HomeMy WebLinkAbout8571-zFOEM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Ot~ice
Southold, N. Y.
Certificate Of Occupancy
No...~?.~.7.Q .... Date ............. Aug ..... 9 ....., 19.
THIS CERTIFIES that the building located at E./.S. P~o. aky. P. oln.~..Roa0, Street
Map No.. X;~X ....... Block No..XXX ...... Lot No, . ~XX. · Eaat. ~arl~n.. N.~Y · .....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............. ~a.y. · 7.., 19.. 76 pursuant to which Building Permit No. ,
dated ......... ~a¥ ...... 7. ·., 19.. ~ was issued, and conforms to all of the require-
ments of ~he applicable provisions of the law. The occupancy for which this certificate is
issued is .. Pr~w.~.e.. one..£~1~, d~<e~.li~g ......................................
The certificate is issued to . .A. & .F,.. Zom]aakos ..... 0~ne~.s .......................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval Aug...1~...~.~76 .... by. 2,. Vi~,~a .....
UNDERWRITERS CERTIFICATE No..E29.~.~16 ..... ~u~y.. 29.. 19.7.6 .............
HOUSE NUMBER .............. Street ..........................................
Building ~Inspect~
· ro~H oF
BUWNO
~UILDIH~ PERMIT
(THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
8571 Z
Permission is hereby granted to:
............... .c.~.~.~.m~. ...........................................
~o ...~.u...~...r~...~e..£~.. ~e~Mx~g ...................................................................................
at premises located at ..F~.~..~...~x~..P,~e,~ ..........................................................................
.................................................. ~.t..~r~on ...... ~.~. ...................................................................
pursuant to application dated ............................. ~,~. ........... .~......, 19...~.6., and approved by the
Building Inspector.
Fee $...~J.a..~.~ .........
Building Inspector
FOI~A~ NO. 6
TOWN OF SOUTHOLD
, Building Deportment
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and sdbmitted 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 disp0sol--(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Ui~derwriters:
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 .....~..Z..~...Z:7...~ .................
New BHilding ..... ~.. Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property .~. '~....~/~.,~'~...,~..~ ........ ~..~...~.~,/./,~.'.,,~,.....~.....~... .............
Or ~ners Of Property.~-- ~ ~~..~.~.....~ ....................................... / , .............
Owner
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No. ~.~Z..~ Date Of Permit .~...ApplJcant ...~~.....~~ .........
Hea~th Dept. Approval ....~..~[s ~.~
Underwriters Approval .~~ .................... Planning B~rd Approval ........................................
Request For Tempora~ Ce~ificate ........................................ Fin~ Certificate
.
Fee Submitted $ ....................................
Construction on above described building and permit meets all applicable ~es and regulations.
Sworn to before me this ~
............ ./.. day or ..~...~..~.4..~ ............ (stomp or
THE NEW YORK BOARD OF FIRE UNDERWRITERS
_ at BUEEAU OF ELECTRtCITY
85 JOHN STREET. NEW YORK, NEW YORK-10038
A. Zompako~, ROCKY Poin[ ~,, R~.27. & Wate~ (Sound], Eas~ M~ion.,..L;~,
flXTURG
OUTLETS
9
Mot ol"/s:
1 G.F.I.
...... RXTUR~:S COOKING OECK$ OVENS
SWITCHJES
22 18 9
CB x I
1- 3/4hp
Gustav Bartra,
227 East Brea~wa~e? Rd., .......
This certificate ~ust not be altered in any manner return te the office of the ~ord ~ incorrect inspectors m~
FOI~M
NO. 1
APPUC~TIOH FOR BULLDOG PER'rUT ~.~
a. This application must be completely filled in by typewriter or' in ink end submitto~'~d~i, ir~llcam tr~h~ t~u~fdlnflT~
Inspector, with 3 sets of plans, accurate, plot plan to scale. Fee accarding to schedule.
b. Plot p~on showing Iocalion af lot and of buildings on premises, relationship to Odioining premises or public streets
areas, end giving o detailed description Of layout ofproperty must be drawn on the diagram which is port of this opplicotion.~,]
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval o{ this oppll¢otlon, tho BuildMg Inspector will ~ssue o 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
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, os here n described
The applicant agrees to comply with all applic~able laws, ordinances, building code, housing code, and ragu at OhS, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
Sto~e whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Builder
Name of owner of premises ........ .A.,...&..~.o...Z, Oi~O~q,~O~ .....................................................................................................
