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Home My WebLink About10045-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Date August 30 79 THIS CERTIFIES that the building ................................................ 1905 Bay Shore Road .Gre.en~or.t Location of Property ~/~s~ Ho ............................................. · ~treet Hamle~ County Tax Map No. 1000 Section .... 53 .Block Oh .Lot 09 .. Subdivision .P.e.c.o..n.Y.c..~..ay..E.s.~..a~.e.~. ........ Filed Map No ..... 3~..Lot No. *. ~..o./~ .30 .... conforms substantially to the Application for Building Permit heretofore filed in this office dated November 29 ,19 .7.8. pursuant to which Building Permit No. 100/~5 dated . ,D.e..c.e.m,b.e..r..1 ............... 19'~.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 ......... Addition to Prlv. ate One Family Dwelling The cer~ficate is ~sued to Mr. and Mrs. S. Mutkoski (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval .......................................... / Building Inspector FOt~i~ NO. ~ 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) Ne 10045 Z Permission is hereby granted to: J~. ~' /~, ~/.L//~ ~-.4,/~/~./.,,~.~/,./~./~/.~ ..~......~......~.~o~./ ....................... ~o ....~.~.~.c/.....~/~/.z./~zw....~......~Z~.....~.~...~.~ .~. / ..~./.Zz~ ............................................................................................................................... ~ ...... ~.. z~Y~ ............ .~..~.~/...g~.~. pursu~n~ fo ~pplic~tio, d~fed ............ ~.~...~.~ ...................... ~ 19F~., and cpproved 5y Building Inspector. FOP~M NO. $ TOWH OF SOUTHOLD , B. ildlng Depmtment Town Clerks Office 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 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 disposol--(S-g 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, o 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 BLlilding ................ Addition ....!~r. ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ¢. .C! n~, Owner Or ~ners Of Prope~y ...,~ ............. /;~.~2.~.C:~.~l ........................................................ Subdlws~on ...~ ................... : ........ ~, ............... ~... ......... Lot No...~..j... Bilk No ............. House No ............. Permit No..~,~.~.~..~te Of Permit Health Dept. Approwl ............................................ L~bor ~pt. Approwl ................................................ Uode~riter~ Approval ...... .~ ..................................... Planning B~rd Approwl ........................................ R~que~t For Tempor~ C~ific~t~ ........................................ Fin~ Certificate ..... ,~';~'~'. ....................... Fee Submitted $ ...... .................. Construction on above described building and permit meets oil appli,cable codes end regulations. Applican ................................................ Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 3S JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT S~dney ~u~koski,~ Ke~in Blvd. ,Oree~por~,L.Z. in the following ~atlon; ~ B~e~nt ~ 1st FI. ~ 2nd FL ~tion B~k ~exami~on ~e~U~y ~ ~70 a~f°u~beln~mpliancewlththerequi~nts°fth~rd: FXTURE / I [ RXTURE$ RAN~S ~I~D~KS OVENS DI~W~ ~HAUST FANS ~T~ ~TA~S SWIT~ES I~AN~ FLUENT ~ ~T. K.W. ~T. ~. W, ~T. K.W. ~T, K.W. ~T. H.P. SERV~S ~NN~T NO ~ S E R V I C E OTHER AflPARATU$: 1-~.F.I. ~-Smoke Detector Paul Burns ., ' Town Harbor Lane ~ ./ Southo]d,~.'f. ] 1'~71 ea~a~ Lic. 282 Per Il "' '~' certificate m~? not be aher~ in ~.y m~nerr re~rn ~ ~he ~l~e o{ the ~r8 i{ lm~rre~, lm~or~ ~ ~ lSe~l~ b~ their FO~ NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Exam,ned ................. · App,,cat o .... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS, 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 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 a detailed description of layout of property must be drawn on the diagram which is port 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 a 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 $outhold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or aJterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. ~aaress or appucanrJ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ............................................................................................. Name of owner of premises ,,.,.,;.~ ........ ~,,,¢,,~, ......... ,~?,~ ......... ,&;¢.,,L,L,5,',L,,,.~.,,. ............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate~f~ficer) Builder's License No ..................................................... Electrician's License Other Trode's License No ............................................... / ; ~ ~ , Location of land on which proposed work will be done. Map No.: ........ /.......~....~.. ................ .Lot No,,~..L....~...,~t...,~b Street and Number .... /..:.:.~.,,:.t,., ........ ..e::.*L*/.:u.'. .......................................................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisitlng use and occupancy ................. ~/~`~;~~/~/~4~(~4~z~/~x~/~/~/~ b. Intended use and occupancy ................ /./4,,.~-.:~(L~ ........ ~.-~:~-...-...~..~-.-.~.../.. ...J~......./.~.... /Z..:. .: ...... 3. Nature of work (check which applicable): New Building .................. Addition l/ Alteration Repair .................. Removal .................. Demolition .................... Other Work .................................................... ~. c_~,~,/,~( 6/2/* t (Description) ' 4. Estimated Cost ...... ~.~.P..~.4~......; .................. · .............. 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 ......,,~...O. ....... Height .......~..../. ............ Number of Stories ..............~ ............................................................................................... Dimensions of same structure with alterations or additions: Front ........ ~ .................... Rear ...... ,.~.....?. ............. Depth .........~....L ................ Height ........... ~ ........... Number of Stories ....... ../. ...................... ............ 8. Dimensions of entire new construction: Front d~..x~'.. ..................... Rear ....... .~. ................. Depth ........................ Height ~ Number of Stories '/ ............... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ ~,rn~,~,~.m,er ~Dwner ........................................................ 11. Zone or use district in which premises are situated ....:...u~.~~ ............ ~~ ......................... 12. Does proposed construction violate~aff~ zoning law, ordinance or regulation: '~..'?..;Y. ................................................ 13. Will lot be regraded ...~//~ ...... Will exc,e, ss fill be rem,oved from premises: (~') Yes ( ) No 14. Name of Owner of prem~es~..' ....... ~/~.¢...s..~.! ................... Address ...~..../'¢..'~...'~....'~'.~...~....;/"Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .~.~.~.....?..~.R,,~....~.......'~..~..~..~¢..¥..'tr....~C~....~..~'Address ~....~..~.?..~.z~..g..~..~.'~.. ..... I~hone' o.2'~''~-~ ¢4.')IN ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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. (Name of individual signing contract) 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 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 be~F~j:'e rpr~is Not , .................................................... ~ ¢~MELA I. ~QH~Ut[R ~ ~ I (Signature of applicant) V~.-~IT-~G p~.W,S OW ANY KIND 3. ES~O~E CO -. - 4. E,,~AL EOR DESIGN -, NOT ~ESPONSt~EN ERRORS $, ALE ¢ONST~UCTION ~uST REQUIrEMENtS OE N.Y. sTATE cODE AND TOWN ~OUSiNG CODE & ZONING Il'--&" ,,, 'Z,- O x3-a