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Home My WebLink About6554-zFOKM NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z THIS CERTIFIES that the building located at.../.3..5.-....Z.~ .~..~.... Map~¢o .... (.<' 7. .;'. . Bloc~o ........ ~.ot~o ....... /7/. .................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ... dated ................... ~, /v/~ ~, , 19 ...73, was issued, and conforms to all of the require- 'n~ents of the applicable provisions of the law. The occupancy for which this certificate is (owner, lessee or tenant) Of the aforesaid building. ,Suffolk County Department of Health Approval ....... ~ ...... u~w~s c~c~ ~o ....... ~... (2. ~. ~.~ ................... HOUSE NUMBER ... ~ ~.~'... Street Z ~ N ~ '~f ~ ~ Building Inspector · 'O]~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6554 Z Date .................. J~li~ ......... 9 .................. , 19'~'3" Permission is hereby granted to: ~_~ ~tw/nd..Home ~..Inc.....A~O.....And~as..Pavlou ........... ~outhold ................................................. to ..~ ..~.n...~.~ .~.~ .Lo...~...~.m ..e..~ mt. ~. n g...¢~.3,I .~m~ ............................................................ ~1 premises located at .... ~t~ ..... :j~ .......... C~0'~.'~[<~d---]~ ........................................................... .......................................... ~e~..Roa~ .............. :. ~a~t Lt~e~ .......................................................... pursuont to opplication dated ....................... ~l~r ............ ~ .......... , 1~;~.~..., crud approved by the Building Inspector. Fee $~-*.,,~,, ............ FORM NO. 8 TOWN OF SOUTHOI. D Building Department Town Clerks Office Southold, FI. 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 wzth the following; for new buildings or new use: 1. Final survey of property with accurate location of all buddings, property lines, streets, aha unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage d~sposal--(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 budding. 5. Submit Planning Board approval of completed site plan requirements where applicable B. For existing buildings (prior to Aprd 1957), Non-conform~ng uses, or buddings and "pre-ex~sting" 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 buddings or premises, or other pertinent 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 ...... ~ ....... Old or Pre-existing Build~ng ............................ Vacant Land ........................... Location Of Property ...~..~'t~..¢11~r. ....... ..,~,..-;.~...I~. ........ r.~.l~..~....t..'~'.~...~....~ ............................... Owner Or Owners Of Property ...]~J.~ ..... ~-....~....~...g~.l~-~ ........ ..?..t~t...b.~}..¢~. ........................... Subdivision .Cl,(~.^ ..... ~.I.~..]~ ...... ~.~.k ....... Lot No ....J,.'~.~Block No ............. House No ............. Permit No.~.~...~Oate Of Permi~.....~....~..~.'~plicant ..~..~..~...~. ...... ~...~-~....~ Health Dept. Approval ............. .~..l..~. .................. Labor Dept. Approval .......... ~.1...~...~ ...................... Underwriters Approvap~...l.~.....,..~...'~...c~:..z~...~ ......... Plann,ng Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....~ ............................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ~.~...~...J~_.~.~ ..... .,~.~;~ ....... ~--"~A~-., ................ Sworn to before me this ..~.~J]~ day~..o~~ --...~.....~...c~M~ ....... .~g..~...._~.. ..... (stamp or seal) TERRt LEE ELAK NOTARY PUBLIC, Sta'e of New York No 52 Quahi~ed In Su~Isl:-, Oomm~ss:on Expzres N.~d~ 3~ 19 FOBM NO. 6 TOWN OF SOUTHOLD 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 braidings or new use: 1. Final survey of property with accurate Iocat,on of all buildings, property lines, streets, and unusual natural or topographic features. 2 F~nal approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and s~milar 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 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 housing code or safety inspechon 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-ex~sting dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ................................................ New Building .... ~ ....... Old or Pre-ex~sting Building ............................ Vacant Land ............................ Location Of Property ........ ~,,.~..i~. ........... ...~.G./~...'J~ ......... ~1~.~..~..~-~ .......................... Owner Or O ners Of roperty .......... ..... ............................ Subdivision ~.....~.L~.~ ........ ~ ...... Lot No...t..Z~ Block No ............. House No ............ Health Dept. Approval ............ ~'..~ ................... Labor Dept Approval .. , ........... ~ ,.,~')'~ .................. Unde~riters Approvol~.~..t~.~.~ ........ plonnin~ ~o~rd Appro~2' ............. ~ ........................ Request For Tempom~ Ce~ffic*te ........................................ Final Cert~{ic~te .......... ~ ........................ Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. App, can, ...... ......... ................ Sworn to before me this ..... '.S...'~..... day of ..~.?....c~,~..~.. ..... ,..~..~...~.....~. Notary Public '-.%s~.'~,~.~ ~~ou nty TERR! LEE ELAR NOTARY PUBLIC, Sta'e al No o2 Qualified tn ~Jhu~: Comrmss~an Exp,~e~ THE NEW YORK BOARD OF FiRE UNDERWRITERS BUREAU OF ELECTRICITY ~-- OS 85 JOHN STREET. NEW YORK. NEW YORK 10038 THI~ CE~IFIES THAT Andrew Pavlou~ w/s #lq7 Zena Rd., Mattituck, L.I. DRYERS ~' FU~NACI~ MOTOR~ TIME CLOCKS SERVICE QT~R APPARAZUS: Furnace/s: Oii, 1-1/8hp, S E E V I C E 3 1 5 W.B. Ruland MatZltuck~ L.I. GENEliAL D This certificate must'not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be'identified by me [ :,% · i'O\4N O F .se~.l~ J % SO' IUILDIHG DIPARTMGIT 'TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ,, ,I 19...7~... Pemi' No. ~.....