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Home My WebLink About9345-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z15938 Date July 10, 1987 THIS CERTIFIES that the building A c c e s s o r y Location of Property ..... 3./,. 5. .7.0..~ .i .d.d.l.e., .R.o.a.d....C.r.y.. ~.d..2. .7.. i~e..c .o.n.i.c. .............. House No. Street Hamlet County Tax Map No. 1000 Section ....7.5 ....... Block 1 .Lot 1 . 2 Subdivision ............................... Filed Map No ...... ~..Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated J u ne..3. O ,.. I. 9. .77 ........ pursuant to which Bmlding Permit No...9 .3.4.5. Z. .............. dated ...J.u.n.e...3.0.,.. J .9.7.7. .......... was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this cert!ficate is ~ssued is ......... .... ~.V.o..c.a..r..a.c.q e..s.s o.r.y...g.a.r. ? g.e.. ............................................... The certificate is issued to John L. Bednoski of the aforesaid building. Suffolk County Department of Health Approval ..... .Iq/A ................................. UNDERWRITERS CERTIFICATE NO ............. ?./.A. ................................ PLUMBERS CERTIFICATION DATED: N/A .................... Build~hg Inspector TOWN OF SOUTHOI-D BUILDING DEPARTMENT TO~VN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT '(THIS PERMIT'MUST BE KEPT ON THE PI~EMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 9345 Z P-ermission is hereby granted to: ~..e~,~..~.~ ~.~...~...~...tt.,. ............................... ........ , ~ ~, \-~'' ~ r/~.--~ : - ~ ~' - ~_~ ~.~, ,~ . , ,~,.~ ~.': .......... : ............. '. .................................... [,~__,:~_ .-- ~ j~rem]ses Ioc6ted ot .... :i~ ~/~.~.....t.~.~,..~.~.. ....... ~ ................................................................. ,~_~.~_ ~,~ c~':~:{ ...... L.~::.Z..:L.Lr~.~,~ ......................................................................................... ..... ~,.~;. ~.~ ....... ~,,.~ .............................. .~ , , , dated ..................... :....~'.,-,,,-~-,--~. ............. , 19..~.~,., and approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCL Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 installa- tions, 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. Bo For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or prewous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety inspection of buddings or premises~ or other pertinent informa- tion reqmred to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certlf~cateofoccupancyonpre-ex~stmgdwelhng/ landuse--?re-EXzstzng C.O. $15.O0 3. Copy of certificate of occupancy $1 .O0 Yacanlt laod C.O. $ 5.00 Date ................ ¢ New Building . . . ~'. ...... Old or Pre-existing Building ............ Vlacant Land Locat,on of Property ~.-J O~___ %~0~[ ~L~,__. '#o ..... "__. .............. .' "k;r;;; V -" 'It5 ................ Owner or Owners of Property .... : ~ .1.._., ~.._ .... ~. . ,,.~ ....................... /. County Tax Map No. 1000 Section ..... . ,/.~., ..... Block ...... ~. ......... Lot Subdw~s~on ............................... Fded Map No ........... Lot No .............. Perm,tNo..~.'~..~..~.. Date of Perm,t ~/.~o.O/.~.¢.Apphcant ..... ~'~... '7(...~..~...r~.u..'~...C'7 ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ....................... Planmng Board Approval ...................... Request for Temporary Certificate ..................... F mai Certificate .X~/ .................... Fee Submitted $..I.O...00 .................... Construction on above described building and permit meets all apphcable coders and regulations. Applicant .... ~k.~. .... ?/, o/, 7 0 :z / NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE . SOUTHOLD, N. Y. · ...... 97Z ............................. Examined ............. Application No. ~.p c/.~ -- ..... ~proved ~ . 19~.Z. Permit No. (Building Insp~tor) APPLICATION FOR BUILOlNG PERMIT I NSTRU~IONS a This application must be completely filled in by ~pewriter o¢ in ink and sqbmiHed in triplicate to the Buildir Inspector, with 3 sets of plans, accurate pl~ plan to ~ale, Fee according to schedule, b. Plot plan showing location of lot and of buddings on premises, relationship to 6djoining premises or public streets areas, and giving a detail~ description of la,ut ofprope~ must be drawn on the diagram which is pa~ of this applicatio, c. The work covered by this application may not be commenc~ before issuancelof Building Permit. d. Upon approval of this application, the Building Inspector will issue a Buildmgi, Permit to the applicant. Such perm shall be kept on the premises available for inspection through~t the work. e. No building shall be ~cupied or used in whole or in pa~ for any pu~ose what~ver until a Ce~ificate of ~cupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY ~DE to the Building Department for ~e issuance &f a Building Permit pursuant to tk Building Zone Ordinance of the Town of Southold, Suffolk County, New York, andJother applicable Laws, Ordinances Regulations, for the constru~ion of buildings, additions or alterahons, or for ~moval or demolition, as herein describe, Z he applicant agrees to comply with all applicable laws, ordinan~s, building c~e, ~ousing code, and regulations, and admit authorized inspecto~ on premises and in buildings for n~essa~ in~ections.