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Home My WebLink About10144-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No..Z96~6 .......... Date .............. Augus.t .21 ........ 19.79 THIS CERTIFIES that the building ................................................ Location of Property .. 5~0 ......... .O].Cl. ~.e~.~G. l~,cl, ............... ]~e~G~;~..tgl~l~... ;... House No. Street Hamlet County Tax Map No. 1000 Section ....~.l~ ..... Block .05 ............ Lot..O~{~. ........... Subdivision.. Sa~.~ .Lake .¥~.1~.~ ......... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore ~ed in this office dated · l~ar¢tt 27 .......... ,197.9. pursuant to which Buildin~ Permit No....1.0.'[./~. ~. .......... dated ...... I/all. oh. ~15 ............ 19.7.9, 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 ......... ..... tw~ .car..garage. acaes sony., s:b~uc~;u~.e .................................. The ~ertificate is issued to .......E.. ~, .]Rit.o~h/LVtIR ................................... (ow~r31111[Ima~) of t.~ ~o~said buUding. Suffolk County Depa~hnent of Health Approval ...... }I/R ................................ UNDERWRITERS CERTIFICATE NO ....... 1~I../~6}0 ................................ Building Inspector FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10144 Z Permission is hereby granted to: .... ~....~.~..L:....~:~.~r~.~' ~ '-~" -~ ................ .......... ~Z~.~:~..z~...: .................... ........... C~.c~.~.~.....~.....~.~: ............ ~o ....~.~2:~cz..~ .....:C~.~....~.~.... ~.~¢.~.G ~T.....~.~: ~:~~ ......... ........ ~ .~.~.~ ~ ................................................................................................................ at premises located at ...~ ....................................... ............................. : ..................................................................... Building Inspector. ~ee*...Z..rJ...~ .... ~ . / 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 Building 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: 1, Accurate survey of peoperty 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 informa- tion 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 · Date .~.~..~-,~. Lt.. ?, .:... k/ New Building .... ~ ...... Old or Pre-existing Bui,lding,,...,.., .... ~. )/aca~t/'Land '- Location of Property ................... ~. · L ~.C/,~-~ .~.. ~., f.~. · ·~· ........... I.~.~~/~ Owner or Owners of Property .... ~ ./..I'. '.~... V..~.~..~. r.. ~:..~.~-..~;~.. ........................... Tax Map No, 1000 Sectipn ,, ,~ ,~1/, ./~. ...... Block ...... .~. ...... Lot.. County ........... .............. 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 permit meets all apl~l~able,oo~es and. regulations. Applicant ..... ~ .~. .i~. ./~: ~ . . ,-" ............. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-- 88 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT Edward N, Richards, s/end Rochelle Pl., opp. Of ~lt ~., pff ~ay ~ve.~[ ~ttlt ucc, ~.~. ~[ ~ exami~ on J ~ ~ ~ ~ . ~ (~ 7 ~ a~ fou~ ~ be in ~mpliance with t~ ~uirements of th~ ~. ~ Euland {~leetric Co, P.O. Box 143 ~attltuck, ]~.Y. ]]952 Lic. 2~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors be identified by t cmde~itiols. may . (:OPY ~ ~ ~AILTMIN{. THI{ COPY OF CIRTWIC, ATI ~ NOT Bi ALI~iD IN ANY~ ~ FOB3~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMIENT TOWN GLIERK'$ OFFI¢£ SOUTHOLD, No Y, Examined ........................................ , Approved 19 Permit No. --...,/.. Disapproved o/c ........................................................................ ./ .................. ........................................................................ ...... ................... Date ................................................. 19 ............ 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 az 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 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 Deportment 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 desBribed. The applicant agrees to comply with all applicable laws, ordinances~ bu)lding code, hoping co,de, and regulations, and to admit authorized inspectors on premises and in buildings for ne~sbr¢ i,nspeof~ions. /J ,) J ~ /. , '''' 7' (Address of applicant) State whether~¢pplicant is c~ne ,~,~ssee,--'~gent, architect engineer, general contractor, electrician, plumber or builder. .................................................. .................................................................................. Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title~( ~__~poraE~/oCf~c¢ //~,~? ¢~ Builder's License No ..................................................... ~ ~' Plumber's License No ................................................. Electrician's License No ............................................. Other T~rode's License No ..................... Csx. ............... , Location of land on whi~d..w~..~on~¢~..~ ........................ Street and Number .................................................................................................................................................... Municipality State existing use and occupancy of premises and~ use and occupancy of proposed construction: a. Exisiting use and occupancy ...~~¢...;;.-/,~..~ ....................................¢¢¢. ',,~ /: z~¢ [/~/~'/t ...........~ .......................... b. Intended use and occupancy .........'.'..~...~~..E:.~...~.....~..~,...i.~...~-.....~ ..~..... ............... · 3. Nature of work (check which applicable): New Building....../~% ........ Addition .................. ~lterc~on Repair .................. Removal .................. Demolitior. .................... Other Work ................................................... ~ ~' (Description) / 4. Estimated Cost .~...(.s:.~ ............................................ 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 .................... Neight ........................ 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 ....... ~.~ .................... Rear ......... ~. .............. Depth ........................ Height ,,.,.].~..,J, .... Number of Stories ....... l~:~ ............................................................. ..... 9. Size of Iot:'lFront . ~ ..~ Rear ~ ~ ~ ~0. ~ o~ ~h~ ....~......~.~/ ..... ~..~ ............. ~e of ~o~ O~..~ ...:.,.......: 1 I. Zone or use district in whi~ premises are situated ....... ~ ................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded .....~ ......... Will excess fill be removed from~ises:L ,),,Yes ( ) No 14. NameofOwnerofprem~ses ~.~.. J .~~....Address~~ ............................ one.. .. ~ No ....................... Name of Architect ............................................................ Address ...... ~ ........... ~.. P~one No.~.,...y~ ........ o, .............. ____.___,. PLOT DIAGRAM Locate c~early and d~stinct~y all buildings, whether existing or proposed, and indicate ail set-~k dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate ~hether interior or corner lot. .... ..~~~.~..'. ..................................... being duly sworn, deposes and says that he is the applicon, ~ (Name of individual signing contract) above named. He is the ..... ,...#.-~J~ ............................................................................... (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 .... .~.~... y f ............................ ,~.~. Notary Public, . ......... County .......... .~:~ .: ............................. · ~ /-~ ,~ (Signature of applicant) Yel, ?$4-6782--Residence CHESTER ORLOWSKI CONTRACTOR & BUILDER CUTCHOGUE, NEW YORK 11935 Office--734-6693 APPROVED AS N9TED , ~'~OT~I:Y ~U~L'~!~IG DEPART~EflT AT y63-2~GO ~,"~,,~ ~o 4PM FOR REQUIR. Tel. ?$~-6782--Residence CHESTER ORLOWSKI CONTRACTOR & BUILDER CUTCHOGUE, NEW YORK 11985 Office--784.6693 '%{7.00' T Z ¢- I 1 £ 'ii ~AST Ei~EYAT~ON ~E..CTi¢~N