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Home My WebLink About9805-zNO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupnncy No... ~.9.}77 .... Date ....J..~.u..a.ry. .... .8. .......... , 19.79. THIS CERTIFIES that the building located at .5. ~./~....~.n.d%..an...N.e.q.k..L..a~l..e. ~ Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~.u~..e. .... Jk. ......, 19.7.8. pursuant to which Building Permit No .... ~805Z dated ..... J.u~e....26 ....... , 19.7.&., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ........... .P~.v.a. ~.e..0.n. ?. ?~ .a~..~.ly..' .D~..e.~..L~. g ............................. The certificate is issued to ........ .D.a.y.t.d..C.~. 9.h..a~.o.¥$,c.z ............................ (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval January 2, 1979 8-SO-67 ....... Rol~ert' ~;' Fi~I~ ........... UNDERWRITERS CERTIFICATE No... P.e~ldLug ................................. 5545 Indian Neck Lane HOUSE NUMBER .............. Street .......................................... Peconic, New York Building Inspector County Tax Map Number 1000-~6-6-I + part of 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) Ne 9805 Z Permission is hereby granted to: ....... ~.~.~,.,..~.47.,~o...*.~,0..~ ............................. to ........ bu.~.l~l,. ~ ..P~-i~age .. One ·.Fami. t~ ..Dwett. X. ng ................................................................ at premises located at ..................... 5~ld,5.....,T.13d,,tarl...~eck. La315....&...1.~...W~d,..Latle ........ ......................................................... ia e~o~ti.o.,...New ...y~ .............................................................. pursuant to application dated ......... J't~l~ ....... .'1]4 ......................... 19...~.8, and approved by the Building Inspector. Fee $...."J32~*.~.5. ...... 1000-86-6-1 & part of 2 H.S. 8-80-67 TOWN OF SOUTHOLD , Building Department Town Clerics Office $outhold, 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 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 installations, 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 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 Bt4 d n ~ A ~ · ' g ................ dd'tion ................ Old or ~'re-existing Building ................ Vacant Land ~ ............. Of Property ................................. . ....L~....:.?.~.?. ...... :~ . -~ Owner Or Owners Of PropertY.J[,)....~..g.'L~.....C...!..c:..,I.,44,,,,, .~'.~.....,°..t,~.:.~.~.../ .........~':3z" ........ : ............................................. Subdivision ................................................................ Lot No.J..~...~.......~l~ck No ............. House No....J.~.~.-~. .................... · ~ ~-..:~.~ ..... pp .............................................. Health Dept. Approval ..~....O. ....... .~..../.~;~'~/.[.'~..:.....Labor Dept. Approval ................................................ Underwriters Approval ........................... P~anning Bo~rd Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certifiaat, .......................................... Fee Submitted $ .................................... Construction on above described buil~r~mit m~)~lf~ codes an.__d~ regulations. Applicant ..~.~.L-~. ~,~,..~m..~~ ............................ Sworn to before me this ~ ~~ ................ day of ............................................ (stomp or seal) ~ ~ TOWN I-IF ~OUTHOLD OF'FlOE OF BUILDINI~ JN.~iPEOTOR TOWN [~LEI~K'B I-IFFIm. E Sl3UTHOLD, N. Y. 119'71 I~O~M NO. 1 TOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... "~e ....... ~ ........... , 19...76 Application No ...... .?..~...0.~ ................. Approved ...... ~Tu33e ....... .~>~ ........... , 19...~'~ Permit No ...... -q~. .................. Disapproved a/c ........................... ..J ............................................................. ...................................................................... ................ (Building Inspector) 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 scheduleJ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property 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 appfication, 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 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 cod~ousing code, and regulations, and to admit authorized inspectors on premises and in~ buildings for nec(e~nspect~6ns. ~x~, ~ /x~ ......... L,4 ........................... corporation) ~m ~ ~ '-~ar~s Roa~, ~.~t¢i~,...~..!l.~5~' ................ Stote whether opplicont is owner, Iosseo, ~ent, orchitect, en~ineer, Oenero~ contractor, electdcion, plumbor or builder. Davzd Oich~owicz Name of owner of premises ...................................... ~ ............. / ........................................................................................ -/0 ~ ~ ... , Ifopplicont isocorporote, signature of duly authorized offic¢ ~ ~~ ~ /~ ~-~ .~ (Name and ti e o corporate o icer) Builder's License No ..................................................... Plumber's License No ................................................. ~j/ ~ (q, c.7 ~' 1. Cocofion o{ lond on which prqposed work will be done~ ~p No.: ........................................ kot ~o...~.~.~ ...... Street ond Number ..... ~.~.~...~.~...~J~.~a...~.~9.~.~a...~.~ ........................................................................ Municip~li~ 2. State existin0 use ~nd occuponcy o{ premises ond in~endod use *nd occuponcy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ ~ · b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building. ........ ~ ...... Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior~ .................... Other Work ................................................ ~... ~ ~ (Description) 4. Estimated Cost ,~.,,5~.-...~..0..,..0..0.,0. ............................. Fee /'~'Z~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....J-.be ................. N mber of dwelling units on each floor ...-6~. ...... .~ .......... If garage, number of cars ..........;~ .............................................................................................................................. 6. If business, cornmercial or mixed accupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Fro~,t ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ............................................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensioas of entire new construction: Front ......... ?~ ...................... Rear .....~.~ .................. Depth ...... ..~. ............. Height ...9_~.! ........... Number of Stories ......... 2 ...................................................................................................... 9. Size of lot: Front ................... .~/~..~.! ............................ P, ear. ............ ~...~. .................... Depth ....... .'1.~ ................ 10. Date of Purchase ....... ~,f).~.2 ........................................ Name of Former Owner "R'J:~'['te.Z'~"'~Z"'O~. ......................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ....... !.~..O. ............................................ 13. Will lot be regraded . ....... .t'~. .............. Will excess fill be removed from premises: ( ) Yes ( ~ No 14. Name of Owner of premises ....D&1r£d....C$~}ta,~l.~w~..o~ ....... Address .....]t~J~.'b~¢.'~e~ ..... Phone No...~.-...L[,~.~.~ Name of Architect ............................................................ Address ................................ Phone No ....................... Name of Contractor ........... ,D~,¥~,d...CJ.~}tazl.~:wJ..¢~. ....... Address .....~a,J;.'l;£.¢.'o,c~, ..... Phone No ..... ~-LI,~.0~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propcrty lines. Give street and block number or description according to deed, and show street names and indicate ~vhether interior or corner Iol. CO~J.e~ ~.J;'J;,~o}tec~ STATE OF NEW YORK. I~ ~ COUNTY OF .~.B,,~.~.O..~ ..............~' :'~ .............. ..D..~.~.Jt..d.....q.~.~....o.W.~..o.~ ........................................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named. Fie is the ....................................... .0.?...~.?.~......0..°...~.~..~..B:..0..¢..9..~. ................................................................................................. (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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before.me this ............... l.¢ day ........................... , Notary Public, . ................................................... County ......... r .............. J'"'i"~' ........ i ....................................................... · ' ~ionatore of applicant) 0