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Home My WebLink About9569-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...Z8962 .... Date ...... Mar'ch . .22 ........... , 19..7.8 THIS CERTIFIES that the building located at . .6.00. N.o.r~h. ~1~..iy.e. ........ Street Map No... ~.~ ........ Block No ........... Lot No ..... I~i. ~ .N ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. November,. 30 ....... , 19. -77 pursuant to which Building Permit No...956.9Z dated .. November,. 30 ........ , 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~..:~VAT~ .ONE.. F. AM..I~Y.. D..W_~L..L...1'3~. ................................ The certificate is issued to ........ L~..L. oo.n.i.k.q.w.s.k.i. ............................... (owner,:~) of the aforesaid building. Suffolk County Department of Health Approval .......... N/.I~ ...................... UNDERWRITERS CERTIFICATE No .................... N..~7.6.7.2..5 ................. HOUSE NUMBER .... 600 ....... Street ......... .N. qv.?h..D.v.iy.e. ................... ................... Mat~ct~uek, ~ ' ~, .................. ........ ......... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIC:E SOUTHOLI), N. Y. BUILDING PEP~IT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9569 Z Permission is hereby granted to: ............ ~;e.t,~J,t~e,k. ............................................. at premises located at ...~.~.~...i.~...~.....~. ....... .~.~.../b~.~ .................................................................. pu~nt ~ ~li~i~ ~ ~ ~0 19.~.., a~ ~ ~ the B~ ~ing ~tor. FORM NO. $ TOWN OF $OUTHOLD , Building Depu~tment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY IflstreCtions 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 New Building ................ Addition .../~'~ ......... Old or Pre-existing Building ..... ~ ..... Vacant Land .............. Location Of Property .......... .~..~..~,.~..~..C.~...:..~....~....~...~....~ ......................... ~....~'~.~.Li~.(,~. .................. Owner Or Owners Of Property ......... ./,,..,...~,,.g-~...~.,...~...!.../..~....~.....c~...~../,C,,..[ ................................................... Subdivision ............~ ~ ....... ~..C.a...~ ....................... Lot ao. ~..~.~.. mock No ............. House ,o../,..~.. Perm,t,o. ~.~."~..~.'..a.. Date Of Permit .................... App,cant ..... ~..'..~..'..~.~ ............................ Health Dept. Approval ...~..~./~..~;.~..~.~_~, ............. Labor Dept. Approval ................................................ Underwriters Approval ............ J-'.q~....~..~..?...~ ............. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .......................................... Fee Submitted $. ffoO ,.. Construction on above describedApplicantbUilding ...... and p.~rmit~ ~'x~'meets all ,a~le codes and regulations. ................ day of ............................................ Notary Public .................................... County (stamP~.r seal) THE NEW YORK BOARD~ OF FIRE UNDERWRITERS _ BUIr~AU OF ELECTRICITY 85 JOHN STREET. NEW YORI~ NEW YORK 10038 ~-- Nerch I. 197, ~p~.,~.~o.o.~ 955608 N376725 ~IS ~1~ ~T P.Lel~lkovlkl(Lackv~d), Pti.Rd. off aiyvlev Ave(Shore Acres), 2 5 2 :11 I [] 2nd FI. ~tlon Sloe& · ndfound to be in compliance with the requirements of tkls Board. OV~ SIRVIC~ ~ S ! ! v I C ~ I 227 E. Breakvs?Rr Rd. HeTtltuck. N.Y. 11952 Lie, 1529E I! 11~is ceftlfk~te mu~t not to fl~e office of flt~ 1 IUILOIN~ IZIFAITMINT ~OUTHOI~. N,Y. eP, C.o. INSTRUCTIONS ,w.c=ion '" a. 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 accord:ng to schedule. b. Plot plan showing locatiOn of lot and of buildings on premises, relationship to adjo n ng premises or publ c streets or areas, and giving a detailed description of layout~ofl~aperty must be drown on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. , cl.,, U,pon approval of this appl!cation, the Build!ng Inspector will issue a Building Permit to the apPlicant. Such permlt/~Q sna. De Kept on the premises avadable for inspect~m throughout the work. e. No building shall be occupied or used in whole or in part for any pmpase whatever until a Certificate of Occupancy shall have been granted by the Butlding Ir~pect~. ~ .A,P,.PLI ~CATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~u.a~r~.. ~on,e Ordinance of t. he T,o,~.o.f. Southold, Suffolk County, New York, and other applicable Laws', Ordinances or .