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Home My WebLink About6761-ZFORM NO. 4 TOWN OF SOUTHOLD BUILI~ING DEPART~NT Tow~ Clerk's Office $outhold, N. Y. Certificnte Of Occupancy No. Z6602 Date July 31 ....................................... , 19.75 THIS CERTIFIES that the building located at .N./.S..S..o.u~..d.¥.i.e.w..A..v.e.n.u..e .... Street Map No. xx Block No. XX ...Lot No. XXX Southold, N. Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated July 30 19.7.3. pursuant to which Building Permit No. 6761Z dated July 30 19.7..3., 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 .P.r..ty.a.~.e..s.wj..m~l. in~ pool with fence and accessories The certificate is issued to Mary E. Kulukundis, Owner (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N.: ~: .............................. UNDERWRITERS CERTIFICATE No.. ?.~. 6..1.1.0.g. ........ .~.?~. 2..2.:. ~.g..'7.4. ........... HOUSE NUMBER 17665 Street Soundview Avenue FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT O.,,~,~--fE PP, EMIS~S UNTIL FULL COMPLETION OF THE WORK AU'.T,~,IZED) : 6761 Z Dote .......................... align. ....... .~0 ........ , 19..~.~t. Permission is hereby granted to: ~'"~-~_ -'~ ~a~ ..~ols...Of...SUff~lk .. A~.....FALta ~ Xul~s ro/nstm20...~ ~'~va.ta .. ~wl~tn&..~ al..&. ~enaa .................................................................. ot ~remises located ot ..~/.~....~O~A~...V~.ew..A~ ............................................................................ pursuant to application dated ........................... .I%~r ....... .~0~ ...... , 19.7~,.., and approved by the Building Inspector. Fee $. ~ ~'~,.00 ........... FORM NO. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N, Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfrucfions 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 naturol 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. of ee ,f,cote of occu,oncy *,.00 New B~lilding ................ Addition ................ Old or Pre-existing Building ...... .x.. ....... Vacant Land .............. Location Of Property ~S~u~d~v~J~e~Y~e~g~u~r~.~t~e~y~k~ ......................................................... Owner Or Owners Of Property ....~....ae~'...~..t...~u..Z.u~..~.s. ............................................................ Subd,v,s,on .. .............................................. ~ .............. Lot No ........ ~,~. Bloqk Nck ............ House No..../..-/.. Permit No......~...~..[..~j~ Date, i ,~i~Of Permit'//~'~' ~....8..)~..App icant. ~....~.....(~....~...._~_, [ ..~...~ ~.~,~..~..~[ Underwriters Approval ..................... Planning Bo~rd Approval ...................... Request For Temporary Certificate ........................................ Fin~ Certificate .......................................... Fee Submitted $ .~. ............... Construction on above described building and oermit meets all applicable codes and regulations. Applicant ..~,,~.. ~ ............................................... Sworn to before me this .... cloy of ....... Notary Public~~...... County (stamp or seal) ~_~- '~' ~'~ '~ ..... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~< BUREAU OF ELECTRICTT~I ~ i' ~ 85 JOHN STREET, NEW YORK. NEW YORK 10038 .-~, ~. ~7,, Ap,,,.,,o. No.o.,,,. ~ " 161109 THIS CEEI~IEJ THAT ~e~ami~on ~ ~0~ ~ a~fou~incomp[iancewitht~requi~m~n~ofth~. I! SERVICE DiSCOnNECT ND. OF I S E CC. COND. PER ~' OTHER AF~ARATIJ~ R V I C EXHAUST FANS DIMMERS (swimming Pool) This Cartificate covers compliance at the da2e of inspection only. Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. Enchanted Pools Inc. County Road, 39A Southampton, L.Z. 11968 COPY FOR BUILDING DEPARTMEN~'HIS COPY OF CERTIFICATE MUST NOt BE ALTERED IN ANY MANNER. Date INSTR~CI'IONS a. This application must be completely filled in by typewriter o~ in in~ and submitted in trip cate to the Building Inspector, with 3 sets of plans, accurate plot plan to scol~. Eee.~o~cl!ngto schedule. b. Plot plan showing location of lot and of buildings oh ~reh~i~e~, relationship to adjoining prem ses or pub ic streets o areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be comrnenc.ed before issuance of Buildiag Permit. d. Upon approval of this aPPFicoti6r{, the~Building Insp~tor 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 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 i~uild!n.g. Zon.e O.,rdinonce. of .t. he T,o,~ ,o~ Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egu~a~ons, ror the consrrucr~on at oui~amgs, additions or a~terations, or for removal or demo itian as here n deSCribed Th.e applicant agrees to comply w'th a applicable laws, ordinances, build ng code, housinn code arid ,~,~ulat OhS and adm,t authorized inspectors on premises and ,n buildings for necessary inspechbr~. ~-~.........0.