~....~'....~../...,~.......~.... Disapproved a/c ........ 'f.~'""'"'"'""~'"'"'"'"'~'"'"'"'"~" .................. ............................... ............................ APPLICATION FOR BUILDIN~ PERMIT Dote ............. ~.,.~. ,,...... ,~,. ...... , 19.,~,.,.~..,,~'' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector. wit 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plar~ shOWing location of lot end of buildings on premises, relationship to adjoining premises or public streets or areas, and giving e 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?emmancad before issuance of Building Permit. d. Upon approval of this application, the Building ~nspector will issue a Building Permit to the applicant. Such permit shall be kept o~ the premises available for inspection throughout the 5. ¥ ' e. No building thMI he occupied or used in whole ~ in ~ for any purpose whatever until a Certificate of Occupancy shall have be~n granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Towa of Southold, Suft~ County, New Yo~k, 8r~otber aPPlicable Laws, Ordinances or Regulations, for the construction of buildings, eddition~ m' alterations, or for ratnoval or demolition, as herein dermribed. The applicant agrees to comply with all applicable laws, ordinence~, buildingeode, housing code, end l~a~Uletions, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, tepee, agent, architect, engineer, general contractor, electrician, plumber or builder. .ame of ow r of .rem.. _" .................... ....... ................................................... If applicant is a corporate, signature of duly authorized officer. " (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ............... 1. Other Trade's License No ..................................................... ~,~ Location of land on which proposed work will be done. Map No .............. ./..~...~...~. ............... Lot No ...... LL..../_: ......... Street and Number ................................. ~..'~.. ....... Municipality 2. Stete exi.ing use and occupancy of premises and ,n~.~.~..~_~c~pancy of proposed consl:ruction: % '3." Nature of work (check which applicable): New Building ....................... Addition ......~... ........... Alteration...:....'.'.. Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) .4. Estimated Cost .............. ~..J..~...~ ................ Fee../. ............................................................................................. (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 use ..................................... 7. Dimensions of existing struc~res, if any: Front ........ ~ ...... Rear ........... ~ ......... Depth ....... ..?c...(~.. ................... Height ............................. ,{.,~.f. ....................... Number of Stories .............). .............................................................. · I Dimensions of same structure with alterations or additions Front ......... ..'~..(2. ......... Rear ......... ..<~..~ ................... Depth ..................... ~ ........... ,,.. Height .................... I....':~ .............. Number of Stories .................................. ~ .[, .~. \ '~/' I .... 8. Dimensions of entire new construction Front ............. .L.~...,... Rear ............. ........ Depth ......... ...~..~. ................ Height ...................... ~...~. ............ Number of Stories .............,...~ ............................................ , ....................... 9. Size of lot: Front ........... ~).,.o.. ................... Rear ................ ~.~.., ................ Depth .......... .~....~_....~...I. .......................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated .............................................. ; ...................................................... 12. Does proposed construction vio!ate any zoning law, ordinanqe ,or regulation: ................. ~J.[~ .................................. 13. Will lot be re,reded ._~...~...~_...O.. .............. Wilt e~lts~ ~ilt b~removed from pre.~ises: ~ Yes . [ ] No 14. Name of Owner of pre~is~ ..D~I~.~.,..~.~[aT,~...I~,jL.~..~r..T.~~......~..-/~j~a~a~, , / L (Address! (Phoh6 N6:) Name of Architect ....~....{ ...................... , ...................................... ~...:..,....,,~::..,'.;....::'. ....................................... G ~ ~ ~'. L * ..... (Address) ............... (Phone No.) Name of Contracto~..i.~,...~ ....... .~....)..~.:~,./~..~.....,..~~. j~......?.~./,~ (Address) (Phone No.} PLOT DIAG RAM Locate clearly and distin~flY all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street end block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. COUNTySTATE OFoFNEW YORK....~.~..~..~. ~ .~..~.~ ) ~ ( Na~ o f individ~l si~ing con~act } ( Con~ctor, ag~t, co~t~ffi~r, e~ of said owner or owners, and is duly authorized to ~rform or have ~rformed the ~id work and to make and file this appli~tion; ~ all statemen~ contained in this application are true to t~ ~st-of his. knowled~ and ~lief; and that the work will be ~rform~ in the ~nner ........................ ........ of ...... ............ , 7 - ~'ie i ~ la County~,,~,,, ~ ~...~.~~. Notary Pubhc, ................................ ................................. '~'~ ~ (S' ~ of appl~t) ~