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Home My WebLink About8095-zI~R~ NO. 4 TOWN OF SOUTHOLD BUn'.FtlNG DEPAR"I~U~NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6..~.? ....... Date .............. . .I~..r.. ?.6. ..... , 19. ?.6. THIS CERTIFIES that the building located at .. ~.l~]f,J~.. AXe. ............ Street Map No..ldai;t .Hel~l;l~mck No ...........Lot No.. P.t .20~1 ~2~3 ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..............~ll~xle.. ~019.7.~. pursuant to which Building Permit No.. dated .........J. uly.. 13 .... , 19.7~., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is issued is .Prt.Vat~..~ne. faml~..dvmJ~ing ....................................... The certificate is issued to . .Zdsislale..l~Jow~d~ .... . .O~t$1~. ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~&.r...2..2...1.9..7.6. ................... UNDERWRITERS CERTIFICATE No...1[27~0~ ..... 1~,~.. 2~.. ~ 9~.(~ ............. HOUSE NUMBER .... ~6.~} .....Street .....l~lekham. &v~ ........................ ....... ..... Building I-.pector ~'OEN~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP~EMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 8095 Z Permission is hereby granted to: chet ....9.r~ .o.~...... ~./..q .. 7~.$.~.~ ...tr. ~k.o.],~,-tcz ~ ............. .Q~,.~.~Z ~e..... :¥;..,:~ .~ ............................... to ... ~.'~;kl~...~e.~...c~v,,e... f. aally... ~,¢a~ .llng .................................................................................. at premises located at ...~,.Q.~...~.Q.-.~.~ ....... ~8.~E.l:.J,.t;.l~..l~.¢~t~.~ ............................................ ..................................................... ~./.~...j~i~kha~. l~.v.~ ....... ~a.~t i.t,u~k .......................................... pursuant to application dated ...................... .~,1~1,~.....~,~ .............. , 19.~.~.., and approved by the Building Inspector. ui lng nspector ~ Disapproved a/c ~ -- APPMCATION'"FOIt~I~fll3J~G I~IMIT a. This a~lication must be completely filled in by typewriter oe in ink a. nd. ~l~i~l in triplicate to the Building~ dll~ector, wit~8 set~ ,of~la~s, o~u~te plc~plan to icale, r~Fea accor~ng~t~ ~mdu~Tn'~ . ' ~-'l~t~l~ .~.n showing~l~'~l~_ buildings me-~el~x(~ll~...~l~ini .r~. p, remises or public streets areas, and giving a detalle~l d~'l~ dlH~ ofpropar~ m~rawn on the diag~hn whicn is part of this application.'~ ~. ~ wink coverec~ .by )his appli~ptj~ (~,ay nm be commencesJ, _beforq'lset~lflcJRof ~j~ldjng Permit. ~/pproval of ~l~~'~J~i~uildlng Inspector ~o the applicant. Such permit'3~ shall I. kept on the prem~es ~aillable for throughout 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 La~,,, Ordinanc..es or Regulations, for the construction of buildings, addltions~r alterations, or for m .~.al' or. demol, ltion, .as i~e?!.n descr, .~ea. The applicant agrees to comply with all aPPlicable laws, ordinances, building coae, housing coae, ana regulations, ancl to admit authorized inspectors on premises and in buildings for necessarZ inspections. '~S'ignature of applicant, or name, if a corporahon) ............................... (0ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ ......................................................... ................................. I{ applicant is a corporate, s~gnoture~f duly outh~n~ff~¢~r.~ w ~t , (Name and title of corporate officer) Builder's License No ...... .../~....:l....~:....,~..~ ............. _ .~.~ Plumber's License No...~.,~...~...-. ....... ~....z..L~ EleCtrician's License No .... ~.....~...~........t~ ............. . Other Trade s L~cense Nq. ~: ..................................... i/ ~,~ . · L~__ _ ~ ~ -r-- ~. 1. Location of land on which prooosed work will be done. Map No.: ..... L~..._~...;.~t.~'...~..'~o.;~..;.~.¢~'L .......... Street 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ";'~"~ '""~"· - ,*. -, ........ '"'"" ............. ~""'n .......................................... 3. Nature~,of work (check which applicable): New Building'. ........... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~,~. (Description) 4. Estimated Cost ...... ~, .... .0...I..~ ............................ Fee ....... l../...~...'....(q...~.. .............................................................. (to be paid on filing this applicatiOn) 5. If dwelling, number of dwelling units ........ 1. ................. Number of dwelling units on each floor ...... ..-T.. .................. 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 ......... --~...~ ................... Rear ......... ~...~... ........... Depth .~..~...~..~..Z .... Height ....J..JL ........ Number of Stories ........ g...l~e~.. .......................................................................... ) .............. 9. Size of lot: Front ......... 1...~..~ ................................... Rear ...... /../..