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Home My WebLink About6921-zFOl~l NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Cerlificnte Of Occupnncy No. ~.?.~ .(~. ...... Date ........ May . .16 ....... , 19. THIS CERTIFIES that the building located a~ 15,/8 l~oa~lv~ez'~ .Read- .. · Street Map NoNasa, Pt, ~°~ck No ........ Lot No, 1.8~ &1.8~...~oho~ ......... confoms substantially to the Application for Building Permit heretofore filed in this office dated ........ 0~ . J1. , 19.~3. pursuant to which Building Permit dated · ~t..I2. ., 19 73, was issued, ~d confoms to ~1 of ~e requ~ ments of the applicable pro~sions of ~e law. The occup~cy for which this certificate is issued is . ~a~e..o~e. ~a~l~ dw~li~g, w~th ~t¢on .................. The certificate is issued to . .~. ~ .~a .ibr~h~. ~sateh ....... ~r~ ............ (owner, lessee or ten,t) of the Moresaid building. S~olk Cowry Dep~tment of HeEth Approval ~,R* ....................... UNDERWRITERS CERTIFICATE No...~337-199- · ~Y..12....$977. .............. HOUSE NUMBER ... ~00 .... Street . ~oadwa-~ers. ~ad- ...Na~s .P~- ........ ~O~ NO. 2 TOWN OF SOUTHOLD B~ILDIN~ 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) No. 6921 Z Permission is hereby granted to: ~..~~.~..Cl..Ab~s~,...g~tch ........ ................ ~tehc~l~ ....................................... ~o .... ~JLd.. e~. ~dd £t ~.. ~u..e~. ~tinl.. d~e~:l~ ............................................................ at premises located at ..... .~..t!t ......... ~lae~.~.-..~t..~-~e~p ............................................................... ..................... ~.~d .~l~::l~..~al~ ............. l~satt....P~~- ............ Cut oho~q~e ............. pursuant to application dated .... t .......... ["'"(~J'JJ .......... ~J'~ .............. , 19.~'~.., and approved by the Building Inspector. Fee $..'~.~'~1~1 .......... TOWN OF SOUTHOLD , Building Department Town Clerks Office Soul, hold, 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 Inspector 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 disposalw(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 installations, 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 opplicoble. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings and unusual notural or topographic features. 2. Sworn stotement 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 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 New Budding ................Addition ................ Old or Pre-existino Building ................ ¥ocant [.and .............. Location Of Property .... ./~/.~..~....~.~.~-~......~..~.../.~....~....,.....~...~...'(. .~..~..~....~..~...~ ....... O ner Or Owne. Of ....... ................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant ......................................... ~./...~......~...... Health Dept. Approval .......... ~ ......................... Labor Dept. Approval ............... ~ ................................ Underwriters Approval .../...~...../..//?../~...~/'...../.J~...~..Z...~Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......... ~ .............. Fee Submitted $ ~ ~ C) Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn t~ before me this .......... l. .... ...... Notary Public ........... ~'..~.i.. County ~n the following location; [] Basement was examlned on, May FIXTURE SWI~TCHES OUTLETS ECE ACLES ~T K W ~t H P G, -H P SERVICE DISCONNECT '- . ,THE', NEW YORK BOARD OF FIRE UNDERWRITERS dp ' ~ BUREAU OF ELECTRICITY J~- '- ~," h, 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT - , -, ,, _ , _-, , . only t~, electrical equipment as deseribe~d below and introduced by the appllcan~ named on the a~ appllca~ion number in t~preml*e~ of ,-, Abe Usatch,, Broadwaters Rd.,&~Nassau Pt, Rd. & Wunneweta Rd., Nassau Poi ~ Ist FI. ~ 2nd FI. Section Bilk ~t and found to be ~n compliance with the requirements of this Board. FUTURE APPLIANCE FEEDERS JSPECIALREC'PT TIME CLOCKS BELL UNIT MULTI-OUTLET DIMMERS HEATERS T ' NO A W G ~T j ~ ~T ~S TRANS ~T ~ P NO OF FEET I ~ S ----E - R V -- -I C E - Paul Bur~s ~,' , ' ', om Town Harbo~~ Lane '_, -' ''~ * ~ k I ~ .- outhold, L.I. 11971 .~. ,... - LIc.