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Home My WebLink About4312-zFORM NO. 4 TOWN OF SOUTHOLD~i BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~.0.2~ ...... Date ....... . . .0e~;ob. er .... lbr.. , 19.70. THIS CERTIFIES that the building located at ... ~. ~. p~,. B~ .l~/¢lStreet MapNo...lfx ....... BlockNo ..... X:~.. LotNo...~ ... I~YP~...I~* ....... conforms substantially to the Applicatign for Building Permit heretofore filed in this office dated ....... ~fay .... ~ ..... , 19 .(~9. pursuant to which Building Permit No.. dated .......... l.iay ....28.. , 19 69., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... P.~iv~e .one. .far, Lily. ~t2~e:~:Li~g ...... ............................. The certificate is issued to E~.lget~ .J,, ~okolO~,qsl~l ..... O~aex' .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval , .~..~.~. ~.~.~0...~.~'. ~.,..~r!~!. House ~180 .... ~.~.~ .('.~...~. .... (~-..~ .:] ....... Building Inspector 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? 312 Z Permission is hereby granted to: .... ~ ..~'~ ..~ ~0¢<~ ......................... ........... .~....~,e~..~L~ ..................... ~ ................. ............. ~.~t~t ........... ~, ....................... to ......... ~1~¢1..~..~¢~.. ~'e~$~,~% .~.~e;b;~:[~ ................................... ~ ....................................... at premises located at .................... ~/:~...~'~(~1%~¢...~...~3,'i10.. ....................................................... .......................................... /~u~'~3.. ........... f;~¥, .................................................................................. pursuan¢ to application doted .............................. ~r.....~ ....... ;....., 19.~., and approved by the Building Inspector. Fee $...1.C~.Q0 .......... Building Inspector / FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-Cj form or equal). 3. Approval of electrical installation from Board of Fire Underwr!ters. 4. Commercial buildings, Industrial buildings, Multiple Residen{~es and similar buildings and installa- tions, a certificate of Code compl ance from the Architect oC Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pm-existing" land uses: 1. Accurate survey of peoperty showing all property lines, stre~ets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupahcy 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. C. 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 Date ...... ??.~, ~ .Z..2.1. ~. ~t~3t 1.........1981 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ......... ~../.~..q t. ~. ~.e.c..op.:l..q . ~.X..~. ~?.K ~ ...... .[,~;.e..a.~. e..~.t..~. ~ ~.. ....... House No. Street Hamlet Owner or Owners of Property l~u~ene ,J', ;Soko].owel~J. County Tax Map No. 1000 Section ............... Block ..... ' .......... Lot ................ Subdivision ................................. Filed Map No. .......... Lot No .............. Permit No ........... Date of Permit .......... Applicant .... ; .............................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...C.O.p.~. ¢.~'..C../{) ........ Fee Submitted $.. 3 ~.0.~ ...................... Construction on above described building and~mit meets all applic~ hie codes and regulations, PP ~ .... ; .~ ........... ~ ........................... Rev, 10-10-78 S-9 SCHD DEPARTMENT O,F HEALTH Date ~ October 1~, 1970 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at s/s ~onic ~flv Blvd. 1 mi. w/o Si~bee Roadle/o (Give deed location) have been inspected by this Builder~Owner - Sokolowski department and found to be satisfactory. D i s t r i c t E n g i'~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in Wpewfiter OR ink, and submit;~ed in duplicate to the Building inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildin"gs, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage d!sposal-(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 oK Engineer r~sponsible 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, buildiqgs and unusual natural or topographic featu res. ' 2. Sworn statement of owner or previous owner as to use, occupahcy 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 Date ...... .A.~,~. ~, .1..2. ! ¥.~-.S.~., .~ .9.8.1 New Building ............. Old or Pre-existing Building ....... ..... Vacant Land ............. Location of Property ......... S f S..G t.. 2.e c o n.i.c . B a.y.. B 1 .~.~ ....... L ~ a.u ~. ¢ 1.,.. N · Y ......... House No, Street Ham/et Owner or Owners of Property . .g..u.~.e.~.e,. ~,...~..o.k.o. 1..o.u?.~i. .... , .............................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No. .Lot No, Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. APProval ........................ Underwriters Approval ........................ Planning Board ~Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. Copy. o£..C/0 ........ Fee Submitted $.. ~ ..~30 ...................... Construction on above described building and pg,rmit meets all applicable codes and regulations. Applican~ .~,~...