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Home My WebLink About7903-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z6~I~ ..... Date ........... THIS CERTIFIES that the building located at . .N/t~ ~a~a .Roa~. @. ~[~acker STreet Map No.. ~ ........ Block No. X~. ........ Lot No. XXX.. ~0UtJlo. ld.. ~,~., ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... gay. ... 8..., 197~.. pursuant to which Building Pemit No. dated ....... . .1~..y...8. ....... , 19.7.%.., 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~.iv.e.~.e..(ac.c.~so~y). ~.~mmi~g .pool .&. &ccess.arys. for. ~.~me ..... The certificate is issued to .~h~.Qdor& .Czar. tos~eski ..... .t~nex. ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N:.R.: ............................. UNDERWRITERS CERTIFICATE No..N. 2~0387 ...... June.. 43...~97-5. .......... HOUSE NI..I~BER ............. Street .......................................... .~,~ ' B~,ilding Inspector ~ FOF,~ NO. 2 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N9 7903 Z Permission is hereby granted to: .~.~.,. ~......q~..e.~.$~..a. .......................... at premises located at ..][/~LIKa:[n..Road~.~..Tueker...Lana ........................................................ lleuthotd Building Inspector. Fee $....~,*~ ...... '.. FORM NO. 6 TOWN OF $OUTHOLD , 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 w~th the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, aha 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, Mulhple Residences and s~mllar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te 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, build~ngs 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: I. 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 Building ................ Addition~. Old or Pre-existing Building ................ Vacant Land .............. kocot,on Of Property .~..._..~...~ ............... ~~......~....~.. ...... ./.../'~...Z../.. ................. Subdivision ................................................................ Lot No~' ............. Block No ............. House No....~'...~.~.. Permit No .~..~..~...~....~. Date Of Perm~.~...?.~.Applicant ..~.......~...~ ~;~hrwr~;' AAp;~' '"Z"': ......... 'J'"'"~'"~ ........ Labor Dept. Approval ..................... J(~"'~'"':"('~' .~...Z....~.....~/..~..~..~..,5 ............ Planning Board Approval Request For Temporary~Certificate ..,~]~.~.././~.~ .~...... FinaJ Certificate ..... ~ .......................... Fee Submitted $ ..~.. .............................. Construction on above described building and E~errn~it meets all ap~icable codes and regulations. Applicant ............................. Sworn,,~__to before me t~l~ ~.....~.. day of ..... ~ ,~, ~~L~/' ~/~(,~"~'~''L''~'~''''~'' (stamp or seal) * FOP--M lqO. I- ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined ...... ..~'~..... 19..~,..~ Application No...~.~[.~...~ ................ ~proved ................................... 19...~..?~Permit No ¢..~..~...~...~.:. ........ D~sapproved a/c ~..~ ..... ~....~.~ ................ .............................. I~STRUCTIO~$ o Th~s applicatfon must be completely filled in by typewriter or' 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 showmg location of lot and of buHdmgs on premises, relationship to adjommg premises or public streets or areas, and g~ving a detailed description of layout of property must be drawn on the d~agram which ~s part of th~s application. c. The work covered by th~s application may not be commenced before ~ssuance of BuHd.ng Permit. d Upon approval of this application, the Building Inspector wdl ~ssue a Buddmg 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 ~ssuance of a Building Permit pursuant to thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmances o: Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and tt admit authorized mspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ......... ...... ...... .......... .... (Address of apphcant) / State whether applicant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builder . r -- ..... ..... ............................................. I , ~ Name of owner of premises .......... ....L~.~..0..O..NX.'~. ...... ..~.....-k~.. ~.~..~.L...P.-..~.~.t ............................................................... If apphcant is a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's bcense No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Zrade's License No ............................................... 1 Location of land on which proposed_work will be done. M~p No ....................... [......~. .... Lot No .............. . ........ Street and Number ..... ..~..~.t.i~....~....~O. ..................... ............................................... ._~/'..~.T..L...o./..~.... Municipality-- 2 State ex,sting use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ....... 3 Nature of work (check which applicable) New Building ................ Addition .................. Alter6tion ....... Repa,r ................ Removal ............. Demol,t~on ............. Other Work (Description~ ............................................................ 4Estimated Cost ................ 4 ........ z .......................... Fee .... (to be pa~d on filing th~s opphcat~on) 5 If dwelhng, number of dwelhng umts ...................... Number of dwelhng umts on each floor ........................ If garage, number of cars ...................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each ~pe of use ...................... 7 D~mens~ons of ex~stmg structures, ~f any Front ................... Rear ................................Depth ........... Height ........................ Number of Stones .......................................................................................................... D~mensions of same structure with alterations or addmons Front .................................... Rear ........................ Depth ............................~.i Hg~ht ..................... Number of Stones ............................ 8 Dimensions of ent,re ne~'const~ctlon' Front ..... , ....... Z .............. Reqr ............................ Depth ..¢...~ ........ Hmght ...... ~. ..... ~~~ .... a,~k~ ..... t r .....A4.,(.~,~..~. ~],,VLtflL~ ~g~,./ .................... 9 S~ze of lot' Front ............................................. Rear ..................................... De~ ~ ............................ 10. Date of Purchase ............................................. Name of Farmer Owner ....................................................... , I 1. Zone or use district in which premises ~re situated .... ~.1.~.~t . .~ ............. ~j~ ..................................... 12 Does proposed constructton v~olate on~ zomn~ law, ordinance or regulation' ...[~ .......................................... 13. W,II lot be re~roded ...... ~.~ .............. W, II excess fill be rfimovod *rom premises ( ) Ye, (~ No t4 F~ame of Owner of prem,ses .~.~.O~,.C~<. K~.[~f.~k.~ Address ....... ~.~.¢ ..... ~J.~hon~ No..~..:.~.~... Name of Architect ............................................ Address ................................ Phone No ...................... Nome of Contractor ........................................ Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and red,cate all set-~ck d~mens~ons fron prope~y hnes Gwe street and block number or descnphon according to deed, and show street names and inducer, whether interior or corner lot I'Ii ...................................................................................... being duly sworn, deposes and soys thot he ~s the apphcar (Nome of individual signing contracf) above named. He ~s the ....................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duJy authorized to perform or have performed the smd work and to make end fi th~s apphcation; that all statements contained that the work w~ll be performed ~n the manner set fodh ~n the application filed therewith. Sworn to~ me th,s ........ .... ........ ..................... J~DITH T BOKEN (Signa{dre of applicant) ~ta~ Pubhc, Stole of New No 52-Q3449o3 Su~oJk ~omm~ss*~ E>pires Mt'~q 30, 19~