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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! !!