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Home My WebLink About6942-zFORM ~0. ,t TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6001 Date J,,Ny 12 19 ~ Dr THIS CERTIFIES that the building located at . .SO~..~he~.l~.. blv.~. 6~. C. .e .d .a x* . Street Map No.A.Q.u~..* V..w,..P~lock No ......... Lot No. 8 Zast }~rion N,Y, confo~TnS substantially to the Application for Building Permit heretofore filed in this office dated ....... 0~..~..2.~... , 19 ?~.. pursuant to which Building Permit No..~..~..2Z.. dated ..... 0.ct ......~.~.., 19..7.~., 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 .. P~'.~?.a. t?..o.~..~, f..a~.~?-y...cl~?.~.~. $ ................................. The certificate is issued to K..~..&..~..et.sy..D??..1~..o?.s.k.~. ....~..e.r.~. ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~..~.~Y .................. 1~ 19~}+ by R, Vi!~Ia U DERWSITERS CER? FICATE So. ...... .e.. .............. HOUSE NUMBER 1000 Street .. Cedar. Dr 120'5 .... '~6~th'~fl' ~I~d ....................... Building Inspecto~ ~OR~ ~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MOST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 69 12 Z Date .................... 0~iliY...i~ ......... , 1973_. Permission is hereby granted to: ...... to .... b~'~X~l..ne~...one..~ntI~..~ws!l:l~g ................................................................................. at premises located at ...I~f~..~....~V.~..l~,/~k .............................................. ., .......................... ................................................ .C~la~..&..S~outher~ .............. ~a~;..~-~a~,~m ...... ~ ......................... pursuont to opplicotion doted .......................~.~......~ ................. ]0..~..3..,ond opproved by the BuiJding Inspector. Fee $.&~e~ .......... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 AFPLICATIGN FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ~nk, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use' 1. F~nal survey of property with accurate location of all build,ngs, property lines, streets, and 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 buddings, Industrial buildings, Mulbple Residences and s~mdar buildings and installations, o certificate of Code comphonce from the Architect or Engineer responsible for the building. 5 Submit Planning Board approval of completed s~te plan requirements where apphcable. B. For existing buddings (prior to April 19.57), Non-conforming uses, or buildings and "pre-ex,sting" land uses. 1. Accurate survey of property showing oil property hnes, 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 hous,ng 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 an pre-existing dwelling or land use $.5.00 3. Copy of certificate of occupancy $1 00 Date ,.--~--.~..~ ~..... ]..,~..~.. ~...~..~..~ ......... New Building .... ~ ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locm,on Of Property 0~.~.~..~...~5.... ..... .¢~..~'.....(~,..¢~¢~:......~..~.....¢t¢~.~ ..... .~,~r.~..~,.~.~ ....... Owner Or Owners Of Property ...J~.~:, ....... .k.i ...... ...o~...~........~.e~.~w~.....k~.,......~..:~y~-~k,.~.~ ............. Subdiwsion ~..~s4~.c~.~.~.~.......--~...c~'.~ ....................... Lot NO ....~ ...... Block No ............. House No.J.-.C'~.Q. Permit No b..ci..'l.-Z.....~... Date Of Permit .C)~."T...,?,~,..9?)~pplicont ..~.~.~.,.r~w(.....~.c~.~:f...~...c~.-.~..~.c~..~.L., Health Dept. Approval ~ ....................................... Labor Dept. Approval ................ ./~...:...~.. ..................... Underwriters Approval ,.~.. ......................................... Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate .......~..... ............................ Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. (stamp or seal) ~.~ .......... day of ............ ~. ........ ~.~ ............ -/~ viCTOR F WILLIAMS Nota~ Public ~ ~ ~~ County ~OTA~ PUBLIC, Slate of New .................................... No. 52-9617601 Quahhed m SuffoJ~ C~nW ~mJssJon Expires Mcrch 30, THE NEW YORK BOARD OF FIRE UNDERWRITERS fi' BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK. NEW YORK 10038 ""'""""""~'°'°"/'~ 7070,1 N 163383 o~ly th~ efeetrieei ~q~m~nt ~s a~fn~rlbed below and int~ by th~ app//can t natural ora t/M m~)ve ~p//~g~ ~um~r ~ t~p~s of K~ ~. Dzan~L, nl~/c/ Cedar ~. & ~u~hern Blvd. inthefollowing~catlon; ~ B~e~nt ~ tstrt. ~ 2nd FI, ~.Lde 36. &6 31 36 DRyERs RJRNACE MOTORS FUTUI~ APf,UAKCE FEEDERS ;PEQALIt~'PT S COOK:NO DECKS OVENS Ims~ WaSO.lm I I ~' R OF CC. COND. 3/0 OTHER APPARAFUS: Hocors: V I NO. OF HI-LEG EXHAUST FANS ~H' ~. DIMMERS C E 1'3.0, 2-2.0, 2-1.5' 5-1.2.~, 3'.75, l'.$k~." OF NEUTRAL 31o T. Dsenkows k.t Road Or £enc, L,Z,11957 11 COPY FOR BUILDING, DEPAKT~M~ENTo THIS COPY OF C~.E~._IFI,CATE~ NOT BE ALTERI~ !~i~.:~J~IY MANNER SUFFOLK COUNTY DEPARTMENT OF HEALTH ~- .~___~ H.D. Reference No.~_~,~U //~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~.,,t*l -f',' ~)z~"f~O~,w~M/ Phone Z~-5. Subdiv. Address . ~ ~0 ~ o~*~ 6. Section 2. Property location ~oo7~ F~D ~ ~D~ 7. Lot No. O ~ ~ ~o~ 8. Private well Village Township ~ ~ 9. Public water 3. Public Water Company name Distance to main 4. Lot size: Width ~7~-- feet Length ~ feet (Enter on center plot below) 10. Sewage Dispos~ystem: tank' Precast ffEqufvalent Special~ B. Leaching pools: If private well fil in blanks below: Tank capacityq% Gal Pump G.P.M. ~ Total well depth Depth to G.W. ~{ Amount of ~!ater in well Test Ho~ Data ~-~ J ?