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Home My WebLink About10410-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificafe Of Occupancy No. Z10227 Date October 29, 19 L~O. THIS CERTIFIES that the building ................................................ 36~ Fequash Avenue~ Cutct~ogue~ New York Location of Property h3&~'~d ....................... County Tax Map No. 1000 Section ...~..0.3 ...... Block ...... 7 ........ Lot ................. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. ~.eJ0.~.~ .~.b.o.~....&~., .... , 19 dated .... .~.e.p. ~ .O~..[.b.~.~...~ .9. t ........ 19.7.9, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for wtfich this certificate is issued is ......... One-F~v~ily Dwelling with &Iterations. The certificate is issued to Robert Kosciusko ..................... .................... of the aforesaid building. Suffolk County Department of Health Approval . .~/.l~. ..................................... UNDERWRITERS CERTIFICATE NO.. 1.(~.97...~6.~ ........................................ Building Inspector Rev 4/79 FOEI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~ / ~ ~.,. ~~. ,Ko~...c., ~, .?.~o , .~...Z~z .......... .~..~ .................................. ..... ~..~z.:c~..~.~...~... ~..~..¢..: ............ ~ .... ~.~.~.~.~.d~:,..~.~...~..~.~ ....... ~....~z~~.....: ............... at premises located at ..~~}}~.~....~.~.., ...... ~.~r~:~:7 ~/ opproved by the Building Inspector. .......................... ~'~;ii ~ng ~n~pector THE NEW YORK BOARD OF FIRE UNDERWRITERS ~1~ BUREAU OF ELECTRICITY I~ e5 JOHN STREET, NEW YORK, NEW YORK 10038 ? o.t~ Oe~o~' .1, 19~) ~-~.o.~o.o,,~ 052923 only the electri~( ~q~ipmgnt ~ des~bed~elo~ ~ i~troduce~o~llean~ ~e~he ~6o~ ~pplic~tio~ n~mber ~n the pr~mlses of inthefollowingloc~tmn~ ~ Bas~,~,~t ~ lst~7. ~ 2~d FL Sectio~O~BIo,'k ? L~~ .~N~SS ~ OVmS rosa WnS.~.S SX,AUSr FIXTURE OUTLETS DRYERS SYSTEMS NO OF FEET OTHER APPARATUS, GENERAl, MANAGER Per Th~s certificate must not be altered ~n uny man~ner; return to the office of th~ Board J in~o~rec~;, Inspectors m~y be identified by thesr credentials. COPY I~OR BUILDING DEPARTM~N?. THIS COPY O/: CE~IIFK:ATE M~T ~N~T BE A[t~D ,IN aNY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 ~. 765~1802 August 11, 1980 Robert Kosciusko P. 0. Box Cutchogue, New York Dear Sir: This is to advise you that the job under Building Permit No. 10410Z issued to R. Kosciusko on ........ Sept. 19, 1979 for alter, porch appears to be completed as of our last inspection. Before you can legally use or occupy this structure a Certificate of Occupancy must be issued. Please fill out the enclosed form and return same to the above office. There is a fee of $5.00 for a Certificate of Occupancy Thank you for your prompt attention. Very truly yours, GEORGE H. FISHER Sr. Building Inspector enol. 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. F~nal survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. ofwater 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: 1. 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 ........ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ,~.".~.~ ............... House No. Street Hamlet Owner or Owners of Property .~,..0..J~.~.-/'4.. County Tax Map ,o. 1000 Section . ./.~.:4 ........ Block... 2 .......... Lot..~'.~...~'. ......... Subdivision ......................./~/~/'/ ....... Filed Map No ........... Lot No .............. - " Permit No./.~.//.~ ,-.~. Date of Perm t ~/.//.~./~:~., .Applicant .~..-~..~ ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...~ .................. Fee,Submitted $ .~.' ~. ~) ....................... Construction on above described building and~oermit meets all applicable codes and regulations. Applicant..~.~./.~, '.~.' .~..~./?~..~.~./..~. ........... ~ ................ BUILDING Dt~PT COPY OF ApPLICAT ON FORM 46;EL. NEW CORK 80~RO (~;F ~tRE UNDerWRITERS F LE THIS COPY WITH BU LDNG D~PT'WHEN RE~UI~E~, ~N~R'S . IS NEW ~ OLD ~ REMODELED ~/ NEW REMOVEP LIST BE~.OWALL EQUIPMENT WHIC~ YOt~ IN~ . CelhA~< W~{{ R~apt:ts Sw,tch Ty~ Each E~ N~ ~ EACH Y ~ ..... 1' , , CHARACTER ; EXPOSED GAS ~b~E SI"~N FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved ~.~. ~..~.., 19-~ ~tmermit No../..~.' .~..//.~.