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Home My WebLink About5226-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...~15.~.6.6. ........ Date December 5, , 19.8..6 THIg CERTIFIES that the building One family dwelling with attached garage Location of Property 1025 Stillwater Avenue Cutchogue, N..Y. " ; - House No. Street Hamlet County Tax Map No. 1000 Section ... ! .0.3 ...... Block .... ! .......... Lot 1 5 ~. '" Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated g~ril 12~ 1,9 7.1. pursuant to which Building Permit No. 5226z dated ... ?~o.v.t._~.~..1.2. ~ .............. 19 .7.1., 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 with attached garage. Th¢ ¢ertificate is issued to ... FRANK T. KLOS & LOIS A KLOS .................. it .................... of the aforesaid building. Suffolk County Department of Health Approval S O- 921 - UNDERWRITERS CERTIFICATE NO ............................................. N60029. T . . . Building Inspector Rw.l~l 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? 5226 Z Permission is hereby granted to: ....................................................... ~Ta;J, el~l:mt ......... I,X,, ................................................................ purs_uc~t to application dat~ecl .......................... ~I~L~J, ......... ~J~ ...... , 19...~.JJ, and approved by the B~ilding Inspector. _ r~ ~.!~0~ .......... Building InspectorI T' I-IE NEW YORK BOARD OF FIRE UNDERWRITERS f~ BUREAU OF ELECTRICITY ~'- BB JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT o~(y the s~td~l equipment ~ ~scri~ ~l~ s~ {ntr~uc~ by t~ applicant ~m~ on the a~ve ~plication number in t~ premises ~ ~os, E/S Srillwat~r Ave., ~~, N.Y. ~ ~...,,~d o. ~1 i8,~ 1983 and found to be in comphance wi~h the requ,re,nen ts of this Board. FIXTURE i SWITCHES OUTLETS DRYERS FURNACE MOTORS FIXTURES RANGES I FLUC~SCENT OVENS DISH WASHERS EXHAUST FANS FUTURE APH.IANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT S E R V I C E OTHER APPARATUS ~ in~t~ectiom has been made of t/~ extmeed electrical equi~nt in cl~ pr~m! sas indicated. No obvzou~ urmagisfacgory condit£o~ wa~ £om~t. ~rank }(los Srillwater Cutchocue, N.Y., 11935 'h~s cerhflcate must not be altered m any manner, return to the office of the Board ~f *ncorrect. Inspectors may be identified COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspeq-~ tor with the following; for new buildings or new use: es,~st ~,~an~ 1. Final survey of property with accurate location of all buildings, property lin r~'e unusu natural or topographic features. , 2. F ~nal 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. Bo For existing buddings (prior to April 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey of property 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date.././..~..< .//..~.. ,~..-~, .......... New Building . ~ ........ Old or Pre-existing Budding ............ Vacant Land ............. Location of Property County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subd~vimon ................................ Fded Map No ........... Lot No .............. Permit No.~.?..~..~..'~... Date of Permit .~./l~/.7/.Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwr,ters Approval..~..~, .~)...~..~..~, ........ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... ~ ............. Fee Submitted $ ........... ~... Construction on above descr,bed buildin '~g~.p~e~mit meets all a~te codes~nd regulations. Rev. 10-10-78 EASTERN DISTRICT, RIVERHEAD,N.Y. iPPLICATION FOR ~PPROVAL TO CONSTRUCT PRIVATE SEWAOE DISPOSAL §YBTEi~, Date [~roval to o'0~truct Said systems is *equested,per~'~ent data herewith: .... 2-Detailed Property loCatioh_:'.~ ~i%a a~T ~~.% No. ~.~',~:~_~:~ Hamlet ......... f% J~ _ .. Town (~ .~-~_h(~o,~-~ .~ 9-Private well? .~ ~-~blic ~ter ~u~Piy ~me ~ ~ -- ~ . ~nce to nearest ~in .~.j~ $-~t Sizel Width~ft. Len~th~ft. (aisc en~r on center plo~ plan below:) 5-~elli~: Single ~amily ~T~ Family? ~ /Cellar? ~b? ~Crawl S~ce? lO-~o~s~ ~st~: Septic tank ~Precast ~Cess~ols ~S~llow ~ols ii-Septic ~ inside dimensions: Vol~e Gals.Length ft. Width ft. Liquid depth Total blocks below inlet. ~1~2~ ..... ~T PLAN .G ! ~ ...... , No~th The Undersign~ ~RTIF~S: "Const~ctton of authoriz~ Installations ~11 be acco~ance ~th the Suffolk County Health De~ments' ~rrent Stan~s, ~lletins, a~ a~e~ents thereto, covering Private opinion of the H~lth De~rtment, that an ad,ustc can be installed on this ~ot. , ,, See~ion 720~ ~ the New yeR~ ~ Z · \ 'IY)WN OF SOUTHOLD BUILDING DEFAi~TMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~.,~..~.../.~ ........ , 19..7/.. ,, " " ..~.~.. ~...4. ~. Approved ........................................ , 19 ........ Permit No ...... Disapproved a/c ............. ./....;,ri ......... ~ .......... ~ .........