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HomeMy WebLinkAbout19695-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219829 Date APRIL 3, 1991 THIS CERTIFIES that the building ADDITION TO ACCESSORY BUILDING Location of Property 510 BAY AVE. MATTITUCK House No. Street Hamlet County Tax Map No. 1000 Section 143 Block 03 Lot 10 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEB. 27, 1991 pursuant to which Building Permit No. 196952 dated MARCH 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 ADDITION TO ACCESSORY BUILDING. The certificate is issued to JOSEPH FASZCZEWSKI, JR. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N/A PLUMBERS CERTIFICATION DATED N/A r~~ Bui ding Inspector Rev. 1/81 IOEY N0. f 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 ° 19 6 9 ~ Z gate ..°I.rl..~~.......... -1 19.x/ Permission is hereby pronted to: . ~ ......s:i . at premises located at ..............:/..~.1./0y./.~..~1.,1... v~f' "5............................................... ...........................................................:•.r./.~.Ak~~~~................................................................ . County Tox Map No. 1000 Section .Black Lot No...1. ,~1.. pursuant to application doted ,~../f~,.~..../ 19./ ~ and approved by the Bui lding~,Insp~ecto/r~.~ Fee S.G~S,../.../...(~..t~ Building Inspector Rev. 6/30/80 Form No. 6 ' ~ TOWN OF SOUTHOLD ~~~~~7~~~~(f J ~ BUILDING DEPARTMENT ~~~~~y~~~ TOWN HALL ~ ~ ~ ~ ~ ~ ~ ~ 765-1802 tp i~~ _____._.mm.. APPLICATION FOR CERTIFICATE OF OCCUPANCY `t~- A. 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 caith 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 frorz. architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. 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 accessorybuilding $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 ........F.~. Z, - New Construction........... Old Or Pre-existing Bui//~~lding.... x Location of Property....SI.O............~~~,,,/,!!?~,,,,,,,,,,,,,/,~/, ir„T~, ~,TG1_cyl~... House No. ~'7~ O Street H?amlet Onwer or Owners of Property.....`~/.i~s~Lrj~...~~~.z~^-~~~i~s.~~...'.~/.~ County Tax Map No 1000, Section...~.l.:3....Block..r,r?...........Lot..` ~ Subdivision ....................................Filed Map............Lot..... Permit No..~ ./.4T~S, , , ...Date Of Permit... ~ : 9l..Applicant. , o?,~f(f.~H..~/!~.?rC'Z~~'`"S~'~ Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate.../.:...... g-c7 Fee Submitted: G1~,.f.:~t/r . d~cc.. ~ lNS¢ Nay/ 9~ .,r . e6r~y~.~~ r'lELD II:SP~C;iO'~ ~ ~~U;,TE ~ OONMENT° ~ ^o 1 . a \ FOUtJDATION _ (1st) - - IV c ti FOUNDATIOIJ (2nd) m 2. z 0 ROUGH FRAME & PLUMBING 4 N~ 3. H IIJSULATIOA] PER N. Y. STATE ENERGY CODE x a~ - - r m 4 . _ ~ . .a l - - FINAL 1 o~ ADDITIONAL COMMENTS: E ca~.~ S A.M DATE ~ ~ TIME FOR - - _ , M C TELEPHONED eF _~~.--1~-~--Z--_ - f7EfURNED ~ Hd~ r~ ~ c 7 / YOUR CALL PHONF_ 9'-- i ,C! _ - PLEASE CALL H MESSAGE WILL CALL AGAIN O ~ Z~ I ~ uC~^ ~ ~~-J CAME ~ rC~ ~ < ~ ~ /J _ TO SEE YOU J- ' 7 t is ~ ~Q- _ _ --R WANTS ---;1 TO SEE YOU x TOPS FURM 4003 (t~ SIGNED 9 r H Z O m l q~ 768.1802 BUILDING DEPT. INSPECTION UNDATION 18T [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ] IN8ULATION [ l FRAMING [ ]FINAL REMARKS: DATE IN8PECTOR i-~ -~s~~ ~Z~z~s.~~ C~~~) Zg~_~3~ P o s ~o ~ n ~ , o~ 64yRQQ-u C I l..c~ IIr~ 1~-~-c.>> `Fe9-F~[~~ ~ ~0'~ fi~.a.-c~ `y I-~ g ~ ~5~~ ~'?4- r?.~~ . f~oc~'O~,v~flE-iZ - ks`T~~ TG`o s Tb f~~R,D~2 To •.STu.