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Home My WebLink About11289-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.I. 0..8.5.6. ......... Date ...... O'..a.n.u.a.r. ¥..1.8. ...............198.2.. THIS CERTIFIES that the, budding ................................................ Location of Property ... ~.6. q ........ ~b.:[ g. 13 ~.e..F.1 .eg.k' .t! 9.a,cl ........... .C.u.~ c. t).o.~t.t ? ....... House No. Street Ham/et County Tax Map No. 1000 Section .Q 9 7 ........ Block .0.7. ............ Lot .q2:.6 :.6. .......... Subdivision .h~, t;.~,]..~, t~I,e.c.k. 17 r'.o.p.e.v.f,.J..e,~. .... Filed Map No. 6.0.~..8 .... Lot No.6 ............. conforms substantially to the Application for Budding Permit heretofore filed in this office dated .... S~ P.l;.o.nll~or'. ,~ 1... , 19 ~ ] pursuant to which Building Permit No.. J .1.2.~9...Z ............ - dated ...S.e.p ¢9in.b.~r.. ~2.9. ........... 19.8. [, 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 ......... .... ti. pje.k~ ~:p~..oaO.--.f.~rt~.~.Y.. 0~.¢.e.2[~ ~.IaK.. ........................................ The certificate is ~ssued to ..... tt.n.g.t.~.o.n.y. Jar. zabko~sk:f. & ........ ...................... of the aforesmd building. Suffolk Cmmty Department of Healtlz Approval .t 1 .--&0.-~88.,..1./. J ~/.8.~ ~. ~.qb. 9.r&..A. :. ~.~:Z..1.a. UNDERWRITERS CERTIFICATE NO ...... .ixl..5. 4. .6.4.6.1. .................................. Rev. 1/81 Budding Insl3e6for .TOWN OF ~0UT'OI~D BUII~DING D£PARTM~N' · TOWN,HALL I SOuTH'OLD, N, Y. BUILDING P,ERMI~ :ULL 11289 Z Permission is hereby granted to;/7 .............................................. .,..,4.....~ ................ ..... ~2~~.=~.~. ............... . _ ............................. ...................................................................... 'Z/~ ....... ~ ............. .~ ..... ~ .............................. Builfling Inspector. F*~ $ ........................ Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD 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 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 Aprit 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. 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 Property . ~,lr-l-~.?. N~.~,-. ~, HouSe No, Street HaMlet 0 ty ~ wner or Owners of Proper .. .' ................................................... County Tax Map No. 1000 Section O ~ 7 Block O 7 , _ 'T 6 Subdivision ................................. Fded Map No ........... Lot No .............. Permit No.././.2~ ~,~? .'.~'~. Date of Permit ~l'//~./, .Applicant.. ~,','.~ .¢-../~. ~//~,, ,~..~:~. ,i~..).,, ,/,%~,~.: Health Dept. Approval ........... *~F~'J~ i''' Labor Dept. Approval ........................ Underwriters Approval../.~. l .11~. ~. ~. t ........... Planning Board Approval ...................... Request for Temporary Certificate ................... Final Certificate .~. Fee Submitted $ .... ~., .~ .0...v/. ............... Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-7e THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT in the followlr~g location; ~ B. se,nen~ ~. 1st Fl, ~ 2,td FL Sect~oa Block Lot was exa.tined on t~LI~' J*4 ~ ~9(~ and found to be in compliance with the require.tents of this Board, ~ECEPTACLES SWITCHES FIXTURES RANGES KING DECKS OVENS DISH WASHERS EXHAUST FANS FLUORESCENT VAPO~ DRYERS FURNACE ~,~OTORS APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT S E R V I C E OTHER APPARATUS, NO OF CC COND pER ,~' 1 AWO Of CC COND NO OF HI LEG AWG OF HI LEO NO ~F NEUTRALS1 AWG OF NEUTRAL Th,s certificate must not be altered in any manner; return to the office of the Board if incd'rrect. Inspectors may be identified FOUNDATION (1st) FOUNDATION (2nd) 2o ROUGH FRAME & PLUMBING COMMENTS INSULATION PER N. STATE ENERGY ~ODE FINAL ADDITIONAL coMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined ~.