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HomeMy WebLinkAbout6364-zFORM NO. 4, TOWN OF $OUTHOLD BUr~[r~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~778 ....... Date .......: .... Jail: .... ~31 ..... , 19. THIS CERTIFIES that the building located at ... l~ralal .AvO ............... Street Map No. ~x ......... Block No.. xx ......Lot No. XxX... ~ttii~lCk...N. ,~.....: .... conforms Substantially to the Application for Building permit heretofOre filed in this office dated ...........~eb .....8., 19.~3. pursuant to which Building Permit No, . ,636~Z dated ............;.F®h... 8.., 19.73., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... Prtva~ .ona .£alLtly. d~e!l~u~. .wi~.h .&ddAtion .......... ........ The certificate is issued to ...P®~x. & .Gla~yl.. D~erke~c~ ...... 0~l~.:~s .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval : .I~,R, .................... ......... UNDERWRITERS CERTIFICATE No~ . .~i..1~...../[an.. 29 .... 197.~ .......... HOUSE NUMBER ..... ~O~ .... Street... 4~and .Av~ ........................... .. ...........----o -.- ............ FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6364 Z Permission is hereby granted to: .... ~.,~, ~.J..,, ........ · =,~.o.~.~ · .- · .,~.~.-;J E~ ~ .~..,~ .................. ..................... ~,.~,~,.i.~ ~)k. ....................................... to ....... ~Z'~" a7~' "~;~C'~ ~'t:S'61i' "~'~' "~ ~,,T.~'t;:L~/~ ' ' ~ C~ ~£~ ~ ....................................................... at premises located at ........~.~.~,.~.....~.~:~.L..J,~/e ................................................................................ ................................................... .~:~.a..~ t.,..~.t.!~.....~ :.:.L, ......................................................................... pursuant to application dated .......................... ~.c];. ....... ~ ............. , 19.....~.~ and approved by the Building Inspector. Fee $...1.~,,.Q0 .......... ........ ...... .............. Building Inspector / THE NEW YORK BOARD oF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT Felix Deerkosk!R 2055 Grand Awenue, Mattltuck, L.X. in the followlng location; ~j~ Basement ~ Ist FI. wase,omi.~do. JanUary 24, 1974 UR.. I FURNAC ,ORS I' 'UEE'''N E A~T, I(. W* OIL . H.P. GAS H, P. AMT, NO, A.W.G. [] 2nd FI. outside Section Block and found to be in compliance ~vlth the requirements of this Board. RANGES COOKING DECKS OVENS DISH WASHERS U~T. K.W. ANAT. K.W. AMT. K.W. V~T. K, W. SPE~IALREC'PT TIMECLOCK$ BELL IUNITHEATERSUNITHEATERS MULTI-OUTLET ~T. ~P. . *. TRAN. .~ SYSTEMS SERVICE DISCONNECT lEo. oF METER R I C Lot EXHAUST FAN: DIMMERS AMT. WATTS I 6OO NO. OF MI-LEG A. W.G. NO. OF NEUTRALS A, W, G OF HI-LEG O~= NEUTRAI- Felix Deerkoski, 2055 Grand Ave., Mattituck, L.I. 11952 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. l~Ol~I NO. $ 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 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 ar 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 . .~/..~.~.~..~......~/../.. ~..7~-~ New Building ................ Addition .....¥,. ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .............. ,,~.4~. ............. .~.....~..,:~..././..Z./.C?.~.~,.....-Z. .............. Owner Or Owners Of Property ..... ..~...~?.,~...~.-~.....~.~...~.....~..~..-~.___~/.[.......'. ....................................... Subdivision ...... ~ ................................................... Lot No ........ "~Z.. Block No.......-~ ..... House Nc~/.~.....~.. Permit No. ~....'~...~.....~..~. Date Of Permit ..~../.~Z~...~....Applican, ..~T../.~..~.'.,5....~,~.~.~-¢~'~....~'....~.../..i ...... Health Dept. Approval ....... ~ ........................... Labor Dept. Approval f Underwriters Approval .............................................. Plann,ng Board Approval ....*~... ................................. Request For Temporary Certificate ........................................ Final Certificate ....~..... ................................ Fee Submitted $ ..~ ................ Construction on above described building and per, it rrLeets all 91~licable codes and regulations. App cant ~-~ '.~- ...... .......... ' . Sw'orn~_.to before ~'t~is ..... · ~..1.. day ~:..'....:.~ .... L.?...?..~... (stamp or seal)/'~~:~ Notary Public .................................... County ~ /y,/, FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... .~. -, .~.......~.... ............ , 19.....~.. Approved ........................................ , ]gt ....... Pemit No ..................................... Application No...(..~...~...~ ............. .~ Disapproved o/c ............................................................................................ .' .............................. ....................... ' APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter 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 adjoining premises or public streets or areas, an d~ 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 kept o 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,tD.e Building Department for the issuance of a Building 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, additid~s 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. (Signature of applicant, or name, if a corporation) · , (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... g~.~..e. ~. ................................................................................................................................................. Name of owner of premises ....F..e.~.~..x.....D.e..e...~..~..o...s..~..~ ......... .G...~.~...d.~..s.....D..e.e...~..k...o..s....k~L.. .......................................................... If applicant is a corporate, signature of du.ly authorized officer. {Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No .............................. ; ...................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ......................... Street and Number ,...~,~),~,~...Cz~UP, C]..,~..~.~D,~ ..................................................... .~..e,..~.~..~..~..q~ ................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... ~Q].~L~.Z3~ .............................................................................................. b. Intended use and occupancy ................. ~.~.~.~,~kT;q[.,;..~ ...................................................................................... Nature of work (check which applicable): New Building ....................... Addition .......X. ............. Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ....$.2.~..0...0.;..0. ·©, ...................... Fee ................................................................................................. {to be paid on filing this application) 5. If dwelling, number of dwelling units ......3. .......... Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use ..................................... i 0I 7. Dimensions of existing structures, if any: Front ...... 3.2, .......... Rear ...... ..~ .................. Del3th ...... .2..6..! ....................... Height ........ ~,(~ J. ............................................ Number of Stories ............... a ............................................................ Dimensions of same structure with alterations or additions: Front ........ .3.~.! ........... Rear .....4.0...~ ............................... Depth ......... ~.~.!. ............................. Height ...... ~.~.. .............................. Number of Stories I ........ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... ~ 100~ I 9. Size of lot: Front ........... ~9.~) .................... Rear .......................................... Depth ......... .3..~.0. .................................. Former w Wm. H. & Harry E. Mason 10. Date of Purchase ........~..~.0.^...~9~ ....... Name of O net ......~ ..................................................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.(~ .................................................... 13. Will Iotberegraded ~D .......................... Will excess fili be removed from premises: ix] Yes_ [ ] No Deerkoskl Mattituck 298 8121 14. Name of Owner of premises ..~.f~f,S...~...~,.~.~ ......................... , .......................................................................... (Address) (Phone No.) Name of Architect ...................................................................... i~'~'s'~i ................................... i~;~'~"~l'~[i ............... Name of Contractor .................................................................... i~.~'~') ................................................................... (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or de.sc/dption er interior or corner lot. iTio 13-'},° / acc°~deed, and s.h°v~ :t;e~xtr~n~a ~es a ~ ,' n~ ~atejWho eth' C) (4. O STATE OF NEW YORK, ) COUNTY OF ......~...~..~..~..q~.~.~.J'~- ...................... ) ~ ~-~ .......... ...~....~.~..~.....~:~;..~).?=....~.[/~..K,Q.~.~.<...~ ................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual si~ing contract} He is the ..............~.~..~.~..~ ............................................................................................................................................................................ (Contractor, agent, corporate o[~cer, etc. J of said owner or owners, and is duly authorized to ~rform or have ~rformed 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 ~rformed in the manner set forth in the application filed therewith. >..~..~.~ .......... day --' TERRI ~E ~ ~ of ~,~~ ~ ~.~Ry PUBLIC, St~o~'~ York ~~~~. ...... ~ '~ ................... ~:'~-~16~5 .......... ......'. ........................ {Si~amre of applicanO