The URL can be used to link to this page

Home My WebLink About7012-zFOKM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ~.fi267 ...... Date ............. D. ec.. 31 ..... .., 19..7.~ THIS CERTIFIES that the building located at . l~aclow .Lam ............. Street Map No..F~a~;t o. gat Block No ........... Lot No..~8 ... l~tti.Cuck.. 1~,¥, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ l~ee .... .~.., 19.7.~. pursuant to which Building Permit No.. dated .......... DeC ....3 ...., 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..oaa £~mi;Ly..rivalling ....................................... The certificate is issued to -Jehr~..&. A~laJ.~e ·. I~abro~skt ...... 0vn~a ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. O¢.t. ]0... ~ 97~ · -by .R ,..~:~l~a .... UNDERWRITERS CERTIFICATE No. l~199.~97-. · ~. · .19...$97~ ................. HOUSE NUMBER ..... 6~0 ..... Street.. ~leado.~ .Lar~ .......................... Building Inspect~ FOR~I NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7012 Z Date ................ .]~..~.. ......... .~ .................... , 19..~.3. Permission is hereby granted to: ...J...q~..~...~aid&..Dab~.owak~ ................. ......... ~..~..'...=.::.$.~.~ ............................................ Mattl~uek to ..~.l...d.....n~E .. ~...~'.~,t~...d ~.~Ll,l~ .................................................................................... at premises located at~..O...~...~..;..~... .............. ~.~,*~.t~l~k...~S:~;l;e~. .................................................. ....................................... ...~....~...~..~a~ .............. g~t~ta~ .......................................................... pursuant to application dated .......................~.~..~ ....... ~ ................ , 19~.~...., and approved by the Building Inspector. Fee ~..!..~..t.~). .......... FORM NO, 6 TOWN OF $OUTHOLD , 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: 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 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, 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. 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 New Bc~ilding .....~...i ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. ...................... Planning/~' ~ Board Approval ........................................ Request For Temporary Certificate ........................................ FineJ Certificate ........... ...~. .......................... Fee Submitted .................................. Construction on above described building and permit meets all applicable codes and regulations. Applicant .'~-........~.~.{,~- .(..¢'~(~.~. ...... ~ . .................................... Sworn to before me t~ Notary Public ..... ~ (stomp or seo¥~-~,~ FOItM NO. 6 TOWN OF $OUTHOLD Building Deportment 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 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 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 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 Date //. ,.. ,~../.. ~ ...?...~. ......................... New Building .......~ .....Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Of Property ...~...~.~.......~....~..~..~.~./~......,~.~..~..~......;....~...~..~..~.~..~...~.~..)..~:.~ .......................... Location Owner Or Owners Of Property ...4~.~'./~.,.~...~.....gt....~.~...~.c~ ...... ~..~...~.,~.~.~..~..~. ................................ Subdivision .~. '.Z~.4~....~-~./...'t~..~.-~.. ....... .~.Y.,~,~ ......... Lot No....~..~.... Block No ............. House No.~...~.~.... Permit No..~.~./.,~.~...... Date Of Permit/.',~..~.~...~.~.~......Applicant ..~¢..~..~......?..~:..,~..~....~...~..~..e~...g..~.~'. ........ Health Dept. Approval ...w~.~...../.~F.,,~..~.. .................. Labor Dept. Approval -- Underwriters Approval .............. ..~.. ............................ Planning Board Approval .......... .T. ........................... Request For Tempo~rary Certificate ........ .~ ......................... Final Certificate .......................................... Fee Submitted $ .~.~...~ .................. Sworn to before me this ./ dayof/? Notary Public ,,,~~... County FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TEMPORARY Certificate Of Occupancy THIS CERTIFIES that the building located at . .g.~.~d. 9W..I..?p~ .............. Street Map No)~a.t..t.o..~$~;.. Block No ........... Lot No...1+.~.... 1.,~.!$.~k.k!qk....N. :¥.o ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... .D.e.c...3. ., 19..73 pursuant to which Building Permit No. ~..{~,.. dated Dec 3 19 73 , 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 . .. ~. ~.i.v.~..tg...ql~..e. f&r~..~y...~W.e.~. ~.z~g ..................................... The certificate is issued to . ~q .1~...~:. ~.~.~a~.~[.e..I)a~.r.~w~k~. ........ ~.~1~.11 .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .C.c..t...~.0....1.~.~.. ~y.. ~....~..~.1.].~. .... UNDERWRITERS CERTIFICATE No...~.e~..~.g ...................... .: ........... HOUSE NUMBER .. 6.G0 ........ Street . .l~d~. Le~ue ........................... Building Inspector f SUFFOLK COUNTY DEPARTMENT OF HEALTH H,D.Reference No ~6 EASTERN DISTRICT, RIVERHEAD,N.Y. A~PLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pertinent data herewith: The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bullebins, and amendments thereto, covering Private S~ge Disposal ~ystems", Date .3~'2 g- ~2 , Signed ! yO%mer 7. or Builder FOR h~ALTH DEPARTMENT USEI ONLY. Based Sn the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactj~y-~wmge Disposal System can be installed on this Plot. Oate ( o/65 Revis.) Indi No :ate ~th Data '~eet 0 2 6 $ 10 12 1-Applicant ,~p£M'.z~/,;D Address/?~.~,~ ~23~. ~ ~J ~:~ ~ ~ ~ ~M ~ ~.~ ~ ?-Section Hamlet ~/~.rrl'F~' To~ 'J~/~z m 9-Private well?.. 3-~blic ~ter supply name ~m~'~ Distance to nearest ~in 4-Lot Size:. Width/~ ft. LenEth~ ft. (also enter on center plot plan below:) 5-~elling. Single Family ;V; T~ Family? ~ /Cellar? /V/Slab? ~ ; Crawl S~ce? ~ / lO-Pro~sed system: Septic tank; yPrecast yV/Cess~ols / /Shallow ~ols ~ YOther / / Il-Septic ~ inside dimensions: ~ol~e ~Gals. LenEth ft. Widt~ft. Liquid depth ft. 12-Precast sections: ~umber~q~re Ft. Cess~ols: Block size~incs.D ~s.H i~. Total blocks below inlet: ~1 ~2~$3 ~ ~ ~;'~ ~T P~N Camcity~2 Gals. ~.P.~. INSTRUCTIONS ~,~.: a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the BuiMi~ Impector, 3 sets of plans, accurate plot Plan to scala. Fee according to schedule. b. Plot p~an sh,owing location of lot and of buildings on premises, relationship to adjoining premises or puldic st~ or giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The. wo~ COvered by this application may not be commenca~ before issuance of Bqilding Permit. d. Upon approval of this application, the Building InSpecto~'W,II issue a Building pe~fnj, ,o the applicant. Such permit .ll~ll 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 ~pancy lh~ll ;h~ bsefl~ granted by the Building Inspector. APPLICATION !S HEREBy MADE to the Building Department for the issuance of a Building Permit pursuant tO ~ Building Z~ Ordinance of lrh~ Tow~ of Southold, S~ffolk County, New York, and other applicable Laws, Ordinances or Raguletiom, ~ ~ een~ ef buildings, additior~,,or alterations, or for removal or demolition, as herein described. The applicant agrees t~ comet ~ all al~i~bl~ la~: ordinances, building code, housing code, and regulations, and to admit authorized inspectors On premisc~ and in buildings f~' n~essery inlpe~tionL n,. or .... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genial contractor, electrician, plumber or build~'. ................... .... .......................... Name of owner of premises ..... ~......~..~,e,~,......~......~).G~z~...~,.....~....c~c~.~,l..~..~; ..................................................... 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 done. Map No.: .......................... Lot No...