~ ......... ~ .......... / ............................ (Building Ins~~ ....................... APPLICATION FOR BUILDING PERMI'~ Date ............... ~ ........ ~.¢~, ............... 19...~..L INSTRUCTIONS a. This apphcation must be completely filled in by typewriter or m ink und submitted in duplicate to the Buddin Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets, areas, and giving a detailed description of layout of property must be drawn an the diagram which il part of this applicatio, c. The work covered by this application may not be commenced before issuance of Building Permit. d, Upon approval of this apDlication, the Building Inspector will issue a Building Permit to the applicant. Such perm shall be kept on the premises available for inspection tFroughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS H.EREB¥ MADE to the Buildmg Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ond other c~pplicc~ble Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ..... ............... ; ....................... (Signature cf applicant, or name, if a corporation) · ....... .................... ~ (Adar;ss or applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises. ,,< ............................................................................................... applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) land on which proposed work w II be done lump No · /~ Lot No °' ........... ................ Street and Number ..................... ,',,~.~,, ...... .'~,.~,,.~ ....... ';,: .......................................................... :,.~, .................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~xlsting use and occupancy,. .............................................. ~"'"'~ "~""i' b intended use and occur:an ........................ ~ ..... .C~'~.../.:.: ......... ..-7.....I .......................... l ...................................... 3 Nature of work (check which applicable) New Budding ....... V... ....... Addlhon ............... Alteration Repair .................. Removal ................. Demolitron .................. Other Work (Describe) ................ /~,, 4 Estimated Cost .... ..~'...:?../..~....T. ............................... Fee ...I...~...: .............................................................. (to be pa~d on fi'.mg th~s apphcat~on) 5 I.~ dwelling, number of dwelhng umts ........................... Number of dwelling umts 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 e×ist,ng structures, if any: F,ont .......................... Rear ............................... Depth . .. Height ....................... Number of Stones .......................................................................................... D~mens~ons of same structure with alterations or addmons. Front .................................... Rear ..... Depth ................................Height ...........................Number of Stories ................................ 8 D,mens~ons of ent,re new construct,on: Front .... Z.~.?../...~...~. ............ Rear ...... /~2-.. .................. ~'-/~:2" . Depth ... Z~' ~: Height .................. Number of Stories ................................................................................. 9. Size of lot: Front ....... ,/....~:...6..,~....~.~?... Rear ... /.2 .0~'.,..2...~. .......... Depth ..................... .... ~- '~'~''' ~'~ 10 Date of Purchase ........................................................Name of Former Owner ..................................................... 11. Zone or use district in which premises are situated ................................................................................................ 12 Does proposed construchon ~lolate any zoning law, ordinance or regulatlonP ............................................ 13 Name of Owner of premises ~J~I.(....K&~.~. ............. Address/~.&~.~..L?~.N.o..A.d/<./~ .......... Phone No..~...~.Y.'.~...~:..' Name of Architect ............................................. Address ...................................... Phone No ............. .~..~.~ '/7~ m~/3~o~ .... ~ '~ Name of Contractor ............................... .~ ................. Address .......................................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and indmate all set-back dimensions ftc property lines. Give street and block number or descript,on according to deed, and show street names and indica ~vhether interior or corner Jot. ,-f STATE OF NEW~OI~J(,~, ~ S S COUNTY OF ..~ ............. ~ ' · .............. '( ..... ' ~'l~i;'c.'~;;;~i ............. be,ng duly sworn, deposes and says that he ,s the apphcc above named. He is the ............................. ~ ................................