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Home My WebLink About11033-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... .g.l. 0. 7 J .6 ....... Date .... 99.~.qb.o.F..5 ................... 19.8.1. THIS CERTIFIES that the, building ................................................ 170 Love Lane, Mattituck, New York Location of Property ............................................................... House IVo. Street Hamlet County Tax Map No. 1000 Section 140 . .Block 3 .Lot 42.1 Subdivision ......................... ....... Filed Map No. ' .Lot No .............. conforlns substantially to the Application for Building Permit heretofore filed in this office dated Febr.u,~l~y..1.2 ............. 19 . 8Jpursuant to which Building Permit No .... ~l..0.3.3..g. .......... dated ...?.~r.~?.~..~..2)., ........... 19..8.1, 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 ......... Alterations to Retail Store The certificate is issued to . . . M, . ~.,..,~e ~S.qY.. !Pp.o.p. O ?.g.i.~.~. ,..I.n.e. :..h..4.o9.n..&...L.o.~@..M.i. lowski as contract ve~r~/essee or tenant] of the aforesaid building. Suffolk County Department of Health Approval lq/R UNDERWRITERS CERTIFICATE NO .... N/R Buildingclnspector FORM NO.~ TO~N OF sOUTHOLp BUILDING Town HA~ SOUTH'OLD, No. 11()33 z BUILDING P, ER~IT (THIS PERMIT MUST BE KEPT ON THE PRE/v ISES UNTIL F~ULL COMPLETION OF THE WORK AUTHORIZED) ' Permission is hereby granted to: ....................... ~F~ / 7 ~ z~w~ ~AN~ ............. at premises located at ................. ~ .......................................... ~?..~t .............. · ...................... ..... ~ ~'~ z~.~ ............... ........................................ ...... ................................................................. Coun~ Tax Map No. ]000 3ection ...... ~.~. ....... BI~A J~...~.~ .........~:Lot No ....... ~.~.~. ..... pursuant ~o application dated .. ~ ~ l~ and approved by the Building I~spector, Fee $ .................... Rev., 6~30/80 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- tot 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 featuros. 2. Final approval of Health Dept, of water supply and sewerage disposaI-(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- tigris, 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 peopert¥ showing all Property lines, streets, building§ 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building Old or Pre-existing Building ~""~'¢'"~- ......................... Vacant Land ............. Location of P,operty ....... l ~. ~. . .Z.O ~ ~ . . .Z. m ~.'~ ...... ,,'CZ.. ,~. Z'/.~. ~. ¢ .LC ...... House No, · Street ~ ~ Hamlet O~,nar or Owners of Property ... Z.~. ~ .... ,I~/.,./.~.~ ~.~.~ .......... ,'¢~','~,. ~.'/,~,~ County~ra× Map No. lO~9Section ...Z..~. ...... ,~oc~ ... 3 ......... Lot .... ~.~.~,/... Subdivision ................................. Filed Map No ........... Lot No .... [ ......... PermitNo. ~.l.~.,J~.%.~at~ofPerm,t ~..'..~...~.~.~. ~ ..~T~.~...~'~..~.~l~t.~.*..~.l~'~ .Applicant , Health Dept. A~prova~ ........................ Labor Dept. Approval .................... Underwriters Approval ........................ Planning Board Approval Request for Temporary Certificate ..................... Final Certificate.....J' ...... .... .~.. Fee Submitted $ .... ~,,~.~.O. ~. ............. Construction on above described building and permit _/~ all appliyble cod~and regulations. ! Applicant ... ~ .......... Rev. 10-10~78 FOUNDATION COMMENTS FOUNDATION 2. ROUGHFRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined 7'~[ ~Y 19 ~ Approved ........ .~?..~.~., 19~. Permit No../. :.0..'.~...~-~. '~ Disapproved ~/c .......... ~ .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. f/ Date February. 1.9 19 81 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 admit authorized inspectors on promises and in buildings for necessary inspections· (Signature of applicant, or name, ff a corporation) &9.5 .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .E.n~Z.n..e.e.r. ..................................................................................... Name of owner of premises ....H...g:....K.e.lfi..e~. Propert±es, Ine. ,&Leon & Lois M±].owsk. i contract vendees (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...T .B..J3 ................. Plumber's License No. ,~.../.A .................... Electrician's License No. ?:.13. :D.: ............... Other Trade's License No.. ~/.~. ................ 1. Location.of land on which prot)osed work will be done...L~..L....H.o.?.k.e.g. .................................... ........................................................... House Number Street Hamlet County Tax Map No. 1000 Section .... c1~5 ........ Block ...... .~... ......... Lot...c~..?Z.,.~ ............ 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 .... ~..OOd. Na, rC:.e.t. ................................................... b. Intended use and occupancy ... ?.9.°.d. . .1~...~.~.~.g. ................................................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .... ;g ...... Demolition ...... X ....... Other Work ............... ~ ~..~.-- (Description) 4. Estimated Cost.,. i)-O00* Fee _.. (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... i .................................................................... 6. If business, commercial or mixed occupancy, specffy.~at~re and extent of each,$,yl~.of use ...~.0..O.d. ~.l~v~.~~ ..... ?. Dunenslons Qf existing structures, ~f any: Front ............... Rear .............. Depth ............... might ...... Number of Stories.. ........................ ...................... Dimensions of~ame structure with alterations or additions: Front ................. Rear .................. Depth ...................... He t ................ Number of Stories ...................... 8. Dimensions of entire new constr~ctlon: Front ............ Rear ............... De .............. He ' . ........... umber of Stories ........................................... 9. Size of lot: Front ...... ,.T..... i.: .......... Rear ..................... Depth .............. .~.'~.~. ~. 10. ~ ' Date of Purchase ........... ~ .................. Name of Former Owner ............................. l ff. Zone or use district in which premises are situated...~.~.~.l: .rl?.8.~. ......................................... 12. Does proposed c'~n~truclion violate any zoning law, ordinance or regulation: ................................ 13. Wiillotberegraded ...~.O. .... : ..................... .Willexcess, flllb~eamvetf, r~r~premises: Yes 14. Name of Owner of premises . ~ .K..~.l~..~.~...P.~..~..~l.l~ss ....~.O~...T~..O.~,G.~... :..~hone No ................. Name of Architect .......... i ................. Address ................... Phone No ................ Name of Contracto~ ......... i ................. Address ................... Phone No ................. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate ail set-back dimensions from property lines. Give street and block rumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ' . couN'rY OF .,~'~,~wo.~.~.., S.S ., ,. .... ~t~, ..... : -~"..$.0..'~..'DY. '~..~. ~.J .... , .......... being duly sworn, deposes and says that he is the applicant (Name of individual sign(ng contract) b ed . He is the (Contractor, agent, corporate dffice'r, etc.) of said owner or owne~, ~d is dul~ au~ofized to perform or have perfomed the said work and to m~e ~d file this application; that ~1 statements cont~ned ~ this application are true to the best of his ~owledge and behef; and that the - work will be perfomed in the m~nef set forth h ~e application filed therewith. Sworn to before me this ........................ - ~'~ .............. l ......,, 19 .... Nota. Public, · · .- ....~~. ....... ~ ~ "' NOTARY PUBLIC, :a~to o[ ['t~w Yod( . ,-'....,~ .... ~ .,.). ~}~ ......... ' ~ . ~ N0.5X-~324771 ~ (Signatur~ of applic~t) Qualified in ~uffolk County .~