~.. ........................ Depth ,~.F,X~..~..~..~... .... 10~. Date of Purchase ...~a~.....'.......~...~..~...~. .............. Name of Former Owner 11. Zone orr'use distr'ct-I ----in which premises are situated .../~~--~ ................................. :'.... ........................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~ .......................................... 13. Will lot be regraded .....~.~1~.~ .......... Will excess fill be removed from premises: ( ) Yes (X) No ,, r~ - - . ~ 14. Name of Owner of premises ..~i~.~.. Address ~~..~ No. " ' ' h't - ¢/ (J O 0 A' 'r ss ~.~...?..~...." Phone No. ............ ~ome or ^rc, ec~ .................... ~...~. .... TX": .............. . .a · ..........~ .......... Name of Contractor ~ ............... ^ddress~,.)~.y~on* NO.'~3~.-.~.~.~'~. 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 YORK,~ ~'~t COUN'I~f-~ i,.,] - .....~Z.- T,?,,/.~....-~-, ~ .......................... ' , ........... ~...L ' ,- .~..~.....:. ................. being duly sworD, deposes and soys that he the appli an, (Name of ind,'dual signing contract) above named. He is the .............. ~..: ................................................................................. (Contractor, agent, ,Corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and tc make one file th s application; that all statements cantoned in this application are true to the best.of his knowJedge and belie~ and thaz the work will be performed in the manner set forth in the application filed therewith~ Swam to before me this ~ /'~ ...'~ ..... day of ........... .~...~.~. ............... , 19...r'[.~ Pub,c, .............................. .ty ..................... NOTARY PUBLIC, No. 52:$125850, Suffolk Tmm Expires March 30, .... , THEi;NEW YOrK BOARD OF FIRE UNDERWRITERS ~ ! ii ,I : ~ BUREAU OF ELECTRICITY f---.,TI.:~ !I iii I~ : !!i [~ : 85 JOHN STREET, NEW YORK, NEW YORK 10038 4 !,__._ ,o.10, ,MarCh il23 ~i1!,~976 : .Ippllcation,%'o. otlJ'ile 819412 ]HI5 CERTIFIES ,THATpi[ i~l' ih i ~ '~ h! ' ' ' ' ;' , only t&e electrtcat equtpme~t ~ ~escrlbed below and introduced y the applicant ~amed on the above apptication number in tbe pretttlses of ~ ~t. Zdzislaw Mick~czyk,.s/s WickhamAve. c/o Grand Ave.,.Mattituck, L I. ;.' '.' .' ~q i [ ~!' I,. '. . , h. Fl __ ,, u.,.... , Section. Block' &,,~.~a;rined2nl; .;s ~I tI~]tl~.Q ihl.'n~ .,I...d ,l!..ardf, ur d to be in co,nl¢li,ince with tbe req,,ires,,ents (¢ tb,s Board. . ITHER APPARATUS: l~ GFCI E R V I AWG. PER ~ OF CC COND J NO OF Hi LEG i Z/o C Electrician Matt it uck, L. I. Th~s ceYllfic~te must no .be oJtered in any manner GENERAL -elurn to me office of the Board :t -correct Inspectors may be identified by redentiais. FORM NO. 8 TOWH 0~: $OUTHOLD , Building Department Town Clerks Office $outhold, 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: I. 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 Date ......~ ......c~.. :....~...'~...?...~.... ~ ...... New Bqilding ..... .~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. '- Location Of Property ,.._..__~. ..... ~. ..;.~ . ~ .. /;.. Subdiv,s,o, ......... ,o se Permit No. ~..O...~.~.S'~..~--'~Date Of Permit~.~-~/2.~plica~t ..~...~~: ............ Health Dept. Approval ........ ~...~...,~...~...~ ............ abo ~pt, ~pra I ............................................... Unde~riters Approval ~..~_~.~.6..,~.~ ............. Planning B~rd ~provol ~ ............................... Request For Tempora~ Ce~ificate ........................................ Fin~ Certificate ,.,~, ................................... Fee Submitted $ ..>~].:...~ .................... Construction on above described building and per.mit meets all applicable codes and regulations. v Sworn to before me,.t~is ...... day of Notary Public ......~.//..~. County (stamp or SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number 4- q (i / ~ / APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~, Address 2. Property Location ~'~'~ Village .......... Township 3, Public Water Comp~n~ ~ame 4, Lot size: Width ~ feet 5. Subdiv.' 6. Section ~K 7. Lot Number ,~ 8. Private Well 9. Public Water Distance to main 10. Sewag~/~sposal System: A. /~O02Zgallon septic tank: Precast~ .Equivalent Block B. Leaching pools: Number of pools :=Precasc~. Block _Special ll.~ pri~a~te .wel,1, fill in the ~'~Ol l ova'§ b/anKs: ~ Ta apac ~ gallons Pq]~t~ G.P.M. ,/,j f' ~ Teilbal well depth D. Depth to ground water' E. Amount of water in well (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE SIGNED S-15 Rev. 4/1/73 Z .F l I APP~kCQVE,D AS NOTED.~_ FEE: II~,~ ~" NOTIFY BUILDING DEPARTMENT 765-2660 9AM TO 4PM FOR REQUIR~ ED INSPECTIONS: 1, BEFORE BACKFILLING FOUNDA,, TION OR START FRAMING 2. BEFORE COVERING PIPELINE 3. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR STRUCTION ERRORS