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Home My WebLink About660-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~TMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33875 Date: 08/05/09 THIS CERTIFIES that the building NEW DWELLING Location of Property: 955 NORTH PARISH DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax~4ap No. 473889 Section 71 Block 1 Lot 10 Subdivision Filed Map No. __ Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 5, 1959 pursuant to which Building Permit No. 660-Z dated MAY 5, 1959 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 ONE FAMILY DWELLING. The certificate is issued to ANN KWASNESKI of the aforesaid building. ( OWNER ) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL C~KTIFICATH NO. PLD~ERS tu~KTIFICATION DA'£~ N/A N/A N/A h/ed ~gnature Rev. 1/81 JUL 1 4 BLDG. DEPT. TOWN OF SOUTHOLD 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 amhitect 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, .~wimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. /"~'2'. ,~2ertificate of Occupancy on Pre-existing Building - $100 00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Construction: Location of Property: Old or Pre-existing Building: House No. Street Owner or Owners of Property: /~JM ~'tOg$3,.~$K7 · / Suffolk County Tax Map No 1000, Section '-fl ! Block Subdivision Permit No. Health Dept. Approval: (check one) ,..~c k r LL Hamlet (check one) e~ t Sign~t~r~"- Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Final Certificate: / Lot / 0 Filed Map. Lot: Date ofUermit.~, ~ ' ~ q Applicant: /a~/IjM l[aOk. SiOe% /¢,'g/~al~.~ d .~. // Underwriters Approval: FOl~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 66o z Dote ........................... ~r ...... ~ ................ ]~1 ..... Permission is hereby granted to: L~..~,...~n~ .. K~,~l~r~. ....................................... .............. 8out, ho:Ld ,....N .! ..................................... to .... ~. nel..one..~.e~.l~..cl.e ~;~g ............................................................................................. at premises located at .N/~....N~x'.~J~..[e~,X';I, JI~X.D,V~,¥.~ ............................................................................. ..................................................... I~n~v...Vl~w.,....~*~ut, h~,....W~:(~ ....................................................... pursuant to application dated ......................... ~l~:....J. .......................... ]9..J~L, ond approved by the Building Inspector Fee $..]...0.:., ,0~. ............. Building Inspector FOEM NO.~ TOWN OF SOUTHOLD BUILDING DEPART/~ENT TOWbl C~.ERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY ~ ? No....~....4~. ............. Date ...................... [.~y..~.m..b..~.t'.....,~.~. ........... , 19.~.~... THIS CERTIFIES that the building located at..IC/.~..lCoZet, l~?.~,~&~h..D~,t,~re ...................... Stree,t Map No.~.~}~.-.~'x'~ ....... Block No ..... ~ .............. Lot No. ~ ........ ~.o.p,.t~.~,'l,.8..~...,~.~.~ ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .................... ~f~,~....,~. ....................... , 19.~9...., pursuant to which Building Permit No...~...~.~.0 ................ dated ............................ ~,q~r.....~. ............... 19.~c)....., 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 .............. ............... .......................................................................................... This certificate is issued to ......~...o....~....A.~....~.~.~.n..e.?..~.~ .......... !.~.~..~.~.m.). .............................................. (owner, lessee or tenant) of the aforesaid building. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............. ...~....!...~.......-~....... 19...~'....~. ,, ,, ,, . Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ...................................................................... ~.....~?...._,7~/._.7,f...~._...7~.......7~.,....~ .............. ..................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 location. 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 issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......................................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: .f..;.../.(.:...?..~ .............. Lot No: ! Municipality 2. State existing use and occupancy of premises a~d intended use and occupancy of proposed construction: b. Intended use and occupancy ............ .~.~ .................................................. 3. Nature of work (check which applicable): New Building / Addition .................... Alteration Repair .................... Removal .................... Demolition .................... Other Work (Descr be) O,o_~O ' 4. Estimated Cost.~'~..~'..~..0...O...O......~-~. ..................... Fee ! (to be paid on filing this a'~pli~i~i ............ 5. 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 type of use .............................. 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number 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 ...~......'~.. ............... Depth .....~...~ .................. Height ............................ Number of Stories ~ 9. Size of lot: Front ....j.....~'~... ............... Rear ......... (....~?.. ............ Depth ....??...W.....~....~.,....~-_~O 10. Date of Purchase ....................... ../..?...'~'....2 ................... Name of Former Owner ...... ..~.~i.q../~.....~...~.h.[ ................. 11. Zone or use district in which premises are situated .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .............. ..,~....~. .............................. 13. Name of Owner of premlses.~....~ ............. Address ............................................ Phone NO ..................... 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 property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YOP.,'K. ,, ) e ~. ................. '- -.., COUNTY OF .. ~C ) o o. ,,-.. .... .......... ,Zr ' eY, o ........................................................................................... : ..... ' g y , p ses a d says that he is the applicant (Name of individual signing application) above named. He is the ............................................. ~.....~...~ ...................................................................................... (Contractor, agent, corlSorate officer, etc.) of said owner or owners, and is duly authorized to perform 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%t Sworn to before me this , ..o ~' ................... of ....................... ·