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Home My WebLink About4685-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ZD,,03i ...... Date .............. 0~; ..... 27..-, 19.70 THIS CERTIFIES that the building located at .R/8 Deet~ .Ho::~e .DX' ....... Street Map No..~ ........ Block No .... XX .... Lot Nc~Ic;It....t~[a~;tit;~l¢~l~ ..... I~1.~, ....... conforms substantially to the Application for Bmldmg Permit heretofore fried in this office dated ........ April.. · .1.5' · ', 19~ .70 pursuant to which Building Permit No. dated ........ Apt.il .... ~.. , 19.70, 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 . .Pri.va~;e. one. ~ami.~y .dwe.~.ting. ..................................... The certificate is issued to ...l~rank .Za,l.eak:L .... (~a~l~ ......................... (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~$p~;. ~1.~ · ] 9~0 .. b.~ .Ro..~.il].a ....... ~Building Inspect~ FOlP~'~ ~O. ~ TOWN OF $OUTNOLD ' BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4685 Z Permission is hereby granted to: ~rank Za~esk~ pursuen¢ to application dated ........................ ~.~.~.,..~.~. ....... ~.~.....:....., 19....?.9, and approved by the Building Inspector. Building Inspecttr FOBM NO. 6 TOWN OF SOUTHOLD ~ Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCcuPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new 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 seweiage disposal--iS-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters 4. Commercial buildings, Industrial buildings, Multiple R~sidences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. §. 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 "pre-existing" land uses: 1. Accurate survey aT property showing all property lines, sireets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, o~cupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildinOs or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use, $5.00 3. Copy of certificate of occupancy $1.00 /Y New Building ..~.,?Z?.7.... Old or Pre-existing Building ............................ Vacant Land ............................ Subdivisionz~ ,-s.~ ->'~'"":':~ ....................//~/.~.~'"'"Y"L°t No...~... Block No.....~... ..... House N .~......~....~. Permit No Underwriters Approval .............................................. P an 'g aa, App ay ...~..~ .~..: ....................... Request For Temporal, Certificate ........................................ Final ~Certff~cate ........................................... Fee Submitted $ ............... ~. .................... Construction on above described building and perrr~t.meets all gl~Plicable.,codes and regulations. Applicant .~. ................................................ Sworn to before me this ........ day of ........................................... P ' ..?../~ County (stamp or seal) NO.~3 OuM~i~ Jn Nas~u ~unW d~ ~mmlssion ~pires March 30, 19/~ FORM NO. 6 TOWN OF SOUTHOLD Building DelM~tmenf Town Clerks Office Southotd, N. Y. 11971 APPLIGATION FOR CERTIFICATE OF ~)CCUPANCY Instructions A. This application must be filled in typewriter OR ink, and sul~mltted in triplicate to the Building Inspector with the following; for new buildings or new use 1. Final survey of property with accurate location of all b. uiidings, property lines, streets, an6 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 afld similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan ~equiremenJ's where applicable. B. For existing buildings (prior to April 1957), Non-conforming u~es, or buildings and "pre-existing" land uses: 1. Accurate survey aT property showing all property lines, streets, buildings and unusual natural or topographic features. [ 2. Sworn statement of owner or previous owner as to use, oCcupancy sod condition of buildings. 3. Date of any houslng code or safety inspection of buildin~ls or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: I. Certificate of occupancy $§.00 2. Certificate of oacupancy on pre-existing dwelling or land use $§.00 3. Copy of certificate of occupancy $1.00 Date ....~..(~....'Z.. ~ ..T... New Building ................ Old or Pre-existing Building ................. i .......... Vacant/and ............................ location Of Property ...... SuMivision .................... ]..........~ ............................ ,...Lot No...-.....m}. Block No..~..... House Underwrit*rs Approval .............................................. P~nnin, Bo~rd ~provo[ ..~., ...................... Request For Tempor~ Ce~ificote ........................................ [in~l C~ffic~to .......................................... Fee Submitted $ /~ Construction on above described buildin~ and p~rmlt meets oll o~plicoblo c~s end Apphc~nt ............................................ Sworn to before me this .... ...... day o, ............ Notary Public~.....~'~: ...6~. ........ County (stamp or seal) ~IORTIMER SELIIGER Notary Public, State of New Yort~ No, 30-35~g9~5 QuSlifiecl in Nassau CounW ~ CommiSsion Expires March 30, 19 S-9 SdHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disposal facilitiels for a structure located - (G{Ve ~eed l~cation) department and found have been inspected by tds to be satisfactory. Dlstriot Engineer DiStrict Engineer lqli No. I TOWN OF SOUTHOLD IUILDINQ DEPARTMB~IT TOWN CLERK'S OFFICE SOUTHO~D, N. Y. Approved ........................................ , Disapproved a/c ................................................................. Application No. APPLICATION FOR BUILDING PERMIT ,N 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 port 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 part for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY/v~DE to the Building Department for the issuance of a Building Permit par~uant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction o.f buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . · Frank Zaleski Name of owner o? premises .................................... ~ ............................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which propaeed work will be done. Map No.: ...~ ................................ Lot No.: E/S Deep Hole ~ Drive Mattituck (east branch) Street and N~e~ '"'~'~-~'"'~1~' .........................................................................................................................Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy vacant land b. In~nded use and occupa.cy .... .o..n...e. fam.i...1.y, dwe.1.,.1...i~...g ............ 3. Nature of work (check which applicable): New Building .~ ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... ~.~.~.000...~ ................................. Fee ...... .1.0~.00. ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .o..~..e. ................ 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 ~...~,J~ ......... Height .................... Number of Stories ..............1.'~......~t~"~l.:L.~b. ert..z~..2~l...~.].o~' ....................................... 9. Size of lot: Front ..... .12~. ............... Rear ...... .~2.~. ...................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone oruse district in which premises are situated .......... ~I.A:..!I....~.~.~..~. ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;> .......... ~.O. ............................................. 13. Name of Owner of premises .~.~l~......~..~..~.e..~.~...~.....Address .....~..~,.~.~.~,.~g.g,g~ .................. Phone No ..................... Name of Architect ...............g..~...[~.,$~ ..................... Address ......~.]:)Q~.~. .................... Phone No ..................... Name of Contractor ....?...~..~].~D)~L ....................... Address ......... ~.~.C~..~.1J. cle ............. 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 number or description according to deed, and show street names and indicate ~hether interior or corner lot. STATE OF NEW YORK, ! ,. ,.. COUNTY OF ....~'l,1~.~'.(~].~ ........... I''~'a'' I ......................................... ,~'~..~,~.~lil~:l. ........................ being duly sworn, deposes and says that he is the applicant (Nome of individual signing application) above named. He is the ................................ ...0~...~..e..~. ............................................................................................................. ' (Contractor, agent, corporate 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 applil~.tion filed therewith. Swam to before me this '~ / ................. day of ................... .......... , _._,../ ,4 ,, ,'g , Notary Pub,, .... County ~/ ,gnature o~ ELIZABETH ANN NEVILLE NOTARY PUBLIC, State of New York No. $2-8Z25850, Suffolk Cou~y~ Term Expires March 30,