~282E Pt Th~s ceH~f~cate must not be altered m any manner, return to the offtce of the Board ~f ~ncorrect inspectors may be identifmd by thru redent, . ACCUSATORY INSTRUMENT INFORMATION - GENERAL C.P.L. 100 15 FORM NO. 256 WILLJAMSOh LAW B(tt.J~ STATE OF NE~ ~ORK : COUNT~ OF .... fig~.T.g.A~. ___~~ ...... COURT .... ~ ........... OF._~DHT~OT,~ ........................................ jlnf rmatian ~. and ~rs. ~braham Usafich Defendant Howard Te.~_r_.y.,._._B_~_J:.]:_~_~_n_g___.Z_n_s_l~.e. ctor ., resld Jockey Creek Drive, SoUthold, New York ..................................................................................... , by this information l written accusation as follows: That .... ................................ on the__.l_~ day of__~_a__n__u._a_r_y_ 19_7_7 ...... at__L_o._2__s____l_8__4__&__, l_8_5__,___B_rog_.cl__w__a_~__e_r_s.___R_p$~ ............. (Locatmn) in the___.H.?__m_.l__e__t3 ................... of__._Cu__~__c_hoc;u__e_ ........................................... County of .... .S_ u f_ .f. _o_ _l._ _k_ ................................................................ , New Yor commit the offense ~---°--c-~u-?-y--i.-n-g--a-~d-~d-iti-°n-~--°~n---e--x-i-s--t-ing.---d-w--e-~-±~-~--y-~)~ securing a Certificate of Occupancy a (mi-s~l, me.a-r~r-) (violation) in violation of Section ..A_r__t_.__X_I_V_.,___S._e_q.~___i_O_Q.-_i_4A_A._[ll, Chapter 10.0 of the Code of the Town of Southold ........ -.-_.-.':~.-_rL-aw't~k'theaSvate~Ft~ew Yorle,-in that (s)he did, at the aforesaid time and p Count0ne: occupy addition built onto existing dwelling without having secured the necessary Certificate of Occupancy. Thefactsupon ~hichthisinformationisbased areasfollows: Through a contractor, Mr. and Mrs. Abraham Usatch obtained Building Permit #6921~ on October 12, 1973, and built an addition onto an existin~ dwelling. After due notice by mail, they have failed to apply for or receive a Certifi- cate of Occupancy. ., . Mr. and Mrs. Abraham Usatch Wherefore, Complainant prays mat. .............................................................. be dealt with pursuant to law. Complainant ] Howard Terry, Building I~spec **Subscribed ~,hd Sworn l-o-before me on ._.. ~ . zJ. --*- .... ~' -~ .......... 7 ....._~9__/ .... " Name Town Justice T~Oa or Off,ce *set forth statutory language constituting the offense **use only one The [oregolng factual allegations are based upon personal knowledge of the compla,nont (and upon ,nfo ACCUSA, TORY INSTRUMENT fNFORMATION- GENERAL C.P.L. 100.15 FORM NO. 256 W~LL~AMSONL^W BOOK CO,ROCH~ST£~,~ Y 14609 STATE OF NEW YORK : COUNTY OF ...... ~ ........................................ against ~ritten accusation as follows: That.. .~_....~___~...~.~ .... ~ .................... , on the...ff.i_ .... day of~_,9..~_._~.. .... , at _._~.._[.~..~.~._[_~._~.. ...... _.~__.~L~__._.c~e~_ ..~.~_~....__.~...__.~.~..., ia the.~__~~ ............ o[ ..... ~~:':::::: .................................. , County of ~ ~ . .. .,New York, did ........ ff .... ~-~ .................................. ~- ...................... ~.~,, ,~ o,,e,~ o,._~~_.~..&_~..~...~~...~ ..... a ~(violation)in violation of Section ~~ ........................ Z...~. .... f the g.~.~..~f the State of Ne] York, in that (s)he did, at the aforesaid time and place* ~- ~/~ The facts upon which this information is based are as follows: / The foregoing factual allegations are based upon personal knowledge of the complainant (and upon ~nformatlon and behef, the sources of complainants reformation and behef being, TOWN OF ~UTHOLD BUILDING DEPARTMENT TO~N CLERK'S OFFICE SOUTH~D, N. Y. Application Disapproved a/c .~ ..................................... ............................... iiii; i ............................. AFPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the BuildingS. 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this apalication.~! 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 work. shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy No building 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 County, New York, and other applicable Lows, Ordinances o~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (A~ress of appffcant)~/' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~./....~..~.<..