINAL CONSTRUCTION MUST ~ BE COMPLETE FOR C.O. ALL CONSTRUCTION SHAD N.V. 7HE REnU1REMENTB ~ ENERGY STATE CONSTRUCTION 6 FOR CODES. NOT RBSPONSI9LE DESIGN OR CONSTRUCTION ERRORS I~ STATE OF NEW K, ~S.S COUNTY Obi g ii being duly sworn, deposes and says that he is the applicant (Nam vi a i n',ing contract) above named. He is the I . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulry 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 work will be performed in the mannef set forth in the application filed therewith. Sworn to before me this ~ day of!,• • , 19 e Notary Public, County /O'~!/IG CLAIRE L. C~11.EV1f Park . Notary Puhlb, State of Neil No.4878B06 i ) Signature of applicant) tluelffied In Suffolk CouptY r~ O/ Commissbn Expires December ,1