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Home My WebLink About7208-zFO~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Date ..... 19~.~... THIS CERTIFIES that the building located at ./.g!~ .5...~'..0._g'.~:.~..O.o.~....~..~. ! .vL~treet Map No....~..~ .~..O.. Block No ..... ~ ..... Lot No ...... '-Z ......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............~...~...~..~.,~ 197..c( pursuant to which Building Permit No-~z g~ ~ ~ dated ....................... 25 ,q'PTx, 1~. ~/..., was issued, and conforms 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 . .~[.~.~.~. !g ..... .~..~./.~..~..t~ !~ ?:(d...~.. ..................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ~L---f I~ ~ ~-~0-'~] UNDF, RWRITF, RS CERTIFICATE No. ~ ! ~ ~ 00~ HOUSE NUMBER..../..~..5..~... Street..-~..0..5..~...~. ~.0..~. .... .~.~? ?..[~ ............ Building Inspector Exom,n~ '~ ~ ~ ~ ,o~Y ~ ...,, _.,__~.-_74 od~ ................... .............. . ........................ ( ...................................... ................ ...... ............. ~.~ ....... i~~;;~ ............................ AFFU~ ~ IUI~N~ ~lT ....... ................... b. Plot plan ~i~ I~ation of lot ~ o~ ~ ~ ~ ml~ti~ip t* ~ioinin~ pmmi~ or p~lt~ ~r~ o* c. ~ WO· c~ by ~i~ ~licati~ m~ ~ be c~m~ ~or~ i~ O{ 8~i~di~ ~it. : ~[. ~ .a~v~ ~ t~ms a~l~tm~, ~:&uddi~ I~r will i~ a Bfiilding '~rm~ to the ~licant. Such permit ~a. oe K~t ~ ~ ~m,~ ~il~le ~r i~ ~ ~ work. e. No ~ildi~ ~11 ~ ~cupi~ or ~ in ~ole or in ~ for any pu~e whmever until a ~ific~ of ~c~y~ ~all ~e ~ gmnt~ ~ the Buildi~ In--or. B ~LI~ATI~N .IS HERE~Y.~DE to the Buildi~ ~t for ~e is~nce of a Buildi~ Pe~it pu~nt ~ ~ ~u a~,~, mr me ~mtruct,~ ot ou~a,~s, ~m~ or al~s, or tot m~l ~ ~liti~ ~ ~n ~. ~e applicant ~r~ to co~ly wi~ all a~lic~le I~, ~, ~ilding c~, h~si~ c~e, a~ ~, ~ ~ ~mit authoriz~ i~tom ~ premiss a~ Jn ~i~in~ ~r ~e~ i~i~. ...~.....~~.....~...~..~,. .................... ..,.~.~ ........... ~.~.~.,..,,..~.~ ............... ~ ............. ~ of ~hco~) State whether appl~ant is ~ner, les~e, ~eht, a~hif~, engineer, general c~tr~tor, el~trician,' plu~ or buil~r. ................... ~~.~ : .................................... ...~ ~ ~ 5 ............. Name of owner of premi,s ...... ~ ............. ~ .~. ~.G. licant is a cq~mte, sig~ture ~f duly ~thoriz~ officer. ........ Bulld*r'~ Lic~ ~0 .................................................... . Plumber's License No .............................................. ;.. Electrician's License No ............................................. Other Trode's License No ............................................... 1. Location of land on whic.~h proposed work,will be.~don.. Map No.: ....~..~...~'J..~. ............ :i' Lot I~1o..../.7.. ......... Street and Number ....~...¢l[~.~.t~J~.~ ........ .~..~ ............. :.~ ........... , ,.~[O~,.~.~.~..~.~....~..~ ................. Municipality 2. State existing use and occupancy of premises and intended Use a~d occupancy of proPosed const~cflon: Nature of work (check which applicable): New Building .......~.... ....... Addition'..L.~ ............. Alteration .................. Repair .................. Removal .................. Demoliticxn .................... Other Work ................................................ . ..... ~ (Description) Estimated Cast~.....~.~.~-'r..~l'...~.~..~....~. ..................... Fee ...~...~.~..,. ........................................................................... (to be paid on filing this application) If dwelling, number of dwelling units ........ ~. ................. Number of dwelling units on each floor ....... L.r. ............... If garage, number of ca~s ..... ~ ................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each t~pe of use ............................ Dimens OhS 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 ......... .~.1~...~. ................. Rear .....~...~.. ............... Depth ...~....~.. ........... Height .................... Number of Stories ..................................................................................................................... I 9. Size of lot; Frant~ ........... ?.~./.~...~. ............................... Rear ....... ~.~.~. ......................... Depth ....~...~..~..! .......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ % 11. Zone or use district Jn which premises are situated :~. 