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HomeMy WebLinkAbout7033-zFO~M NO. 4 TOWN OF SOUTHOLD BUIi,r~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .. ]{ ,~e& .Dr. & .l~t.el~. F~.. Street Map No..0. ri.e.n.t...~. Block No ..... ~.I....Lot No....8~.....o.~.$ .e.n.t. .................. conforms substantially to the Application for Building Permit heretofore filed in t. hic office dated .....~ ....... D.c..e....1.1..., 19..~.. pursuant to which Building Permit No..~.0.3~... dated ..........D.e.e....1.~.; ..... , 19.?.~., was issued, and conforms to all o4 ithe require- ments of th~plicable, provisions of the law. The occupancy for which this certificate is issued is ?.?.s~..,..o?.:..~..,~...z~ ?.::~.~..n~. ............................ , ........... The certificate is issued t° ...G~..e.s.t.~. r...Y~-.gp.o.~ .C~'..s.k.~. .... . .OKi..e..1' ....... i ...... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval l~[ay 20 197~ by a' Villa UNDERWRITER~ CER~TIFICATE No Ii 1 ~8029 l~ay 7 197b~ HOUSE NUMBER ..... $ ~.6.0. .... JitterS..D~.~,¥9 .................................. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7033 Z Permission is hereby granted to: ............ ~z~....1.1.2 .......... ............... ~;t~.tu~k ........................................... to~u&~d...~w.. ~ ...f~mA ~.y .. d~ ~i.E.~n~ ....................................................................................... at premises located at ..~D.t...~O.....~.~e. TL~...b~....t;;~tg...~.e.~.....ill.e.g....~.~ .......................................... ........................ ~e~,..~aam ..an ..& ..~.t~..~ea..~iP, ......... .G~,Le~.~ ..................................... pursuant to application dated ........................... ~llg ............... t..~.., 19.~.~.., and approved by the Building Inspector. Fee $..~..0..,2 ~ .......... /- I~OEM NO. $ TOWN OF SOUTHOLD Building Depo~tment 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 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 New Building ...~:~ .......Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .31.~/~..~x.~..~.~z:~;~..~`~.e~..D~..^...~.....I~y...d..~.~.....~...~....z~....~..e.x....~...z..~.e...~.~.t..~.~.~. Owner Or Owners Of Property ..... ~s.t. ez...I(,~.o~o~o~S~,~, .................................................................... Subdivision ...O~.~.t,..~...t;he..~ea. ................... Lot No......8..0..... Block. No ............. House No ............. Permit No....2Q33Z..... Date Of Permit ...3.~-./.;~..~/...7.~l~pplicant ,]:.n:~&nd Homes~ Thc. A/C C. Klo~3o. 1: Health Dept. Approval ..... 5Z.2~Q/.?.z~ ...................... Labor Dept. Approval ................................................ Underwriters Approval ..... 5/.7../..7.~ ........................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........ ~ ............................. Fee Submitted $ ....5......0..0. ........................ Construction on above described building and permit meets all applicable codes and regulations. ... Tl~l.e,r~L .~.qm.e.s..,....~..n...c..../...~.... ~....c...~;~ ~.;......./. Z'hu~j ,.e.~ ...... Applicant Sworn to before me this ..... .~.J. ..... day of ....... gl~.~. .......................... (stamp or seal) ~. , Notary Public ..... ..~.....u,.-~.<:l.~..J~. ....... County MERLE JOAN EIOUIqGUIGON N,~tary Public, State of New Yerk No, 52.4513750 v~'"'~'~T~ ~t~ ~ (~,u~ lifiecJ in Suffolk C~lnty .,/ ~g~mrm ~smn exllires Mar, 30, Jg/.~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY I-"- 85 JOHN STREET, NEW YORK, NEW YORK 10038 7, N 158029 THIS CERTIFIES THAT only the electrical equipment ~ de~ribed (M]o~ mtd introduced 6y the ~pp~te~tt n~rned on the ~bo~e ~pplleotion nurturer in the peemise~ o~ Chester Klopolowskt,n/w/eor. North Sea Orlve & Ryder ~arm Lane, OrXent, L.I. Job 209 inthefollowi,gloeation; [] Bu~ement ~IstFI. [] 2nd Fl. outside Section Block ,~ e=o,d,~d o. ,~ay 2 l~ 197 ~ ~td found to be in compliance with the ~equi~ements of thi~ s~wc~ mSCO. N~C~ NO.O~ S E 1 100 C B x :'~- OTHER ~ARATU$: ICOOmNO DECKS I OVENS i DISH WASHERS A~T. K, W. I AMT. K,W, MT, K, W, TiMBc:LOCKS BML tUNITHEATERS MULTI.OUTLET i AMT. )a, tPS. TK~N), H.P. NO. OF FlIT EXHAUST FANS DIMMERS q Oeorge Zlmlinghaus, Park Plaee, Patchogue, L.I. 11772 m MANA~ Per I '~ .C coPY FOR BUILDING DEPARTMENT. . -- .~MA~I=~ .~_~_~ ,~/ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPEY 1. Applicant .~k~)~ ~>~ //~ Phone-J~- Address 2. Property Location~i~ ~-~)~ ~~;2'F~A Village O'~(~F Township j~(~Fdo~- Public Water Company Name ~ow~ Lot size: Width/~ feet Length ~ feet Sewa~Disposal System: A. ~-gallon septic tank: Precast /~quivalent Block Special 10. B. Leaching pools: Number of pools Precast{ ~ Block ll~ If private well, fill in the ~>.