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Home My WebLink About19840-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19898 Date MAY 6~ 1991 THIS CERTIFIES that the building ADDITION Location of Property 1790 DEEP HOLE DRIVE House No. Street County Tax Map No. 1000 Section 123 Block 4 Subdivision Filed Map No. MATTITUCK~ N.Y. Hamlet Lot 1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 6~ 1991 pursuant to which Building Permit No. 19840-Z dated MAY 6~ 1991 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 JOHN V. SAWICKI (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED MIA N/A N/A Building Inspector Rev. 1/81 Form No. 6 TOWN OF SOUTIIOLD 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 inspector with the following: 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 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. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . ~.7..~..%~.~ .......................... New Construction ........... Old Or Pre-existing ~uildin~ ........... Location of Property.../.ff~ .......... /-~-.f~?.~-. ~{~.~.. ii''' ~7-fq~/~ House No. Street .......... /'~l~g ............ Onwer or Owners of Property....~. ~..~.~<..~.'.~.~.'.~f. ~.Cf .......................... County Tax Map No 1000, Section.../~.~ ...... Block ..... ~. ......... Lot ...... ~ ............... Subdivision .................................... Filed Map ............ Lot ...................... ...........· . ... Date Of Permit ............. .. . Applican~__~..~?~.~.~ . .~.~.~. ~..~ Permit No Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ..................... ... Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ ............................. APPLICANT lq)mM' BO, · TOWN OF SOUI'J'IOLD BUILDING D£PARTM~NT TOWN HALL SOUTHOLD, N. ¥, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO_ 19840 Z Permission is hereby granted to: ............. ~ .... ..~. .:.%. .:..~ . ...'...I/~ ~t~.,.~ .... .~.~.~ ...... ~.:~.:....~.~..~..~.~. ........ ~ ...~.~........~.....~...~.......~...~......~....~.~ .......... ; I .~,~_ --~ ....... ~ ........ 4"7 ..... :"~'"'"'~f .................... at premises located at ../...7..~...6.......L~J~.....~....I.~...~.., ....... ~.~.~,~.~ ................. County Tax Map No. 1000 Section .../..~....~ ......... Block ...... ...(~.....~. ...... Lot No......(~....I ............ pursuant to application doted ........ --.~..~...(~ ........................... , 19.~.1 .... and approved the Building Inspector. Building Insl:~-'tor Rev. 6/30/80 FOUNDATION {1st) FOUNDATION 2. (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FINAL ADDITIONA'L COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ,amined... ) .... )isapproved a/c ..................................... ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOAF~D OF HEALI'II 3 SETS OF PLA~tS .......... SURVEY ................... CIIECK .................... SEPTIC FOR:I .............. CALL ................... }IA[L TO: 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 ' areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- Ltion. C. The work covered by tkis application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit all 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 all 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 ailding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or :gulations, for the construction of buildings, additions or alterations, or for removrl or demolition, as herein described. te applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to mit authorized inspectors on premises and in building for necessary inspgcti~ns. ate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .0. w. line of owner o remises ... O . ,. . . (as on the tzr~: 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 ....................... Other Trade's License No ...................... of land on which proposed work will be done ............ ¢ .......... ................. }louse Number Street Hamlet ' " County Tax Map No. 1000 Section .... /~ ......... Block ...... ~ .......... Lot ...... l ............ Subdivision ..................................... Filed Map No. Lot (Name) ............................. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ ~:~ ~ ~' , , , ...... / .....,. ...... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost (Description) 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 ............... Rear .............. Depth Height ............... Number of Stories ............................ i i ............. Dimensions of same structure with alterations or additions: Front .......................... Depth He" · ............... Rear . 8. · .................. gn[ ..... . ........ Dm~ensions of entire new construction- Front ............. Number oI Stones ...................... ................ Rear ............. Depth ..... Height ............... Num her of Stories ............. 9. Size of lot: Front I0. Date of Purchase ...................... Rear ...................... Depth 11. ' ............................ Name of Former Owner ...................... Zone or use district in which premises are situated .................................................... 12. Does proposed construction violate any zoning law, ordinance or regu etlon 13. Will ot be regraded : ......................... ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address Name of Architect ................... Phone No ................ ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ ~5. Is this property within 300 feet of a tidal wetland? *Yes ........ No ......... ·If yes, Southold Town Trustees Permit may be required. .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from 7roperty lines. Give street and block number or descriptioh according to deed, and show street names and indicate whether interior or comer lot. FOLL Oyd', "C~ i; 1. FOLJND/~ !C~' -. ,jIF/-[) FORPOURIDC(:'~ ;t·~ 3. INSULATION 4. FINAL CONSTR~CTION MUST SE COMPLETE FOR CO ALI. CON,~TRUCTION SHALL MEET THE REQUIREMENTS OF THE STATE ~ONSTRuCTION & ENERGY CODES, NOT RESPON$16I.E FOR DESIGN OR CONSTRUCTION ERRORS ~ATE OF NEW YOR-K,,,.t, __ )UNT¥ oi: . s.s ........... . (Name of individual signing contract) . being duly sworn, deposes and says that he is the applicant ore named. ............................ r r a , said Owner or owners, and is duly authorized to perform or have performed the said work and to m~e and file this ~lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the rk will be perfomed in the m~ner set forth in the application filed therewith. om to before me this · .. County \ (Signature of Jp~licant)