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Home My WebLink About9055-z FOBM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) No. 9055 Z Date .......................... F~ .......... 2.~ ......... 19..7~... Permission is hereby granted to: /~l.~w..~[u3,.~e~...Ccms.~.....A/C..~c.ha.r.d...~tr~epek & Wife ............ ~..~5./~. ........... ~.~.e,.~,,~.me..e ............. at premises located at .....~.~q1~.....1...8. ....... ~..O..S..~.,,~.O..o..d:...~..s...~. ..................................................................... .................................................. ~9...s..e.~.o...q.¢....D.~. ...... ~.¢.t4,.t.uc~ ....................................................... pursuant to application dated .........................~.~.b.......~.~ ................ 19...~.~..., and approved by the Building Inspector. Fee $..33.~...~.. ......... first floor only 1~0~,~ NO. S TOWN OF $OUTHOLD , Building Depmtment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This oppticotion must be filled in typewriter OR ink, and submitted in DUPLICATE to the Buildlng Inspector with the following; for new buildings or new use: I. Final survey of property with accurate location of oil buildings, property lines, streets, end unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(5-9 form or equal), 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, /vtultiple Residences end similar buildings end installations, o certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit P~anning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April ]957), Non-conforming uses, or buildings end "pre-existing" land uses: ]. Accurate survey.of property showing all property lines, streets, buildings end 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 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 ..... .~.... Additi~n ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... ~.. ....................................................................................................................... Health Dept. Approval ............ ~ ....................... Labor D~pt. Approval ................................................ Underwriters Approval .............................................. ~anning Bo~rd Approval Request For Temporary Certificate ........................................ Fin~ Certificate Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this .Y~// ...... ~ ...... day of ....~...~.~..~.. ........... ../.?.;.~ (stamp or seal) Nota P .....~.~ ........ Co ty ~nly ~ Fldct~cal equipment as descr~bed below and ~gtroduc~ b~ t~ applwant named on the above appl~cat~o~ number ~ ~ prem~es of ~:, ~- ~-~Ric~ard St~zepek~ e~Sid e Rosewood Drive, Rosewood Estates,. ~ Mattituck. h.I. ...... . ........ ~ mtheyollo,v,nglocatmn~ ~ B~e~nt :~.IstFl,~ ~nd ~1.. ~0 side so~t~o. ~to~- rot filS. ~ w~.**~.,.,,,odo. ~AuEust 25 [977 andfoundtobemcomplmncewtththercqu,r,.mentsofthtsBoard ..... FIXTURE, S9~ITCHE~' ~: ' ~,, FIXTURES RANGES I' COOKINGDECKS OVENS OUTLETS gO Lot OBSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS THE WATER SUPPLY AND SE~JAGE DrSPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO ?HE APPLICANT: ___ SUFFOLK COUNTY FOR APPROVAL OF CONST;:UCTION ONLY DATE , ? .~s REF. 'NO. 75~ :~*iL-~/ NQ ?E : · -' MONUMENI' SUOOIVISlON t~4P FILEO IN I'I'~E Ob'F/CE N. DR/V£ $15.19 REVISqON$ YOUNG & YOUN 400 OSTRANDER AVENUE, RIVERHE SURVEY FOR: R/CHARD STRZEPEK LOT NO. 18 . ROSEWOOD ESTATES" MA TTI TUCK TOWN OF SOUTHOLD GUARANTEED TO: $OUrNO£O SAVINGS BANI( 1083 Chief of ~eneral ~erv~ees TITLE~ IVO. 7~'$- 76~42 WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMEN] OF HEALTH SERVICES APPLICANT:__ ADDRESS _ TEL NO TE ~ m -' MONUMENT SUBDIVISION A~4P F/LEO IN rRE O~lC6 ~ ?NE CL~RK oFs~K ~NFY ON JAN, ~, WATER SERVI~E = PBIVAT~ WELL NE&R~T WATER M~IN DP/VE- MA~ 28,1977 JU£y,,~5, 1977 YOUNG & YOUNG 400 OST~ANDER AVENUE, EIVERHEAD, HEW YORK AL. IDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR.'" R/CHARD STRZEPEK 8 PATRICIA STRZEPEK IOT NO. I~ "ROSEWOOD ESTATES" ^T MArT/TUCK su^~^~'r~o SOUTNOLD SAVINGS TOWN OF SOUTHOLD CHICAGO TITLE INSURANCE CO.