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Home My WebLink About11440-zFORM NO. 4 TOWN OF 50UTHOLD BUILDING D EPAR. TMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..~J 9 .~.5 ......... Date ........ .g..u, gg.8~..2.9 .............. 1 THIS CERTIFIES that the building .... ~.,~.O.~.~g.l~ ................................. Location of Property .. ~.O. Q0. Q.e. da~7. ~.~i¥~ .................. ~.g~'¢. ~a.~igT~ .......... House No. Street Hamlet County Tax Map No. 1000 Section . .. 022 ..... Block ..... .Off. ....... Lot ..... .0fi.~... Subdivision..~q~.±e~r..t?al~k .............. Filed Map No..65~9...Lot No ...... ~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Oct~.laar. 6 ........ 19E[q. pursuant to which Building Permit No..J .q .~.Q~ ............. dated ... Dc~okex. 2~3 ............. 19 .~q, 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 ......... ...... g~ .~¢ce~s~rF storage b.uilding ........................... The certificate is issued to K~3v~ T. ..................... /oWn'e;, 'l~s~e'~r 't~a'n't} ...................... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO ................................................. Building Inspector Rev. 1/81 FORM TOWN ~0£: B U I LDI N~ DI~PX TOWN SOUTH'OLD, N~ Y. ~ pursuant· tp; application dated Bfiildlng I~spector. BUILDING PERMIT (THIS PERMIT MUST KEPT ON 'i~H,E PRE~IS~S UNTIL !:~ULL COMPLETION OF THE WORK AUTHORIZED) 111440 Z Date :. Permissior is hereby granted to:. ~ ' ~ '~! and ~pproved by the FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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. For existing buildings (prior to April 19574 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 c'~ndition 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 o~ land 3. Copy of certificate of occupancy $1,00 / use ~;/5/$5.00 Date ....2~..~U, .G..8.~. ............ New Building .... .~. ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property 1000 (~e~a~ House No. Street Hem/et Owner or Owners of Property ~:J,~ ~2, D~,enkowek& County Tax Map No. 1000 Section Aquaview Park Subdivision ...... ( ........................... Filed Map No, ,~', .~..~..~.. ,Lot No .... ~ ....... Permit No. ,1,1,~, ,4,0, , ,, Date of Permit , ,1,0,/, .2,8/,8./~pplicant ..... ,t[,l,~, ,~,;, ,~,~,e,~.l~,o,w. ,~,i, ........ Health Dept. Approval .... ,~./..~ ................ Labor Dept. Approval .... ,~',/. ,~ ................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~..~ ................ Fee Submitted $...S...99 ...................... Construction on above described building and permit ~ts all applicable codes and regulations. Applicant..~1¢k% ...... .~,..~.¢~,~ .................... Rev, 10-10-78 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ ·/.o.o.o....C.~,,~.. Z,)~.. ....... PLEASE TAKE NOTICE that your application dated ... Q~f~../~.~. · .~. ...... 19 ~..~.. for pe~it to construct ...... ~->~... ~(.~.~. ................ at ~o~,~o~ o~o~e~,~.../~ ........ C~-~...~.. ....... ~.~ ~~ ~ ~. House No. Street County Tax Map No. 1000 Section . .~ .~.~ ..... Block .... Q/ ...... Lot .~/.~ ....... Subdivisio~~.~. Filed Map No...~ ....... Lot No. ~ is returned/herewith and dis~proved on the follow~g grounds. ~~...~ ...... .... ~/~...~ ....~~... ~~.. :.. :.. ~... ~.. Bu/Iding Inspector RV 1/80 KlM T. DZENKOWSKI HOME IMPROVEMENT 1000 CEDAR DRIVE. EAST MARION, NEW YORK 11939. PHONE 477.2465 /( Con. C, THE NEW YORK BOARD OF FIRE UNDERWRITERS 1.~ BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORtK, NEW CORK 10038 THIS CERTIFIES THAT only tile electrical equipment as described beJo~v and introduced by the applicant ~amd on the above application ~umber in the premises of ~c3~n T. Oze~ow~ki, i000 Cedar Or., East Marion, L~.Y. ~ the/otlo~i,~ ~o~tlo,~; [] ~eme,~t [] ~t rt. [] ~,,d ri. Gara$~ se~tlo,~ ~loc~ rot ,~a~ ~;~,,,,i,,ed o, Aug~os~ 1~, 1983 and found to be in compllaace with the r~qulrements of t&i$ Board. FIXTURE OUTLETS DRYERS FIXTURE~ RANGES COOKINGDECKS OVENS DISH WASHERS EXHAUST FANS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I C A W.G. NO.O$¢ HI-tEG A W G NO OF NEUTRALS A.W g PER ~' OF CC. COND* OF HI-LEG OF NEUTRAL 1 4 1 4 ~im T. Oz~owski 1000 Cedar Dr. ~ast b&~rion~ N.Y., 11939 GENERAl. This certificate must not be altered in any manner; return to the office of the Board if incorrect. Im may be identified coPY FOR aU LOING DEPARTMENt TH s Copy oe cEry F c~t~ M~a]~ N~v~E asTe~Ep n a~¥ manner FIELD INSPECTION FOUNDATIOU (1st) FOUI]DATION (2nd) 2 o ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL COMMEIJTS · ' ADDITIOHAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a[c ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT Ap plication No..ff./. ~..~.O. ....... d, OcT- Date ........ , INSTRUCTIONS a. This application must be completely filled in'by typewriter or in ink and submitted in triplicate to the Buildi Inspector, witb 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 description of layout of property must be drawn on the diagram which is part of this apl: cation. c. The work covered by this application may uot be commenced before issuance of Building Permit. d. Upon apprcTaI of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern 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 HEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to t Building Zone Ordinance of the Town bf Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the coustruction of buildings, additions or alterations, or for removal or demolition, as herein describe Tl~.e applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and admit authorized iuspectors on premises and in buildings for necessary inspections. . ................ ~ ' ' (Signature of app"licant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Nmneofownerofprcmises.............S''~-'4a .... ~-~ ..................................................... .. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly artthorized officer. (Name and title of corporate officer) Builder's License No .... l .~/.L./ .................. Plumber's License No ......................... Electricia ~ s License No.' ...................... Other Trade's License No. I. Location of land on which proposed work will be done...t.O..O..O ..... .c'-.~./.)..~. .... ./9./.~ ................... House Number Street Hamlet County Tax Map No. 10O0 Section t~,~ Block d / Lot .~./.,~. Subdivision ?~.O, ~...~. L/~'b~t.~ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... [ ......~.,~.."9 ././r...~. ...... fi .c'5'./.~d'.C";(..~-r-..i b. Intended use and occupancy ....................... 3. Nature of work (check which applicable): New Buildiag .......... Addition .......... Alteration; .......... Repair .............. Remgval .............. Demolition .............. Other Work ............... : (Description) ' Estimated Cost i (to be paid on filing this application) ;. If dwelling, number of dwelling iunits ............... Nmnber of dwelling units on each floor ................ If garage number of cars i. If business, commercial or mixed occupancy, specify hatnre and extent of each type of use .................... 1. Dm~ensmns ofex~stmg structures, if any: Front ............... Rear .............. Depth .............. Height Nunjber of Stories Dimensions of same structure with alterations or additions: Front Rear Depth .................... :.. Height ...................... Number of Stories · · L Dimensions of entire neTM constiuction: Front ..... 2..I. '. ...... Rear ..... i .~TT...~... i 'l~e'p'ti~' i i '. i i } ~.~i Height ..... i.e./..,.;.. Nm'obe, r of Stories ....... { ....................... ' ........................ ~. Size eliot: Front .... ~ .~.F~. {7,~.... ......... Rear ...... ¢.'~..'~. ......... Depth,... !,7.~.,~. .... ~ ...... ). Date dr Purchase .... ~ ...... i .................. Name of Former Owner ,,~?MP. ~ .M~,... ~..'-~.~...w'<.~P. g4d.~./:e,. 1. Zone or use district in which premises are situated ................................ " . ....... 2. Does proposed construc,tion vioiate any zoning law, ordinance or regulation: ....,,'?<-...c~. ...................... L Will lot be regraded ...... r~...c~. ................. Will excess fill be removed from premises: Yes ~. Name of Owner of premises . . J...~M~r'~:~.~ . .,... ~? ~4~,$ ·. Address ... 5',-4z~...'~. ........ Phone No..-~...~ ........ Name of Architect ' Address Phone No Name Of Contractor ....... ~/~. A~, ......... Address . ...~.4-:..~:~. 'i~ ........Phone No .... 5,~...'.'.~ .... PLOT DIAGRAM Locate clearly ~d distinctly ,-all' buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block'number or description according to deed, and show street names and indicate whether ~terior or corner lot. FATE OF iNEW Y_O RK, OUNTY OF ~ k-5¢1~'.'~..O l. I~ S.S ......' ,~ (Name or~' ~nd~v~" ingl'/~'O~cJ~"'~'l~contract) ......... being duly sworn, deposes and says that he is the applicant >eve named. e is the ..................... i ................................................................... : (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly author~ed to perform or have performed the said work and to make and file this ~plication; that all statements coniained 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/n the application filed therewith. worn to before me this [ , ....... ...... .... ........ - ,. CZ,. 4'- zg - , ............. NOTARY PUBLIC, Stat0 of NOW York . . . ."/".'.'.'.'.'.~'.~ ,'7 ..................... : No. 52-452477! ~ ' F~"''''''- ] i Q~alifidd in Suffo~ cO~lnty ' t~]gna[ure oI appncant) I [ CommiSsion Expires: March 30~ ]000 Cedar Drive EAST MARIOn, NY I J. 9.~9 KlM DZ~KOWSKI l~ Cedar Drive EAST MARION, NY 1~939.' I~.NSSELAER ~. TERRY, ATfORNEY - Al' , LAW ~OUTHOLD, ~ Y* 10700304-0 5¢dJ~ : 50'= I" 11300 Cedar Or Ye FAST MAR ON, NY 1193~ :'1 I Co>t 'I (~ A V,A ,~, K~ OZEI~O~KI NO~NG DEPARTMENT A FOLLOWING iNsPECTIONS: 1 FODN~ATION - ~O REQUIRED 3 ~NcU~Am~O~NSTRUCZiON MUST o[