HomeMy WebLinkAbout10741-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
THIS CERTIFIES that the building ................................................
Location of Property .. 27.7.~.. S.J..g.~..l~??..R.O..~.~., ....................... .~.~.~..~.~.~.1~.0..~ ......
House No Street Hamlet
County Tax Map No. 1000 Section ............ Block .............. Lot .................
Subdivision, .I~I..8.'1;.'1;.~.~..l:lg.k..P..a.x'.k. ............ Filed Map No..~.0..'1 .... Lot No ...... ~..7 ......
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... ,I...1~..e..~.6. ......... , 19.8.0. pursuant to which Building Permit No...]-.0.7..41.. ~ ............
dated .... ~...1~..e..'].9. ~...~9.~.0. ......... 19... , 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 .........
................. J,n.. p.o.r.c..h ...........................................
The certificate is issued to ...~1.~?.~.~..13..~.°...&.
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .... .~t/R. ..................................
UNDERWRITERS CERTIFICATE NO ............ .I~I/.R. ..................................
Rev 4/79
Building Inspector
FOR~Vl NO. 2
TOWN OF $OUTHOLD
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 ^UTHORIZED)
N? 10741 Z
Permission is hereby granted to:
.~.~.~,..~......./.....L.:...Cc.~..C/.(:/.~ .... ..zy..z UL o
........... ?~.....£.~.Z../.!.~.~/..~..~.~? .......
....................... .~..~....c...~.../.:~.£.!v ...... l.'q.. '~... ........ r o ~o ~
to ...... ~.~. ...... ~¢z..~,~Lf.~.~,/~.bo ...... ~.~z....R~.~,'~..~.. ....... ~4~.~..~..~......!{~..e...°..~. ....... O.b.L......~.7../..~.Z!?.: .~.
at premises located at ............................................................................ : ..............................................
L~U F~ tz- L__
............... }';fTiZU;'i,'"'"f;":T;~7'"'?i'd"~'"'~';"~"~ ~'"~'~'i .......... z;'¥'""~'7 ................................
pursuant to application dated .................................................... , 19 ........ , and approved by the
Building Inspector.
Fee $ ......~...2. ............
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instruotions
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 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.
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 '.~..~.~-.%~q~..?, .6...~..~. ~.~,~
New Building .~...~...L ..... Old or Pre-existing Building ..~/. ......... Vacant Land .............
Location of Property .~Q'- ~-~ ~*-~' .~i~t!~.~/~,.~.~...~',{ r,~..~/(~,,~{,.~..~(~, .~.~r~/~
Ho'u;; '/V'o: ........... $'t~e;; ................. 't
Owner or Owners of Property .~..?.~.C?,~.~.~.\..?~..~.~}.~.J/:~<..~ ~(~.~ ?.~.~.../.(..). ...........
County Tax Map No. 1000 Section ............... Block ............... Lot ................
'~L ~,~'~v,-~ ~L, '~L~L. ~,'~,). .1 .... Lot No.."~ .,~, .......
Subdivision..~'... ~,'/~t. ............ ~ ........ Filed Map No,
Permit No. LO.?.~./~. Date of Permit ~. ~).Applicant . ~.~.~;~,..~/.{.4,~,J().,.
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 applicable codes and regulations
Applicant...~. -~-~b.~.~..~...,~,~( :~,~,~'(~ .~,.~d,.1~. ..................
Rev. 10-10-78
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL,: 765-1803
Examined... !~'f~... f?, 19 .~..~)
^pproved ...
Disapproved a/ ............. .~i~ <,~_.~_. .....
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Application No .................
INSTRUCTIONS
a. This apphcatmn 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 w~ll 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 Bmlding 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 a~plicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in buildings for necessaryj~pections.
..............
(Signature of applicant, or name, if a corporation)
789 PELHAMDALE AVE., PELHAM,NY 10803
(Mailing address of applicant)
State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
OWNER
MARTIN V. & CECILIA ZUZULO
Name of owner of premises ..........................................................................
(as on the tax roll or latest deed)
If applicant is a corporation, 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 ......................
Location of land on which proposed work will be done ...............................................
2375 S1GSBEE ROAD MATTITUCKr N.Y.
House Number Street Hamlet
County Tax Map No. 1000 Section .................. Block .................. Lot ...................
Subd~wsmn .lV~-T.TI ,.UCK .PARK .PRO,R. Et~%,t,ES Filed Map No. 80.1. Lot . 5.7 ............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .T.O..E..N.C.L.O.~.E..E.X..I.ST.I.N..G. ??.T..I.O..~..'[ .T.H..gr.. ~.C.R.E.E..N.E?.-.I.N...P.O.R.C..ff .........
b. Intended use and occupancy ....................................................................
3. Nature .of work (check which applicable): New Building .......... Addition i ......... Alteration ..........
Repair ..............Removal .............. Demolition .............. Other Work$¢RE~J.
i (Description)
~ $15
$1500 ,
4. Estimated Cost ...................................... Fee .....................................
~ (to be paid on filing this application)
5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ...............
If garage, number of cars ...... ! .................................. 't .............................
If business, commercial or ;nixed [occupancy, specify nature and extent of eacg type of use ...................
Dimensions of existing structuresi if any: Front..2.4 '. .......... Rear .../. .......... Depth.
Height .4.'..O~;~..g~OPr*.C~umber of Stories . .(.~ONCRETE, BASE )
Dimensigns of same structure witch alterations or additions: Front ................. Rear .................
Depth ..................... . Height ...................... Number of Stories .....................
-.. 8. Dimensions of entire new construbtion: Front. 2.6. ' ........... Rear ............... Depth . 12.' ...........
Height B.'..q .f;~. h~O.. Number of Stories... (S.¢.l~lq, ~I.C.~Q$ .URn. ~I.~tt. RO.O.P.). ....................
9. Size of lot: Front , .50 ........ ] .......... Rear ...................... Depth ~OO ...................
10. Date of Purchase . .% 9. O J~ ........................ Name of Former Owner ... ,7.a.c,k...Rg~.c.h~ ).~L.e. .........
11..Zone or use. district in whach .... pren3ases are satuated... ' . ,P~. ,8,: ..........' ............................
12. Does proposed construction violatle any zoning law, ordinance or regulation: ........ .bio. ......... ~ ...........
13. Will lot be regraded .......... i ................. Will excess fill be removed from premises: Yes No
14. Name of Owner of premiseslVJ~R[rZM. V,;..& ....... Address , .7,89. Pe.lharad, ale. Phone No.. [ 91.4).. 73.8-.2656
Name of Architect ........ CEC.:ILIA, ZUT, ULO... Address A.v.e, Pell~ara. N.E... Phone No ................
Name of Contractor .......................... Address ................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly all b~ildings, whether existing or proposed, and, indicate all set-back dimensions from
property lin'es, Give street and block nu~ber or description according to deed, and show street names and indicate whether
interior or corner lot.
Interior lot - 2375 .Sigsbee Rd., Mattituck, Map 801 Lot 57
Structure approx 14" set-back
STATE OF NEWI YORK,
COUNTY OF ?..~.fi.T.C.H.$.f~fl.R.... S.S
CECILIA ZUZULO
................................. i ................ being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is thei .......................... ~ ...............................................................
i (Contractor, agent, corporate officer, etc.)
aRl~lld owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
applic'ation; that all statements contained 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
· , June 80
....... day of~..
Notary Pubhc, . ........ ~. ·
' · / tl~,~.,~2~ (Signature of applicant)
I J