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Home My WebLink About11415-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No....Z.~.~.~.67 ........ Date Auqust 24 19 83 THIS CERTIFIES that the building . a.e.q~.g~.or.y. ~.~.o.r.~.g.e..~.$ .rig., .................... Location of Property I45 Southern Blvd, East Marion County Tax Map No. 1000 Section 2I ...Block 3 .Lot 26 Subdivision ............. ;~ ................ Filed Map No. x .Lot No. x conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. O~tober..6 ........ 19 8.~. pursuant to which Bhilding Permit No .... .:y .~.47. 5. .Z ........... dated .... .O.q~.o..~??..8. ............. 19 8I..., 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 ......... Accessory storage building. Thc certificate is issued to ALICE DZENKOWSKI ...................... '~:~2ZA'2. '~1 -' J--:. ...................... [owner, ................ of the aforesaid building. Suffolk County Department of Health Approval .................. ~/.R. .................... UNDERWRITERS CERTIFICATE NO .......................... .N/.R. .................... Rev, 1/81 Building Inspector * TOWNOF'~.OUTHOI~,D i! BUILDING TOWN HALL SOUTH'O~D, N~ Y. BUiLDiNG / : : (THIs PERMIT MUST BE KEPT ON THE PAE~iS~S UNTILI ULL C~PLETION OF THE WORK AUTHORIZED~ Per~iasiofl s hereby granted to: ............ ~__. ~__~ .... · ......... ~ ............. ~. ........... ~.... ........ __.. ......__ .......... .... ~ ........... ~ .............................................................. ~ ............. ~r**?*:'~ ............... ~ ........... X; .......................... ~o,~ ,~x ~,~ No. ~o0o ~,o; ;....~.~....... %~ LA~:..,..:ko~ ~o.~.~.~.6 .......... pursuant to ,pphcot,on d,ted .~..~, ....... ,.~.~., ..,?.., 1~'" ond *pprov~ by the · Builalng I.hspector.. ~.{ ~/3oY8o 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 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 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" 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 ! /s-/$5.00 2. Certificate of occupancy on pre-existing dwelling ~r land use $ 3. Copy of certificate of occupancy $1.00 Date . .~-'- . . '.~--U ~_~ )L'~r,? ~ orPre-existingBuilding(~)._..~ .... ~ f~acant Land ] ........... New Building ..... '.- .l, ... Old ,~ %~.~'-Ll-~q ~ ~, ~,~.~t . Location of Property ]..~. ~.-.. . ~ 0.~. ~, ~,4/~'../~ ~.. )- House No. .................... I" 'S'tr'e; [ ................ ' ...... Ham/et Owner or Owners of Property ....... ~) -~'~ /~ o bu-5'~'~ j' ........................................... County Tax Map No. 1000 Section . ,~..?~..I ........ Block . ..~). ~,~ ......... Lot.. ~ ........... Subdivision .......... / ,Filed Map No, / ,Lot No, Permit No.. (( .6(,( .~,~'~,, Date of Permit (4~..°c.T...~,( .Applicant.. g(?.t. , .~,.., .~. ?. ,~.. ,/~/~, .o..c~...~. ,/~../', , , 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~meeSs all app~cable~.ode~ and regulations. Rev. 10-10-78 1000708 THE NEW YORK BOARD OF FIRE UNDERWRITERS [~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..,~ April 11, 1983 A..,icatio. No..n fie 209335-83 N5 9 8 7 0 0 THIS CERTIFIES THAT only the e~ctrlcal equipment ~ described below and int~duced by t~ applicant named on the able application nu tuber in the premises of ~ice Dz~sl : 45 Ro~y PoLn~d~, EaS~ N.Y. was examined on A~ri~ ~ ~ ~98~ and found to be in compliance wi~h the requirements of this Board. FIXTURE OUTLETS SWITCHES FIXTURES RANGES :OOKING DECKS OVENS EXHAUST FANS DRYERS SYSTEMS OTHER APPARATUS: Eleet. ri~ Rocca ~k~aters:6-1.5 K.W. ~ E R V I C t~1.25K.W., OF CC. COND, 1-1.0 K.W., OF HI-LEG 1-.75 K.W.~ NO. OF NEUTRALS OF NEUTRAL Sal Prato Elect. ~ Gr~R?rt, N.Y., 11944 Lic,~1049 This certificate must not be altered in any manner; return to the office of the 8oard if incorrect. Inspectois may be identified cOPY FOI , ~ !HIS COP? OF gER MANNER. FIELD INSPECTION ~ COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: KlM T. DZENKOWSKI HOME IMPROVEMENT 1000 CEDAR DRIVE - EAST MARION, NEW YORK 11939 - PHONE 477-2465 ara FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined O.