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Home My WebLink About10038-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z95/~2 Date JLule 1 19 .7.9 THIS CERTIFIES that the building ................................................ Location of Property ....553.5. .......... .T.h..e..L.o.~g~.ay. .................. Eas.~. House No, Street Hamlet County Tax Map No, 1000 Section .... ~..0 ......Block ...1 ............ Lot .... ~.~.r~L..o.~..1... Subdivision ..... ~b.~,'L ~. B.e.~c~_ ~;;~'~$ ..... Filed Map No, .6.-,~..Lot No ...... 1l$-~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... V.o.v..o .m.b.o. x7.' .1.7..., 19.7.~. pursuant to which Building Permit No ..... ?.0.0.~.~ .......... dated .... ~qO.V. elllb.e~... ~.~. ........ 19. ~, 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 ......... .Private One Family Dwelling The certificate is issued to Magdalan Levas (owner, ~C~ of the aforesaid building. Suffolk County Department of Health Approval ...... I.~.ay, .7'..'1.9.7...9 .... ~..-5.0.-.~..~.7 .......... Robert UNDERWRITERS CERTIFICATE NO ..... N~3.~.0.98 .................................... Rev 4/79 Building Inspector FOI/~ 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) No. 10038 Z Permission is hereby granted to: ~/'/~/'/~-~ ~Z~c~'~'o,¢~ ~ . ~. ~....~.~.~.~...~. ............... ~..x....~.~.~....~ ...................... .... ~~~...~.,.~: ........ /~.~ to ..~.~...,.~.~ ....................... ,~ ~m~ ,o~,~ ,~ ~<Z~X~....:Z~:......~::::..:~..~..~,...: ........... ................ . ................................... : ................... ,: .................................... ~.~~.~.:y ~:. ~>: ....... ~=~z~ .. m:==:x.. ~x .......... ~ z.~z~-. ................... pursuant to ~pplic~tlon d~teJ ........... ]~.~.,..~.~ .................. lt.~ and ~pproved by the Building Inspector. .... ? 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 Bui)ding 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 res. 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of peoperty showing all 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. 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 .... .~?'~ ./.?_...c~,/,' ./.'./,~. ....... .~. New Building . ...J~,. i ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~. ,~. j~. ~ ...... /.',~Z'..~... House No. ' .......... ~e~ ' ...................... Owner or Ownersof Property /~. '. ~,~,. ~'.. ~. ~'. ......................... County Tax Map No, 1000 Section ............... Block .... ~'. ......... Lot../. ~.~ ....... Subdivision ~ ~Z. ~'~ ~Y. ~J.Map No ............... Lot No ............... Permit No/C: (~ ~. Date of Permit Health Dept. Approval /~ ~. .............. ~..Labor Dept. Approval ........................ Unde~riters Approval ~ ~5~O ~ ~ .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ..... ~. ........... Fee Submitted $..-,.:.: ...................... Construction on above described building and permit meets all applicable cod, es and regul,adg~ns. Applicant ~.~. ~ ....... ,, ? ,THE,NEW YORK BOARD OF FIRE' UNDERWRIT Rg ~ ' ~' ~ ~ :, ':" '.' : .':~,'~ --..L : : .m------,- ,'T''' ~ ' ~ uuI~EAU OF ELECTR C TY r~l i ~, 85 JOHN STREET NEW YORK NEW YORK 10038 ~ !~833 ~,=~ kI~Q~OO - : . ' . ~ ,r , y ~p a edo~ the above apphcat on number ~ ~hepre,~ sos o ~F~il~on~ Levas~n,~ ~on~W~y~Lane,2OO,n/o Strand L~ne,East Ma~ion,L.I q: i :~ . S,ct'on Block ' ' " [[ ~[ ;h a~d~ound to be in compliance with ti e requirements of th s Itoar~ 'FIXYUE ' ' S OVEN5 DISHWASH$g ~XHAUST FAN5 !ii IFURNACE'MOTORS TIME CLOCKS UNII HEATERS SYSTEMS NO. OF fEET OTHER APPARATUS: 1/0 feeders:l-2 #14,1-2 JoSeph"D. Mazzoni 227 Wa~erly Ave, Medford,M.f. ~.!763 #12,1-3 #6 GENERAL MANAGEI L~ e'. ~82 "Per :.~,- This altered ;n any manner: return to' the office of the Board if incorrect.' Insoectors may be identified by their credentials. Memorandum from.... BUILDING INSPECTOR'S OFFICE TOWN OF $OUTHOLD TOWN HALL, SOUTHOI~D, N. Y. 11971 765-1802 TOWN OF SOUTHOLD nFFIE:E OF I::IUILDING INSPE[-~TOR TOWN ~LERK'S I-1FFIBE SOUTHOLD, N. Y. 119'71 TEL, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , 19 Permit No ...................... Disapproved a/c ......................... ; :.:~..~2~ ............................. ..j ............. ........................................................... i~' ..................... 7"'"~"~" ................ (~uil~iing Inspector) APPLICATION FOR BUILDING PERMIT Date ...~....~......~... ........ Z...~.. ......... ,19...~....~... / INSTRUCTIONS o. 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 adjoining premises or public streets of areas, and giving o detailed description of layout ofproperty 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 a 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 o Certificate of Occupancy shall have 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if o corporation) (Address of applicant). State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........