~;~:----....~~ .................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of cof'porote officer) Builder's License No ............. Plumber's License No ......... .!!!...~..........?....~.....?.. ......... Electrician's, License No ..... ~.~ ....................... -- Other Trade s License No ................................................ 1. Location of land on which~.,.~ ~pr°p°sed work will be done. Map No.: ...~.y...~......v_..~,,~ ' '; --~'L°t/l~l° '....~,.~....~'.../..~.:~...] Street and Number ...... ~.~/~. ........................ ~gS~.~.....--. '"' '' '"(~unicipalJty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..................... ~...,,,,,-~ ................................................................... b, Intended use and occupancy .............................................. ~.,-,~Z.~..,.~....~...~ ..................................................... 3. Nature of work (check which applicable): New Building Addition .................. t on ................. Repair .................. Removal .................. Demolitiori ........ i.....~,ii. Other Work .................................................... .~ (Descriptic~) 4. Estimated Cost :.~.¢ ................................ Fee ........ ........... J .................................................................... (to be paid on filing this application) 5. If dwelling, 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 ...... . .Z/..~... ............ Rear ..... .~....~.. ................... Depth .,.~..~. ....... Height ../:~'.../. ............. Number of Stories ..............Z .............................................................................................. Dimensions of same structure with alterations or additions: Front ...... ~...b...~.../. .................. Rear .....~....D~....~. ............ ! Depth ......~...~..~ ................. Height ..../.~.. ................. Number of Stories .........../.. .................. 8. Dimensions of entire new construction: Front ..... ~..,~../. .................... Rear ...~..~...../. ............. Depth ../.~...!. .......... Height ../~...../. ........ Number of Stories . / ................................................................................................ ! 9. Size of lot: Front ...... ~..O.../. .................................... Rear ../..~.. .............................. Depth ~..~3 10~ Date of Purchase ...-..~ .................................................. Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated .............................................................. · ...................................... 12. Does proposed construction violat~ ar~¥'zoning law, Ordinance or regulation: .......... /,~./....~.. ................................... 13. Will lot be regraded ..... //..~...,. ........... Will excess fill be removed from premises: ( ) Yes ( ~ 14. Name of Owner of premises ~.~..~.s~./~...~.C~.~.... .............. Address ~ Phone NoZ~,~.~..~,,~..>- Name of Architect .............................................................. Address ........ ;~...f) .......... t'"' Phone No ....................... Name of Contractor ...~../...~Z~,-.~..~.~..¢Z/ .......................... Address~...~.~. Phone N2.~...~ .7.~..~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from and indicate whetherPr°perty interiorlines' GiVeor cornerStreetlot.and block number Or description according to deed, and show street_ names ~ /0o' STATE OF NEW YORK, ~ c c COU N TY~0 F ................................ )' ............. Z(~.~..~.~....~......~..*.....'~..~.,/'~../..~.. ....... '.; .................. being duly sworn, deposes Ond says that t~e is the applicant (Name of individual signing controcf) above named. He is the ................................. t~...(~<....~';~.~....~'.-.~. ........................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du~ ~uthorized to, perform or have performed the said work and to make and fife this application; that all statemen~~c~ta~e~' ~is application are true to the best of his knowledge and belief; and that the work will be performed in the manner set foMh in the application filed therewith. Sworn to before me this (Signature of applicant)