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Home My WebLink About6938-zFOB,M NO, 4 TOWN OF SOUTHOLD BUr[,F)INC. DEPARTMENT Town Clerk's Office Southold, N0 Y. Certificate Of OCcupancy No. Z~.68 Date Jail . ..~.. 19..~. THIS CERTIFIF~ that the ,building l~a~ at;. ~~..~ ...... S~t Map No.B~. ~.~1~ No ..... ~ ..... Lot No. 2 S~thol~ co,om subst~y ~ ~e A~H~on f~ B~ding Pe~there~fo~ ~ ~ thia o~ce dasd ........ ~... ~ .., 19-.~. p~su~t ~ wM~ B~i~g P~it No, ~.. dat~ ...........~.. ~..., 19~., was i~ued, ~d co,ores W ~1 of ~e ~q~ men~ of ~e app~cab~ ~o~io~ ~ ~e law. ~e o~up~ for ~su~ ~ ~iva~ one f~llY dvell~ ~e ce~fficate M ~ ~ . ~. ~W~. ~.. e. ~ ....... ~eF ..................... (o~er, lessee or te~t) of ~e ~ores~d b~glng. S~o~ Co~ty Dep~ent of He~ Approv~ ~ .................. ,. ............ U~ER~ITERS CERTIFICATE No. ~, .................................. HOUSE NU~ ...... 2~ .... S~et... ~a~, D~ ................... IrOB,M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT ~r~ (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL '~ COMPLETION OF THE WORK AUTHORIZED) ~ N? 6938 Z Permission is hereby granted to: at premises located at ...~t..:~.....~J~lilelk..~,..,.~ ~31;~I~ILl~&t ............................. ;: ........................ ........................................ 1~ ............. ~'. ............. ~,~1~t~.3,4..... ~. A Z ~ .................. ...~ ........................ pursuant to application dated ....................... ~Nt.~; ......... ~ .......... , 19~.~...., and al?proved by the Building Inspector. ' Fee $~ ~..e...O~... ............ TOW~ O~ 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 DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. 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 dispasal--(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, o 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. 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 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 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 I / __ New Building ................ Ad~)~o~n ....~%,/.), ~ ...... Old o: ~,~xisting/uilding .~.....~....~~,~/~_Vacant La~l .............. Location Of Property ..... /'~.A~...~~zr. ............ ~~ ......... Owner Or Owners Of Proper~y~-..~-~.....~.....~..~ ........................................ Subd,v,sion ................. ............. ,otNo ..... ......... .ouseNo ............. Permit No..~....~..?-.<~.....~.... Date Of Permit/?/..?...~./...Z..}...Applicant .~.~..~.~-¥ ....................... Health Dept. Approval ......... ...~.....(..~-. ...................... Labor Dept. Approval ~:~i ~r i;~ 7 .[.eA PmPpro°;;; ~; ~'i~'f~'~'~' ................ Planning F,~a°al r~e~f~:' ..... .~-..~ ........... Fee Submitted $ ...'~........~ ................ Construction on above described building an~l permit meets all ap/~licable codes and regulations. Applicant ....¥~~~ .......................................................... Sworn to before me.~~ ~ ...... of .......... L.f..?. Nota~"~blic ......... ~ ........... County (stamp or seal) I[ _-i_ .C'e Ree'~ Disapproved a/c ................................................. ;.. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Buildirt~ 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, end giving a detailed description of layout ofpraperty 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 permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. ~PPLICATION IS HEREBY N~DE to the Building Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applic.able Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolihon, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. Leo Kwasne ski (Signature of applicant, or name, if a corporation) Southold N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................... ....................................................................................................................... Name of owner of premises ....~.~l.e...~.W.,...~'.~..~D~ ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's L. ice~se No ..................................................... McCarvell Plumber's License No ................................................. Electrician's License No. R,...B~.=~s.....~ .................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ..~...e...z.~.~...°..~.......~..!~....? ..... Lot No.2 ........................ Street and Number ...... ~,l,~8.([~.Q~t..~.~ ..............~D.~,~,.....~.,.~.s ........................................................... Municipality State existing use and occupancy of premises .and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .d~..e...]:.]:.~..~.j~. ........................................................................................................... b. Intended use and occupancy same ~ith e.n a~d;Lt'lon & altera, t~Lon Locate clearly and distinctly oil buildi~ property lines. Give street and block nun e/bather interior or corner lot. 3. Nature of work (check which applicable): New Building .................. Addition..................~ Alteration ....... ~. Repair .................. Removal .................. DemOlition ........ ......~ ..... Other Work .................................................... (Description) 4. Estimated Cost .................. ~.~.~.0..0.. ~ [ Fee ?..?.....0...0. ................................. (to be paid on filing this application) one 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, spec/fy 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 ....~2. ........................... Rear .....1.~ ................... Depth ....$.~...-..~. ........... Height .................... Number of Stories ....... .o..~...e. ....................................................................................................... . 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ,~,tt ~ist 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ..~..O. ........................................ 13. Will lot be regroded ...... ..n..o,. ................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises ..J~.$.,...$.gl, W...W~..e.~.. .................. Address ....... ,,~.,o.,~.~.~..o..];...~. ..... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..~..e...o....~...~..a...s.~.e...s..~...~. ............................ Address................................S°uth°ld Phone No ....................... PLOT DIAGRAM ~, whether existing or proposed, and indicate all set-beck dimensions from :r or description according to deed, and show street names and indicate STATE OF NEW~-~Ip~-jt. COUNTY OF ................................ Leo K~asne ski ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name. of individual signing contraclO above named. He is the contractor (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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .................... .2.~ .... f ............... .0. C. t_.o..b..e..r,~ .......... ,o..7.~.. .................................... JUDITH T, BoKEN (Signature of applicant) public, State oJ NeW ¥ot~ NelarY ^~-~963 Suf~oD, C°unty~f''/ No. 52-uo~" . "ch 30, CommiSsion Expires /~,,ar