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Home My WebLink About8016-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6%58 Date THIS CERTIFIES that the building located at . .Rose.wood. Dmitre .......... Street Map Nogo,~.wc. od. ~$~Block No ........... Lot No...47 ..... l~/.at~;ituak.. N.,.Y, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. J.une.. ,2~ 19. ?~. pursuant to which Building Permit No. 8.Q] ~.Z... dated ............ JVn~.. ~.h:.., 1975.., 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~iva.t.~ .OHO..~'~tuk~. ~;~'.~;:e~_ling..with .ad~lktlon ..................... The certificate is issued to . .Fraa~k. Swo~;k~wicz ....... O)~r~(;~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~ .,.R... .............................. UNDERWRITERS CERTIFICATE No. A · R. HOUSE NUMBER .... 1Q~.~' ..... Street . ~%o.s~WQ.Q~..~);~iYe ........................ Building Insp~ 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) No. 8016 Z Date .................... ~T.~I~ .....2J+. ................. 19...V.~ Permission is hereby granted to: ............. · ~ e~.. ~tt£.~o..~ ........................................ to ..~J,~k~,.. ~m.. ~,l.~.i~ .. ozs.- ~bxJ- a .~.Z~k~ ..~bze ~Z Jmg ............................................................... at premises located at .]aQ%...~t, ............. ~fi~;~.O~..~k~.~,~ .......................................................... ...................................................... ~o ae~ood...~' .*, .~e ............ ~,~,t ~.t,u~]~ ....................................... pursuant to application dated .......................~'.~B.e...2.~. ............... , lC~.~'...., and approved by the Building Inspector, Fee $']. ~..f).O. ............ Building Inspector FORM NO. $ TOWN OF $OUTHOLD , Building Deportment Town Clerks Office So,thold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 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 / I De,e ..................... blew Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... ~...~..~.-...~....~.~.. ......... ~.~ .......................................................... Owner Or Owners Of Property ....~.~.~.,/~ ........ ..~..~.....(~..~...~.~...~e.:.7~ .................................... Subdivision .(...~..~r~[O.~......~..~.....Lot No ............. Block No ............. House No Permit No. Of Permit .~.Nh..~..,Applicant .~.~.......~...-.~1~...~ ..................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate I,/ Fee Submitted $ ......,~,..~..~ ................. Construction on above Sworn to before me / Notary Public ..~ described building ~.)~rm/~zeets all~/und regulations. Applicant ,, .,~7m-,, .~,,4~r.. ,. ,,-c,,7.,A,~,.~.- .,,,~,,~ .~ ~,~,~_~, ~,~,,~ ................................... . ~ ....... ~ ........ (stamp or s.')~~ Examined Approved FOI~I~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. I92. TPerm,t No..X ....... ........ Disapproved a/c ............................................................................................ APPLICATION FOR SUILDING PERMIT CD Date .................. . .~. · .1;~....e....~ .bt, · ............ , ] 9...Z~...,.~'( INSTRUCTIONS ~ o. 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, m- b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining 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, cb 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 o 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. The applicant agrees to comply with oil applicable laws, ordinances, building code, housJn9 code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) New Suffolk N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Name of owner of premises rank awo.~.k.e.,~;~c}a .................................................. If applicant is a corporate, signature of duly authorized officer. .................. i~ig ~;"~;;;Z '~i~'l';"gY ~';'$';'~g'fZ ';~fi;:'-"~i ......... Builder's License No. .~. Idoi'toi1 & S Plumber's License No ................................................. Electric an s License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ..~.?.~.l?..o...o..cl:..~.~.a...~.?..~. Lot No ......................... Street and Number ...~.~Q~q.e.W.O.QCl...~.~0~ ........... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... d~e:L].;iZlg. ....................................................................................................... b. intended use and occupancy ............ ~.~:~.l?....l~.~..~.....a....cl:~..~.~.S...o..I1.....(.~.o..~.). ........................................................ 3. Nature'of work (check which applicable): New Building'. ................. Addition ...~..~....:~......,]. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ (Description) 4. Estimated Cost .................... ~,0..0......+ ......................... Fee ..~i,~......O..O. ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... .o.b.e.. ............ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial ar 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 ......... .]..9. ...................... Rear ....J. 9 ................... Depth .....~ ............... Height .................... Number of Stories ..... Q~t ......................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ~ ]. Zone or use district in which premises are situated ..................................................................................................... 1~. Does proposed construction violate any zoning law, o~dinance or regulation: ....... ~C~ ............................................ 13. Will lot be regraded ....~Q ................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..)~...~krD.'~.~,J,f~ .................. Address ....... ..~..a..~.? ............. Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ~.,..}][D.~.t.~Zl...¢~...~gS...~ ........... Address ....N..:...~R.g~'.f..o...~..k. ..... Phone No ....................... PLOT DIAGRAM Locate dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from prape~¢y 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, I c c COUNTY ,OF ...~.~f~..o.~¢ ............ f"," .................................... .G..e...~.~..~....~.I..o.~,..~..o.~ ............................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the builder (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 tho~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this C~ ~ \ L' ~' ~ ................. ~..~... day of ............. ~.'g..~..e, ...................... , 19.~'.~... Notary Public, .................................................... County ...~.~.....~'~ ~.......~. ................... ~.~ignoture of oppiicant)