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Home My WebLink About8809-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at75~.. A L?O....??.~,. ~.E. ....... Street Map No ........... Block No ........ Lot No ................................ conforms substantially to the Application for Building Permit heretofore fried in this office dated ........ .~..U .&/.. I~., 19'7...~. pursuant to which Building Permit No. ~..~.O. ?...~_ dated. .. .~.?..~...~.7., 197.(e., wasissued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is (owner, J~r~Int) of the aforesaid building. Suffolk County Department of Health Approval ~( U~DE~W~I~,~S C~,~TIF~CATE ~o.. ~!.. }.~..7. {. !. ?. .... , ..................... ~OUSE ~n~E~ ... 7. ~... Street ..... ~..~...~. ~ ..... ~.~..'.f.~.~ ............. Building Inspector ro~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) sso z Permission is hereby granted to: ~ursuont to .app!icatic~q' dated .......................... J~*aE- ......... .I.-~ ........ , 1S/~:~., and a'l~proved by the TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcahon must be filled in typewriter OR ak, and submitted in DUPLICATE to the Buildmng Inspector w~th the follow~ng; for new buildmgs or new use: 1. Fmal survey of property w~th accurate Iocahon of all buildings, property hnes, streets, and unusual natural or topographm features. 2. Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical installahon from Board of F~re Underwriters. 4. Commercial buddmgs, Industrial buddmgs, Multiple Residences and simdar buildings and mstollations, a cerhficate of Code comphance from the Archttect or Engineer responmble for the buildmg. 5. Submit Plannmg Board approval of completed site plan requirements where apphcable. B For existmg buddmgs (prior to April 1957), Non-conformmg uses, or buddings and "pre-exmting" land uses: 1 Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condmtion of buildmgs 3. Date of any housmg code or safety inspection of buddings or premises, or other pertment formation required to prepare a cerhficate C. Fees. 1. Cerhflcate of occupancy $5 00 2 Certificate of occupancy on pre-existing dwelhng or land use $.5.00 3 Copy of certificate of occupancy $1.00 New Buildmg ..... ~ ......... Ad&tion ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... 7.5..ALh~..Dl~L!ze.,...I~aLucf:% ...................................................................................... Owner Or Owners Of Property ....F-r..a-n.~...a..n.d...M..a.~.i..1.~..n..?..1..i..s..s. ...................................................................... Subdivision ............... D~ac ......................................... Lot No ............. Block N~ ............. House No ............ 4/24/76 ^ h - Riverside Homes, .Inc. A/C Frank & Mari Permit No ....8..8..0.~. ......... Date Of Permit .................... ~pp cant .................................................................. Fli Health Dept. Approval ..... 6S01.~7. .......................... Labor Dept. Approval ............................................... Underw.ters Approval ..... 3DZ~iD ............................ Planmng Board Approval ........................................ Request For Temporary Certificate ....................................... Final Certificate ............ .X. .......................... Fee Submitted $ ..... 5~DD ....................... Construction on above described building and per~eets~ all a. ppl~able codes and regulations. Applicant Rive~'~~'t~']"-'"" Richlard Wandoloskz, Yzce-Pres, Sworn to before me this · ..c~...~....7~... day of .....~..~..T.~.~..C.~ ...... ./...~....~...~' No! ....... .~f.. · · ..~.' .~..~ County PHILIP F. SWOTKEWICZ NOTARY PUBLIC, Sta+. No 4506960 m ,THE NEW'YORK-BOARD OF ,FIRE UNDERWRITERS _ ~ ' ', IB~ JDHN SFT':RIEET,, HI,fAF ~Y'ORK. NEW yol~K IOO;3~" , ,,.. ,-~..~ ?.. Ave, Beach,L,l, TOWN OF sO~rHOLD BUILDING DEPARTMENT TO~ ~RK'S OFFI~. ~omined ..... , ~c ~ Disapproved a/c ....~ ..............................................:=a ................... ~ . .... ............... APPUCATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relahonshtp to odjotmng premises or public streets or~ 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 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. C~ 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 of applicant, or name, if a corporation) P. O. Box 274, Riverhead~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. builder Name of owner of premises .......... .~...r....~!...k....~...-......a~....d...~.i. 1XIg.....~..,.....Y.i..i..~.~. .................................................................. [ (Name and title of corporate officer) Richard #andoloski; Vice President: Builder's License No ..................................................... Plumber's License No ......... ..4..]:...2..-..P. ........................... Electrician's License No ..... .5..~.e.-.Jl ........................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: c~.~.~.~;~'.