-z~ Disapproved a/c ....................... (Buil/ding Inspector) 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 adjoining premises or public streets or areas, and ~ving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 penmt 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 herem 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 insl2ections. .... ................. (Signature of applicant, or name, if a corporation) · ....... (Mailing address of appTicarit) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· DCg . ' · ................ Name of owner of prem~ses~. ~.0~. ...... · -~.~..~'. ]..~-~. ~.Q · · . ''" (as on the tax roll or latest deed) If apphcant is a corporation, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... [: .............. Plumber's License No...~]~ ..... ./'~. .°.~. .~7 ...... Electrician's License No. ~j.[~.. Other Trade's License No...~. I~t .... .~7- ....... I. Location of land on which proposed work will be done ................................................. ..... ...... ...................... House Number ' ~ ~Street %Hamlet County Tax Map No. 1000 Section ... IO.5 ........... Block ..... .~ ........... Lot...c-~c~ ............. Subdivision .................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .~-43d~ . . .~.e>Et2~ ........................... ~.~ ..... h .............. b. Intended use and occupancy . . . ~-~g~ ...................... 3. Nature of work (check which app icable): New Building .......... Addition .......... Alteration .......... Repair ... ~ ........ Remo, al .............. Demolition ............ Other Work ............... ? p',~i ~' ('.1~ (Description) 4. Estimated Cost . ~ . . ff~.d.P. ......................... Fee . .0, .Q ......................... i / (to be paid on filing this applj):ation) 5. - s m f 1 t nea h floor ~/../[ If dwelling, number of dwelling uhit .,. ~./.~. ........ Nu her o dwe ling uni s o c ·: · · .~ ........... If garage, number of cars ...... i' ' ~//~' '~' ............................................ ' .............. 6, If business, commercial or mixed occupancy, specify nat_ur~ and extent of each type of use .... /,,)/~1~. ..... , ...... 7. Dimensions of, qxisting structuresi if any: Front .... .[. ~ ....... Rear .............. Deptht .~?.. ~. .......... Height '..,;~. P/! ......... Numbe~ of Stories./.~ ............. ...:,., ................. :.~ .~ .......... Dimensions of. s.ar~e structure with~dterations or additions: Front ... ]. ~' .......... Rear .../.~. ............ Depth .... .~.~. .............. Height . ,~ ............ Number of Stories.. ]..'c'd,.< ............. 8. Dimensions of entire new construction: Front ........ : ...... Rear ............... Depth ................ Height ............... Number of Stories ........................................................ 9. Size of lot: Front . .~,~.... .... i ......:,,.~_ Rear ...~...~--. .............. _Depth .c~..~..... .... , ........ 10. Date of Purchase ../~/O~l. t..~..d.t. ].~(oO~. ....... Name of Form ,¢~Owner ~../TI!19~. ~,.~ .~-;t.g..5~:9 ....... 11. 2}one or use district in which premises are situated. ~ot~T(~O .~7~ .... ]1~.~*-). · l . ~. ~.~.£~)../~. ~ ..... 12. Does proposed construction vigl~te any zoning law, ordinance or regulation: ....~/.C), ............ : r~x ........... 13. Will lot be regraded ...... IQ//~. ................. Will excess fill be removed from premises: ~//P'Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name 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 umber or description according to deed, and show street names and indicate whether property lines. Give street and block r interior or corner lot. STATE OF NEW YOlk, COUNTY 07.. ~"~J(~.3tf~-)//q- ..... l'S'S . · · ~ ...... 1 .................... being duly sworn, deposes and says that he is the applicant, (Name of individual signlng contract) above named. He is the .. '~]~Yg-L/~e (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duty authorized to perform or have performed the said work and to make and file this application; that all statements cont~dned 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 before me this ~' N~I'AI~' I~IlBLIO, stats of N~w ~o~ (,~iignal:Ul~ oiapplicant) NO. 52-8125850, Suffolk County Term Expires March 30, 19~