HomeMy WebLinkAbout17126-z FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. ..,?,',17047...... Date .,July 1, 1988
THIS CERTIFIES that the building , ADDITION
Location of Property „5705 Main Road East Marion, N.Y.
House No. ~ ~ ~ ~ ~ ~ ~ ~ ~ Street ...................Ham%et
County Tax Map No. 1000 Section , , ,035 , ,Block ....?..........Lot ~ 6........... .
Subdivision ...............................Filed Map No. ........Lot No. .
conforms substantially to the Application far Building Permit heretofore filed in this office dated
June 9, 1958 17126-Z
pursuant to which Building Permit No . .
datcd , , ,June 1 7., 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 .
DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to STANLEY RUTKOWSKI
owner,~otFkt~i~Ari+`~i~k....................
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. 7181
xoaas xo. a
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~ 017126 Z Dote .................(~'!.t:..~..T.................., 19.b..~
Permission is hereby granted to:
...~~:..~.,...>r...=. rt.q..
o. ~..1. ~ .
. ,
at premises located at . ~..~~.......~.r~:!:r.....!!-~1.:.........•~,~d,.....f r.)~-~?~
County Tox Map No. 1000 Section ......Q.3s......oBlock .......Q..?:-..~.9.. Lot No.....~
pursuant to application dated .........~.R....J 19.A~.., and approved by the
Bui ldi ngC~Inspector.
Fee
Bui ng Inspector
Rev. 6/30/80 ~
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ sn~_ 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 farm 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 where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn 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 a certificate.
C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1.Cer[ificateotoccupancy New Dwellino,$25.00, Accessory~$]0.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 5 0.00
3. Copy of certificate of occupancy $ 5.00 , over 5 years $ 1 0.00
. 4.Vacant Land C.O. $ 20.00
S.Updated C.O. $ 50.00 Date ...~v.r`l.`c°..~~. ~.).q°a
NewConstruction,,,,,,OldorPre-existin Buildin Vacant Land
9 9 ,
Y,• .
Location of Property ~ ,V..J~........... ~~AC~, , , , , , , , ~f1S~,, ;/i¢t^1O1.~
House No. ~ ~ Street ~ ~ ~ ~ -Hamlet
Owner or Owners of Property ....~~.1.!9,rv {.~.;y , , , '~'f ;KuwS K~ , , . , . ,
County Tax Map No. 1000 Section 0 3~ Block Q.Z.-, Lot .....t! h , , . , . .
Subdivision .................................Filed Map Not^~.~.{.....`~..Lot No.
Permit No.d~~.).~..(a?DateofPermit ~~/,~/~,Applicant.. l~,t,+~.,(7,Olvl~,,,~~~......,_
Health Dept. Approval ........................Labor Depi. Approval
Underwriters Approval ........................Planning Board Approval ,
/
Request for Temporary Certificate .....................Final Certificate .....t/.:. , . , , , , , , , , , , , ,
w
Fee Submitted $ ~
Construction on above described building and permit meets all applicable odes an egulations.
Applicant .
Rev. 1010.78
Rte, 3So 1~
C r7oy~
~ ~ / z~, ~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [~INAL
REMARKS: U , Ic , ~ •
G' •
`ATE ~ 3 ~ INSPECTOR 4' ~ ~r.~,
c'1cLD I;:SPEC:MU:1 ~~Ui,iC, ~ COMMENTS r-
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INSULATION PER N. Y. y
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STATE ENERGY '
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FINAL
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ADDITIOPIAL COMMENTS: x
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4~~r""jr''~°'::~ TEL. 7G5-180?.
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p~ 'r. T'~~Y'1`I !)I' SOUTIIOL~1
,rr4~~,alt.~?ri4 ;t. Or1 iCfi01~ i1tI1Lll1NG IidSPF.CTOR
f>w `~~`~~lj~'i~.. s>.o. Boh ns
t1 ~~~n, ~.:.:i~~,>i~•~ ~f OPr'iJ f FALL
~~"y'" SOIJ i'1 fO1.U, N.Y. i ! 971
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To 6.7hom This [day Conoern,
t9e are un~61e r_o complete your Certificate
of~Uccupanol becau;c,of the following reasons.
An application for Certificate of Occupancy
is not on file.
/ / =to Under:•~riters Certifirate on file.
The check is (outdated/not
o~_fylo_)~~5~
!_1 t:o ?Iealth Dept. Approval on file.
!:o final inspection hay been made.
P]c:ase contar_t our of•f-ice on this matter.
Thank you for your cooperation.
Buildin , Permit i! ~ ~ ~ Z
Building UcpL-.
'tkk/_/ f(o P.lumbcr Solder Certificate on £ile.
( all permits involving plumb_ng being
is:nce<1 after April 1,19II9 )
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R & R HOME IMPROVEMENT JOB Si~,aNLe.~ lam. v"~Ko~s k:
? & BUILDING INC. SHEET NO I OF t
P.O. Box 676
CALCULATED BY DATE 6'9-88
,,,rv, ~ GREENPORT, NEW YORK 11944
(S16) 4]]•1255 CHECKED BY DATE G 9'~
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R & R HOME IMPROVEMENT
& BUILDING INC. SHEET NO. I OF ~
( ~ P.O. BOX 676 CALCULATED BV DATE G ' 4 -g8
GREENPORT, NEW YORK 11944
(516) 477-1255 CHECKED BY DATE G - 9 -$g
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' ~ , BOARD OF HEALTH
I J - vl~~4 3 SETS OF PLANS • Y• • • -
;~K.,....,,,a.,.,.,~. W..
