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Home My WebLink About8785-zFORM NO. 4 TOWN Of SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. 7Certificate :Of Occupancy Z10724 ..Date October 9 .,19~ THIS CERTIFI ES'~at thg building ........................... · ...................... · __ 3500 S/S Eugene Road Cut,chogue, New York ~ocafioneO~L~ro. pert y ............................ ....................................... House No. Street Hamlet 097 08 009 tCounty"Ta~Map~NOFIr000 Section ........... :'Block ............ ;..Lot ................. Subdivision ........................ i. ......Filed Map No... - .Lot No .............. conforms substantially to the Application for Building Pemfit hei:etofore filed 'in this office dated 76 8785 Z August; 6 19... pursuant to which Building Permit No. dated August, 6 1976 , was issued, and conforms to all of the requirement8 of tt~e applicable provisions of the law. The occupancy for which this certificate is issued is ......... Addit,ion t;o Dwelling Veronica Solowianick The certificate is issued to ........................................................... of the aforesaid building. Suffolk County Department of Health Approval ..... N./.~ .................................. UNDERWRITERS CERTIFICATE NO....N./?. ........................................... Building Inspector Rev. 1/81 FOBM NO. I! TOWN OF SOUTHOLD BUILDIHG DEPARTMENT' TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8785 Z Permissio~ is hereby granted to: ........................... .C..u...t.g..h..o.~..e ................................ L~ilf an a~,dition on existing dwelling S/S Eugene Road at premises located at ............................................................................................................................ ............................................................ .q.u..t..c. ko..~ .u..e. ............................................................................... pursuant to 'application dated ............................. .{~..u...g. ....... .6. .......... , 19.~.6...., and approved by the Building Inspector. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This apphcation must be filled in typewriter OR ink, and submitted in duplicate 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. 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 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 informa- tion 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 I October 7, 1981 ~ew Buildin§ ........ Old or Pre-existin§ Building ....... I ¥,cant [.and ............. Location of Property . .s.o.u..th, .ez~.l:z .s.J.c~t .qJ~ .Eu.c~e.',s. ¢qF~_ _~_,..-E,s~E~%~_. House No. Street Owner or Owners of Property VERQ~TCA SOI_OWI_ANIT~4 I County Tax Map No. 1000 Section ...0.9.7...0.0. ...... Block ,0.82.0,0 .....I .... Lot .~;;: .0..~....0.0.9:0.00 Subdivision ................................. Map No ........... +... Lot No ............... Permit No...8.7.S.5...Z.. Date of Permit .8./. 6. [.7.6...Applicant , .W,m.,..J... lq ~,c,o.b.~ ................. Health Dept. Approval ........................ Labor Dept. Approval~ ........................ Underwriters Approval Planning Board ApproVal ./ Fee Submitted $ .'~.,~ ........................ / ' Construct,on on above descr,bed '~ -- --/' / '/" / ~''~' · ' building anu pur,,.bmee[s au appdcab[e codes~and reguqatio-ns. Wickha. r~, ,Wic.]/.ha~ '~B~ s ~ ,~. C: Applicant ....... (--~/..~/~.: ....... ....................... by Wiltia~ Wickham Rev 10-10-78 *I~OL~S~a~Cq~s~~ Mrs. Solowianiuk in 196. (previously c~ed by /ep .... ~ ~rc~ areo~md 1974-1975. Examined Approved ........................................ , TOWN OF SOUTHOLD IUli*DIN~ DEfARTMINT TOWN CLIIK'$ OFFICE SOUTHOU}, N. Y. Dir~oproved a/c . APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by ~/pawriter o~. in ink and submitted in triplicate te the Building Inspector, with 3 sate of plato, accurate plot plan t~ l~ale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a d~tailed description of ~ayout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application maynot 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 impectlon throughout the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the BuildingDepartm~t fro. the issUa,nce of a Build!