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Home My WebLink About8108-zTO]~N OF SOUTHOLD Bu~.r~ING DEPARTMENT Town Clerk's O~iee Southold, N. Y. Certificate Of Occupancy No. Z79.~3 ..... Date ................ Septl .- · ~., 19. '77 THIS CERTIFIES that the building located at . E/S...l~eqtmsh. AVe ....... Street Map No. xx ..........Block No. xx ........ Lot No...~ .....~utohoffue .... 1/,¥, .... conforms substantially to the Application for Buildin~ Permit heretofore fled in this office dated ............ JuSy.. 28, 19.?~. pursuant to which Buildin~ Permit No..8108Z · dated ...........July...28..., 197.~.., was issue~ 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.~ivat~ · swimming .peo.1..with. feneir~g ,&. ~ees~oz?e ............. The certificate is issued to .Dorathy. Kubacki ........ owner ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval -!I,1% ............................... UNDERWRITERS CERTIFICATE No... 1/~989 ...... ~ug...5.. 19.7-~. · ~ .......... HOUSE NUMBER ..... ~9.~ ..... Street .. Paquash .ava ....autelmSue,. .......... Building Inspector (THIS QDMPLETtON OF ~ No. 8'108 Z Perminian is ~ ~ to: Dis,~p.;,~wed a/c ........................................... a. This ailiitcation must be comph~y filled in by ~F~ter o~ in' Ink and ~ in triplicate to the Building areas, and givin~l detailed dmcrlptina of layout ~ must be dmem on the diagram whl~ i;paet of bl~. d, U~ ~ ~'~1~ ~lic~tkx{, 'the ~uildlng Inspector will ~ 0 Building Permff to tl~ al~. '~ch permit e. NObullding d~ll be occupied o~ ~ in whole or in part for any pu~aee whatever until a Certificate of Occupancy dna I Hav~ been granted by the Building I~r, AP..PLI~,,~TI.O~. .. IS HERF~_Y MADE to the Building Depart_merit fo~_ be i~suance of a Bui .ld~ng .P~t. ~ to the euildmng ~ O~linance 6f the Town Regulatic~, f~r the comtructlo~ of bulldin~Bl~ odmit au~orized ir~oectors on pr~nlse~ and 'l,~ UI~II~i~ for ~ece~o~y Inllm~lom. ~'Address of applicant) State, whefner applicant is owner, lessee, agent, architect, engin~e~r, general contractor, electrician, plumber or builder. ........... ~ .................... '",~-'"~ ....... ;""~'t'"'7~ ........................ ~ ............ ;'"";; ........... ;;~=~'" If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....................... ~..~...1~..~.... ............ Plumber's License No ................................................. Electrician's License No. ,.,~.....~......4~....~..~.~........;.....: Other Trade's LIc~rme'l~lo ........... : ....... ~ ........................... 1. p will bm derle p No ................ Lot · · .........' ' Street and Number ..,~-,~~,.~,~,. ............ Slate existing use and occupan~ of premises and intended use and occupancy of proposed comtruction: a. Extsiting use and occupancy ......... .~,,..,;~.,,~,~,.~'.~'..~ .................................................................................. b. i.,..~ use o~ ~upa,,~ ............ .~.~.~.,~.~.../~..~...,~J~ ...................................................... 3. Nature of work (check which applicable): New Building-. ................. A~dition .................. Alteration ................ Re.ir .................. Removal .................. D~rnolitior, .................... Other ~o~ ...: ............................................ ~ ~ ~ ~ . ~ (~ripti~) 4. ~fimat~ C~ ...................................................... Fee ..L.~ ..................................................................... (to..~ ~id ~ filing ~is a~licatlon) 5. If dwelling, nu~r of ~elling units ............................Number of d~lli~ unJ~ ~ ~h flor ............................ If garage, numar of ~m ................................... : ........................................................................................................ 6. If busine~, comme~ial or mix~ ~c~ncy, speci~ nature a~ e~ent of ~ch ~e of u~ ............................ 7. Dimensions of ~isti~ st~r~, if any: Front ............................ ~ar ................................ ~ .................... Height ........................ Nu~er of Stori~ .............................................................................................................. Dimensions of ~me stratum wi~ alterations or addJtions:~ Frbnt .................................... ~r .......................... ~pth ................................ Height ............................ Numar oratories ................................ . 8. Dimensions q[ entire n~ constr~ti~: F~t ............ ~.....~ ....... R~or .....~.=~. ...... ~h ..... ~.....~ ...... N.m r ..................................................................................................................... 9. Size of lot: Fret ............... 7=.~ ............................... R~r ........... ........................... ._..... ........ ........ ........ ........................................................ na, ............... 11. Zone or u~ district in which premises are situat~ ..................................................................................................... 12. Does pr~o~ constru~i~ff~iolate any z~ing I~, ordinance or r~ulati~: ....... ~.~ ........................................ 13. Will lot be r~rad~ ....... ~.~, ............ Will e~e~ fill ~ r~ fr~ p~: ( )~ ~No 14. Name of ~ner of premis, . ~~~.~ ~. Name of Architect ................... ,..~ ...................................... A~r~.. ............................... ~ No ....................... ~a~ o{ Contractor . ~ t .............. 2 ..... ~ ~ . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensio~s from property lines. Give street and block number or description according to dee~, and show street names and indicate whether interior or corner lot. COUNTY O~...~T.. ..... .................................. ~ ................ .~......,..~ ............................. L ..being d~/,swoKn,' d~ipose~, and says that he is the applicant (Name'oT individual 'sighing c~traef), " - ' ~' ~ '~ '~ above named. He is the ................................................................................................................................................................................. (Contractor, ,clgeg, t, corpora,re 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 stotem~n, ts, egntai~ed jr) Ns af~Jicg,tion ,,o~re true to the best of his knowledge and belief; and that the work will be performed in the mann~r'seJ' f6'r~h ir{ The 61~plr~:6tion filed fl~erewlfh. (/ · (Signature of applicant) JUDITH T. BOKEN Notary Public, State of New Yon~ No. 52-0344~63 SuffoJk County Commission Expires March 30, ,,,~,;~ : THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY '~ ~ :'- 85 JOHN ~=TREET, NEW YORK, NEW YORK 10038 'THI~ C~IFIES THAT ~. JoSeph ~back!, 595 Pequa~h Ave. Cutchogue, L.I. in the foll~ing l~ation; ~B~ement ~ Ist FL ~ $nd FI. O~ ~ S X ~e S~tion al~k ~,~d~ Au~us~ 1~ 19~5 ~dfoundto~incomplia~e~iththerequire~ntsofth~rd. SWITCHES iNC~,~O~CENT ~ LP ~u~TK[,~EENST ~,~. FIXTURE OUTLETS RANGES SPECIAL RE~': TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET ANAT. ~q~PS* TRANS. ~ SYSTEMS A~T. A/~P. TYPE 1~'2W 1.~3W 3.e'3W 3~'4W NO.(:g~C~.COND. OF CC.C~D. OTHER A~ARATUS: ~ G.F.C.[. for Pool :~-~I~ P~L'~ T~is cer~if!cate cover:-~ comp~r~e ~:~c ~he date of ~pec'cior~ omly. Because of unus~al enricO.men, ts it is advisable have ~r,cquen~ te~ts and/~ g~[rs made by a qualified person. Jo~eph 59:5 Pequ~h Ave. Cutchogue, L.I. EXHAUST FANS DIMMEES 1193: Per_ TNI~TTHINIWYORKQ~ISJC~ST~ET, ~ .Y. 10038~ ~_. FOI~M NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, 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: t. 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: L 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 New Bqilding ................ Addition ........ ,,~..... Old or Pre-existing Building ................ Vacant Land .............. Locot on Of Property ................... .~.. ,~..~..~,?...,~ ~.'-; ............................................. ~ ~: ............/~~- ................. Owner Or Owners Of Pro ert .,~.., ~..¢-.....~,~.. ~--,.~....L,~... Subdivision ................... .~......~ ..................... Lot No ...... ./......~>Block No. ~ ....... House No....~/.~. Permit No ..... Of Permit .~..~..~C'.Applicant ........... ..~...'.c~.....~...~..~..~E<,~ .............. Health Dept. Approval ...,..~.....!~. ..................... Labor Dept. Approval ........ ..~..../(.~ ........................... ? 11/,~> Request For Temporary Certificate ........................................ Fined Certificate Fee Submitted $ .;z~.' ........................... Construction on above described building anal©permit meets all applicable code~ a~nd regulations. Applicant .....W~f~....~......~... i~..~. ~. ................................... Sworn to before me ,his~ --/ .......... ~ dLof ...~......~..~...?..~...... (stamp or seol)~