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Home My WebLink About1999-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Town Clerk's Office 5outhold, N.Y. Certificate Of Occupancy No.. Z9.60 J .......... Date ........ ~T~I¥..25 ................. 19.7.9 THIS CERTIFIES that the building ................................................ Location of Property ~ [5 ......... Bv~r.~.:[.e~t. Road ..... S.ou~;ho~l.cl House No. Street Hamlet County Tax Map No. 1000 Section . D.7.8 ....... Block . 0.1 ............ Lot . 0.1./{ ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... March. A.1 ...... ,196~.pursuant to which Building Permit No..'1.999Z ............... dated ................ ~Ia~.eh..1.4... 1963., 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 ......... ..... · ~iv~'be · on.e · family, dJ~.elling .......................................... The certificate is issued to ....Jos ep.h. Pol~oO~ ..................................... of the aforesaid building. Suffolk County Department of Health Approval . ~/1~ ........................... ., ......... UNDERWRITERS CERTIFICATE NO ......... ~1/l:[ .......................... /. ......... / / Buildihg Inspector Rev 4/79 FOE~I NO. 2 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.o 1999 Z Date ................... ]~1~h....1.1. ................. 19..64~. Permission is hereby granted to: .......... BaF"¥~ew"~aact ...................................... .................. ~o~t:~olct ........................................... to ..~,~e t...as~d.. ~a.~n.t.a.S ~.. ~e~ .. One ..£em~..1 :r .. d~el..~.~ .................................................... at premises located at "]~'/~'""~"V~'ew"~Joal~ ................................................................................ .......................................... Seu%h~td.t......lJ~.Z., ................................................................................. pursuant to application dated .......................... Ml~h'""~' .................. 19.63.., and approved by the Building Inspector Fee $'"~' ~)i: O0 ......... ........... J~uilding Inspector ~ORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filJed in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. FinaJ 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. For existing buildings (prior to April 1957}, Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ~/~ Old or Pre-existing Building Vadant Land Location of Property O- . ).~. .~..~.~,. .0..O, , 0 ........... ............ ~Street ' .......... Hamlet House No. Owner or Owners of Property ..~.:...~., .~. · .U~. ?..'..-'~..V~..C~r~ .................................. County Tax Map No. 1000Section .(~c] .~.(~).(~..... Block ..Q!..~..~. Lot.~.~:.O..O..~..O~.~ Subdivision ................... ~ ./...Map No ............... Lot No.~ ,~f~;{'~'~ ~//E.)"?~ .Applicant J~. '-~--~. . f .~. ~z~.t~, f~2. O/2~ ........ Permit No./.~.~.. ~..i~'~.. Date of Permit ~.z~'/~ .~. ~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... FeeSubmitte:~ib~i'~'~s~i,~j~l~,J'a~" ';~1" ,,~ Ila hc lecod sand re ulat,ons Construction ' ' 'g ~r/'~t pp':~ op, sa, g ' . RiDER ~0 ~CONTRACT SELLER: Bo ARTHUR THUPJ~ PURCHASER: DORIS M. GABLE New York DESCRIPTION ALL that certain plot, piece or parcel of land, with the buildings and Improvements thereon erected, -situate, lying and being in the Town of Southold G~unty of Suffolk and State of NeW York, bounded end described as follows: BEGINNING at a monument at the point of Intersection of the easterly side of MA Beyvtew Road. and tiaa n°rUlerly '~lde of Right of Way known as Glenn Road:?' ' RUNNING THENCE along the easterly aide of Main Bayvlew Road, North 26 degre~ 06 ~n~s ~0 sec~ East ~6 f~t ~ a ~lnt on ~e soberly ~i~ of I~ of Teresa ~liwoda; RUNNING THENCE a~g said I~ds of Te~sa Pollw~e $~ 69 ~rees ~n~ 10 s~ East ~O f~t to o~er I~s Of Te~a ~liw~; RUN~JNO TRBN~ ~ 26 ~grm 06 mln~s~ s~ds W~t Ga ~t .RUNNING THENCE along said northerly side of Glenn Road North 69 degrees 19 mlnut~es 10 seconds West 90 feet to the point o1, place of BEGINNING BEING AND INTENDED to be the same premises conveyed by deed dated the llst day of August, 1976 between JOSEPH POLYWODA a/k/a JOSEPH POUWt to B, 'ARTHUR THURM, and filed in the ~fflce of the clerk ef Suffolk County or the'Zath day of September, Ili76 In Uber 811~ page 72. The purcJlaser shall' have the right to-have the premises !nspeeted for the purpoee of determining the e~dstence of terndte Infestation or t~rmlte ,damaltle. In the event tarndte Infestation or damage Is found, a copy of f,fll~ report lasted by the termite company, or other whiten noticeashall be ~lven to aeJler'S aitorney within twenty (20) days from the date hereof. Upon receipt of suCh notice, the seller may do one of the following: (a) deiierge eaUS~ by such InfestaUon, In wMch event lite Purchaser agrees FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~'N CLERK'S OFFICE SOUTHOLD, N. Exam,ned ...... Approved t t 19 ........ Permit No Disapproved a ................................................................... Applicotion No. / ~ ~ ~ .. APPLICATION FOR BUILDING PERMIT Dote ................ ~. ~..g~...~'. ...................... , 19.6.,.~ ........... 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 application. 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 pa rt for dny purpose whatever until a Certificate of Occupancy shall have be&n 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 comply with all applicable laws, ordinances and regulations. Ida .Poliwod~ D.~..~ll~O.d~..~..~eaflp~.l>nli~r~j~ ........................ [ ......... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, !essee, agent, architect, engineer, general contractor, electrician, plumber c~r builder. .................................... ~.~/a~.~. ,~ ................................................................................................................................................ Name of owner of premises ..... ~.~,..~..O~.ll~e.,...g.O~, 8...L,...P..o.Z:L'~o.Cl~,.~...~T.c~.i~B...~.q~O.C& ........................... If applicant is a Corporate, signature of duly authoriz~ officer. (Name and title of co~orate officer) . · 1. Location of land on which proposed work will be done. Map No: .......... ~ ........................ Lot No: ....~ ...... Street and Numar ....~..~&~...~e~..~Q~..~..~S...~=.~..~O~.....S.Q~[~ ................................ Municipali~ 2. State existing use and ~cuponcy of premises and intended use and ~cupency of propos~ construction: a. Existing use and ~cupancy .~Q~...[~[e~...S~ ........................................... b. Inten~d use and ~cupancy ....g.~...~.~.~...~.~ ........................................... 3. Nature of work (check which applicable): New Building ,~ ......... Addition ................ Alteration .............. ~;.. Repair .................... ~,~ - -~-Rem°val .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ..... L.~.I..~....~..?......~i.. .......................... Fee ....1.0.~.0.Q ........................................................................ ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .O.~.~ ................. Number of dwelling units on each floor ,.. .......................... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify natureand 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 alterqtions or additions: FrOr~t. ............................... Rear ................................ Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new constructiph: Front ......... ...'~'.....(~.. ............. Rear .......... ..~'....~.. .......... Depth ........... Height ............................ Number of Stories .......~ ........ 9. Size of lot: Front ...'1 ~).0...!~1~$i ........ Rear ...g;~...~IL].S ........ Depth ....£0Q ............................ ]0. Date of Purchase ........................................................ Name of Former Owner .....~.(2~;....~..Q..1.~....0..~...~. .................... 1]. Zone or use district in which premises are situated ....... !!A.?...~.~.:~..e..13.~..1.[~ .~..~..~..c..e ................................. 12:' Does proposed construction violate any zoning law, ordinance or regulation? ............ ~Q ..................................... ]3. Name of Owner of premises .~.~.a..~..~...o.~..~..~..~..g'..o...e.....~..o..]/~:;~ ....... ..s..o..~...~..~...o..1..~.. ................. Phone No ..................... Name of Architect ...................................................... Address ......................................... Phone No ..................... Name of Contractor ...~..D.~.~,~.~..D,.~}Z~O~a .............Address ....... ~O;g.~;~O~,~l.'..~ .......... i~. P~one 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 na ~es and indicate whether interior or corner lot. :. STATE OF NEW YORK, ) "S ........... I...~...~7.... ...... .(J...~......~....~...~.o~.......~.......~.....,.h .............. being duly sworn, de~oses and says tha~he is~he applican~ (Nome of indi,vidual signing application) above named~He isAthe ............ O.~.~...D~..D~.~.~.B...~..~W~I~ ........................................................................... (Contractor, agent, corporate officer, etc.) ~~ ~is duly authorized to perform or have performed the said work and to make and file ements contained in this application are true to t~ best of ~knowledge an~ belief; formed in the manner set fo~h in the application ~lgd ~~.. ~?~. s, ~OTAR~L? Stateof NewYork ~ I~ 0 /~O ~4 TI XVt' O ............. . .......................... : ..................................... BUILDER'S .JOB[ NO.~ ~ 'rlTL~ NO.~O~O7~ - Chte of ~eneral 14LtUH SiI~CES SUFFOtK CO~INTY ~A~Tk~ENT OF APl'ROY,ED ...... rile F-XISTI~iCE OF R~GHT OF WAY~ AND OR/~E~s OF RECORD, ~ ANY, NOT SHOWN ARE GUARANTEED. MAP NO. DATE: & GUARANTEED TO: ~ ~1~ ~~TEE CO. SURVEYED: ~-~ ~/~~ ~/~