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Home My WebLink About10035-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No..Z97~2 .......... Date .... November..'19 ................ 19 '?'9 THIS CERTIFIES that the building ................................................ ,?.~.~O~e~o. .............. S~ll~hoid,. I~...Y.... Location of Property hl . N..SkOm~t.~t .ROg[d ....... Street Ham/et County Tax Map No. 1000 Section ... 0.87. ..... Block ..... .01 ....... Lot ... p.~,..Of..02/4.. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore Fried in this office dated ·., ~O¥Otllhel?. 2./~ .... , 19~.8. pursuant to which Building Permit No ..... 1.00.~5Z .......... dated .~O~ellll~Ol~..2./~ .............. 197.8., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ........ PTiva.t.e. One..Family.. D~.elling.w/a~%ached. Oar. age .................. The certificate is issued to ........ JOSe.~h. ~d .Doro~.hy. t{~baO~, i .................... fowner, ~ of the aforesaid building. Suffolk Coimty Department of Health Approval . .~.'.~. 0r.'l/~!...~t}¥.Ol~b. eU..8.,..197.t:/ ......... UNDERWRITERS CERTIFICATE NO ......... i~/4~ .~ ~.~.~ ................................ Rev 4/79 Building Inspector FORaM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE.KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Building Inspector. Fee $ ,.~d~....~ · .?..?. · · FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 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 featu ms. 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. B. For. existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing alt property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. C. Fees: 1, Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ././~'..~.'..~.~. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ./.?..~d../,~/,,/~.,/'~..g)./~,l.),,~.,,?,~?,~.'.,.~-,~-~O ~ 7~/~0 Z; ~ ..... /.~.:.L~,../,./.~,,/'. · House No. t Street Ham/et Owner or Owners of Property .................................... County Tax Map No. 100~0,Se, ctio~ ................ Block ............... Lot ................ Subdivision, ........................... ,z...,/.._Filed Map No,~. ......... Lqt J~o ........ ~ ..... l' o O. .T / / f Permit No ........... /D/a t/~y~r nl~ .......... Applicant .................................. Health Dept. Approval' ' ' 2_~/~ '~'-"/'~ '~, ....... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary ,~ej;~ifje~te....~ ................. Final Certificate ....................... Fee Submitted $ ""~'"~'~"' ~'~/~) Construction on above described building and p~it meets ~1 app~c~co~s an~regulations, Applicant...~ .... ~ .......... : ............................ ~ Rev, 10-10o78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY F- ~p=il ~.~. 19~9E' ~o,, ST,EET.,EW ¥O,~. ..,. .,,,,,,,c.,,,,. No. o.~,. N 4 3 THIS CERTIFIES THAT ~vasexamlnedon April 23, 1979 andfoundtobelncompllancewiththerequireraentsofthlsEoard. FIXTURE OUTLETS 2.9 IECEPTACLES 37 2 7 FIXTURES DRYERS FURNACE MOTORS FUTURE APFUANC$ F~EDERS AMT. K.W. Oil H.P. GAS H.P. AMT. NO. A.W.G. RANGES ;PECIAL REC'PT 1 30 ICOOmNG DECKS I OVENS I DiS~ WASHERS_ AMT, K, W. AMT. K.W. ~IT. / K. w, TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET SERVICE DISCONNECT I NO. OF I S ~ 200 CB MEIER X w i°~cc#c°N°' ~ocors: l-3/4hp Elec. ~oom heeCe~: 4-20, 2-1.0~ 2-,5, 2 C.~i, 2 smoke de~ec~Ors, 2-4.5kw. hoc wa~er heaters .... OF CC. COND. t-.65KW I C NO. OF Hi-LEG EXHAUST FANS ~MMERS 1/0 Joseph W. Kub~cki This ce.ificat, must not. altered in any COPY FOR BUILDING TOWN I-IF SOUTHnLD OFFIE:E OF' BUILDING INC:PEOTDR TOWN BLERK'=: OFFII2E SOUTHE]LD, N. Y, 11971 TEL. ?65-2660 r2. 100' NEW Y~RK STATE DEPARTMEI~ OF E';VIRO[~AL C~SEKVATION Buildin5 40 State Un~vcraity o! New York ~StertY Broolq, N~w York Mr. Edmund E. Zeneski Bay Avenue , . .; Cntchogue~ NY 119~5 ~ · 11794 April 9, 1976 Re: Petition No. TW- 15276-0149 Your petition for a Tidal wetlands Moratorium Permit has ~ : ' been r~viawed by'.~his office,~ ,-Aa a result~ ~;e hava.detez'mined. : that construction of a one-family dwelling on earner lot' 0fl~( ' ' Noko~s Road,. "~aughing Waters" section, southotd, NY. will have no adverse ~ffec~ upO~ adjacent ~idal.~l~:t~rpBs.: Ail . construction is to be limited ~o wooded area. Cesspools must from line of ~w~ Th~rqfo~,,pursuan~ to S~tion 25-0202 of theEnviro~men~ai "~ ~ ....... c hereby Conse'rvation La%~ an~ 6 ~yC~R~ ~Iaru oo0.3 % )~ you are A copy of ~his d,:tarmina i~n~ mu~ ~e availabl~ at L~ j~b DJL:slm Corps of Engineers, N,;'w York District Louis l'l. Ccmcra ]~OC~%1 TidJl IA;tlands .Permit Administrator Approved ...~.~.. ............ , FOB~ NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Application No. /4~.~4..~.~;~..~... ......... APPLICATION FOR BUILDING PERMIT iNSTRUCTIONS a. This application 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 showing location of lot and of buildings on premises, relationship to adioining premises or public streets or areas, and giving a detailed description of layout ofpraperty must be drawn 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. d. Upon approval of this application, the Building Inspector will issue o Building 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for .removal or demolition, as herein described. The applicant agrees to comply with oll applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections, C/ (Signature of applicant, or name, if a corporation) .... :... (Address of applicant) State whether applicant is o~i~j~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~.~,~,*~.~,,..~,.~.~. ,~...~,,/'~....~,,~4~,,, ,~,,.(.~ .................................................................. 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..~'..~¢~.4~..-. .............................. Other Trade's License No ............................................... 1. Location of land on whLch, prpposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ....}.~..~,.~/'..~..~/~,~./..~...~.P.,"~/~ ......... ..~,~...~/~.Z-.Z~,Z~4~ .~....~...~.~ .~.: ......................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....~'~/~//J/./~....~../~.~,~ ........................................................................................ b. Intended use and occupancy ....... ~..~..5].~p...~..,~..,.~.,,~,. ............................................................................................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~ · ,..~ ~, (Description) 4. Estimated Cost ......~..,.~i.;...' .......................................... Fee ................................................................... (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 ............................ ~ -,?,, ,Nu~-~-ber of Stories ................ , ........ :i ..... 8. Dimensions of entire new construction: Front ...~...{...~'...'...C?.~'Rear .....Z..~.....-..~..~ ..... Depth t Height .................... Number of Stories ..................................................................................................... ; ................ · . 7 /.Z4 9. S~ze of lot. Front ........................... ~...., ....................... Rear ................................ :~v ..... De,.~th ..'~.......~.. ........... !.....~ 10. Date of Purchase",.....-:..../..././'f~..~....~.~-:./..:./..~... ............... Name of Former Owner 11. Zone or use district in which premises are situated ................ .*.~t~...~ .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ./~...~.. .......................................... 13. Will lot be regraded ..... ~..?. .............. Will excess fill be removed from premises: ( ) Yes (~ No · ~J,,~ ~, r,' -j~ /~'~ .... " ...................... 14. Name of Owner of prem,ses ................. ~ ................................ Address ~:,.~/.../.~....~.~.~..~.:...~.... Phone ~o. .......... ~..?~c - ~4 ~ . Nome of Architect ...... : ............. ~.~...~.....: ............ Address ................................ Phone No ....................... Name of Contractor ............................................................ 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 Nb-NV YORK, .¢ ~ ¢ 5 COUNTY OF .......... '.~:./ ........ ............................................ ; ....................... ~.. ........................ being duly sworn, deposes and says that he is the applicant (Name of individual signing controc~) above named. He is the ................................................................. ~ ................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained Jn this application are true to the best of his knowledge and belief; and that the w0r, k v~ill be performed in the manner set forth in the 'application filed therewith. Sworn to be'fore me this ........................ day of ............................................ , 19 ........ Notary Public, . ................................................... County (Signature of applicant) JO ,S EPh.I ,/ - · 7 , I:7 - ,t !1 '-o" _.0%1o :1 --11'-0 -- 14L 4"- ]0~~ "1 APPROV/E,D AS NOTED NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM to 4PM FOR REQUIR. 1. BEFORE BACFF[LLJNG FOUNDA- OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTION MUST MEET ~EQUIREMENTS OF N.Y. STATE CODE AND TOWN HOUSING CODE & ZONING / /-£6 '- o',' T