~l~ Pe..r?it purSuant to the Building Zone Ordinance of the Town of Southotd, Suffolk County, New York, and ~her apPl,cab.!e I~aws, 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 mgulati°ns, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~ (Sig~f applic/on,, or i~, ~/corporation) '- ~/ (Address of applicant) State whether applicant is _~ lessee,jagent, architect, engineer, general contractor, electrician, plumber or builder. ..................................... ................................................................................................... Nome of owner of Premises ..'...:[.~...~..~...iiiiii~0....~.../....~.....~ ........ ~.~..~....i~.../.~./....~.Z.~, ............. 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 Trade's License No ............................................... 1. Location of land on which proposed work will be doJ3~. Map No.: .............. /. ....... ~ ............... ~- -,.- ,~__ ~L--°t Nq(...~ ............ ~... Street and Number ............ .~.....&".~....~..-~-~.. ....... J~..~...~.. ............................................. ..~...'C~.Z.G.-~...~.....~...~....:.. / Munlefpality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ........................................................................................................................... b. Intended use and occupancy .............. ~./. ............................. : .............................................. 3. Nature of work (check which applicable): New Building-. ................. Addition ........ Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) ,. ,,mo,ed Co,t ............ .................... Fee /a (to be paid on filing this application) 5.If dwelling, number of dwelling units ............................ Number of dwelling units on each floor .............. "--Z. ............. If garage, number of cars ........... ~ ...................................................................................................................... 5. If business, commercial or mixed occupancy, specify nature and exte. rR ofj~och type of use ......... ~, ................. Dimensions of e~isting structures, if any: Front 'v""~'''~''--''_L .......... Rear ..~1~.,..,./~'.. .............. Depth ~ ........... 7. Height ....~..~.,. .......... Number of Stories ..~.....~...Z-~..: ....................................................................................... Dimensions of soJ~structum with alterations or addit.ons:"/ Front .....~...~¢~... ..................... Rear ..~....~ ............ Depth ........'~. ..................... ~' Height ...... : ............ i ........ Number of Stories .................. i ............. · 8. Dimensions of entire new construction: Front .................................... Rear ..... ~......~. ............... Depth ..../.~ ............. t 1 Height .....~.0. ......... Number of Stories .................................... :u .......................................................................... ~'" eth ~OO ~" 9. S,ze of lot: Front ........... /~.~ ................................... Rear ....?....~... .......................... ,.Depth ................................ . 10. Date of Purchase ..: .................. :~; ................................ Name/~[:~Former ,Owner ....~....~:...~L~.~,~..[. 11. Zone or use district in which premises are situated .......... '" ~-- ' '~.~...~..~....~.~:..~ 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~..~....:.~ ............................. 13. Will lot be regraded .......... ~"~"~,,' ~-/--,~'Will excess ,fill be removed fro,m.,,premises: 14. Name of Owner of premises ....~.~'--~P..~..I..e,,.I~,.,~..CL/O..~..6~.. ~lress ...~...~..~.,~.?~....~..'~.../...':~... Phone No ....................... Name of Architect ............................................................. Add,ess .......... .... .................. Phone No ....................... Name of contractor ..... ..~..:...]~..~.~/~,~ ..................Addre~...~..r~,~........~'.,~....~... Phone No. 2.~...~...~...,~.... 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.,,Y-ORJ~, ~. ~ S S COUNTY OF :.~.-~...~.J,~. ........ f ' ........... ..~.~.i.!:[l~/t~ ........ .'..~J,,~......'~....~c_z2b.,~ ................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named. He is the ....................................... C~..~..~':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 to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn. to before me this ...... ..mm, ....... doyof ......... .............. , r~otary ~'uouc, ....................... ~ ~,.~ ~ ~. ........ ~oumy .................................... ~'.7,...7~,~ .~....: ...~.: ............................... (Sig ~a~'u r~_.~applicant) ~J £LIZASEIH ANN N[VILL~w Yo~k NOTARY PUBLIC, Sta e of Ne NO. 52-81258§0, Sutfork