~fol l(~)~ing blanks: ~5::A. l~nk capacity llons '-'~ ~ B. t~mp G.P.M. . ~ C. ~T~)tal wel 1 depth OI ~ D: ,~epth ~:o ground water ~/0 E. gmount of water in well 5. Subdiv.6~ml 6. Section qr~o 7. Lot Number ~o 8. Private Well ~J 9. Public Water ~ DistanCe to main, (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in eff~ct~ Date I /~/,,~/r,/m ~ Signed .......... mmm--m~.wm.mm ............. mmmmmmmmmm. .... m wmmmlmm.lm~M FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this p)ot. APPROVAL DATE i/~72 SIGNED S-15 Rev, 4/1/73 DisQpproved a/c ............................................... · ~ ~ APPLICATI IT : Dote Dec. 11, a. This application must be completely filled in by typewriter or in ink anp submitted in triplicate to the Building ,nspeCtoh~itt~~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. r b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or area~dlnd giving a detailed description of layout of property must be drawn on 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 kelR~t or~' 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 Occupancy shall have beed. gran~d by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of e Building Permit pursuant to the Buildin bailings, additions or alterations, or for removal or demolition, as herein described. The elxotical~t agree~ to cc mply'witl~ a/i'aPPiicai · law~ ord::llK__n~, housing..code' and regulations, and tc~ admit authorized inspecto~ls II~ll~i~nd in build 7 for n~ry insp =ions. /~'/4 ~}i F, '1 ............ (Signature' ...................................... ~ applicant,, ,r ~, ii e~' ........................... corpureti¢ ) State whether applicant i,-Ow~f~~l~l'. ,nera[ contra~te~electr, rln~l*ber or b,ilder. ..... , .......... .............................. ...!,.. ........ '..::; .... Name__of owner of premises .... .....C~.~.~.~~.~ ......... ~k.~.~.%.~ .......................... :~ .............................. If apphcant ~s a cor~rat~u,~ :~ ..... '~ ~h~e~ .............. ~ . ~.. .... .~.~.~ V. ~:.1..V.P. , Builder's Licen~ No .......................................................... Plum ,'sLicefi No ...... .................................... Ele~rician's Licen~ No. ;.....~:~. ................................. Other Trade's L ~n~ No ....... ......... ' ...... 1. L~on OT ~ana on wn~cn pro~ WOrK wall ~ cone. Map mo .............................................. Lot NO ........... ~.x ........... St~t and Numar ..~Z~..~.G~...~..~.d~A.'~..~..g~A~...~.~..~.~a...~$m..~s~m ...... ~ ~ 0 t ~ O o MunicipaliW 2. Sta~ exi~ing u~ and ~upancy of premi~ and in~nded u~ and ~upancy of pm~ con~mction: a. Exi~ing u~ and ~upancy ....... .~ ................................................................................................................... b. Inten~d u~ and o~u~ncy gee 3. Nature of work (check which apl~licable): New Building .......X~.. ..............Addition ..................... Alteration ............... Repair ....................... , Removal ............. ..... ..... .. Demolition ........................ Other Work ........................... .... . .... i (~ (Description) 4. Estimated Cost ..................................... Fee (to be paid on filing this application) 5. If dwelling, number of dwell~g units ..... ~, ......... Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ 6. If business, commemial 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 ............... '.....=, .................. Numl~er of =S, tories ........................................ . . . 5.5-g6~¢5'- (, ,~-~=~'6 J= & De th 29.0 8. Dimensions of entire new construct on. Front ......................... Rear ............................ p ................................. Height ................................................. Number of Stories ...................... 163 9." Size of lot: Front ...................................... Rear ......1..0...2. .............................. Depth .......... .1...3...3......6.,5. .......................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11, Zone or usa district in which premises are situated ..................................................................................................... · 110 12. Does proposed construction violate any zoning law, ordinance or regulation: .......................................... ... ......... · · · · · · yes -- . 13. Will lot be regraded ................................... Wdlexcassfillberemoved~ompremisas: [ ] Yes [ ] No 14. Name of Owner of premises ..... ...t~.........&......l~....s........C~...?..s..t..e.,~..~?:.o.?..o.t.....o~_.....k../.. ............................ .3.. ~, .3..-. .3.,5.. .~.. .3. .......... (Address) (Phone No.} Name of Architect ....................................................................................... (Address) (Phone No.) Name of Contractor ....................................................................................... ; ........................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW Y.O.RK,,,)~ , .~ ) -- - ' .: ................ ~.~...~:..Ed~/. ....... ~ ................................ ~lng duly sworn, ~,s and says that he Is the applicant above name. (Con~ctor, a~ent, coyote o~cer, etc.) of said owner or owners, and is duly aut~orizld to ~fform or ha~ ~rfor~d the said work and to makl and fill this appli~tion; statements containd in this application ar~ tru~ ~ t~ ~t of ~l~d ~lif; ed tbet tbe work will ~ ~dormd in tbe an~r ~t forth in the application filed t~rewith ' ' ~ Pu~JIc~ Stole of N~ y~ (Si~m~ of applic~t} fhe se~a~e disposal and watep SupplF facflTties for this location have been Chief of General Engineex, i~ Services FEE: .-- BY r ~ NOT FY' BU LD NG DEPARTMENT ,~T' , , 3 -F NAk WHE~ JOB CO~LETED , ' , 7.11' 4t.o" 4:~" t _ . / 7:'/" I1,0' C~o . ...... 17,4" 10.4"