~ ............................... .t...,....~, ............. (Signature of applicant, or name~ if a corporation) ...7. ................... .;....... .... ....... .....2/,..y. ~ (Address o~' applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... ............................................................................................................................................... Nome of owner of premises ........ ~.~.~/.~.S ....... d~, ...... ~.~,,,.~...~.~..~./..,~. ........................................................... If opp,~ is~to.~orate,/~u~e of d~ o~orized officer. ...... ~...~~ ........ ~.~.~.:. (Name and title ~ c~orate officer) Builder's License No ..................................................... Plumber's License No..~"/~¥~ ............................... Electrician's License No..~.~.....~.....~:.. ........................ Other Trade's License No ............................................... 1. Locahon of Iond on whi~,~h prapos~l ~/o~rk will be do. ne. ~ap No.: ..................... ~ No ............... Street and Number ...~42~, ~......~.l,~...~...~:~..//~T.. ~~" ' '~._ _.. . ...... :?, ............................................... ~.,~,~,,~a~. .......... Munlcil~li~ State existing use and accq.pq?C',v of pte,m!se~ and i[~tendecl .use and occupancy of proposed construction: b htended use and occupancy .~.~"~./,~...~...~'...{-.~':. ..... ...~.4.~.~....i....~..~..I..~..~...~...~...,~......~.~(~ ........................ _~3. Nature of work (check which applicable): New Buildlng ...~%. ......... Addition .................. Alteratk, n .... ~...%...'~? Repair ............ Removal .................. Demolition .................... Other Wa r k .~/,~M~IJ~.6,....t~/~....Cb.~%"~,... ~ Z.x~. ~ (Description) (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~,m~_l~'~wi~ alJ;erations or additions: Front ...~...~..../. ........................ Rear .~...~...~ Depth ~.. ........................ Height ~:~'~.~.....~... ......... Number of Stories ........ 8. D,mens,ons of ent,re ~: Front .....~.~. ......................... Rear .....~..~... ................. Depth .~... .................. Height~:'~.~,==.... Number of Stories .............. : ............................. .] ............................................................... ./. ..... 9. Size of lot: Front ,...~/'5~..~.~°~ ' ....................................... Rear .../...~'...~...~. ........................... Depth .~..~..e..~./. .......... 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 Iow, ordinance or regulation: ....... ~'..~. ...................................... 13. Will lot be regraded .y..~..~.....: ............. Willexcess fill be removed from premises: ( ~)~es ( ) No 14. Name of Owner of premises .................... ,/~/~.~...~'.~..~.. Address ................................ Phone No ....................... Nome of Architect ................................................ ~n~ ........ Address ................................ Phone No ....................... Name of Contractor~/~r~,~.. '.~...~....~...~....)~.~.....~ddres~~'O~..... Phone NO~...~.~.. PLOT DIAGRAM Locate clearly and distinctly all buildir~gs, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description occording to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW ~ COUNTY OF .... ~'.j~..~,,... · ' '~" /// .............................. ~' ................................................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing controcf) above named. _ He is the ...... .~..~,~.~I...~....~'./~.Z~,......~..~..~./......~....~'....~ ............... .~.~.~...~...~...~......~...~...~.S ............................................... (Contractor, agent, corporate officer, .etc.) of said owner or owners, and is duly authorized to perform or have perform'ed the said work and to make and file this application; that alt statements contained Jn this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth Jn the application filed therewith. Swam to bgfore me this ~ . .... ..... .......................... , , , /,////. (Signature~f applicant) TERRI LEE El.AK NOTARY PUBLIC, State of New York No. 52-G16~295 ~ualihed in Su;tol~ County Commission Expires March 30, 19 '/~ tV. 80'54 '~'0""£. - /~0.0 1 t~f~AP OF ,Sl.l~ V. ~Oo ~9CA