~ , ......... p.. ~ ~...t.~.J ...... ~~...~ ......... ....... ('Address of applicant) t State whether applicant is owner, lessee, agent, architect, engineer, general con factor, electncian, plumber or builde Name of owner of premises ...~.6/3~. ..... ~ ...... ~....~...~....,~...~..~...~.../:..t..,~/.'~.(.~.: ........... J ........... If applicant is a corporate, signature of duly authorized officer. .~ (Name and title of corporate officer) Builder's License No .......... ~ ............... Plumber's License No ................................................. Electrician's License No ............................................. work will be done. Mop No ...................................... Lot No .................... ..... ................... k4GXiSi ;iiO ...... ~f premi~ and intended use and occupan6y of proposed construction: ..~...=...~z~. ....... ~.~..~.~. ...... I 3. Nature of work (check which applicable) New BuCdrng .... ~ .... Addition ............... Alteration ........... Repair ............... Removal ................ Demolmor~ ............. Other Work ............................................. (Description)" 4. Est, mated Cos{l~.~.f~...~....~.. ................................. Fee Z4 ................................................................... (to be pa~d on filing th~s application) 5 If dwelhng0 number of dwelhng umts ................ Numbcr of dwelling umts on each floor ...................... If garage, number of cars ..;:3~ ................... 6 If business, commercial or m~xed occupancy, spec,fy nature and extent of each type of use ....................... 7 Dimensions of ex~shng structures, if any Front .......................... Rear ................................Depth ................. Hmght ....................... Number of Stones .......................................................................................................... D~mens~ons of same structure w~th alterahons or addmons' Front ................................... Rear ....................... Depth ............................ Hmght ... Number of Stories ........................ 8 D~mens~ons of enhre new construchon' Front ...~'~.~.~ ....................... Rear ..... ~/.~. ..............Depth ..~q~:~X ..... t-le,ght ...~ ~...? ........ Nu~ber~,,~, ~.Pf ~Sto'r,es .... [I. ........ . !; .............. : ...... :.~ .... ~;.....,~, ................ : .................... S~ze~ 9 of lot Front ..... ,---'/'~"~(3,~'4~' ..... Re ............ ar ......... /..~..~.~.,(~ ._. ....... Depth ........ 10 Date of Purchase ............. -.~f./~, ...................... Name of Former Owner .~f~.~:.¢4)~:~..:~.~5. ...... .~'. -~,~ ....... 11 Zone or use district m which premises are s~tuated .............................................................................. 12 Does proposed construchon wolate any zoning law, ordinance or regulahon ...................................................... 13 W~II lot be regraded ....... ~b~.~. ........ Wdl excess fill be removed from prem!ses: ( ) Yes V) No 14. Name of Owner of premises~.~.~./, ..~.~.O..q..~..~i.~.~'z~... Address~z'~.~y,.~.~.~.,~./Phone ... i ................... A" ~ C¢ ,~c, r,.y Name of Architect aaress ............... ~ ................ Phone No ...................... Contractor ;~"~k.~...k :T~e~l~$ k~ ~.-?. Address ...... .~,,~/~.m.l~ ........ Phone No ...................... Nome of PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~st~ng or proposed, and mdmate all set-back d~mens~ons fron property hnes Gwe street and block number or descr~phon according to deed, and show street names and indicaf= whether interior or corner lot being duly sworn, deposes and says th<~t he ~s the apphcar STATE OF NEW YORK, 1 c S COUNTY OFk_~.~/, ,.:..~,~..¢; ......... f~ , .......... ........ ........ ............ (Name of mdwidual signing contracf) above named He is the .............................. .~...~.&,~ ................................. ~ .................................................... (Contractor, agent, corporate officer, otc ) J of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and f~[ th;s apphcahon, that all statements contained ~n thCs apphcchon are true to the ~est of his knowledge and behef; an that the work will be performed m the manner set foffh m the apphcat~on filed there, ,ith Sworn to ~ me th,s ~ f ....... ........ ¢ Nota~ Publ~~/~. ............ ~ .....,~~...v ' -' ? O~ ~ (~ tT ~omtsstOn ~ Il. D. R~F. ~ The sewage disposal and water supply facilities for this location have been inspected by this department ~d feund 'Sum co. ~^,_'m PC. &7£E T Y z ~5. to ONAU~HORIZD ALT[iRAT1ON TO THIS SURVEY IS A P~