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Home My WebLink About6580-z~0~ NO. 'l TOWN OF $OUTHOLD BUILI)ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at . ~&..&..~9~.~.t*.$.1..9.1~. i ... Street Map ~vn Capt Kidd ~t~o~ No. .Lot No. ¶19 J(attltuek conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... . .[I~...1.8...., 19..~.3 pursuant to which Building Permit No .... 6..~.8..~ dated .......... ~ .... 18..., 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 ....~.F.~.?&.~....O~..O..f..a~..i.].~....&~..1.!t~M[ ..................................... The certificate is issued to ..... M.b.a. :T.,.e. qn..s.t..~..~.t.i, qa.. c...o~.......0~lO...~ .............. (owner, lessee or tenant) of the aforesaid building. 3'1117 19 1973 by a. Villa Suffolk County Depsrtment of Health Approval .................................... ~'~"-~-------'-'-'-"'---' · 110'/8'/8 UNDERWRITERS CERTIFICATE No..-..: ::.:: :. :: .z;.~.::. :.:. ::: .-. .............. HOUSE NUMBER . ~0...L.~..n~.... Street .......................................... · ....... TO~VN OF SOUTHOLD BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, H.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6580 Z Permission is hereby granted to: ~.:.~:..~.~:....~.:..~.~.: -- , ........... ~_.~.~ ..................... ~o.../..~L.~..~ ....... ~..~~ ......... ~~ ........................................... ........ ~~.~ ...... ~...~J ..... ~..: ................... .2~.~.'.~...:. .............. Building Inspector. FORM 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 Jn typewriter OR ink, and submitted m duphcote to the Budding Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of alt buildings, property lines, streets, aha 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 s~te plan requirements where applicable B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~sting" land uses: I. Accurate survey of property showing all property hnes, streets, buddings 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 buddings or premises, or other pertinent in- formation required to prepare a certificate C. Fees: 1. Certihcate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building .... ~ ...... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property (.4 ~-'~.~ g--~ . COv~.~ C-L~~'~i~--- ~ - ~-~'V~,-'¢ i~ Owner Or Owners Of Property ...... ..~....~.j~.m~.. ..... .C~.~..r~...~..,~...~....~...e.z..-~..t...~....~.. ..... ,.~...~r~...,t~..: .................................. Subdivision .,~..~,'.....~....~..o....O. ...... ..~,~..,S~.....~..~ ..... Lot No..!..~...~..... Block No ............. House No ............. Pe,-mit No..~-'?,~C~ .... Date Of Permit ....~../!.~.!.~,..~..Applicant ..... ..1~...,..'..~.-~'. ...... ..(...~..~.~....,~/...~......,..c...~,.~.~.L~.......C.,~f~.f'~ Health Dept. Approval .... ..,~....i...~.~.....~....,~.....¥. ......... Labor Dept. Approval ..............~...:...~... ....................... Underwriters Approval ...../t~...'./~7...,~........°c~/...~?]~Planning Board Approval Request For Temporary Certificate ........................................ Final Cerhficate Fee Subm,tted $ .....~..:...O....C?. ................... Construction on above described building and permit[ meets~dl, applicable codes and regulations. Sworn to before me~ ........ [..~... day of ..~...~,.. ...... (...~...?./~ (stomp or seal) Notary Public .................................... County ~U'~'~OLK~COUNTY DEPARTMENT OF HEALTH Reference No. 3. Public W~ter Company name~ /-'YJ-'~)?- ' -,D~stance' ~o main~ ~. Lot size. Wid~f. eet Lens~h ~ feeZ (Enter on cehter plot below) 10. Sewase Dispo~ System. . A. ~.8e~l. on septic tank. P~'e~s~ ~qDi~lent , B!~ck B. ~i~S po4l's: NumbeY I PreCast~'iock Special ~" ' If private ~elllj f.i~l' .i,n_ blanks bel~;~i "' :' Pump. G we11~ Test Feet~ 0 2 6 8 10 12 18 =-~.,The-,-lindersigned CERTIFIES: astruction of ed'inst~'~ations will be~acC:e~'dance with the Suffolk County.De'partment ~ H~ait~'~"~urrent stand-' Dete s gn.d , Owu~r o~ui!d.e~ ~ :... FOR HEALTH DEPART~EN~.U, SE .ONLY. Based on ~he ihf~rmatfon [rese~t'ed'.h~rewith, it is"the o'pinion of ch~ee.!th Department,, that an adequate ~nd/-s'a~tsfa~0~y Sewage Disposal 'S~stem can~ be',~n'sta~lied On ~his plot. Date [~./~) Signed : p,r eD ~ ~0,666 s°''t~' NOTE: I= MONUMENT SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFF. CO. ON ,JAN. 19, 1949 AS FILE NO. 1672. DIETZGEN L3'~11846 REViSiONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: PETER STAIKOS ~ MARINA ST~d{O~-.~ SOUTHOLD ~)::.,77 ', ~::;?: .;} SUFFOLK CO., N.Y. ~:~~ REVISIONS YOUNG & YOUNG MAY II, 1975 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK MAY 22,1973 ALDEN W. YOUNG HOWARD W. YOUNG MAY ;~1, 1973 PROFESSIONAL ENGINEER AND LAND SURVEYOR SURVEY FOR: PETER STAIKOS 8~ MARINA ST~ /~~ [ s, =~T~>~.~ co. =..~.,, i:,~'/~' ~ SUFFOLK CO., N.Y. [BY~"~ A, ~ ~' ;~ SCALE: I ,e = ~, DATE: MAY 4, ~6 DIETZGEN 135 11846 JUL 1 9 1973 ~hief of Genor~l Enginceri~ S~rvioes BUILDING DE,P,A. RTMENT TOWN CLERKS ~UTH~D, N. Examined ........ ~.~,. ......... ; ........ Approved ........................................ , 19,.~.,.,~. Pemit No. (C..~...~,!.