The URL can be used to link to this page

Home My WebLink About6918-zFORM NO. 4 TOWN OF $OUTHOLD BUII.BING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z687.6 ..... Date ............ Deoembe~,. · ~., 19..~ THIS CERTIFIES that the building located at ...Wickha~. Ate. & 27. gR.. Street Map No....~.~rd. OD..l~ock No ...........Lot No .......l~tti.tuck.. ~ ,¥.. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............0c~.. 1 I..,. 19.73. pursuant to which Building Permit No. 69 dated ...........~Ct...~ 1 .... , 19. ?3, 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 . Pr&rate..one. £amil~ .dweilSng. wAt~. acldit.ton ...................... The certificate is issued to .Jotm .Bielowi~ ....... 0~ne~. ......................... (owner, lessee or tenant) of the sforesaid building. Suffolk County Department of Health Approval .I~,R., .............................. UNDERWRITERS CERTIFICATE No. pe~l~ng .................................... HOUSE NUMBER ..... ~.~.00 .... Street .. ~ckha~. a~a .......................... ........................ .... ........................................ Building Inspector FORM NO. 2 TOWN O~ $OUTSOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6918 Z Permission is hereby granted to: J.~..~./e.e].l~,~ ............................................ .............. .,.~,.t..~.~ .......................................... at premises located at .-TI/':~i~iJ~ll~.-AV~.~.~ ....... G~ie~,-~e-:~g~ ...................................... ............................................. ..~.~.t;~.~)~ ....... ~.,~.: ............................................................................. pursuant to application dated ...................... 0~.~ .......... :t.~ ............ , 197.~ ....and approved by the Building Inspector. Fee ~.J~ .............. FO~RI~ NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, Iq. Y. 11971 APPLICATIOlq FOR CERTIFICATE OF OCCUPANCY Instructions A Th~s apphcation must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1 Final survey of property with accurate Iocat,on of all buildings, property lines, streets, and unusual natural or topographm features. 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 Underwr,ters. 4 Commercml buildings, Industrial buildings, Multiple Residences and similar buildings and installahons, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of compleled s~te plan requirements where applicable. B For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~sting" land uses: 1. Accurate survey of 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 and condition of buildings 3. Date of any housing code or safety inspection of buildings or premises, or ether pertinent 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 Date .'/.2.'~.....~. · ...~...T..~....~. · blew Building ................ Addition ................ Old or Pre-existin§ Building ................ Vo¢ont kand .............. Location Of Property ..................~...!...~...~/~.......~...~..~..~. .......... /~...~.z~.~. ....................................................... Owner Or Owners Of Property ~.~.~.....~......,/.~...~.. ......... ~.~. ...... .~..../..~..~.~...~../..~O...~. .................... Subdivision .............................................................. Lot No ............. Block No ............. House No ~...~....~....~ Permit No .~..~.~...~'...'.....~'Date Of Permit .~.°....'.../..~...-.~..~pplicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval ^~ / ~t ~1-/~ tf .............................................. Planning Board Approval .............. .F./.....!..~ .............. Request For Temporary Certificate ........................................ Final Certificate ................. .~..~.~. ................... Fee Submitted $ .....~ .............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant Sworn to before me this "-/ Notary unty NOTARy PUBLIC, S,ate of Ne',,/York (~, chhcd m Su~J%jk CounJy THE NEW YORK BOARD OF FIRE. UNDERWRITERS ~ BUREAU OF EL. ECTRICrT~ · ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,,,,.~..,,,..,,r, 2~, ,7,, ~,,,,.,,.,,o.,No.o.,,,,~ ,~.~,.. N 144794 THIS CEFFFIRIES THAT John Blelewlcz, e/s 1~20 Wlckha~ Ave., Matt/tuck, L.I. in thefol~i~g I~ation; ~ B~e~.t ~ Ist FL ~ 2~ FL ~t~n B~k ~t ~.,~i~o. Feb~y 20, 197~ ~fou~tobeln~m~ia~wlththerequ~rementsofth~. ~X~U~ ~XT~ ~A~ 0~N$ ~SH W~$~ SXHAUST FANS 1 5 3 1 DRYERS IKII~4AC;~ i MOTORS SERVlC~ ~ S E R V I ~m~Cck. c ^.w.. OF NEUTRAL W.B. Ruland~ Electr/elan -Mattltuok~ New York TOWN OF SOUTHOLD ..~/,.// BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. '~ Examined .................. , ....... .......... ........................... .... a. This application must be completely filled in by htpewriter or~ in ink and submitted in triplicate to the Build~ ~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. .~] .~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets~f areas, and giving a detailed description of layout ofproperty 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 perr~t ~, shall be kept on the premises available for inspection throughout the work. ~[ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occup 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 CountyrNew York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or a~terations, ar :for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................... ............................................................................................ ::'" If applicant is a carper te,~l~nature ol du y authorized officer. (Name and title of corporate officer) Builder's License No ......... ~ ........................................... Plumber's License No ................................................. ~ Electrici~an's License No ............................................. Other Trade's License No ............................................... ~/3 /'/~ 1. Location of land on which Rr..opj~ed v~r~will be done. Map Uo.:~.~../.~.....J_c~No._...i~.. .................. Street and Number ....... .~...~...~...~..~.....~......~....,~.....~...Z. ....... ~~ ........................ /c./o ~ Municipality 2. State existing use and occupancy of p.~m~ses ~ intended use and occupancy of proposed construction: a. Ex,s,t, g use' ' 'n and occupancy ....... ~..:..~.../~ ....... .~......./y., ............................................................... b ntended use and occupancy t( "~--OV~ .. . :, ..... property lines. Give street and block number or description according to deed, and show street whether interior or corner lot. ~3 Nature of work (check which applicable): New Building .................. Addition .....~ ..... Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) Estimated Cost .......... :..-~..~.'-~.. ................................. Fee/..~...Z ................................................................................ (to be paid on filing this application) If dwelHng, number of dwelling units ................ L .......... 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 ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ I~la~9 o~_~r Owner ........................................................ 11. Zone or use district in Which premises are situated ...... ~ ............................ ~ .. .......... ~ ........... =: .................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~ ........................................ 13. Will lot be regraded~ ...... ill be removed fro ) Yes ( ) No 14. Name of Owner of premises ..~..~...~'..~ ........ Address ....L~.':.'.. phone No Name of Architect ............................................................ Address ................................ Phone No ....................... Name of Contractor ...............~ ..................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-beck dimensions from names and indicate STATE OF NEW COUNTY O~ /~ ..................... be ng duly sworn, deposes (~nd soys that he is the applicam (Name of individual signing controc~) above nomad. He is the ................................................................................................................................................................................. (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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before,~e this ~ .~ ~ _~ ~ o ;;2;2;;";';;Z ....... ...... ~ ..... ~ ................ :' '71 ........ (Signature of appl~nt). JUDITH T BOKEN ....................................................................... No, 52.0344963 SuE¢oik Count~/~ · ~ rch 30, 1~