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HomeMy WebLinkAbout10651-z FOAM NO.4 TOWN Of SOUTHOLD BUILDING DEPARTM~NT Office of the Building Inspet;tor Town Hall South old, N.Y. Certificate Of Occupancy Z10604 July 27 81 No.............,." . Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 19 . . . THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 Tuckers Lane, Southold, New York LocatIOn of Property .........,..................................................... House No. Street Hamlet County Tax Map No. 1000 Section .., ~ ~. . . . . . .Block .... ~ ~. . . . . . . . .Lat . . . . ~ . . . . . . . . . .. . Subdivision. . . . . . . , . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. ....... .Lot Na. ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . . A \'!'.i.1. . ~? . . . . . . , 19 . .~~ursuant to which Building Permit Na. .. ~9.6.~~. '? . .. . . . . . . . f'iay 2 J 80 . . dated .......................,.... 19 . . . , was Issued, and conforms ta all of the reqUirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .., . . . . . . "storage Accessory Use" .......... ,. .,. ......... ..,... ,....... -,..,. ......, ......., .......... ... ,....... Stanley and Terase Rakowic~ The certificate is issued to ......................... .~~~fitfY.X' . . . . . . . . . . . . . . . . . . (owner, of the aforesaid building. Suffolk County Departme!1t of Health Approval . . . . . ~/ ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/R UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . . . . .. . L ;);?~) t:7 .---- ---- . \.4',. ':&f , 4~L. . ,..... ....r.... .,'...... .... ...... .., ....,. Building Inspector Rev. 1/81 , ...,! ,iL : . . J FORI\I NO. 2 TO~N OF SOUTH OLD BUILDING DEPARTMENT TO~N CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10651 Z Date ........................7J1atl....::?".,.,......, lli.D Permission is hereby granted to' A k -D,L. . ~..+.......:~....,A:?..c.~1.!,~.e..3 .........'i...!:i..$.......~.~?x.(.k.'9... ..,..edi~~.,.. . ..................~.t:k(r!........../:r..lf.,' . (.'/1 f I to ......?~(:.f.d......~....a(c.A4?f!:1~t....,..(g.~..\f.lid.).... ..&.~~.f..!..~........................".,' " ..............................................................,................................................................................................. at premises located at ,....,.......':I.$.$.........-:/..#..(;JA:\&.....~~.........4u.r.ih:d..,.../:.7.{I. I I' ................................................................................................................................................................ .............................................................................. .................................................................................. pursuant to application dated ...........................~...,...d...t.::.., 19.~ and approved by the Building Inspector. ~. Fee $...!.~.......,....... &~ ~ / /Ir-'f" -:;;f.J.. ~5Y~ /000"'5'1- II-(p ..,...... ........~...............b.1f.;....................... Building Inspector i " . ^ > FORM NO.6 TOWN OF SOUTHOLD Building Department Town Hall Sauthald, 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- tar 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 appraval of Health Dept. of water supply and sewerage disposal-(S-9 farm or equal). 3. Approval of electrical installatian fram 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. B. For existing buildings (prior to April 1957), Non.conforming uses, or buildings and "pre-existing" lang uses: 1'~tccurate ~rvey of peoperty showing all property lines, streets, buildings and unusual natural or pograph IC featu res. 2. Sworn statement of owner or previous owner as to use, accupancy and conditian of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or ather pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate af occupancy $5.00 2. Certificate of occupancy on pre.existing dwelling or land use $5.00 3. Copy of certificate of accupancy $1.00 Date . . . . . tp/;~ Ii. ~ . . . . . . . . . . . . New Building. . . . . . . . . . . . . Old o~xisting BUlld!iiQ\ .. . . . . . . . . .. Vacant Land ............. Lacation of Property . fl~ -:-. . . . . . .7iJ.~hr. . .i..tJ.lIc-. . . . . . . . . ~'!H ~I.;t.. . . . #/:. . . . . . . House No, Street Hamlet Owner ar Owners of Property . .:5tHN./~'I' ~ .ff.J:ff.e.. . . .#,t,(A!/~. ~. . . .. . . . . . .. .. .. . County Tax Map No. 1000 Section .... r::S:f. . . . . .. Block...lI........... Lot.. k.. . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map Na. , . . . . . . . . .Lot No. ............. Permit No.lIl~5i.z.... Date of Permit5/'i?'I'l! . . .Applicant . . . .:5.~)yky . . .~.(:;;Wi~.~. . . Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . Labor Dept. Approval ........................") Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . .Planning Board Approval. . . . . . . . . . . . . . . . . .\4rI~ I J Ro,"," foe T~,"~~ Com""" . . . . .. . . . . . . . . . . . . . . .FI",' C'rtl".." .. . .. ./. . . jf" i.\r~", \0 '7 A ~ ,H ~# Fee Submitted $ . . .. 't!...................... ~ jI !r^ C","".<I", "" .b,," d=elbod 00 ""'9 ~~"~""b", "d,,,,d _'MI"",. I} , ~ Applicant.. ~. ~......................... Rev. 10-10-78 o. j ? ~ _'1 _L..iLI, ::k~. .