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Home My WebLink About16944-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17333 Date SEPT. 21~ 1988 THIS CERTIFIES that the buildin~ Location of Propert~ 3375 WELLS ROAD House No. County Tax Map No. 1000 Section 86 Subdivision XX ADDITION & ALTERATION Street Block 02 Filed Map No. ~ PECONIC Lot 08 Lot No. XX Hamlet conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 11~ 1988 pursuant to which Building Permit No. 16944Z dated MAY 9~ 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 GARAGE ADDITION AND ALTERATION TO EXISTING ONE FAMILY DWELLING The certificate is issued to BENJAMIN & JOAN KOWALCHUK (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N015654 JUNE 9, 1988 PLUMBERS CERTIFICATION DATED JOHN E. WALTERS PLUMBING 9/i /88 Rev. 1/81 ~]d~'/~rginspector FOF.~ NO. 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*_16944 Z Date ~ .............................................. , 19...~'... County Tox Map No. 1000 Section ......... ..~....~.. ....... Block .............. .~..... Lot No .................. ~.... pursuant ,o application dated .............. ~...././/. ............................. 19~....~., and opproved by the Building Inspector. Fee $.......~..?~ ~ ~ -si Rev. 6/30180 / THE NEW YORK BOARD OF FIRE UNDERWRITERS 100 ~1,~. I. mm~Au OF ELECTRICITY --' 8S JOHN STREET, NEW YORK, NEW YORK 10038 Date NENJAMiNE [OWAt,CHUK, ~ ezimi~ ~ a~/ound to be in ~m~ian~ with the r~l~ments of thb ~. ~ RX'IU{I~ {XHAU$T FAN$ MOTORS KtTUIB M~MNC~ NI01RS TIMICLOCKS NOOff THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000121 BUREAU OF ELECTRICITY [-- 8B JOHN STREET. NEW YORK. NEW YORK 10038 ~ CE~IFIES THAT ~ t~ ~t~ ~u~nt ~ ~ ~ ~ I~t~ ~ t~ ~t ~ ~ t~ .~ ~t~ ~ ~ t~ ~ ~NdA~N ~OWAh(7~{IK, 3~?~ ~L~ ~D., POf,g 23A, P~CONIC, N~Y~ ~A~ 09. 1988 w exemi~ ~ and/ound to ~ in ~m~ian~ ~ith the ~qui~men~s o/th~ ~. SWITC~4S RXRIIB ~ OVE4 EXHAUST FAHS S R V I C E MMMAL MIMAMJ .<ti P#r ALTERED BLDG. DEPT. TOWN OF SOUTHOLD 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 .- m to the Building Inspec- tor with the following; for new buildings or new use: I. 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, a certificate 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. Certificate of occupancy New Dwelling. S25.00, Accessoryi$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5 00, over 5 years $]0./00 / · 4.Vacant Land C.O. $ 20 00 ' 5.Updated C.O. $ 50~00 Date . ( 'Z.~ ~..... ..... NewC°nstr'uc~'i°n ...... OId or Pre-existing Building .... ~ .... i ~/~i'~')a~i ..'.''''.'... Location of Property ....................................... · ..... . ... Hou~ No. Street Ham/et Owner or Owners of Property ................. County Tax Map No. 1000 Section ..... .~. ........ Block ..... ~ ............ ..ff~.. · Lot ........ Subdivision ..... .Filed Map No ........... Lot No ........... Health Dept. Approval ........................ Labor Dept. Approval ........................ .................... Planning Board Approval .................... Underwriters Approval .... tequest for Temporary Certificate ..................... Final Certificate ................. ,e S. mi.ed $ .,,, nstruction on above described building and per, nit meets all applicab_le codes al3/~ regulations ¢... · .. .... ..... ..................... TOWN OF SOUTttOI,B OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 TOWn O~ ~OU~oL~ CERTIFICATION Date Building Permit NO. Owner (please print) Plumber ~4~-~(~C% ~% {please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this /6 day Notary Public, ~County (plumber's signature) UNDA & COOPER Not~ry Publlo, S~te of New No. 4822563, Suffolk COU _nty mrm Expires December DUNDATION DUGH FRAME~ .?LUMBING ~$ULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~ ~INAL DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ]/~OUNDATION ZNO [*~NSULATION FRAMING [ ]FINAL REMARKS: DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [~/] FRAMING [ ] FINAL REMARKS: DATE 76S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [//]/FOUNDATION 2ND [ ] INSULATION FRAMING FINAL REMARKS: INSPECTOR BLDG. Df.: VL TOWN OF $OUTHOLD BOARD OF HEALTH 3 SETS OF 'FORMNO. 1 SURVEY . .q'~<, TO NO SOUTNOL -i-M BU~LDINGD~PAMT~NT SEPTIC FORM ............. TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/c ..................................... NOTIFY MAIL TO: APPLICATION FOR BUILDING PERMIT Date ................... 