~...~..? ..... ,19~../. ^ppro,edO. ...... , l&. ermit Disapproved a/c ....-7.~'~ ...... i~Q .......... .'/ (Bnikting Inspector) Application No..z/~./.~..-'~. ...... APPLICATION FOR BUILDING PERMIT Date ...... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 stre* or areas, and giving a detailed descriptiou of layout of property must be drawn ou the diagram which is part of this apt: cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprcval of this application, the Building Inspector will issue a Building Permit to the applicant. Such peru 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS ItEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town ~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and adnfit authorized inspectors on prenfises and in buildings for necessary iuspections. , .......... (Signature of appllcant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, .~.LI ~ D 'zco-'Kc.) .5 14 [ Name of owner of premises .... r__' ~ (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 .... ~;..O..~..,'~.~'../.~ .... .~.o. ~.[~...~.~ ~ ....... House Number ~/d Street Hamlet County Tax Map No. ~ 0O0 Section ~ ~/ Block ~ ,~ Lot... ~.~.~.,. 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 . [ /~,~,44, .~.~ /~e'~/~9~C ~ b. Intended use and occupancy F~...d.~ ~ c~! t; .~.(,-~ O..~. 3. Nature of work (check wbict, applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... .~ 'F' ~ (Description) Estimated Cost .. ~ ~ ~ Fee /~ ' ~ (to be paid on filing this application) ;. If dwelling, nmnber of dwelling units ............... Nutnber of dwelling units on each floor ................ If garage, number of cars ........................................................................ i. If business, commercial or mixed occupancy, specify t~ature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ..... ~ ......... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ............ '/ ......... Number of Stories ...................... t. D nensions of e t re new constnction Front '~ ~e~r ~ / Psonth ~" ! Height .. .~.. .. Number of Stories ~, ....... 1. Szeoflot'Front '~' ' Rear "5~' '2- / De th ~ I! ~ ). Date 6f Purchase ............................. Name of Former Owner ............................. I. Zone or use distr/ct in which premises are situated ................................... : .................. 1. D,oes proposed construction violate any zoning law, ordinance or regnlation: .... . .~..~.. ..................... ~,MIJ lot be regraded ...... · .'~..~. ............... ,.. Will excess fill be removed from premises: Yes ~-. Name of Owner ofpremises :~bl.r.~ 0.2~'~oo~Addr,,,,~ ...... ~-., _ ·~ ,e"-t---~., ~ ,.- .................................. rnone r~ o.,~.r,' ............. Name of Architect ......................... '.. Address ................... Phone No ................ Nam e of Contractor fl//~,... ~.7-,-e'./~./40..ur'.5/~ i .... Address ................... Phone No. q7.7..~..~..~ f,q ..~-'". PLOT DIAGRAM Locate clearly and distinctly all buiklings, whether existing or proposed, and. indicate all set-back dimensions from roperty hnes. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. OUNTY OF .~'q P"~-O ~ - S.S .... 'R"i,,M' '-'' ~'-~'r/.k:~£ -g'/:l .................. being (N"~iie ~t'~ng~a~s~gm ~g contract) >eve named. duly sworn, deposes and says that he is the applicant e is the ............................ i~;~t'r~t'o'rl .~;~t', 'c;;~;;a't; 'o'f~i~';i,'e't~.') ............................ f said owner or owners, snd is duly authorized to perform or have performed the said work and to make and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth h~ the application filed ti~erewith. worn to before me this ..................... ~..day of ..... ~.~ .~. ..... 19 ° t ary P _u blic, c~:r:'-'-~~: ....... Cotrr~ NOTARY PUbLiC, State of New Yo~ ' No, ~2-4524771 ...................... Qualified Jn Suffolk Co~mty (Signature of applicant) Commission Expires triarch 30, 198,~'~