~....~. .... ~0= ~" Street and Number ............ I.:...~9.~......1~.....~. ~ .................................................................. 4~.J.~,t-~...~ ....... Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .../~...o.O...e.~.. ........................................................................ ......- ---- ........................ ................................ b. Intended use and occupancy Nature of work (check which applicable): New Building ........ ~ ....... Addition ..................... AIteratiofl; ...... .;: ..... Repar .............. Removal ....................... Demolition, ....................... Other Work .............................. :'~ .... ~ .~ ,o . ,, ~ ~ ! Description) 4. Est, mated Costw. ........ ~......c2.....~ ...................... F.ee .../..(. ......................................................................................... (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 usa ..................................... 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 ...... ..~...5.~ ......... Rear ...~..5.....~.~ ............ Depth ...~...o....~..~ .................. Height ..... ...~..~...~..(:....~..;.o.: ................... Number of Stories ........ ~ ........................................................................... Size of lot: Front .......Z~..~......~..~,. ............ Rear ........ (..~.P.....~.2c:. ................. Depth .....~..~..~..~.. ........................... Date of Purchase ..... ~.~..V.,.....~/.~./~ ............ Name of Former Owner .~.:~/~.~.,~v,r~...~F~.~..~..~.~...~---o.~.~ ............... Zone or usa district in which premisa~ are situated ......... ~:i....~'..~...?.....:= ................ i ........................................... Does proposad construction violate any zoning law, ordinance or re~Jlatioh: .i......./~...°. ............................................... Will lot be regraded .... ~/C.,~. ....................... 'Will excess fill be removed from premises: ,[~ Yes [ ] No ·~} L ( ,~. k ffl /~ ~L-~, o. ~ k'' , · =?~,:~;..,.~.!- 4.o.~ ..... Name of Owner of prem,se, r~,~n~L~(a~.F...'~r~a..~..,..~.W..:'....'..~.LL~__,~f.-,.-'~-,.^~,.~-~ ............ ..... ' _ , _ . -~ . (Address) ,~ (Phone NO.I Name of Architect .,~...u~...~.....~.=-~ .~.~=~L ........ .~....~.....5.=.p~dxi(~;j.~re;iid~:/.(~*~.v~:...~.~.~. ...... i~p~;7~.~**)~/.~. ........ Name of Contractor ................................................................................................................................................... (Address) (Phone No.) PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- 10. 12. 13. 14. "'er interior or corner lot. ) t~~ , STATE OF NEW VO . ) COUNTY OF ................... ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. /Name of indivi~;n_! signing contract) He is the ................................................................................................................................................................................................................. {Contractor, agent, corporate officer, etc. } of said owner or owners, and is duly authorized to perf(~r~r~ ~l.a)~:)~l~ell.~o. rmed the said work and to make and file this application; that all statements contained in this application are true to~o~'~[',l~t~n~vt~i<~g~qkld belief; and that the work will .be performed in the manner set forth in the ap~ication filed therewith. No. 5~-0344~<53 Suffolk Count~c-'~ ................ ................ Lot SUFFOLK COUNTY HEALTH DEPARTMENT nA~0CY ~0 19Z4 ~:~ D~ ~. ~$O /-~7 00' Lot /, Lot 47 20( NEW SUFFOLK AVE - ' ~"^~^~',~:~ ,~°,:^~0 .~.~o,~ ~.~ ,..I SURVEY F R o~,.,o ,.~ ~[~o~ ~o. ~.o~.., ~"' I ,JOHNdDABR~I & ADELAI~ DABROWSKI I I ~o ..~ ~,~.~ o~ ,.~ ,,~.,.~ ,.~.,. ~ MATTtT~K ESTATES. I NC. 1 -~ · I TOWN OF ~UTHOLD SECURITY TITLZ ~UARANTY I J I surF. ~., ..~. · · ~mum~mT I ocT~ ,, ~e ~ . ~ ~/ I / ~. g~, ~e P~E AND OF THE O~RK ~ NO. 4 't '1 LLJ F, LL. ....... U