~...~.~. .... l .~/. Approved .~-7.. ,~.~. ...... 1~../. Permit No.~//d~7..~ Disapproved a/c ..... il.....-~. ........ · · 5~ .~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No ............... Date../~.~/ .......... , 19 .~./ INSTRUCTIONS a. This application must be completely filled ~n 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 premises and in buildings for necessary inspectmns. ..... /q... /. /. . 4?.,v. ): . ./. ...... (Signature of applicant, or name, if a corporation) r:. .... /v4(. ............... (Mailing address of al~plicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....fq ./~. ~./~ .0. I.~. ,,~. ...... '~ .ggg. gg. ~q W.5~ ~ ....................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .......... (Name and title of co,orate office~ Builder's License No.../.~ ................... Plumber's License No .... ~ .~ .~./.~.O. ............ Electrician's License No.../..o7./?.?. g p.,.~..i. ........ Other Trade's License No ...................... 1. Location of land on which proposed work will be done ..... /..7-.?.t.~.. .dc,...~. ,. '/' ..~.? ./.q;.' .~tp. , House Number Street Hamlet / / /' County Tax Map No. 1000 Section ...~.~. 7 ........ Block...O.~. · .......... Lot .~.~..~.7 ........ .. ................ .......... Subd~ws~on t' .... Filed Map No. ~O ~ o(7 Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .~.,~..~4~.../~,.~../'f'~,,,~..d,4~.. ....... · ................................... b. Intended use and occupancy ..... /...~../J..~). ~.~.~ .... .O..bvf..~.L..L./..A(Gf. ............................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Remoyal .............. Demolition .............. Other Work ............... 4. Estimated Cost .......... ~.Ce'~../ ~ ,> Fe ............... (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 6. If business, commercial or mixed! occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ,. Height .......... .,~, .......... Number of Stories . 8. Dimensions of entire new construction: Front. ~....~.. ....... Rear .............. Height ............ /... Number of Stories ........................................................ 9. Sizeoflot: Front ........... i .......... Rear ...................... Depth ...................... 10 Date of. Purchase Name of Former Owner I 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Willl t' ere a ' o b gr ded ............................ Will excess fill be removed from premises: Ye~s No 14. Name of Owner of premises .4.',~qt.g ~q. t3/¢ew.&'/f/Address . .~'..o.7'.c. ?..o.6'..o..~..... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor ~ :.~.~/. c. ~/..~..,Y~,j' ...... Address ~)< ~/g,ff...'~#..r'/.~.'. . Phone No. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block interior or corner lot. tumber or description according to deed, and show street names and indicate whether 5~ 3 u ~ ve y. STATE OF NEW,)z~RK._ .~ ~ ~ ....... ~.O..~,~..~-.,~...--,Z}--:-~ .~<-.~../.c..C/ .............. being duly sworn, deposes and says that he is the applicant . (Name of individual sign!ng contract) above named. He is the ...................... ~ .... ~ ...................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;, 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 ............... day .... NOTARY P Count .lC, State of New York Ho. 52*8125850, Suffolk Countach~ Tarm ~ires March 30, ~re of applicant) Lot 00S£ SUltrY FOf~ ANTHONY JARZABKOWSK! LOT NO. ~ , "LITTLE NECK PROPERTIES" TOWN OF SOUTHOLD SUFFOLK COUNTY, N£W YORK SC~E: J" = §0 NO. 81 - 505 ANTHONY U~RZABKOWSKI ~OT NO. 6. ' UTT~E 'NECK PHOPEHTIES ' ~WN ~ ~UTHOLD sc~, I" = 50' ~ CO~TY, ~ ~ ~. ~1- 505 NOT~: I ~ MONUMEN~ '~.. ~ ~ ALDEN W ~NG~ PROFE~IONAL ENGINEER ~EDIVISION ~P ~1~ I~ ~E OF~I~ OF ~E C~E~ ~F HOWARD W. YOUNG, LAND S~VEYOR ~ - - SUFFO~ COUNTY, NEW ~ NO. BI-~05