LJ CSC ~I\ i
~ FORM NO. 1 SURVEY .
~ g~~ qI V TOWN OF SOUTHOLD CHECK • • • • • • -
' BUILDING DEPARTMENT SEPTIC FORM
TOWN HAIL
BLDG. DEPT. N O T I F Y
MOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 CALL
TEL.: 765-1802 .
f MAIL T0:
Examined `l.•!'!M,R•, ~ 19 g~ ~
Approved ~~!~-f"u, . ~ ~ 19Y~. Permit No.J.~].I ~-t?~, ri v /
Disapproved a/c ~'/j~l~ (7
(Buil mg Inspector)
APPLICATION FOR BUILDING PERMIT
Date . ~.~.W~ 1953:4
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.
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 $uilding Inspector.
APPLICATION IS HEREBX 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 inspections. L
. 1~~' R ~o Yn~ _Zwlerouemen't; ~'o8y.?a i n~~ -1.!x~,
(Signature of applicant, or name, if a corporation)
..~'.,c~• Bo,,~ ~`t~. ~Ct.r.~~.Wpor~~ov.Y, it`ly.`~
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~3. v. q~. C~;P ~ .
Name of owner of premises ..`a.'f-frN. ~-s`/...~~.1. K4 1 .
(as on the tax roll or latest deed)
If appli t is a corpo t' 'nature of duly authoorized officer.
' Name a d title oPcorporate officer)
ALL ONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
ilder's License No. ! 1. 1-! x....... .
Plumber's License No. .
Electrician's License No. .
OtlierTrade's License No. .
1. Location of land on which proposed work will be done
. . .
................-1~ ..N'1 !fi 1 r~? S:f"g~ e . ~v ~d lY~~ . Y`1: ~3,r 1 o v~ .
House Number Street Hamlet
County Tax Map No. 1000 Section ......a 35....... Block Lot t.~ .
Subdivision Filed Map No. Lot .
(Name) ,
2. State existing use and occupancy of premises and intended use and occup,,af_ncy of proposed construction:
a. Existing use and occupancy A:~'!':4 .
, , e~,
/ ...........1.....
b. Intended use and occupancy (=~}m ~ ~ .
3. Nature of work (check which applicable): New Building Addition ~-?rr. G Alteration .
Repair Removal Demolition Other Work .
' fl}icriplion)
4. Estimated Cost ~1 ~.A'.'~ Fee .
' (to be paid on fl}ing this application)
S, 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 typpe,of use r .
7. Dimensions of existing structures, if any: Front o : ;Rear 3 0...... Depth :.,$g. ~ .
Height Number of Stories , . . .
Dimensions of same structure With alterations or additions: Front , 3 O '
Rear...a.4
p ~ .......Height , ....:?-G . Number of Stories .
Height Nu ruction: Front , ? r~. ~ Rear . .......Depth ~ 5! .
9. SDi e of lot SFronttire new const, . , , , • • .
De th ~berof nes......~1
< Rear . i : Depth
10. Date of Purchase ...................Name of Former Owner .
1,1. Zone or use district in which premises are situated .....2 D. 4=... ~ .....f'~.~S,~.A.f~)2•.......'........... .
12. Does proposed construction vjdlate any zprying law, ordinance or regulation: ...(v O , , , , , , , , , , , , , , , , , , , , , , , , ,
13. Will lot be regraded ...t~?..... ..........Will excess fill be removed from premises: Yes No
14. Name of Owner of premises R.N~~y..1~,r)-.K4u:5Ki Address , MR!N..~~. ~ ; ~~"N,lhe~:+-Phone No .
Name, of Architect ............Address ...................Phone No............... .
Name of Contractor P~.R..:R~.~~ ~`e~......... Address ..~cr.'~-G.~.~r')-, , , ,Phone No. N~~T: ??Sb;
, , .
15. Is this property located', within 300 feet of a tiidal wetland? *Yes No rrr.':
*If yes, Southold Town Trpstees PermitPLO~ DIAGRAM ed.
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
propt;rty lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
ae~ 5~r~~
STATE OF N O ' S.S
COUNTY OF.. . .
. , .....(f l....... , / ~ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
FIeisthe
(Contractor, a ent, corporate officer, etcJ
of said owner or owners, and is drjly authonz erform 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 Ue performed in the manner set forth in the application filed therewith.
Sworn to before me this r
1
/~j~,..dgy o
Notary Public, ...5~:"~~-Y.~!!"{.ri. , . County
Notary pu~blio, $ta ~ off
Now Yak • .
No.467~606 A/ (Sig to of a licant)
Qualtfled In Suffolk County a ~K! '
Commission Expires D;acember 8,1 ~^^SSS...111 "'lll
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