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and f this applicahon, that all statements contained m th~s apphcation are true to the best of his knowledge and belief: a ti,ar the work will be performed in the manner set forth m the apphcation filed therewith Sworn to before me this . /~ n.~tu~r~.~ ....... ......... ............... "L Notary Public~.~,~ ......... h," " ;~'~'~ ........................ No. 52-8125850, Suffolk C0~o~ Term ExpireS ~arch 30, 19. . BUILDING DEPARTMENT APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit punmant to the Building Zone Ordinonco of the Town of Southold Suffolk County, New York, and other al~llcoble Laws, Ordlrmrmes Regulations, for the construction of buildings, additions or alterations, or for remOVal or demolition, al herein described. The applicant agrees to comply with oll applicable lows, ordinances, building code, housing code, and regulations. ......... ~.~....,...~ ....... ~:.~...:.. ........................................... (Signature af applicant, or name, If a corporation) (Address of applicant) State whether applicant is ~r;.l?see, a_gent, architect, engineer, general contractor, electrl¢lan~' plumber or builder. if applicant is a corporate, signature of duly authorized officer. --~ ~ (Name and title 'of corporate officer) 1. Location of land on which proposed work will be d ne. Mop No.: ......... ~ ....................... Lot N ...../~.. ............. Street and Number ..................~ ....~, 7~.~_¢.,~ ~___¢.._,~ ........................................................................................... ~ ~'~ ( / 0,7~ 5~' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. existing use ana occupancy ....... ~. .................................................................................................................... b. ]ntenaea use ana occu[on ....................................................... I .......................... f ........................................ e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. TOWN CLERK'S OFFICl //-/ ..... / /~ ,-~ ~ ~ · ~ ~,"'~' ~'~.~ ~,- . ....."-"" "~...,~ ........ ,,,.~.."' _ . ,~,,~,,o" ~o...~.~.~. ...... ~mln~ ~r~ ........................................ , 19 ........ Permit No..~ ................. _ - ~ ~ I~ ' ::::::::::::::::::::::::::: .............. ...: . ~/,/Tr ~ ~ ~ ~ ............. ~' ~'ng '~:~ ............. / APPLI~TION FOR ~~ ~ t~, ~,. ............... ~ ....... ,/~ .............. ,,,..~/.....~ a. This applicoti~ must be c~ple~ly fill~ in by ~ewrJter or in Ink und ~ubmitted In ~pllcote to the Buildi~ In~r. b. PI~ plan s~ing I~ation of lot a~ of buildings ~ premiss, mlatlon~ip to adjalnl~ or~ a~ glvl~ a d~alled ~rl~l~ of I~t ofp~ must ~ dr~n on the dl~mm ~e ~rk ¢~ by this a~llc~l~ m~ not ~ commenc~ before i~ua~e of Bulldl~ Pe~lt. d. Up~ ~1 of this appllcoti~, the Building Inl~ctor will I~ a Bulldl~ Pe~lt to t~ a~ll~nt. ~all ~ k~t ~ the premiss ~llable for in~ectJ~ throughout the p~m~ of the wo~. 3. Nature of work (check which applicable): New Building..................~/ Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ....c~......~,~..~...~.. ................................ Fee [ 0 ~ . (to be paid on filing this application) 5. If dwefllng, 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 ......... ?.....~:'...~../...~.....' ....... 72- ' /~ ' .~ ~ ~ * Rear ............................ Depth ........................ Height ..~...~..~....~..:. Number of Stories .......... ./....'./~...~.. ............................................................................................... 9. Size of lot: Front ...../....~...J...-.'.....~....'... Rear ..;......./...~...,.d~.:....~..?....x.... Depth ........ ~...?...../..:....?....? ' 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction vio~... ~.n~, zor}~Jaw,~ordinance or re~,%~l .~ ................................................. 13. Name of Owner of premises .~.(..~....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 line.s. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW(~'O~J~_v/A ! e e ............ ............... ......... ~ .................................. being duly sworn, d~es and says t~t he is the applicant ~ame of individual signing application) above named. He is the ............................... ~ ................................................ '~ ....................................................... (~ntmctor, ag~t, co~orate officer, ~c.) of said ow~r or owners, and is duly authorized to pe~orm or hove performed the said work a~ to ~ke ~d file this application; that all statements contained in this application are tree to the ~st of his knowl~ge and belief; and tha~ the work will ~ performed in the manner set fo~h in the applicati~ fil~ ~er~ith. Swam to ~fom ~ ~is ....... o, ......... .................. . ~R? PUBLIC. ~ ot ~ Yo~ ~o. ~-81258[0, ~ll~t C~ Term ~i~s ~rch ~, [~~,_