The URL can be used to link to this page

Home My WebLink About7439-zFORM NO. · TOWN OF $OUTHOLD BUll.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z?~'~.I ..... Date ............ F.s.b .....2..8 ..... , 19..~. THIS CERTIFIES that the building located at ...Pika .Str.~.et ............ Street Map No.. X~; ........ Block No.xx. :~ ...... Lot No, xx ... lla~;t:i..tuck.. 1to~ ......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ........... Ju.ty..2~..., 19.71~. pursuant to which Building Permit No.. dated ........... July.. - 2.5., 19. ~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pr. lva.t,a, swimming .pool .with. ant® saorys .......................... The certificate is issued to .L®o~ .l~ll.o. wsk;i,... 01aler .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .I/,Ro ............................... UNDERWRITERS CERTIFICATE No..I~..1.0~ ~ ...... .~.~g...~ .~... ] 9.~. ............. HOUSE NUMBER .... 23 ~ ..... Street .. P.t,ko. ~.~ .... ~4~l;~l,~$k ................ / Building Inspector/ II/ll,,mNg ~ (THIS PERMIT ~/t~UST BE KEPT ON THE f~EMISF..S UNTIL FULL COMPLETION OF THE WI~K AUTHORIZED) 7439 Z Permis,~Jon Is hereby ~ranted ........... ,1~11,.~ ......... l~Jt~.t.l~ .................... A,oprov~l ...................... Permit No. Disapproved a/c .................................................... BUILDING TOWN ¢LIItK'i · rnau, N. Y...--. ~DUllalr~ Insl)ector) APPUCATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter oe. in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing lacatJon of lot and of buildings on premises, relationship to adjo n ng prem ses or Dub lc streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of ~his 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 Deportment for the issuance of a Bu Id .ng Perm t pursuant to the Building Zone Ordinance of the Town of Southold, Suffo k County, New York, and other apphcuble Laws, Ordinances or TR.egulati.ons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ne 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 imp~ons. ~ /! // (Slgr%c, lture of applicclnt, or'name, ,f a c~rpo~i~'i ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Name of owner of p~'emises T'eon lc .................... · . ..................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome 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 ...~.;I,)R~R..~..'~ ....... ...~.~.~.~P~J[ .................................................................................................. Municlpali'b/ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: (twel a. Exisiting use and occupancy ................. ~ ............. : ........................................................................................ b. Intended use and occupancy ............... l~.n...m..q...~'~1,t~..~)z:l.T~,.l;.e...~¥,~[~1,g~..[O.~gl.....~gE.~...~g.~ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .~.~..J)D.O]. ................ .... (Description) 1300 + ....................................................................................... 4. Estimated Cost .......................... ..--. ............................... Fee 1 ~eO0 . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .?..~..e. ................ 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 ............................... 8. Dimensions of entire new construction: Front ............ ~,~..,..~L~, ....... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....... ~,....~lJ,,,q.~ ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... .~...e. .............................................. 13. Will lot be regraded ....... 331a ............... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ~ttJ.~.:l:J,..~;J~l,~.~Ji~:;J, .................... Address .......~...~.t;...t;..~..t,...~...o...~..... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .~.Qg~I,..~J).IiIZ'.~J) .............................. Address ...~J.~...~T&Jke. ll~ ........ Phone No. ...................... ~ I PLOT DIAGP, AM p?c~ eL~a[~eC~.ea rJ.Yvea nsdt red~:t 'anCntJy b~ Io~1 kbuinlduimn~:'r Wchretc~ee rsc ~'tYjnnga c°cro rPJ i°~n;S~od'daee~ whether interior or corner lot. ....... ~ ................ ~g~..~~ ......................................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named. He is the .................................. ~.e.~ ................................................................................................................................... (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~q the best of his knowledge and belief; and that' the work will be performed in the manner set forth in the application j~le~l tllerewith. Swam to before me this / / \ A i Notary Public, . ................................................... County ./.....~.J..~J,,r,~..'...~...:;.l.l~F....:.!..............."- - -' -~:,, .......................... ~/ (Signature of applicant) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted~to the Building Inspec- tor 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 installa- tions, 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 peoperty showing all property lines, streets, buildings and unusua~ natural or topographic featu res. 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 2 copies of. C.O. 2.00 landuse--?re-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ..... ~X~. ~.' 1984 New Building ............. Old or Pre-existing Building............× Vacant Land ............. Location of Property 21.00 Pike St. .M .a.t.t.. . ....... House No. Street Ham/et Leon Milowski Owner or Owners of Property ............................................................ : County Tax Map No. 1000 Section 140 Block 03 Lot 022 Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ H 109. 39 P lan ning B~ard Approval Underwriters Approval ............................................. ,-Cop±es o£ C,,.O. Request TOt ff emperar~-~-e~t~eat~ ..... 2 ............... Final Certificate ....................... Fee Submitted $ .... 2... O..0 ..................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .... M.i..c.h.a.e. 1...H.a.l. 1...f.o.r...W.ip.k.h..a.m.,..W..i.c.k.h.a..m.&..B.r..e.s.s. ler Rev. 10-10-78