HomeMy WebLinkAbout7015-zNO, d,
TOWN OF SOUTHOLD
BUll,DINe DEPARTMRNT
Town Clerk'o Of[ice
Southold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building, located a~7~ 0 El' ~t~¢~~'~: ~/~ ~ i~_v' b
............................ Street
Map No. --' Block No ...........Lot No ..................................
conforms substantially to the Application for Building Permit heretofore ~ed in this office
dated .............~.?...~.~.0..~, 19.~.~.. purs,~t to which Building Permit No. 7~;... .... ~'-~7_._.
dated .............'5. ~[~[ .C.., 19.~...~., 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 ....... .~ .... A c.c..¢..~--.~. ~X ..... '.~..c: ! ?. ~.,?.,..~.... ....................
The certificate is issued to..~..fl. ~.'! !.-. ~...~ .... ~?..~.~-~..:1 .... .~..d. ~.~..o..~.,.~. ! .............
(owner, ~
of the aforesaid building.
Suffolk County Department of Health Approval ~/ ~<
UNDERWRITERS CERTIFICATE No. A~' ~'
HOUSE NUMBER / ~/~ ~ Street ..... : ....................................
Building Impec~or
I~OI~M NO. 2
TOWN OF $OUTHOLDi
BUILDING DEPARTMEN~
TOWN GLERK'S OFFIGI
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
COMPLETION OF THE WORK AUTHORIZED)
UNTIL FULL
N? 7015 Z
Permission is hereby granted to:
.... Jz~,s.. ~.. ~ta~.y*..Lo.u....:~o~.o~l ...............
· L~%u~v.91 N .Y · ' . .......
to ..h~..~e~...~)r,3~a.~,~..e,~,g.e:~.Or, y....h~t~lu~ ........ i ................................................ : ......
at premises located at ....~g.t~...1.~ ....... ]4;B~b~J~l.,~.~.;ek ......... :...j ...........................................
.......................................... ~Zf~...P.e.~ont~ ..~r.. ~8~ .v~ ........... iZ~tme:L ...........................................
pursuant to application dated ................ ~l~......~....O..~'.....~.~..~. , 19~.~.i.., and approved by the
Building Inspector.
Building Inspector/
TOWN OF SOUTHOLD!
Building Department :
Town Clerks Office :
Sou~hold, N. Y. 11971
APPLICATION FOR CERTIFICATE O1~ OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and s~bmitted 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 line~, 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 U:nderwriters.
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 compleled site .plon~ requirements where applicable.
B. For existing buildings (prior to April ]957), 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 .~..~..r.(~.~4 ~ .4'.,,,, ./..-¢.~., ./..q.,..7...~. ......
New Building ....... .~....... Addition ................ Old or Pre-existing Bu~ilding ................ Vacant Land ..............
Location Of Property .~.~.~...~..,~..~.6..~..'/...~..~.~..~..Y ~odA~'FY'/r/.~..~.~., ~Z~
Owner Or ~ners Of Property ~' D, ~ ~ '~, ~ ~ ~ O~ O ~/
Subdivision ........ AE.~.C~ ~ .~ Lot N~/ 4~ ~o House Nn
Permit No..~ J.~...~ ..
x----~ ..... PP ~ · ................................
................ .................. ........ ................................
Hea th Dept Approval ~ ~ Labor ~ t ~ rova . ~ ~
............... ................... ,,-,., , row, ........................
Underwriters
Approval
Request For Temporary Ce~ificate ........................................ Final Certificate ....~ ................................
Fee Submitted $ z~.~ ...........................
Construction on above described building ~ permit meets a~l-~l~le c~es and/~gulations.
.....................................
/'~/! ~ ~. ~0~1 . '
Sworn to before me this /// / ~/2
..... 4,~ ....... day of .~..l.~.~.~ .............. JOAN HIN.ERM~N (stamp or seal) ~ ~.~ t /. ~
N~ARY PUBLIC, Slate oJ N.w Yo~ ~
Nota~ubhc ..... ,~t .............. ~ ......... County No,
NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
~ sOUT.O~O, N. ~. '~/~ ~/~ ·
Examined:~Z..:.L .~.,-........., ~ 19~... -'~plication No.
'
Approved q ~ ]9. Permit No ....................................
Disapproved a/c~_...~ ,~ ~
INSTRUCTIONS
a. This application must be completely filled in by typewr ter or~ in ink and submitted in triplicate to the Building~
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 adjo n ng premises or publ c streets
areas, and g~wng 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 who e or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bud ng Permit Pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, add t ohs or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to~
admit auth°rized inspect°rs °n premlses and in buildings f°~essary 'nsp~in~ .~
........ ; ........ .. ......................... ; .................. . .............
/fl~ ~ ~ P~.c~,.~...~.~..r..~.~.e, z~,~.z~ .~...,__y.:
' ' / ( (Address of apphcant);r'' '
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................... : ........................................................................................................................................................