12. Does proposed construction violate any zoning law, ordinahce or regulation: ...... ]3. Will lot be regraded~ . ........................... Will excess fill be removed from premises: (') Yes ( ) No !4. Name of Owner of premises .....~.~L~.~....~..~'~)~r~.~G.~Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...~..,....~.~.~&......~......~ ..... Address .~.~....~Phone No. ~.~..~..~..~r~, PLOT DIAGRAM Locat.e clearly and distinctly all buildings, whether exi,~ting or proposed, and incli~ate all set.back dimensions from property hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. I 58-- ....................... .~.~...~..~. ....... ~.0~...~...~.~,~ ...................... being duly ~worni d~o~*' ~d 'says t~t h* i~ the ~pplicom (~ame of individual signing contract) above name. ~ ~ He Js the ........ .~.~x...~ ............ ~. .~ ............................................................................................ (Contractor, agent, co~or0te officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work ~d to ~ke and file this application; that all statements contained in this application are tr~ to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the applicaHon filed therewith. Swam to~efore me this ~ ' ~ ~ ~ . . ~ ..... Commission ~pire~ March 30~ ~ , ~ig~ture of applicant) ~DITH T, ~OKEN ~ PubJlc, State of New York No. 52-034~9~3 $uffol~ County Commission Expire~ SOUTHOLD, N.Y. ' ,-4 ~FFLI~ATIO~ INSTRUCTIONS o. This applicotion must be completely filled in by typewriter o~ in ink end submitted in triplicate to th,~ Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot end of buildings On premises relationsh p to ad o n na orem ses or nuhl areas, and g'v'ng a deta led descnphon of layout ofproperty must be drawn on the diagram wh'ic~h is part of t'-hi~ ~-p~'l~c-~;i"o~ 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. No building shall be occupied or used in whole or in pa rt 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 ~r, Building Zone Ordinance of the 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 cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. /(Signatu~rFi applicant, or name, if a corporation) ........... ..................... (Address of'opplicad) ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ........... : ......... . ...... Name of owner of premises .....~...l~l~d~.t~'~. ...... ~...~..'~...k,r....l~..(~...l.~...'~. I~licant is a corporate, sigr'~ture of duly authorized officer. ........ (~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.: ......~'...~....~..{~. ................ LotNo...-~7 ........... Street and Number ....~...~.~.1~.).~..~ ........ .~::~-~..~, ............................. i...{~..<:;~.~..~...~.~..,.~.~ .............. Municipality 2. State existing use and occupancy of premises and intended us~ and occupancy of proposed construction: a. ExisitJng use and occupancy ........ ~..~l~,.,~..~-.,..~,~ .................... i ......................................................... b. Intended use and occupancy ...~'.t,~.~.~........~. ~..C~.V~.~.!..~..........~...e,~..~.~..[..~.~.yt~.~ ................ i ...... 3. Nature of work (check which applicable): New Building .... ~ ....... Addition~ . ................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... ................................................................... 4. Estimated Cos, ..../...~;./...~.~t~..~.....~..~. ........ · ............ Fee (to be paid on filing this application) 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 .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ I 8. Dimensions of entire new construction: Front ......... .~.~..~ ................. Rear .....~....~....;. ............. Depth ...~....~.. ........... Height .................... Number of Stories ..................................................................................................................... 9. Size of lot:. Fron~, ...........,,..~./.~...:--' ............................... Rear ....... ~'..,~.~..:.--'' ...................... Depth ....~...~..~..! ............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ~ ~. '~ 12. Does proposed construction violate any zoning law, ordinCmce or regulation: ...... 13. Will lot be regraded~ ............................ Will excess fill be removed from premises: ( ) Yes ( ) No !4. Name of Owner of premises .....