If applicant is a corporate, signature of duly authorized officer.
.......................................................................... ..Or.e..9..z?.g,.e AbZers,
(Name and title of corporate officer)
Builder's License No. 170 HI
Plumber's License No .............. ~.~ .......
President
Electrician's, License No ...... ~~.o~.,, ...........
Other Trades License No ............................................... ~
Location of land on which proposed work will be done. /~Aep No.: ................. (......~....:-.~ ........ Lot No.....J.... ...............
Street and Number .......... .R.~~..~.~.~.~.~.~.~.~.~.~..~..~...~.d.~.~.E.~.~.~.~.~.~.i~.~.~'~.N...e..~9~:~ ................
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ............................................................................................................................
b. Intended use and occupancy ....... .rJ, w~J,.l,~Dg; .....................................................................................................
3. Nature of work (check which applicable): New Building .... Z, ........... Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................... Other Work ......................................................
c~/ ~- (Description)
4. Estimated Cost ..$.~.~.,3~.7.2,.0.0 .................................. 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 some structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front 3?' 3?'
.................................... Rear ............................ Depth 25'
Height ...~.8..'. .......... Number of Stories ......................... ~-. ..........................................................................................
9. Size of lot: Front .......... ~L.Q0.'. ..................................... Rear :LO0 ' 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, ordinance or regulation: ............... n..o. ....................................
13. Will lot be regraded . ........... y...e.,~. ........ Will excess fill be removed frora premises: L )Yes (X) No
56-07 136th St
14, Name of Owner of premises ...~.,...~.Q.m..p.~.,~...o...~. ...................... Address .~]:Lt.~thti. ng.~...~¥.. Phone No...~.~...~.7...]:...
Name of Architect .............................................................. Address '2'~O'"C~"~L,~" Phone No .......................
Name of Contractor ...... ~.:.....A~.]r...e.~.~ ................................ Address '~XJ. lY~'~'O'gD.'~ ......... Phone No. Z~.~..~..0,~..O...
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail 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 YORK, ~ ~ ~
COUNTY OF ....~.~;~;~.0.~ ........... ~'~
................................ .~.~..~q}c,,..M_,az?.t~t:~,D,~ ............................ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contracf)
above named.
He is the .................................................... ' ....... ~t~.l;...~.Qz'...~.a~zt:r~a.taz~ ......................................................................
(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 stateraents contained in this application are true to the best of his knowledge and belief; and
tha~ the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
......... ...... ................
~~ ~ (Signature of applicant)
~LIZABETH ANN NEVILLE
NOTARY PUBLIC, State or New York
No. 52-812FJ1150, Suflolk County,..,,
Te~m Expires M~rch 30, 19~'~
we. If
SUFFOLK COUNTy HEALTH DEp~2~rEN~Z
be sewage disposal a~d ~ater SUDD1F
~t~es for this locat!on have been
be satisfactory. ~t ~d found
L
Name GEORGE AHLERS Posit!on President
Company GEORGE AHLERS BUILDEE INC.
Address 250 cox LANE
CUTCHOGUE, N.Y. 11935
~AST ~%~A R l ON
,/ ·
APl:ROVED AS b~OTED ' .
NOTIFY: BUILDING DEJ~ARTMEN/ AT~
765.2660 9AM TO 4PM FOR REQU
ED, INSP~CTION$~ '
1. BEFORE BACKFILLING FOUND.~.
TION OR START FR^MING
2. BEFOP, E COVERING PIPELINE
ft