~ ......................... BUILDIHG DEPARTMENT /# ~ /~/~' APPLICATION FOR BUILDING PERMII .... ....... ~. .... ~..y. ....... .9. ................ . IN~RU~I~S a. This applicati~ must be complm~ fill~ in by ~writer or in ink and s~mi~ in ~pli¢~e ~ the Building I n~tor. b. Plot ~lan showin~ I~ation of lot a~ of ~ildi~ ~ p~mim, mlati~ship to adjo n ng pmmi~ or public struts or areas, and g~vJng a ~aded ~ri~i~ of I~ of p~ mU~ ~ drown ~ the diagram ~ich is ~ of ~ ~plicati~. c. ~e work cover~ by this a~li~ti~ m~ ~ ~ ~menc~ ~m i~ce of Buildi~ Pe~it. ~.., U~ appr~el of this a~lic~i~, ~ Buildi~ Ins~c~ will i~e a Building Pe~it to the ~plicant. Such ~rmit sno, ~ Kept on the p~mJ~ ~ir~le for i~ ~ ~h~ ~e p~ of h work. e. No building s~ll ~ ~cupi~ or u~ in whole or in pa~ for any pu~ whatever until a ~ifi~te ~ ~c~ancy shall h~e been granted by the Building I~r. ~ ~u,~= ~:utr~ur~c= aT [fl~ /~ aT ~Tnom, ~IK ~n~ ~ YORK, and ~r O~[~ODle ~ O~i~ncK or Regulahons, for the constructi~ of buildings, ~itl~-or al~mti~s, or for mm~al or dem~ffi~n, ~ h~min de~rib~. The ppplicont agrees to comply with all applicable I~o~inanc~, building c~e,.housing ~e, ~d ~ulations. .......... .............. ............................... ~rm ~ ~plicant) State w_.hether applicant is owner, lesse~, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............................................ .c~ ............... .~.**. .......................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land _on whJ~lhnpraposed work wilJ,J~!l done Mop No.: ................................ Lot No' . ..Z ... Street and Number .... .~..~...~.....~...~j~...:..e~.. ...... .~...'~......~...ZJ. ...... ~.[..~...: ...... .~.~.....~.~,~.. ....... .~....~..~...,. ............... Municipality , / ........ State existing use ar~ occupancy of premises ar~. intended use al~d occupancy o~f Praposed construction: o. ExisfingUse'ondoccupancy..~.~...J/~......(~/.:?......t..~.....~. ....... ~..../~.....~...... ~...':.~.J...~..~.....~..~ ..~...~.L~j/,~..~...~.~./.~7 b. . 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alterotion.. .............. Repair .................. Removal .................. Demoliti0r.....~ ........... ; Other Work (Describe))~/3,~t~..~.~../~0~.~Z.~3H 4. Estimated Cost ..... .v.~.~..,.~)b). ...................... , ........... Fee ....... :, ................................................................................. ~ (to be paid on filing this application) 5. if dwelling, number of c~well!ng units ..... ..~..]i...~...~........Number of dwelling units on each floor If garage, number of cors ................. .~....~... ................................................................................................................ If business, commercial or mixed occupancy, sp_ecif~ nature and extent of each type of use .............. ~ ........... Height ........................ Number of Stories ........................r,~J~l''~' .................................................................................... Dimensions of same structure with olterations or additions: Front .................................... Rear ............................ Depth ................................ Height ........................... Number of ~ories ................................ 8. Dimensions of entire new construction: Front ........ -'~.3....! ............. Rear ....... ..~..~...~. ........ De~th ...~. ............. Height .~..~...~...~..~., ~u~mb~er of Stories~ ........ ,,/ c~ k"~'~:'"'";'"i' .......... :'_"_':;: ...... 7~';'i ............................... ' ....................... 9. Size of lot: Front ..:...[..0...~ .............. Kear ........ .w]....t/...I ............. ~l~m ..... ~ ....................... 10. Date of Purchase .~..~...~,-- ........ .~...~ ................ Name of Former Owner ....~.~. ............................................ 11. ' Zone or use district in which premises are situated .................................................. ~ ......................... ,...~..., ........ ..~...../ .... _. 12. Does proposed construct,on vmlate any zomng law, ordnance or regular,on..~.(}....~./~.~..~.~..~... 13. Nome of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... ~1~ Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or p..mpaeed, and indicate all set-back dimensi .o?..from property lines. Give street and block number or description occord[r~l to deed, and show street names end mmcote whether interior or comer lot. ~ ,~ ~LLU, STATE OF NEW_YORK, ,., ( ,- ,~ COUNTY O~ ~.~.~...~...~.~/.~.....~='~' .... ........... (Na~ of individual signi~ ~lic~i~) swom, deposes and says that.d~ is the applicant above named. He is the ................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa d work and to make and file this applicafion;"thaf'611 Statements c0ntoinecl 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 the~]iwith. Swem tobefore me this ,....~.../~.. ..~,, ,tFeMID/"'~I~<2B~KER , 19 ................... : ~n~:~_.~m~"'" ....... . ..... :" ,~~~ .................. I ffo urals. ...... · f ....... ........... C n. o opp,,co.t) Notary