~..I;~fil. .................. Lot No ......................... Street and Number .... .~Zll/.~..x~lJ~g...Dr,...~'td,..B~'a.y...Ave ..................................................... Z,~u~e.1 ....... -~_~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ....... .V. JI~;...~.~JC~CJ .............................................................................................. b. Intended use and occupancy ....one..,~mal,~,y...dwe3..1t,n9 ............................................................................ 3. Nature of work (check which applicable): New Building-......~r ......... Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior .................... Other Work ................................................... (Description) 4. Estimated Cost .......... ..?. ........................................ .....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 ................................ 8. Dimensions of entire new construction: Front ........... .&0 .................... Rear .......... ,~,0 ............. Depth ...2,4.., ............. Height .......... 16 .....Ngmber-of Stories ...... .On ........................................................................ ~ ........... ............ 9. Size of lot: Front 1L05 o 38 Rear 205° 74 Depth~.~.p..~..~..~......~..0..~.~ ........ 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, ordinance or regulation: ............. .~...O.i ..................................... 13. Will lot be regraded . .......res ............. Will excess fill be removed from premises: ( ) Ye~ ( ) No 14. Name of Owner of premises Rr~'~:..~.Zisi ........................ Address ~,t,~,xl.t~, ......... Phoee No...~ ............ .~ ...... ,- . . R'lvers~de Homes~ Tnc .... R:l.~erhe&d ...................... Nome of ~onrracror ............................................................ t~aaress ................................ Phone No. 727-3395 PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. . SEE SURVEY ATTACHED STATE OF NEW YO~I~,,,~, I S S COUNTY OF ......... .~...u.{;f:~.....f -- ................................ IJ~C/C~JD...JJ~ID.~O.,,~.T, ................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contrac~ above named. He is the ....................... ~.~.~.~r. ........................................................................................................................................ (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 applicction are true to the best of his knowledge and belief; and that the work will be perfo~ in the manner set fo~h in the application filed therewith. Sworn to before me this ...... ........... Nota~ (Signature of applicant) Wandoloaki D~/ELL.(WELL) / LBO (W~LLS) O.A~OCT. j . 26 1976 .. g. ~z~. #.,/~$o-,/~?, . _ The~ewage disposal and water supplF facilities for this IDeation ~ve been inspected by this department and found to ~k~ ~~sati~atory. ·. So.ices · 3 o DATUM ASSUMEb LOT AREA,., tG. GTZ S~iFT NEAREST WATER MA)N IN EXCESS OF IpO0 FT. Fir, lAM SUFFOLK COUNTY DEPARTMENT Of HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE HS RES NO. APPROVED THE WATER SUPPLY SEWAGE DISPOSAL FOR THiS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SU FF'OLK COUNT Y DEPARTMENT OF HEALTH SERVICES NAME ADDRESS TELEPHONE d-AW GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON GUARANTEED ONLY TO. U.S,A. ~AF~MI~RS HOME ADMINISTRATION THETITLE ~UARANTEE COMPANY HAROLD F TRA~HON JR, N,YS. LIC. NO. 048902 PENN. LIC NO, 2~115- E JOb NOI '7(~-335 FILE NO: P-lEaP' SURVEYED FOR' FRANK 4. MARiLYN FltS$ SITUATED AT LAUREL -FowN OF 50UTHOLO- SUFI:OLK COUNTy N.Y. SCALE:: 1"-40~ DATE: FILED MAP NO, DATE: BOOK NO:LoOSE LEAF PAGE HAROLD F. TRANCHON Jr PC LAND SURVEYOR SUCCESSOR TO WILLIAM G. MEIER NORTH COUNTRY ROAD- WADING RIVER NY (516'1 9 29-46 g 5 473'3§26 ALT CALL D~,/ELL,(WELL ]) - STANLEY FLISS - 7L-~J 6^,,-, A LBO ~)P, IVI5 'o DWELLS. (WELLS) 40, 0 DATUM ASSL)I~IED LoT ARIA. I~.G7Z $~F NEAREST WATER, MA~N IN EXCESS OF IpO0 TEST BOR~ r,~G SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPI~OVAL OF CONSTRUCTION J , ,- _ -~ _,:-_ . ~1~.. SHOWN HEREON FR·M THE STRUCTUre,S TO THE THE WATER SUPPLY SEWAGE DISPOSAL FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPA.~RTMENT OF GUARANTEED ONLY TO, IUARANTEE$ INDICATED HEREON IHALL RUN ONLY TO THE PERION FOR WHC)A4 THE SURVEY II PRE, A VALID TRUE COPY. U .~ A. I::AP, MF-RS HOME ADMINISTRATION THETI'TLE CoUARANTEE COMPANY FRANK ~ MARIL'~N ~LISS HAROLC F TRANCHON JR N,YS, LIC, NO. 048992 PENN, LIC NO 2"1115- E NAME ADDRE~I~VERSiDi~ NOM~S, lNG, WEST MAiN S..:;.:Y RIVERH£AD, h. Y. PHO~ PAR~ ~.3395 JOB NO 7&- :555 FILE ~ SURVEYED FOR' FRANK4MARILYN~LIS$ SITUATED AT LAUREL TOWN OF 50UTHOL~- ~UFPO~K SCALE' I'l=40' DATE: ~- Iq~ FILED MAP NO, DATE' BOOK NO,L~osE L~AF PAGE HAROLD F TRANCHON JR PC ~ -- LAND SURVEYOR SUCCESSOR TO WILLIAM G MEIER NORTH COUNTRY ROAD-WADING RIVER NY 929-4595 (516~ 473'362G ALT, CALL APPROVED AS NOTED DATE: ~k.~ }- ~{ ~'~' F~E:,-~5-~-~ BY, ~ NOTIFY BUILDING DEPART/d, ENT ,i L