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HomeMy WebLinkAbout12541-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31962 Date: 10/30/06 THIS CERTIFIES that the building ADDITION Location of Property: PVT RD INNER BAY FISHERS ISLAND (HOUSE NO.} (STREET) (HAMLET) County TaxMap No. 473889 Section 10 Block 9 Lot 14 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 8, 1983 pursuant to which Building Permit No. 12541-Z dated AUGUST 4, 1983 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 AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RICHARD & ELIZABETH DALKOWSKI (OWNER) of the aforesaid building. SUFFOI=K COUBTY DEpARTMEIqT OF ~EALTH APPRO~KAL ELE~'£KIC3%L CERTIFICATE NO. PLUMBERS CERTIFICATION DA'r~u N/A N/A N/A - A~/ze~Sign~ure Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 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 1% lead. 5. Commercial building, industrial building, multiple residences and 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. 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 consent to inspect signed by the applicant. Ifa 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. Copy of Certificate of Occupancy- $.25 4. UpdatedCertificateofOccupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Construction: ')(v Old or Pre-existing Building: (check one) LocationofProperty: ?V'IL ~ -'~--n~--~' ~ House No. Street Owner or Owners of Property: Hamlet Suffolk County Ta5 Map No 1000, Section Subdivision Block q Lot Filed Map. Lot: Applicant: PermitNo. 'l~'~c~ I DateofPermit. ~ '~-~3 Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~, lDO Underwriters Approval: Final Certificate: ~ (check one) Applicant Signature 10/20/2006 09:45 FA~ 631 788 7798 TOWN OF SOUTHOLD BUILDING DEPT. 765'1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2Nr) [ ] INSULATION FRAMING / STIWPING [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION ~002/003 FO~M NO. m TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12541 Z Permission is hereby granted to: .......... · .................. ~...~......~ ......... ~.~.... ~,- ~ .................................................. ~..~..~..2..~ .... at~ premises located at ............... ..~>../....~.. ....... ..~.~... ........... ~.---..~, ..~E~........~.'. .......................... ~,ursuant to application dated ...................................... ~..~...../......., 19.~,., and approved by the Building Inspector. Fee $...'~....'~.. .............. ~" .IBuilding Inspector Rev. 6/30/80 woo~ 4/= · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......................... ~.~v~..., 19......~. -- · ^pproved ............................ Pe lt No ..................................... D~sapproved a/c .~,...,-......,~.. .................... ~ ..... · Application No ................... / ............. APPLICATION FOR BUILDING PERMIT INSTRUCTIO'I~IS a. This application must be completely filled in by typewriter o~. In Ink and submitted In triplicate 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before Issuance of Building Permit. d. Upon approval of this opplicatlon, the Building Inspector will Issue o Building Permit to the applicant. Such permit s.~all be kept on the premises ?alloble for Inspactlo~ throughout the work. e. No building shall be occupied or used tn 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 Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Coumy, New York, and other applicable Laws, O. rdlnonces or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as harem described. The opplican.t agrees to comply with otl applicable I~ws, ordinances, building code, housing code, and regulations, and to admit author,zed inspectors on premises and in buildings for necessary Inspections. ~ignoture of applicant, or name, ,f a corporation) ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .A..p.R.1..i...c..a...n.t .i..s..o....wD..e..r..' .a.n.d.....b..u..i..lder Name of owner of premises ...L...e..o....Z~....3;..~...O...~......)~:.. and Virginia Dalko~. If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ........................................ . ... . Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No. ........................ Street and Number ~.Z..~.~.~...~..e.~..a.~..e..a.~..~..~.~...1~...~.a.~.~.~.~...h..e.~.G.~..~..a.'.~.~.~.~ ................................................................. Municipality State existing use and occupancy of premises and in:ended use and occupancy of proposed construction: a. Exisiting use and occupancy ~?...e..r.~.s~.~..n...a..~:.~.r..e."~..j:..d..e..n...~..e..~.~...~..n...q.r.~.~.~. ............................................. b. Intended use and occupancy ~?...e..r.~.~..~...z~..'~.~.e.'~.j:..d..e..~...q.e..~.~...~..~..~...Z~...C...~.~..~.~.=..e..~.~.~.~.~'~ ......... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................... Other Work Rrect wood Deck (Description) 4. Estimated Cost * ~.800.00 Fee c:~.~ (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, co.mmercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ....2..5....~.e..e..~. ......... Rear .....2...5.....~..e..e...~. ........... Depth ...]....2.....~..e...e..~.. Height Number of Stories ............................................................. Dimensions of same structure with alterations or additions: Front 25 feet. Rear 25 feet. Depth ].2 feet. Height 2 feet. of~...Number of Stories ................................ ......................................... 8 Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ....................................................................................... 9 Size of lot: Front ..... .4..2..,...~..5.....~..e...e.~. .......................... Rear .....4...5,.*..0...0....f..e..e.~ .............. Depth .?..4..:..4..~...~..~s...~.....s..J:6 10. Date of Purchase ..~.p..~.~.]......B..~....]....g..5...4. ........................ Name of Former Owner ..~.~..s..})..e..r..s.....Z...s.~.a..~.d.....~..a....~....m~...L...Z.~' I 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 ..... ..N..O. .................. Will excess fill be removed from premises: ( ) Yes (X) Nc~ 14. Name of Owner of premises Leo Da. lkows~J. Ad,lr,,,Fishers, Ii=il~nd~h,~, No.(..~..~...~.7..4..0...2... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly'all buildings, whether existing or proposed, and indicate all set-back dimensions from ~roperty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK. C9UNTY OF ....... -.~'~..~-..~.-....!.~....~...~'....-I.1.1.1.1.1.1.~d3....~..8.../.~..! .................................................. being duly sworn, deposes and says that he is the applicon, (Name of individual signing contract~ above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to ~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 be performed In the manner set forth in the application filed therewith. Sworn~. before me this ........................ · ,,~et)a ry Pubhc, . ....... ;~ .......................................... County .... ; ...................... ~ ......... ~ ................... ~~ (Signature of applicant, :,,.. TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DISTRICT SUB. LOT s ~~ w .x/~. ~o~,u,~,.~l LAND AGE NEW SEAS. IMP. NORMAL Farm Acre Tillable 1 VL. TOTAL DATE REMARKS .~0. . ,' ,.~-- ,z.~© O_' BUILDING CONDITION BELOW ~ ABOVE J Value Per Acre j Value THIoble 2 Tillable 3 Wcodlond Swampland Brushlond House PI~ _~ ~_'~ _._ M. Bldg. Extension Extension Extension Breezewa Garage Foundation Basement Ext. Walls Fire Place Porch Porch Patio Driveway Bath Floors Interior Finish Heat Attic Rooms 1st Floor Rooms 2nd Floor 1490.,,,~4 GL 0,,~ r,