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Home My WebLink About9538-zNO. & TOWN OF $OUTHOLD BUH.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .~..~.L/.~. .... .H. ~.~..L .... ./-.~..a.~ .~-.. Street Map No ..... .~. ~ cl... Block No ........... Lot No ..... !! ?.Z. !?.~. ................... conforms substantially to the Application for Building Permit heretofore fried in this office dated ............. /~/. f.~...'/., 19.7..~. pursuant to which Building Permit No..?.ff..~..~. dated ......... ./~..~.~ ~/, 19.7.~.., was issued, and confor~s to all of the req-i~e- merits of the applicable provisions of the law. The occupancy for which this certificate is (owner, le~le~mld~ ) of the aforesaid building. Suffolk County Department of Health Approval HOUSE NUMBER ~ ~ ~ Street ~ I L Building Inspector (THIS PERMIT MUST BE KEPT ON :THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 9538 Z Permission is hereby granted to: .~ , , ~- Nor. ber..t Mullio & T. .................. J.6 3~,.....Mon.tauk ..~L~ .......... ~p~on Bays Polak at premises located at .tJ/.,.~...~E~],,,,...],~,~/~, ............................................................................................ .......................................... R~¢~i~ ....... N.,Y., ..................................................................................... · ¢ b 19..~.~.., and approved by the pursuant to application dated .......................~,~cz~ ......... - ................ , Building Inspector. Fee $..&Q,~.~. ......... FO~tM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerk~ Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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--tS-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 $1.00 Date .... ,5~. 3,~,/.2.8 ........................... New Building ....x.. .............. Old or Pre-existing Building ............................ Vacant Land ............................ p..e...q ' Location Of Property ~. onzc Owner Or Owners Of Property Norbert Mullio & Theresea Po[ak Subdivision P.~.c...o..m,.~.~....S..h...o..r...e..s.....M..~..p....~,~6.5...4. .......... Lot No...]:.~,.6..-...l~Pock No ............. House No ............. · K' Permit No. ,.9..5..~..8..~ ....... Date Of Permit .,.],~./,./f/.Z..7. Applicant .~.~¢~qjg.¢..~.0.1O.$.~...%'.q.c..~.~..(p.~,..w.g~p..: ...... Health Dept. Approval .... .~. J~/?., ~t.~.~ ...................... Labor Dept. Approval ................................................ Underwriters Approval ~8.,0..5...8.~.-./.~./..~,/..7...8. ............... Planning Board Approval ................... >. ................... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ......... ~ ~" Construction on above described building and permit meets all applicable codes and regulations. Applicant gwynne Construction. Corp. ~ ~ , u~~ /~verett J,~uch~;~resid~t,,- Notary Public ...£q~o,lk ....... .~e... County Notary l: ubhc. 3~4,~Zot New York No. 52 - 461 ~q407 ,%uffolk County Te~m Ex~,~ .s ~4arch ~0, 19 ~ ~D OF FiRE UNDERWRITERS 85 JOHN STREET, NEW YORK. NEW YORK 10038 947176 ~,,. April 3,1978 ~,,,u~.,~,,,,. ...... f.. N THiS CERTIFIES THAT jCapyg.a~.Co~ecr, w/! ~111 Ed. 45'a/o Seco~ Ave. ~ecoate, OD fDU/ ,,,~ ,..~..-,.,~ -- ~ch 30,1978 ,,.,u.,..a ., ~,,* ~. ,',,,.w~.,,~ ,,*"~, ,~ ~ 2 f ~ ~ 2 z4 1 moke de~ec~or 1 JOY glec. Serv. 54 Scratler Dr. Shirley, LI.11967 lie. l12E om~ ~ANAq. U. BUILDING DEPARTMENT' f' TOWN CLERK'S OFFICE ~ ...... :, ~p~ .............................. ~ ......... , ~9 ........ ~e~it ~o ..... & ................. = .I.. ,~ / ~ I. - ~L ' ......................................................................... .......... ~ ....... :~ ~~ ~-~ .......- ~ ~ .~ - /' . ................... ....... ...................._. .............. .