Name of owner of premises ...~.'~.~).ff).~.~.......~...,.....~...~...~....O. ~/.~../. ~ ..~,,,..~.~.. ,~0~'
If applicant is a corporate, signature of duly authorized officer.
~u,der's '~c~se No ............. .~../.~. ............................
P'umber's License No. . .......................
Electrician's License No.
Other Trade's License No ........................................... ,, /_ ~a ~,~ ~r'~ /~,~-~
1. Location of land on which proposed work will be done. Map No.: og~/n~,
................................... Lot No..~..~.~/T..R.~....4'./..
Street and Number ./.7..~.~(?.......~...~.~C.O...~..(.~-..../,~.~.~tZ....~.l)J,/.(./r~.~'~..~.~/...~,.e.~...~.~ ...........
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ..... ..~.....4..'.~../..~...~..,~..~../.~...~.,....
b. Intended use and occupancy ..-/~.~..~.'~'.~.~.t~..~.....~./'...~...&......~.~'......~.~'.c~z~:...~.. ~...~...~.~.
~work (check which applicable): New Building .................. Addition ...
Repair ................. Removal .................. Demolition .................... Other Work ~. ...... .~.. ,~...C...~..~.~?....~..~....~..~..~...(:~.. .....
- ~ ~ (Description)
/ (to be paid on filing this application) /
5. If dwelling/number of dwelling units ...... /~..t.~.. .......... Number of dwelling units on each floor~,....~./....'~.....'..;.'.:.~2
7. Dimensions of existing structures, if any: Front .../.~....~. ............... Rear .................. Depth
Height ...../..~...'. ............. Number of Stories ...O...~.~'. .................... ~.i ..............................................................
Dimensions of same structure with alterations or additions: Front ........ .~....~....~?.~. .............. Rear ....~'~..../~...,~' ..........
Depth ...~...,~....r~....~.~ .............. Height ..~'...~....~......~. ............ Number of Stories ....~..~...~/....~.~. ..............
8. Dimensions of entire new construction: Front ......... ~.~. ..................... Rear . /.~./. ...... Depth ..../..~.. !
Height ....z~,../. ......... Number of Stories ..... .~ ..............................................................................................................
10. Date of Purchase ...../..O.../.././..7/ ................................ Name of Former Owner ~..~.~/'#~...~.~ .~....,~'.~.~..~.C..~.~..~.....
] ]:_. Zone or use district in//which premises are-situated '~...~:.~.~..~../~.~..~.Z'./..~/,...~....~.I~.~.C...~.~...~.~...~..~ ...........................
12. Does proposed construction violate any zoning law, ordinance or regulation: ./~.~ ................................................
13. Will lot be regroded ........... ~.~ ......... Will excess fill be removed from premises: ( ) Yes ( ) No
]4. Nome of Owner of pre.~ses~.*.~.e.t.~...L.~.~...~.~.~"~.. Aaar~s .L~.~-..G~...~. ...... Phone No...Z.~..:£f~.~.
Name of Architect ......... ..~/.~...'~. ............................................ Address .......~./~f~. ............... Phone No....~.X.4~... .........
Name of Contractor...~../..~.. . Address ....... "/?~ ................. Phone No...'~.~/./~.... .........
PLOT DIAGRAM
Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-bock 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.
STATE OF NEW YORK. ~. [¢c
COUNTY OF ...E.(/.~.Z~..~..A...~. ......... ~'~
.... ~.~.~").~'~.,~.....~..?..,~...O.J~...~...~....~..Z .................................. being duly sworn, d~o~s and soys t~t he is the opplicam
(Name of individual signing contract~
above named.
He is ~~..~...~...~ .............................................................................................................................
(C -, - :- , ~:-: c ' -. .)
~ owners, and is duly authorized to perform or have performed the said work and to ~ke and fi[e
this application; that all statements contained in this application ore tree to the best of his knowledge and belief; and
that the work will be performed in the manner set fo~h in the application filed therewith.
Sworn to before me this ~ ~ ~
..... ..... o, ....... ........ .
................. ................ ........................
/I ~1 ' ~ ~ ~ (Signature of applicant)
~elirm8 i. Suffolk Coun~_
II
i.o! ,.
% Lot ~,,,,
.£ws~oas YOUNG & YOUNG
400 OSTRANDER AVENUE:, RIV£RHEAD, NEW YORK
AI. OI=N W. YOUNG HOWARD W. YOUN<?'~
i SURVEY FOR:
,JAMESD. DOROSKI ~ MARY LOUISE DOROSKI
PARTOF LOT I0 & PART OF LOT II "LAUREL PARK"
GUARANTEED TO:
AT LAUREL SECURITY TITLE i!~ GUARANTY CO.
$0UTHOLD SAVINGS BANK
TOWN OF
SOUTHOLD