~l ,J,<< ,0.~, ~;'I- ",'~ l1 fORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. . . . . . .-:11~i.y. . .~19 ,PV Application No. .! 1, f. !t!. . ... . Approved.... .'?!J1.-tt/ !~, 192.D. Permit NO/~ .~~~/ ,?~ Disapproved a/c . . , , . . . 'i' . . . . . . . . , , . . , . . . , , , . ---- ~ ..........'.............'.......::: :;4;,:~: ~~.. :o!~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date. . . ~~. . . . . . , . " 19'5'P. 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 giving 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 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 code, housing code, and regulations, and to ,dmit .,th,,,,,,, m""t,~ ,. p~'" ~d m b"'W,"" "'"'~'.~&~. . . . . . . . . . . . . (Signature of pplicant or ~2tiOn) ..1/.~:;:~ . ~... ... ... .~ .0//.. (Mailing address of applicant) State whether applicant iGW~; lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nom,;' OW;" ;fP;"'~'~.~ ;~~.d:.~~:~) . . . .. . . . . . . .. . .. . . . . . . .. If applieant is a corporation, signature of duly authorized officer. ............................................. . (Name and title 02 officer) Builder's License No. .. .. . .~. , . . . Plumber's License No. ......."...,."... ... . Electrician's License No. ............... . .... . Other Trade's License No. ..................... I. Location~ land on which proposed work~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , . . . . . . Hf:&~?~' &. . , . Str~~t' . ,.. ......... ~j! 'H~;;l~t ... . . . .. . . .. . .. . . . . . . . '. County Tax Map No. 1000 Section ....., -:-fl. . . . . .. Block . . . . . . . . /. ! , . . , . .. Lot....lf?............. Subdivision. . . . . . . . . . , . , . . . . . . , . . , , , . . . : . . . . . . . . Filed Map No. ., . . , . . . .. . . . . Lot,.....,........ (Name) 2, State existing use and occupancy of premis~d intended use and occupancy of proposed construction: .. E."mi, = ~d ,'",,,.'" .. a. . . .~ . . . .. . . . .. . . . ... .. .. . . . . .. . .. . . . .. . .. . b.lntendeduseandoccupancy .~... . ~ ...~..'1-.'~'-?--r .,................ ", _, t i%. " j 3. Nature, of work (check whicp applicable): New Building. '. . . . . . . . . Addition. . .~. .. Alteration .......... Repair .............. Removal . . . . . . . . . . . . .: Demolition .............. Other Work. . . . . . . . . . . . . . . "', ' , ~ (Description) , ~ ~ '/~ ." 4. Estimated Cost.... .t?,O',..;::?:r:......................... Fee.. . J..~............................ (to be paid on filing this application) S. 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 structure's, if any: Front. . . . . . . . . . . . . . . Rear ...'........... Depth.. . . . . . . . . . . . . . ' Height ............... Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I ' Dimensions of same structure with alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . , . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new constt;uction: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth ............... Height ............... Nunjber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size oflot: Front. . . . . . . . . . .:. . . . . . . . . .. Rear..;...... '. . . . . . . . . . . " Depth ...................... 10. Date of Purchase .......... .'.... ..,.,.. ........ .~owner ........... ...... ............ 11 Z d't't' h'h '. ;'t'd'" , . ,one or use IS nc In w IC premises are sltua e .... . ..................................... , ' 12: Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. WiI110t be regraded .........'..'Ie'............... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . -?!. . . . ~ ~~~ .I../.I.C; ~ . Address .. . . . . . . . . . . . . . . . . . Phone No. .7 fR.j-;-..J. 3jcf:. Name of Architect ......... "1' . . . . . . " . . . . ',' . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name ofContnictor . . . . .. . . '," . .. ',' . . '," .." . . Address.. . . . . .. . .. . " ~ .. . . Pl).one No. .. . .. . .. . .... .. PLOT DIAGRAM Locate clearly and distinctly ail' buildings,' whether existing or proposed, and, indicate all 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. (UC(~t::.'R' S t...A '2. j/. '(lc'I\F'To:;1'!9 " ~ , , :H'i ' EX"ST ST\J D S -";:>- 13LD l"aR\<>\J&/l-TfJ) ~ ./)tV F I 13&1<' 6(.1\$$ T<'OOF If WALL> r - GI\'PI\GI{ - 'P1<O?/JSE ~ ..." {'I bDrTI 01'/ ::t-: ._---~ - , L3'+ STATEOFNE~ )( '8 COUNTY OF . . . .. ff'./ . ';R . . . . . . . ~ f?kt:!.Ie.1u . . . . i.. .Ci<.v.'/;! V. W l'tC;;L. being duly sworn, deposes and says that he is the applicant (Name of indivi ual sigl).ing contract) above named. He is the. . . . . . . . . . . . . . . . . . . . .0. .w .N. e..r.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d41y authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applic!jtion are true to the best of his knowledge and belief; and that the work wi1l be performed in the manner set forth in the application filed therewith. Sworn to before me this ; A ' \ ........ ...;(.1]%..... .day~f... " ~~..... .., 198:D N't~ "'~H', pP S,.,., \ II C,"" ~I:ZL' CI~~~' .J-. . ... . 5"(sig~~t~;e'~i:~~~li~~t) , '. tate of New York , , NO, 52-8125850. :Suffolk co"1' d.- , 1 f.,m Expire. Me!1'h 30. 19, ,