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Home My WebLink About10107-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin, g Inspector Town Hall $outhold, N,Y, Certi{icate Of Occupancy No..7J. 5~.~5.8. ......... Date .. p.qqe..m.b.e.r., .~., ................. ,198..6. THIS CERTIFIES that the building Location of Property 16105 NoW guf£oJ, k .Ave~u,e., l~l[~d~ Ho: ................. : '' ' $~/eet ............. ~l~rn/et County Tax Map No. 1000 Section .. ] .~ .7 ....... Block ....6 ........... Lot .... .2.6.,.. ~'. ...." Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4~.~.~.a.r¥..?.9., ........ , I.9.7.9. pursuant to which Building Pem~it No. ] .0J.0.7. ~ .............. dated . .d.a.n.u.a. ? ¥..}? t .............. 197.9. ., 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 ......... ' ' 'ly d 11' Porch enclosure to ex~.stzng one fam~ we lng The certificate is issued to Robert Sledzieski & Patri¢ia Sledmieski (owner,~or~ ~>~t~t~'): x of the aforesaid buihliug. Suffolk County Department of Health Approval N / Rev. 1/81 Building Inspector FORI~ NO. 2 TOWN aP 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. 10107 Z Permission is hereby granted to: ..4./~.~£.S..~..../~.;......~..u../~ ............... ......4"/.c, ....... ~.~.'~-.,e..~7. ....... 2"~..~-:..L%Z...~..~tU Sk" } .... ~......~.~..~.~..~.. ................ (~.z ....... ...~.......~. ....... ~.~..z~..~..\. ......................... at premises located at ....... /.~.~/.t~.~./~....A4'..~.~.....~./~4.~./¢;~..~./'~..T.....¢11.¢'~:.~; ................................... ................................................... ,¢. .5:. . . . . .~. u uA/ y. ........ .L.A . .¢. .i:-. . ................................................. .................................................................. 4,/.4..~. ...... ~.u.~.~-~..~ ............................................ pursuant to application dated .............................. .~.~.......I.~:..., T~..~ .....and approved by the Building Inspector. Fee $..],.~..~ ..... FORM NO. 6 TOWN OF SOUTHOLD I~uiiding Department Town Hall Southold, N,Y. 13971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~ to the Building Inspec- tor witb the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, st'reets, 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 installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit P~annin9 Board approval of comp{eted site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildin.qs and "pre-existing" land uses: 1. Accurate survey of property showing ail 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 informa- tlon required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4,Vacant Land C.O. $5.00 5. Updated C.Oo $15.00 $15.00 ,, Date .. ~.o.v.? .m.b.e~., .~..,..% .9 ,8.6 ..... New Building f,C~e, rC3.,q,u.s,e..~ Old or Pre-existing Building ............ Vacant Land ............. enclosure of porch) Location of Property ......... ~ .~Uft~, .~,]¢. ~.v.(~D.e. ..... ~V. Suf fplk House No. Street Ham/6't Owner or Owners of Property .... ~.o.b.e.~. ~. County Tax Map No. 1000 Section .... ~.7 ........ Block .. 6 Lot 24 Subdivision ................................. Filed Map No ........... Lot No Permit No..~p.z. qT... Date of Permit .],~/.7.9. .... Applicant .~..o~.e.~..&. Health Dept. Approval ........................ Labor Dept. Approval ....................... Underwriters Approval ........................ Planning Board Approval ..................... tf T por C rtific Fi lC rtifi Reques or em ary e ate ........... na e cate . X Fee Submitted $ ............................. Construction on above described building and permit mee:ts al~ a~pplj~ca~ole codes and regulations. Applicant ........................ Rev. 10-10-78 FORM NO. t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Examined ................ .~ .............. 19..~.~5, pplicotion No..L..~.../.,,~,.Z. ............. Approved .~..¢..~4~- 70, 19f./~.~.~.. Permit No /0/0~ ~ ..... Disapproved a/c .... /.~...............~--"'..~.............~)..................... ................................. ..................................................................... ........................... I .sp":'r" ................................ APPUCAT,ON FOR BUILDING PERM,T Date ......... .......................... 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, re!ationship to adjoining premises or public streets o~ areas, and giving a 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. ..... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber pr builder. Name of owner of premises ..i~ /)('~-P'~... .?~../.'~?~.,:~./'(z) W ~ / If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No..~.'..'.~..'...,.C¢.Z~.' ..................... Location of land on which propo~sed work v~ill be done. Map ~));¢"x'~¢ ............................... L~9t No ......................... Stateexistinguseandoccupancyofpremisesand,~ ~~i2~nd~sedc°nstructi°n: 3. NQture of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair Removal Demolition .................... Other Work '~...~.r~. ~ .................................... ' .............. ii3'~'~Ji~'~i~f ............. 4. Estimated Cost ......... '-~:...~i .~..~. ~ .~..O...~. ..... 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 bxtent of each type of use ............................ 7. Dimensions of existing structures, if any: Fronl ............................ Rear ................................Depth .................... Height ........................ Number of Stories ......... _~...~.,....~..........~...~.~......~.~...z/....~...%~.~.. ...................................... Dimensions of same structure with alterations or add tions: Front .................................... Rear !' ........... . ~'~"~ ........... Depth ................................ Height ............................Number of Stories ....... .~..~...~'.-.C..L/~....--.-....~. ~) )~ '/ 7 8, Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ............................................ ~' ...................................................................... ...... /~d) Rear ./. ~ ...... Depth ........... 9. Size o~ lot: ~rom' . ............. .~ ....... ~ .............................................................. ,. t ._/, 10. Date of Purchase ................. ../././.-.~..~ ...................... Name of Former Owner ,..~. ~/..~,./.. Z~. //'~,c~'.ff /' 11. Zone or use district in which premises are situated ........ .~.4.~..~.;/-~...~,~.' '7~"/-.'~' l ......... f,"~ ...................................... 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 14. Name of Owner of prernises ..../~./.~-.../T.'.,~-,.-..,~.~-..~,-~..~.~.~,.~..~?-"Address .../~..~...1~.....~..~..~. '.~.~. ./. ./(. /~. ./f: Phone No, Name of Architect .............................................................. Address ..,¥...~....~.~.l~...l~l,~hone No ..................... Contractor .~/..-~..~..../H....~..~...~(.::...~(~.~..~..\./_ ........... Address ,~J~.ll.!.~..~f.'J~. Phone No.'.~..~....~..m.6.-.~../.t Nome of PLC~T DIAGRAM Locate c early and distinctly ali buildings whether ex sting or proposed, and indicate all set-back dimens!ons..from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot. L p~rch NEW COUNT~ O~ ................... :.'.: ........ =) , ,, ....... ............................. wor . he '~"'"(N.me of i.d~vid..~ ~ ~o.t~.~t~ able 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 ill. this application; that all statements contained'in t~is application are true to the best of his knowledge and belief; an. a e set forth m th~ a lication filed therewith that the work will be perforated in the m nn r ' .'- PP ' Sworn to before me this No~ar~ V,bl~c, .J/~/.~..Z:~.:.~~.. Co,,~ ............. ~X.Z./.: ...... ;. ...... ?..:.~ .................. // ~, ~,~>Z~ ~ // t~gnature at applicon/ ;'5'q ¢,., E- F, ooF