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Home My WebLink About7604-zs, ,...~ds FOBM NO. 4 TOWN OF SOUTHOLD BUn.DING DEPART~n~NT Town Clerk', Office Southola, N. Y. Certificate Of Occupency THIS C a e building loca~ea a~ .......... .~.' ......... ., .,.. ~a~o ....... ~ ..... ~o~,~o...~ ....... ~,~o..X~ .... ~.~~~... aa~ ................. .~.~., 19~..p~su~t W w~ch B~ Pe~t No ......... dat~ : ........~e.~..., 19/~., was ments of the~pp.licable provisions of ~he law. The occ~ancv, for which th, i~ certificate is ..................... ¥ .... ~¥ L--' '~'~'b'~ ~'iC''/' .................... The certificate is issued to ............................................. _ ........... (owne~, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No ........ ~ ............................. BUilding Inspectbr FO~,.M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 760~ Z Permission is hereby granted to: ..... ~ ....................................... a ................. ~ .... ........... ~ ................................... z ............... ~.. at premises located at .0...[.. !.~. ~ ~...~-~ 0...~.. -~ ..~.,~ I',1 I- ~,A/ ~(./Fi--OL' pursuant to application dated ........................... ~ ......................... , lyf.~..., and approved by the Building In~ector. too .. ,.../...S.....Z ......... Building Inspector Di~l:~roved a/¢ ............................................................................................ (Building Inspector) IUILDII~ ~IlIAITMI~r ~ . ~ /~plicafion No ............................... ~ APPLICATION FOR BUILDING PERMIT Date ................................................ , 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and sl~omJtted in triplk;ote to the Building~ Inspector, with 3 sete 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 adjoin ng premises or public streets areas, and giving 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 ~ssuance 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 whole or Jn part for any purpose whatever until a Certificate of Occupancy shall have been gr~nted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or .~uala~ti,o. ns, .for the c.onstructi, on of. bu!!ding~, a.d,d, itions or alterations, or for removal or demolltk~n, as herein cl~¢ribed e pp,~canT agrees To compty with a. appficaom laws, ordinances, building code, hous ng 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. If applicant is a corporate,,signature of duly authorized officer. (Name and title of corporate officer) Builder's Lic~se 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. ........................ Mu~iclpality State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ............................................ ./. .............. ; ............................. ~ ............................. 3. Nature of work (check which applicable): New Building'. ................. Addition .......~.:.~.~.~... Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 4. Estimated Cost .............................. /./. ....... ~.,~.../...'. ...... Fee ............. /. .......................................................................... (to be paid on fdmg th~s apphcat~on) 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 structures, if any: Front .............. ~. ............. Rear ................................ Depth .....~...e ........ 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 ..,~ .................... ,~/.. Depth ........................ Height .................... Number of Stories .................................................. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase .............. Name of Former Owner t .~, ............~ ..... 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 regraded ............................ Will excess fill be removed from premises: ( ) Yes ( 14. Name of Owner of premises .................................................... Address ................................ Phone'No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor Address ................................ Pho~e No. " ' PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-ba~k dimensions from property lines. Give street and block number or description according to deed, ond show street names ond indicate whether interior or corner lot. STATE OF NEW YORK, ~ S S COUNTY OF ..... , .......................... ~ ' ................. ' ......... ;...~.x.,..~..~ ......... ~ ....... ..~.,....~' .......................... being duly sworn, deposes and says that he is the applicam (Nam~ of individual signing contracf) above named. 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 appl'Jcation; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work:will be performed in the manner set forth in the appti~:ation filed therewith. Sworn to before me this ./ : . ' ....... ; ................ day of .................................. ..Z......, 19 ......... Notary Public, ....................................... ~..~....i.. County ' · (Signature of applicant) ~lggl~H T. BOKEN Notal¥ I~elllle, Irate of New York No. 52-0344963 -Suffolk County FO]P~M NO. 6 TOWN OF SOUTHOLD Building Department 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 Date May 10, 1976 New Building ................ Addition ..... ~ ......Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........ .Qi~- J:~9,rb.q~'. ~J,d .~.erw S.g. ffolk~ N,¥, Owner Or Owners Of Property ...~4~..V.i~g.~.D,~...~.±eg~oz'ek Subdivision ................................................................ Lot No ............. Block No ............. House No ............. 10/25/74 Eugene O. Horton & Sons Ir~ Permit No. 7604Z Date Of Permit .................... Applicant Health Dept. Approval ........ ..~.... ~ .... Labor Dept. Approval Underwriters Approval ......... ~.--.A/....-~.---/.-~.-~...O.-~Planning Board Approval ............... ..~..(.......~... ......... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .....5...D.Q ...................... Construction on above described building a~er~,,~~~licable codes and regulations. Applicant ...,~'~-~..c~ .~~ ...................................................... Sworn to before me this ................ day of ............................................ (stamp or seal) ~--~c'~ I I ~l Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS (tl BUREAU OF ELECTRICITY [~- 85 JOHN STREET. NEW YORK, NEW YORK 10038 v.t,, ~.!arch 17, 1976 Appf~.ti..~'o. on/Ue 842108 N 274202 THIS CERTIFIES THAT only the electrlcot equipment ~ ~scdbed bel~ and introduc~ by t~ applicant named on the abo~ application number in t~ premlses of Vincent R. W~eczorek, Old ~arbor Road 750 New Suffolk Road ~ Peconic ~y, New ~u~olk_ L.I. in thefolhnrlng location: ~Basement ~lst FI. ~ 2nd FI. outs ideSection Bilk ~t u~a ......... irted on ~,larch 15, [9 7 6 and.found to be in compliance urlt h the requirements of this Board. FIXTURE FIXTURES OUTLETS1 !ECEPTACLES 11 SWITCHES 3INCAND~CENT [FtUORESCEN¥ SERVICE DISCONNECT NO. OF OTHER APPARATUS: FlIT HEATERS MULTI-OUTLET ~ SYSTEMS NO, OF PEET C EXHAUST FANS DIMMERS E ] GFI Vincent R. ]iieczorek ~d Harbor Rd. New Suffolk, L.I. 11956 This certificate must not be ahered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by thei