~ tv.~G a i ~~i,..~ a rc 3/y ~ yx A ~ ~ x • wow o ~ ~ ©.~9 d? 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F~.I, I Fo' \ oYm°nd P~IIGV)Ine ~ rlcrmB~QlhBrine K' 3g7[)5 rurm I / ~ ~ I~ u Jo)BPn PU' II ~ 24680 ~ D ~ or IyGEQr9B I(. RIIeY Z n~ ErIY c ~ o0 ~ _ 6Y~5Y 30 6 ~ / _ N X00 25 i Bl _ ~ 3 OQ J, a o u5f. p1'a2 o'f o asEp= 3 0 ~ n _ _ ~ -c o 3 ~ oQ ~ Slain nOrdl v ~ elYn ck - Erly Epn NBIIO Nk°11° YOUNG R YOUNG c ~ Om (a!m JO nm n:: nr>r.nur x: nll xi c....r~_:a+... .r 'r ,a r. ° °f erlY ~N.: ~ 3 6 6' tiJINLY YR'1k` • • ~ . ,ov-m~ - o 4~E)E NfW Y Nola S, U/A RREI~I IrJa LDVOGEL o+~LrPpO "'~+o ~'r •r NIAT TITUCN _ , bUt CO ITLE I~NC P \ lIOTE~ a NONU MfNT fOUNO ,awn oP SOUTIIOLO ~ `~Q ie9B) ` \ - _ ~ SUEG.CO. TOT MnP-01ST. SECT. BLK~ L01 IFS Llyj {y~iT~~ - loco H] 00) qo $IO FOLK LO., N. Y - I rr + ' , r u~rc . . . I -30' I MaY 13.1981 IN.,. BI-223 m ; D ° a " ~ 80,\AD OF HEALTH !r- _ 3 SETS OF PL.IYS ~ ~ • ~j7 FORM NO.1 SURVEY /t O;rS J TOWN OF SOUTHOLD CtICCI: _ _'f~• J'~ S•~. • • BUILDING DEPARTMENT SEPTIC FORtI ~ • BLDG. DEPT. TOWN HALL ~ ~ ~ • • • • ~ • ' • " TOWN OF SOUTHOLD $OUTHp1~ ley. LL'SZL t:OT I FY ; TEL.:7GS~IB02 CALLS.o,E, ~i?SZcZEwSn'~ ExarttincJ l9 PIA L L TO . • • _ Approved .ei„ ~ ~ :s Jo,/~f/~,/S'~'~ ?~~fl~'~ . I9 Permit No. !Ylf}TT/T~2e-;~e ,v, Disapproved a/c " !7 `~5..~ (Building Inspect r) TG% APPLICATION FOR BUILDING PERMIT Date Z... Z~ Iy~/ INSTRUCTIONS ' a. This application must be completely filicd in by typewriter or in ink and submitted to the Building Insp~inr, wiL` sets of pLzas, arrttrate 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 stye: or areas, and giving a detailed description of layout of property must be drawn on the diagram which is par, of this apr cation. ' e. The work covered by this application may not be commenced before issuance of Building Permit. tl. Upon approval of this application, [he Building Inspector will issued a Building Permit to the appiicaat. Such pez:r 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 Occupa:.: shall have been granted by the Building Inspector. APPLICATION IS HEREBY hiADE [o the Building Department for the issuance of a Building pr...it p_:s•~ant to t! Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable 13tvs. Ordinances ; Recnlations, for the construction of buildings, additions or alterations, or for iemoval or demolition, herein describe: the applicant aerces to comply with all applicable laws, ordinances, building code, housin, code, ana r^gc!atia.^s, and ; id^'•'• authorized inspectors on premises and in building for necessary ins~ect~ioJns~ ' • • ridf ` ~L9 . r. C--. t^ urco plicaad, name,iCacorporation)• • (Dtailing address of applicant) 9'S . Z State tvhether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, piumber or builder dame of owner of premises ~/.C?S~,~N.. !!.~,S.~.G Z ~LcJ.S ~`i . • • • . . (as on the tax roll or latest deed) ~ • • • ~ • • • ~ • • ~ • f applicant is a corporation, signature of duly authorized officer. ' • ~ ~ ~ ~ ~ (Name and title of corporate oC[iccr) ~ • Huildci s Liccnsc No_ , ,GG~2_~~~_ • • Plurnbcr's Liccnsc No. . /~r7~Grra~i~? Electrician's Liccnsc No. _ . (L?r7, .~/l ~ e %~i C- Olhcr Trade's Liccnsc No. ' Location of land on which proposcJ work will be dorc; !louse Nun~re, ...............6~ f.`:.~TT/•% LLL-/~ ~Ircct ~ Hatnlct • • • • • • County Tai \lap No. 1000 Section ~ 3 Bluck ....3. .