~ ......... ~~ OJ~ ~'~' Di~pproYe~ ................ APPLICATION FOR BUILDING PERMIT Date .... ...~.....~...-~........~.?..L ......... , 19.~.....~. ..... INSTRUCTIONS , ~ .~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector,~l~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an~[ giving a detailed description of layout of property must be drawn on diagram which is part of this appJication T~,c3/ 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 kepi 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 Occupancy 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 the Building Zone Ordinance of the Town of Southold, Suffo[l~ County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions 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 authorized inspectors on premises and in buildings for necessary inspections. . : .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; Name of owner of premises ........ . .~...~..~'......Ca,Cx~,...tl.~~.....~...~...~......(~....' .............................................................. If applicant is a corporat_~,e signature of duly authorized officer. .......... ....... (Name ande~le of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ..~....~...&...~......~. ct No. ~ ~ c~ . Street and Number ...... .~J ........ ..C...~...f~.~ ......... ..~..~..?~.....O...~........1~.....q~......~.....C:..,..~-..~....;~:~ .~..)..~...~.. ............... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................ t,-)~.,.~ ...~..'t~.~-"~'v~"~ b. Intended use and occupancy .......................................................... ~ ......................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration....~ ......... Repair ....................... Removal ......................... Demolition ........................ Other Work .......................... :, ........ " (Oescription) 4. I:stimated Cost ..... ............... Fee ........... ............................... §. If dwelling, number of dwelling units ........ L.,,. Number of dwelling units on each floor ......................................... If garage, number of cars ...................... .~ ...................................................... $. If business, commercial or mixed occupant/, specify neture and extent of eech type of use .............. 1...'~. ................. 7. Dimensions of existing structures, if any: Front ........ ,....[...,., Rear ............ ~ .......... Depth ...~. ............................... Height ~ . ........ Number of Stories ...................... Dimensions of same structure with alterations or additions: Front ......... ~ .......... Rear ......................................... Depth .................... ~ ...................... Height ............ ..'~... ........................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ....... ..~:'....~.......~..:..Rear ............................ M ~4 ~ Depth .... ...--~....~.....~'....~.. .......... · . .... Height ................................................. Number of Stones .................................................................... i ................ 9. Size of lot: Front ...................................... Rear ..................... ..~.....I ........... Oepth .................................................. Height .................................................... Number of Stories. ............................ . .......... ......... .......... · · · .-...- .-..- 10. Date of Purchase ................................... :. Name of ~ormer uwner .................................................................... 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be recjraded .........~?...G.. .................... Will excess fill be removed from premises: [ ] Yes [~"~o 14. Na~ne of Owner of premises ............ ..!~...$..~.. ............................................................................................ ~. ........ (Address) (Phone No.) Name of Architect .................. ; .................................................................................................................................. (Address) (Phone No.) Name of Contractor ....................................................... (A~J~r~') ......... ' (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensibns 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 YORK, ) COUNTY OF .......'~...~..~..k...x~.. ......................... ) .................. t .................................................................................... :.. being duly sworn, dep~,ses and say~ that he is the applicant above named. - ~ {Name of individual signing contract) He is the ................................................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. /~ '""7. TERR! LEE ELAK ~ ~ /'~ /1 .............. ~...~.. ............... day of ............. ~Y...P.~..B.L).C., Sta:~ ?l~e.w~ff.o.~Ll~..... / ~ ? /~ / ff ~ ~-> .............~0. 5~':~i'~'~,5 / // ~ -~ // Notary Public, ~...,.,--~,~~.~41i~Ai ~l;ll~l~,O, 19'7~....~....~.~;~ ................ ~ .............. l ........................... ; ........................ (Signature of appticant) i