HomeMy WebLinkAbout7194-zFO~M NO. &
TOWN OF SOUTHOLD
BUH_.r)I~G DEPARTMI/~NT
Town Clerk's Office
$outhold, N, Y.
Certificete Of Occupancy
No. Z. 73.1.1 ...... Date .......... Oat...1.¢) ......... ,19..76
THIS CERTIFIES that the building located at ,..°.ak..s.t. ................... Street
Map No.E.ugO .ne..1~$~, Block No ........... Lot No...$0. & .$1...Cutchogue ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............. .A!0rll.. ?Qg. ~.. pursuant to which Building Permit No. 7.~.~..Z...
dated ......... A.p.r.i.1....2.2.,,., 19~..., was issued, and cordorms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
The certificate is issued to . .J.o.s.e.l~.h..K.o.$.e.1 .... .'.~..e..r ...............................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval N.: R.' ................................
UNDERWRITERS CERTIFICATE No. N1 ~.~f~l ,. Apr. 2~.. 194 .&. 1~2516.~2.. 0~t. 22
HOUSE NUMBER ...... .~.8~ ....Street ..... 0$k..~t ..............................
FOBM NO. ~
YOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN GLERK'S OFFIGE
SOUTHOLD, N~ Y.
BUILDING PERMIT
CTHIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? ?194 Z
Permission is hereby granted to:
. .,,T...,;,.~ ~,.U~...~.eze,1, .................................................
.:...1.1.0~t .... ltLdla~..~.t .....................................
.............. g~.lldale.....~ ,,~,~ ..............................
~o ....~...~.l.~..~...~.t..$..9~.....~...~.$.~L ,d..~.~,~ ..............................................................
at premises located at .~.....~I.~Z.~.I ....... .JJ~l&~l~e..lTe,J.l~f,,h~ ..................................................
.................................. .~k..~l~.eo.~ ....... .~t,~l~e j~J .........................................................................
pursuant to application dated .......................~ ......4~J~,~ ........ , 19~...., and approved by the
Building Inspector.
Fee $!~...~ ............
~O~g~ NO. 1
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
Disopproved o~...~ ~ ~
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 ~ plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing locbtion of lot and of buildings on premises, relationship to adjoining 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 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 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 th~ Town of Southold, Suffolk 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.
(Signature or appdcant, Of name, it a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.................................... .Q.W;~' ..................................................................................................................................................
Name of owner of premises ..... .J.g~.f~.~..,~iQZ. f~. .................................................................................................................
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 .............................................
Other Trode's License No ...............................................
1.
Location of land on which proposed work will be done. Map No.: .......... ~.~ ....................... Lot No...~J0..-.~,l, ..........
Street and Number ................. ~Q...Q~k~..~.~.~.~.~.,...¢.1~.~hQ~.,...~.~W...~D.~.k ...............................................
Municipality
State existing use and occupancy of premises and in?ended use and occupancy of proposed construction:
a. Exisiting use and occupancy ......S..g.~.i~.~.~....~.~.~.~,.~..~..n.g..¢ .....................................................................................
b. Intended use and occupancy .....~..]~li;[~e.~....7~,,,~.itle~u~e .....................................................................................
3~. Nature'of work (check which applicable): New Building . ................. Addition ......~' ......... Alteration ..................
Repair .................. Removal Demolition .................... Other Work ..........................................
(Description)
4. Estimated Cost ........... ~...! ................................... .. ........ ee
(to be paid on filing this application)
5. If dwelling, number of dwelling units ........ 0~f~ ............. 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 .~..~..e. et~ ........... Rear ..... 2~...~.~.e~ .......... Depth ...~,,,~...~.(t~.[
Height L~.....~.~.e..~..r..... Number of Stories .O. Tte. ..............................................................................................
Dimensions of same structure with alterations or additions: Front ........ 2.2...~.eP, t ........... Rear ..~.~..E.e~.[ .........
Depth ...2...bf....~..e...e.~....h:....[TX. Height ./.~/.../~..~,~..T.. ......... Number of Stories ...... Dzte ...................
8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................
Height .................... Number of Stories ......................................................................................................................
9. Size of lot: Front ...~..0...~..~.~.~. .................................... Rear ....... ~0..~e,e:b ................... Depth ...~..~....~..~.f~.t;. .........