~...~.....~...~.....~..~.../~....~../. .......... ...~...~ ..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..../....~....~.../T.~....Z....?...~..~...~.~..~LI/~?~//vd;- ~' /~/~-x~/~ Other Trade's License No ............................................... 1. Location of land on which p~posed work wi~ be dane. Map No.:~.~.~ ........ f ................. Lot No ....... ~.~ ....... Street and Number :~.~.~...~//~...~9.~.~ ...................................... Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........... ~.~..~ ................... ~ ~.~ ........................................................... b. Intended use and occupancy ................. Z..~.~.Z.~ ........ ~...~ ........... 3. Nature of work (check which applicable): New Building ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... 4. Estimated Cost ................................................... Fee ................ ~, ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ...~.....*~...~-'7..-~. ...... Number of dwelling units on each floor ..... C~./J~.....~Z.":.. ........ If garage, number of cars ........ ..'.~.'...~....~....,...~.,..~........(~'....~....~.....~....~...A~, ....................................................................... 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 ................................ Oepth .................... 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 ....... .0(7... ........................ Rear ........ .~...,~t ............ Depth .....:~...,.,/'Z/T.~ ........ ,f Height ....... .~...~....I... Number of Stories ............ ./......,.-~(... ............................................................................................ 9. Size of lot: Front ................... ..-~.....-~.....:. ....................... Rear ............ ................... Depth ..... 10. Date of Purchase ........................................................ Name of Former Owner .....~....~-5---~X,~i..~..~.-~..~.~...~..~..~ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... .~......c).. ..................................... 13. Will lot be regraded . ........................... Will excess fill be removed from premises: (,/): Yes ( ) No 14. Name of Owner of premises~..~.~,f~..~.~...~....~...~...~'.~-.~'. ...... Address ~././.7....~...~.~...'~.,.~/;,.~ Phone"~.~...~.../.~.,~...~..~.~.. Name of Architect ./~...: ..~t:..o,.~'/~'....~..,e. CTh/~.,~h-Z'.0..~....Lff...~h..~f~-~l~kidress ...~.~.r.E.~...~..~C../...~/... Phone No.~.~....3...~.~..~...~ ' Name of Contractor ..C:~...~/,~..~,...~..d(.~....~_ .~..~.. ............. Address ..................... ~.. ....... Phone PLOT DIAGRAM d~ ~ ~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-J~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot. STATE OF NEW~YOI~,I~,, , n/' ~ I S S COUNTY OF ..C~.~....~ ' ~ r/~--¢ 'n ............................. :.~........ ~(,~'.L...~.. ........................................ be, g duly sworn, deposes and says that he is the applicon, (Name of individual signing contract) above named. , .~....~..~ ~ He is the ...............................: ....................................................................................................................... ........ t (Contract6'r, [:gent, 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 aH statements contained in this application are true to thebest of his knowledge and belief; and tk, az the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ......... ....... ........ . Notaw Public, .......~ ............... Coun~ ........................:..~......~...~: ................. X ................................. /- / ~ (Sign~ure of applicant) ~ ~ ~A~ETTE C, COK LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO, HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL ~FOL~O;DEPT. OF HEALTH SERmCES. ~PLtC~NT ~ ~~ SUFF~K. COUNTY ~PT. OF HEAET~ SERVICES -- FOR APPROVAL OF CO~RU~ION ONL~ ~ SUFFOLK CO. TAX MAP ~S.I~NAT.~t'~. ~; : D:ST. · SECT. BLOCK PCL. DEED: L. TEST HOLE STAMP sE~L uc .s o GREEN~RT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. 5'- -'?,-' '. ~ / STATEMENT OF~]'NTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF SUFFOLK CO. DEPT. OF HEALTH SERVICES (si_ APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SER VICES FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF. NO,: APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PC L. ..... :-----]ADDRESS: (".~". z..,, ~ ...~?¢: ,. - .,_~.' DEED: L. TEST HOLE STAMP SEAL iI 7)°0 G '\ ,. APPROVED :AS NOTED ---" ~ NOTIFY BUIEDING-DE~ARTMENT'Af , , . L ~ .... ": ,. 765-~660 9AM lb' 4PM'FO~r EEQU R- " ' k'%'- 0" ? r i / %-'Z.x Io 1 1.1