~gumr,,o. ns, ~or the c.onstruct~on o.~ ou~!dmg~,: ,ac~d, it!ons or a.!terations/or ~or removal' or. demolition, as he_rein described e appucanr agrees 7o comply w~n a, app,came ~ws, oramances, ~ullding code, hoas~ng code, and regulations, and tog admit authorized inspectors on premises and in buildings for necessa.~, inspections. .... . ....................... C~ffgn~re o.~ alSp[ica~t, or/~me, i{ a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .............. ,~....~.... ..................... /Do0 ,--koC_e --~-- ,~' ~ o~7 Electrician's License NO .......... ?......~.... ..................... 'T [~ 9/'~ .,~-~ ,;> , Other Trades License No ............................................... G~,~', ~ ~1~ ' ' Location of land on whi.c,h/j~r~.~d w.o~will,be .done. Map No~~ ......... Lot No].//.~....~.....: ..... Street and Number ../..~.~...~ ................... ~.1~~... ....................................... Municipality State existing use and occupancy of/P/~e.,.m~.~ .an/:j,, intended use and occupancy of proposed construction: a. Exisiting use and occupancy ,...~.i~...'....i ................................................................................. b. ntended use and occupancy........~ .~. ~ , .~,..'.~., ' '- 3. Nature of work (check which applicable): New Building'. ................. Addition ..... .[~.. ......... Alteration .....~.. ......... Repair .................. Removal .................. Demolition:; .................. Other Work ..................................................... , / ~, ~ (Description) 4. Estimated Cost ............................................................ tee ........ .................................................................................. (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 ...~....~.. .......................Rear ......~;...~... .............. Depth .L.~.. ................ Height .................... Number of Stories ....... ~-.....~ .......................................................................................... 9. Size of lot: Froot ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ '~.~" 1:)~. . .... 11. Zone or use district in which premises are situated .......................................................................................... __ 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ...~.....~ ...................................... 13. Will lot be regraded ........ ..~......~.. ......... Will ~ccess fill be removed from_pren3j.~S.: (.) Yes ( ) No 14. Name of Owner of premises~......~......., ~~ddress ..../~.~ ....... Phone No ....................... Name of Architect ............................................................ Address .......... ...~---,.~...,... Phone No ....................... Name of Contractor ..~..C~.....~1~3~:.:~- ........ Address ..~.~.~........~.~,~. Phone No ....................... 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(~O.,P,J~L~, ~J' ~sS COUNW of ....,~/~.~-.~ ~ , ........................... ~.~ ...................... being duly sworn, deposes and says that he is tne applicant (Nam~'d//Jal signing ~ontracf) above named. .....lie ss me .................... ~.o:..~.o: .............. ..-~. ...................................................................................................... ~:;:~...k~ ..... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty 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 that the work will be performed in the manner set forth in the application filed therewith~ Sworn to bef~_r~ me this , .................. mo, ............ ,, zz .... Nora, Public,. ........ ....... ...................... Acres YOUNG' & YOUNG· '.,.'-;':, 400 OSTRANDER AVENUE, RIVERHEADo NEW' YORI( ':" ALDEN W. YOUNG HOWARD W. YOKING ,~_ SURVEY FOR LOIS PATRIClA LESNIKOWSKI LOTS M & N "SHORE ACRES" MATTITUCK. TOWN OF SOUTHOLD SUFF. CO., N.Y. SCALE, I" = 40' -.. NOV. 12, 1968 PROFESSIOfi'~ ENG~'EER AND dAN. 8~ 1973 , '- £.~DSU~VEYOR,NY. SLCNO 284-5 GUAR '~ ~ GHOM E TITLt