10. Date'of Purchase ....S...e.]~.~..~.~.(~.~...]..~.~.~,~.~.~ ............ Name of Former Owner ..~.~[]~.~,...~.f}.~.~,~ ........................
11. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~O. .........................................
[3~ Will lot be regraded. .........[~.Q ............. Will excess fill be removed fr~.~0~er~j.~Tt~Y~s' ( ) No
14. Name of Owner of premises ..... ~T.Q~.e]p~..[Q~.e]. .................. Address .~Zt~LO.~l~,~,,~.o~',~hone No. T~'...~r'I ~.~
Name of Architect .......... .0.1t~.ft~ ........................................ Address ................................ Phone No .......................
Name of Contractor ........ .0....~....e.?. ........................................ Address ................................ 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 description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW_YORK, _ ~ ¢ c
COUNTY OF ...q.~.~.~..~.L~ ........ ~'~
...................... ~&'..5..g~..~./.,~'...../..~..~..?~....~T~.~. ............................... be ng duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the .......... ~..~d...~...b-?~ ...................................................................................................................................................
(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 end belief; and
thor the work will be performed in the manner set forth in the application filed therewith.
Swom to before me this .~
..... day of ........................ ,
~otsry Public, State of New York
Residi~ in Suffolk County
No. 52-7~35315
Comm~sion Expires March 30,
FOB, M NO. 6
TOWN OF $OUTHOLD
~ Bnilding Depoffment
Town Clerks Office
Sou~hold, 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 BHilding ................ Addition .............. ~" .. Old or Pre-existing Building ................ Vacant Land ..............
Location of Property ...... ........
Owner Or Owners Of Property ..... ..'~-..~....5...?.~.!.~.......I..~....°....~....c....L-~. ..............................................................
Subd~,~s~on ................................................................ Lot No.~.~..-..S'..!. B~o~k No ............. House No.;~.a..~ir, -~-
Permit No..-].,!.,q..?...~..... Date Of Permit ...H.!~.~J2.Y.App,cant J~t CH/~ ~- L_ ~o
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ ....................................
Construction on above described building and ~.rn~iyeet_~ all ap~ab~le c, od~ and regulations.
Applicant .............. ~ .... I-.~rN-~ ...................................
Sworn to before me this
,,
................ day of ............................................ (stamp or sea ~ 73 / /
Notary P.b,c .................................... County
'~ THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~ Tlr E8 JOHN STREET, NEW YORK. NEW YORK 10038
8199 7 N 251652
THIS CERT~:~]~I~/~'T 22, 1975
Joseph Kozel, Oak St., Harbor Lane, Pierce Dr., Cutchogue, L.I.
~.,m.l,,.,,u.~.gZo~.t~o.; [] Bm,er,~e,,t [~l.tFl. [] ~.a ~z. outside sect~, m~ tOrSO_81
October 20, 1975
OTHER APPARATUS:
Joseph Kozel
Unlondale, L.I.1155B D ~/ ~ ~
This certificate must not be altered in any monner; return to the off,ce of the Board if incorre~, inspectors may be identified b~dentlals. ~
THE NEW YORK BOARD OF FIRE .UNDERWRITERS
BUREAU OF ELECTRICITY
~-- 8.~ 85 JOHN STREET, NEW YORK. NEw' YORK 10038
~"toApri:t 2~. ::tg"t'~ .~,~,.t,o,,No.o..f,~ 72~6~ N 155631
THIS CERTIFIES THAT
mdy the e/ectr/ca/equipment as d~cr/bed be/ow and i~troduced by the app/ica~t named on t/w abo~ app//cat/o, mumber ia the prem/s~ of
Joseph Kozel, Oak Street. w/o Harbor Lane, Cu~cho~;ue, L.T.
in the following location; [] Basement ~ 1st Fl.
,.~,~.,,.,i,,~o. Ap:ril 22, 197~
RXTURE
OUTLETS
II~ACLES SWITCHRS INCANDESCENT fiXTURES
S E R V I C E
~ 1 100 CB x 1
OTHER APPARATUS:
Lot
IXHAUST FANS
AMT, H.P.
DIMMERS
2
OF NEUTRAL
Ronald B. Busch, ~ ,~,
925 Long Creek Drive. r~
Southold, Lolo 11971
copY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY~I~
I!
!!