~t= c~ j o Ihe undersigned ]ERTIFIES: "Construction of authorized installations wil be in accordance with the Suffolk County Department of Health's current stand ards thereto." Date ~c~ / 7 ~ Signed ~. ~ ~~' ! Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, is the opinion of the Health Department, that an adequate and satisfactory Se. Disposal System can be installed on this plot. Date ~ Signed ¢ ..... ~ S-15 Revised 4/]/72 Disapproved a/c ................................... ~ ..... :__. ~,. *PPI.lC*TI(MI mR BUILDING PEI~AIT Oct 23 .?...3..;~', Date ................................................ ~ - --~ INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Buili~tg Inspector, with 3 sete of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot arid of buildings on premises, relationship to adjoining premises or public street~ 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 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 part for any purpose whatever until a Certificate of Occupar~y 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~e ~uildlng Zon,e O .rsiinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egu arians, tar the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .... .................................... {Signature of oppli~'~nt, or frame, if a corporefion) East Marion N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owners Name of owner of premises Klm & Betsy Dzenkowski If applicant is a corporate, signature of duly authorized officer, Builder's License No ..................................................... ' Plumber's License No. TaPlin " Electrician's License No. owner Other Trode's License No ............................................... L t n f ' . Aqua iew Park 8 1. oca o o and on wh~hprop~_ d work will be done. Map No .......................................... Lot No ......................... .... ~eara ur & Southern Biv~ Street ana Number ........................................................................ *~w~,~..^:~.,~.¥A$ ................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...v.~.c.~..z!..t.....l...a...13..d... ................................................................................................... b. Intended use and occupancy ......... .°...n..e.....f..a...~...i..1.~.....d...w~.,;~.l...i~n..~ ......................................................................... 3. Nature of work (check which applicable): New Buii~ing ~ Addition Alteration Repair .................. Removal .................. Demolition .................... Other Work ..................................................... 26 ~ ~'00 -t- (Description) 4. Estimated Cost ........................ ..'T.. ................................ Fee ...6..8.....~..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, 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 .......... ~'2..~6 ................. Rear ...~...2..-..~ ............... Depth ....2.~'../...~.~.. ....... 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 s~tuated ...~.......~.~.~.~ .................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~. ........................................... 13. ~/ill Iot'be regraded .....~..e..~.. ............... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ~;J~,..~.~,T~q'R~.]~l,..~..T~., ...... Address................................~' * H'~z'ion Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .....$.~.~..e. ............................................... Address ................................ 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 whether interior or corner lot. See filed plans STATE OF NEW' YO2K._' .. [~ ~ COUNTY OF ........ ~..t~j....I..o.....L~:.. ....... ~3.3 Klm '])~.enko~rs!~i - ................................................................................................. being duly sworn, deposes and soys that he is the applicom (Name of individual signing contracf) above named. He is the .................................. .o....~g.....e.?.....-.....~..U..~..];...~..e..Z'.. .......................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to n~ke 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 .................... · at .............. , ..... ........................ Nofal~ Public, State of New YorJ~ No. 52-0344963 Suffolk County.// Cornrnissi~n Expiree March 30~ ! NO RT H APPROVED AS NOTED W F-- S "J- 7~5-2660 9AM TO 4PM FO~ REQUIR. I I REF. I OF5 SCALE: PRAWN BY: Ff. ._1 it 3/ C O,-VC.. FINAL COURSE TO 13~ IZ" ~LOC~ cji L~II ~ CONC. eOO~FI~G PLY -\ -- LoLLy .,qCA.L E ' I LOT # ~ EAST M/~RIoN ~ff~T' 5 o~: 5 $oc/,Tff~RN BLt/'D '4, ~.' x~., E,~ APPRoV~ AS W~£T 5CALE ' SOUTH i0/ ql uP- M,~ S T E F'~ BE8 f- BATI~ ROOM N OVERHANG , · $£AL'E: 8 Y ~ K,,, LE~I.I,(OWS, K:I A rs~ __L__ I xTP- 3 ]' COMC. Co,_ R,S ~ TO tZ" rSLOC_ ~, ~" C ONC. SCALE: /~' r.)~A WN BY; .1~'. PZEHKOWSKI ~.l.o:L ,J //,, /' & CDV PL.~' t/~ , cO k , -- LoLLy' Cocf~/v~hJ ¸,t $CA L E ~ 3/~ = I S°~ 5 LOT # ~ ~AB'T M /~: ~ l c) N t.... 8q~ SouTheRN ~LVD Cou~ cFs IN GA,qA~