~1~ SuDJivis Lot.. ion F.ileJ N ' Alap o. (Name) Lot... a Stztc °xtstin^ use and occupancy of premises and iutcnJcJ use auJ occupancy of proposed construction: A. l:xiscing use and occupancy.....~.~~,~•-,.~~. ~ B. Incended use and Qecupancy.:.........- ..1.QI,~~~..... I 3. Nature oC work (cheek which applicable): Ncw DuildinS - • ,Utcnhon . • • • • • • Repair Rpmaval • • • Addition • - Tennis Court~•••••~• Demolition .S~~wl„ ; Accessory Building...... .Other cork. 4. Estimated Cast . • • • • Fence , - • • 5. If dtvcllin>. number oC dtvc!ling units (tn be paid an filing this aoolicauon~ If gara_e, number of cars " • Number of dlveping units on each floor 6. IC business, commercial or mixed occupancy, specify nature and extent of cacti t c of use . ~ ~ • • • • • • 7• Dimensions o(cxisfin^ sttvctures, if any: Front (v. ! Rear LL ~ • / Hci;ltt Jg • • • .1 ..a24 Depth .,.;,217........ . Nuntbcr of Stories _ _ _ _ _ _ Dimensions oCsamc structure with alterations or additio~ Front p Depth......'4~`Q.!.........licisJt[......~.`..... .....3~....... Rear...--..1~. ' 8. Dirncnsions oC entire ncsv eonstntction: Front • ' ' ' ' • • • Number of Stories ~ . • • , . Hci_Itt .....lvZ• ; , • , ~ °Z~• • Rcar ~ Dc th s~17....... . Number oC Stories • • - . . - _ - . • • • P 9. Sizcoflct: Front _ 10. Date oCPurehase P.ca- Depth . . .........Name oC Former Otvner 17f~'1 ~ !.4'."~!.. ,1-T.f?~<!.~!!~O I I. Zone ar use district in wlticlr premises arc situated _ _ _ • l Does proposed construction violate any zonins law, ordinance or regulation: . 13. 1Villlotbtregraded ,,,(fp•1~ /~'a•,••.••-,•,•--•••••.•.. !h. Name of Owner of prcmiser~'?E A ZcZE,t,s " • • tiVdl excess fill be removed from prcmi;cs: Yc:... • : 9aP ~-3Yi NamcofArchitecL •~•~~"•'••_!~_,_Address~!a{d?~!R+!E,•,_••_-PlroncNo.~ . .Address ~~:'TtiT+~-«~., • • phone No. NamcofContractor....s.F,~!?r~,~••_•~~••••••~ ...........Address ~ • • • • ......Phone No........... . IS_Ls this gropertp located within 300 feet of a tidal wetland? =YL•S_...2tO.~C. xIf yes, SouChold Town Trustees Permit may be required. • PLOT DIAGRARI Locate clearly and distinctly all buildings, whethcr~existing or proposed, and.indicatc all set-back dirncrsior.~ t: property lines. Give street and block number or description according to deed, and show street names and indicate interior or comer lot. f V,/ / ` ~Z l * - ~j/1 Q~r/y,/uj a/~ a °wfen L4. zrJe4~~ v r ~ ~1 //9~t~.v 3 /yT~/jev/<' ~°T • ~p~5 t Z~ ~ E SAN bJ°S"/'"`""' ~3~0'/" g5,- 2fn S'/a ? /?t'~' / I~ ~P TN ,,z1'D oy,aa.,V /osu. west ~ p/crrt- {?7,~7TT lTU, t-/G /f7~ 4/ f'r{~/, TNE~'_ /1/. c~4" °/S- 3Y y ~ b / < S_ l ice' N 3~.~c sd~, 1P T/~~N°~ Nc~, ~ ~ lr/~~`7 f °-I _ ;a ~ 'OU~JyT-Y OF S.S I D,~B•/7N.. ~~SZGZ/4d..S!~! • • • . • boino duly sworn, deposes and says that he is the appli;ar • (Name of individual si~nittg contract) rove named. c is tltc . Erl L'V - (Contractor, agent, corporate officer, etc.) • • • • • • • ~ • • • ' • • " • ' said owner or owners, and is duly authorized to perform or have pcrformctl the said work and to make and file tl: ~plication; that all statements contained in this application arc true to the best of his knou•Icdgt: and belief; and clot L': ork will be performed in [tic manner set forth in the application filed therewith. om to bciorc me this • 'tan' Public.....<~..~c<..zY..~:~.Ur~.... County ~ HELEN K DE YOE ~ ~ ~ ~ ~ ~L...~ NOTARY PUBIIC, Stage of Nan Yglt ~ • . • . No.QO)878,Su1folkCouM~~ 1 ~ ($ignature of applicarr' Term•Expires March 30,19-J~.J