~~~'~~~ ~ c XBuilding Ins~tor) ~'~~ ~ ~ ~ -- APPLICATION FOR BUILDING PE~IT~'~ o. ~hi~ ~lic~tion mu*t b~ compl~t~l~ fill~ in b~ ~p~writ~r o~ in i~k o~ ~mitt~ in ~ripli~ to ~h~ Inspector~ with ~ ~t, o{ pl~n~, ~ccurat. pl~ plan ~ ~1~. ~ ~oco~ino to b. Plot plan showin~ I~ti[n of I~t ond o{ buildinos on promises, relotionship to ~jo n oreos, ~ ~Nin~ ~ dotod~ d~ription of I~out o{pr~ must be drown on th* dio~ram which c. Th~ work cowrad by thi~ o~lic~tion m~y n~ ~ commenced b~{ore i~uonce d. ~pon ~pprov~l of this ~pplicofion, th~ Buildin~ Inspector will i~su~ a Buildin~ Permit to th~ ~pplicant. Such p~rmit shall be k~pt on th~ premi~e~ ~v~il~bl~ {or in~p~tion throughout th~ work. e. ~o buildin~ sh~ll be ~cupled or u~ed in whol~ or in pa~ for ~n~ pu~ose whoever until ~ ~e~ific~t~ o{ ~eupancg sholl have been ~ranted by Ih~ Buildln~ In~p~tor. APPklCATIO~ I$ ~[REBY ~D[ to the Buildin0 D~pa~ment {or th~ issuance o{ o 8uildin0 ~rmit pumuont to tho~ ~uild~n~ Zon~ Or~in~nce o{ th~ lown of ~uthold, Suffolk County, ~ew York, ~nd other ~e~u~or~ons, tor th~ constru~ion of buildings, oddifion~ or o t~rat one, or for mmow or d~mofition The opplicont ~Ore~s to compl~ with ~11 applicobl~ I*w~, ordinances, buildinO c~, odmit *uthori~ed in*p~ctom on promise, ~nd in buildln~ {or n~e~ i~fion~. G..w~....n..e Construction Corp."Circa Des£Rns" (Signature of applicant, or name, if a corporation) · .1.6 3A..Montauk. Rw~.,~..,Ham~tn~ ~y.s ................. (Address of applicant) ' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Nome of owner af premises ~Qr~.~.~..Mal~iO.~......Th...e...r..e_s..e...a.....P.p..!.i...k' ........................................................................... If applicant is a corporate, signature of duly authorized officer. ~,~I (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ..... 7. 7.. .0. .-. . .~. ................................ Electrician's License No. Other Trade's License No ............................................... ~l~toiv't~__ .~AIo r'~.c- 1. Location of land on which proposed work will be done. Map No.: ..... ..6.~..~. ........................... Lot Ncr~. ~.6...'.~..~..9.....~.~...0.1. Street and Number ..... t~:J.~l.1..~.oa.d~...]~_oo.~.c..~hoze,s~....s.....S..o.~.~.~ ..................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ve,6a~...l&~, ................................................................................................. b. Intended use and occupancy ..... ¢~¢....¢..a..~.~.].~.....d.~.e...],.1..~.~..g ............................................................................. 3. Nature of work (check which applicable): New Building......x. ............ Addition .................. Alteration ................ Repair .................. Removal .................. Demolition ........ : ........... Other Work ..................................................... (Description) ,tlmated ost ................................... .................................................................... (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 same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....~.9..~. ......................... Rear ..~..9..~ ................... Depth ....~.7..". ............. Height .................... Number of Stories ....... Dll, f~ ....................................................................................................... 9. Size of lot: Front .... 2.C~0...35. ..................................... Rear ..... 116~,93, ...................... 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: ....... ri~ ............................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .[Vtl.Ll-lio..&..~.o-l-ak ................ Addres~)0.],..R0~'.h&t..~JcL~one No ....................... Name of Architect ~..:.E...~..J:..c..k...s..°..~.. ...................................... Address .~......~..o..~.J:..c..~...e..s. ........ Phone No~..7..8..-..?..~...0..7. ...... Name of ContractoPwy~ne Construction Corp , Address .~__~..~..t..o._~....B.~..a.s.... ~- .. 728-9221 ............................................................ I-'rtorle INa ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions fram 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. [.S.S COUNTY OF .&uf.~o.]~k ............. Ev~'rett J. Fuchs be ng duly sworn, deposes and says that he is the applicam (Name of individual signing contract). above named. He is the ...Vice..l~r. eai~eD, t ............................................................................................................................................ (Contractor, agent, corporate officer, etc.) o~ said owner or owners, and is duJy authorized to perform or have performed the said work and to ~ke and ~iJe this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn ~ore me this ~~ ~ ~ ~' ~ P~llc Jn the Stat~ 0f ~ew York No. 52.8996~0 Residing in SuHotk Cmmty .-,'~ OolTImlsslon Expires March 30, AND Op./f~ASE~.NT$ OF I~E. coRD, IF ANY, NOT 'SHOWN ARE NOT //7 //'5 / / / / / / / / / .9 -) 'T ............ = _,=_u~ _ ._I . --m,.h '0