19... 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 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 ~'*p,!.~, ~¢j~]tl~j~l~cable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors ondo[e~aises and in brl~,_d?~ for necessary inspections. ..... .,x...8 ...... ,. ~,~.,__ ~;~ ......... -t J (Signature of applicant, or name, if a corporation) ,~,.4m,~ o~',~.',,:. ~ ~rn .... '?,.~...B.p.x.. ¢~... ~. ~.v./T~ ~.~ 0.4.. !V..y.. ...... State whether ap~j~r~lo~o~n~r~Se~.,.~g~lO..t4~rc~itect, engineer, general contractor, electrician, plumber or builder. .............. · ~1.~,~. ,.,:: ....... ',.,u.. ;h ...................................................... Name of owner of¢~ise~:~,:~ & .-H. UK ................................ ,~' ~ 9~T O ~M¥~ .~i: ;~.~', ~, (as on the tax roll or latest deed) If applicant isa co~t~.~i~g~!~. 6t~d~!y a,ihorized officer, ........ ~ame a''~'' '~ ti' 'ti~ of co' - ' ~;rat' 'e' ;~;r3 ......... ALL GO~TRAGTOR~S NUST BE S~FFOLK COUNTY Builder's License No .... Lqd. ~ · ~ ......... Plumber's License No..~oq~ .5; .~ &72~:~'. ...... Electrician's License No...'~d .~ b...~.cL~./V. ~5: ....... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ....................................~.~ 7S"- W e.-.q~. A ................... ......... ?~c~ t .~'. .... ................ House Number Street Hamlet County Tax Map No. 1000 Section .................. Block ............... Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existinguseandoccupancy . .l?.~.. .Z ]-?:~. .I.4x/. ~.t~. & ld~/ ,Q~ ~10 ~ tlt1~,~ . ............... ~.~¢ ~ ~ ,~,~ ~ ............. b. Intended use and occupancy . ~ ~ ~.. ~ ~ '.~. }~ud.~ .~&./N ~ . ~7~ ~ ~ ~ ~ JJ b~ I~FI OM ..... ~ i,~t~ .,r~&;;~'~ 'nc -- '. ....... 3. Nature of work (check which appiicable): New Building ' Addition . 'Alteratibn Repair Remov¢l Demolition Other Work . ...... , (~)elc~)~on) ~]OFJi F 4. Estimated Cost....v.-t ............................ ee ...................................... I " (to be paid on filing this application) 5. If dwelling, number of dwelling ugits ............... 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. D]mensmns of existing structures,: ff any: Front ..... : ......... Rear .............. Depth ............... Height Numb'er'of Stories Dimensions'of same structure with alterations or additions: Front Rear Depth ~ Height Number of Stories '- 8. Dimensions of entire new construction: Front .......... ..... Rear .../.6' - Height ............... Nmnber of Stories ..... 6.,q. ~.. ............................................... 9. Sizeoflot: Front ............ i .......... Rear ...................... Depth ...................... 10. Date of Purchase ............ : ................. Name of Former Owner ............................. 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 .......... i .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . .B~.~.l.~'.'/~.&d .]~o~.4~.e.~t<. Address . .t,9.~.~q,s. ~.otto. ~[vcp,,q.t.~.. Phone No. 7~;.ff.".~?.a7 ..... Name of ArchiteCt ...... ' ......... Address . Phone No ... Name of Contractor ...Z~.t .~4...c.i .~0~.. ~ctl.c.~.% Address .~.,q. flo.~, fg,Y..~-./~t0gt.0~.. ~hone No..3.g.~. 7.~..~.R.M. .... 15. Is this property located wlithin 300 fee~of a tidal wetland? *Yes .~... No ..... *If yes, Southold Town Trusitees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-beak 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. AP,')IIOVED AS NOTED . FEE.~BY:~ NOT FY eLm.om · INSULATIC~ i 4. FINAL . ' CONSTftU(~ITON MUST BE COMPLETE FOR C,O, ALL. CONSTRUCll,0N'~d& ~ THE REQUIREMENT8 M, TR~ N~,,'~ STATE ~t11~¥ ~' CONeT~ ~ DESIGN OR CONSTRUC~ ERRO~ ...... . ........ (Name of individual signihg contract) above named. He is the ...................... ........ being duly sworn, deposes and says that he is the applicant (Contractor, agent, corporate officer, etc.) authorized to perform or have performed the said work and to make and file this ned in this application am true to the best of his knowledge and belief; and that the of said owner or owners, and is duB. application; that all statements conta work will be performed in the manner~set forth in the application filed therewith. Commission Fa(plre~ Deoember 8, 1 a2..Z