~.~l~,~.~....~.,~D~'~.~.C:~Address. ............................... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...1~,....~......~......~,~ ..... Address .~..~....~.k~°hone 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. (~omo of individuol sionin~ controc~ above name. ~ He is the ......... ~.~x...~.~.~ ............ ~. ..~ ............................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work ~d to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thaz the work will be performed in the manner set forth Jn the application filed therewith. Swam to~e~e this Commission ~pire~-Mar~ 30~ ~ ~Jg~ture of applicant) JUDITH T. BOKEN FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PEPJ~IT MUST BE KEPT ON THE PR£MISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7208 Z Permission is hereby granted to: E ,.. I-I o,'C f, oA,1.. ~ .. ~ OllS...IXl~ .....A~.C.. li~A'n nk ..JJ,~otkovie z ....... 3e~, .. ~[t'J~o.l.ir. ............................................. t,, Build new one family dwelling at premises located at .................................................................. ................................. ~ae~o~l..~&v~ ............... J~t~L~ueOc....~-~- ........................................ pursuant to application dated ...................... ~,J~:[~.....2~. .......... ~, 1~..i~'....., and approved by the Building Inspector. FORM 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 ................................. New Build ng ~ Ad'~'tion Old or Pre existin Build n ' ' ................ u/ ................. g g.. .............. Vacant Lana .............. Locot on Of Property l~..1~ ........ ~.,~.~.~...~..~ .......... ..~,..~...~....~..~~' .................................................. Owner Or Owners Of Property ..~..~..,.....~Z......~.~.~......~...~.~.......~....~.....~..~...~,,...~.~.(,.,..'~.. ..... ~-~ .~.. ~-.'~'..g~:~.~.....~..~..~.,~.~ Lot----//_ !1 No. 'J'7'"' Block./iNo ............. House No ............. ¢~ Subdivision Pe tm it No...~....~.....~.~.... Date Of Psrm it...~./...~..~.~'.Applicant . .~.~...,~'.'.~.~.~.... ~ ~.~1..~. ............ Health Dept. Approval~.....~...i'....~../.~...~./..~.~..~_.~..~...~......Lobor Dept Approval .... ..'.~..~.. ..... Underwriters Approval ~/~lg0 ~"/ Planning Board Approval /~/- ~"i ................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Subm tted $ ....~.....:...?~... .................... Construction on above described building d~d~d~d~rmit meets all .apl~licab~jcodes a_.~,~.~nd regulations. Applicant .~..~......~ .,, ...~?~..~ ................ Sworn ~t~_~efore me~is ..... ~.z.'~ dayof .~~......~ ~.~~ (stamp or seal) ~ ~~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~k BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT only the e~a~ equip~nt ~ ~sc~b~ bel~ ~ iqt~c~ by t~ ~p~t ~d om ~ ~ ~i~ation numar in the p~mises of M~tt ~t uck, L.I. i. thefotiowl.g Ioc.tlon; ~ B~ement ~ Ist Ft. ~ 2nd Fl. 0 Ut Slde Section St~k ~t w~examin~on OC~ObeP 1~ 197~ and found to be ln rompliance with the requirements of this B~rd. FIXTURE OUTLETS DRYERS IECEPTACLES SWITCHES 33 BXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FLUORESCENT SYSTEMS OTHER APPARATUS: *Furnaces: Oil 2-1/Shp, Panelboard/s: 1 Poat light 2-1/12bp 1-19cir. 125 amps. NO. OF HI-LEG A, W. G, NO. OF NEUTRALS Dettner Electric Co., P.O.Box 482 Riverg~ead, L.I. 11901 Per 11 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY 1285026 found ~uthorized alteration or addition to this survey is a violation of ion 7209 of the Now York State I:ducation Law. les of this survey map nat bearing the land surveyor's inked or embas,.ed sea! shall not be considered to be a valid copy. or cz ti~icafions indicated hereon shall run only to the ~ whom th~ ~ur~ey is prepared, and on his behalf to the c~m-~ony, governmental agency and lending institution lisled on, and to the assignees of the lending institution. Guarantees are not lransferable to additional institutions or All dl!tances to wells and by location from house owners and puell are not visible the4e SURVEY FOR FRANK SWOTKEWICZ AT MATTIFUCK TOWN OF ~OUTHOLD ~IFFOLK COUNTY~ N. Y. REFERENCE ' "ROSEWOOD IfSTATES " FILED 1'24'6~ A~MAP NO. 5Z40 eDAIMMT~a TO' RI VERHEAD SAVINSB BANK THE TITLE eUARANTEE COMPANY FRANK SWOTKEWlGZ ~CALE, I"' 40' AUGUS T ZO, ~ F4 APPP>OVI:D AS I'!O~ED