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Home My WebLink About10167-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupancy No ...... Z 105.33 ..... Date ........... .J.u.n. 9' .2.2. .............19~.1.. THIS CERTIFIES that the building ................................................ Location of Property ...... .3.7..65..3. b. ~. ~.~.~.q ~ 9.r..A.v. 9.n.u.e. ~ ..... ~..u.t;.h.h..o~.u.e.t..}l...l.: ...... House No. Street Ham/et County Tax Map Ho. 1000 Section ... 13 7 ...... Bloqk ...... .1: ....... Lot ......... 7. ....... Subdivision ............................ "~..me~t Mai(No ......... Lot No ........... conforms substantially to the Applicat~ofl for~ ~dtfig ~ermit heretofore fried in this office dated l*~bl'ua.~.y. 2A ........ ,19'/9. pursuant t~ which Building Permit No ...... ]-~/,67. ig ........ dated ..... .A p?.i. 1...1.3.,. ............ 19..7 .9, 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 ......... .............. ~o~l.~on..~o. D~.e. ll$~ .......................................... The certificate is issued to ..... C.a~l Boo~ ............... '_'2 - - - '_ .............. of the aforesaid building. Suffolk County Department of Health Approval ......... .~./.~ ............................. UNDERWRITERS CERTIFICATE NO .... :!57.. ~. ¢ :)~7 ...................................... Rev. 1/81 ~ OF ~O~JTHOLD BUILI)I~ DIPABTMIHT TOWN CLERK'S ~ SoI,rr~LD, N-. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPI' ON THE PJ~:MISES UNTIL FULL CCJ~PI.ETIOIN OF THE WORK AUTHORIZED) N? 10167 Z ....................................................................... .~..u...~..C..~..~..~L~. .......... b./.,.~.'.. ................................. .... .~.P...T.. ...... !..~ ...... ;.. ........ .~.~.~ ....... ~!.~.~.:.~.~. ......... ..-.......~.~...~...~....z.~.~ .......................... ~rk~nt to application dated ................................. .../~..~..~.......~..~/, 19.~.., and approved I~y the Buildin~ Impector. ..... Building Insl~ctor OWNER TOWN FORMER OWNER .STREET VILLAGE I $~ ~ W~,~/ ".~ . TYPE OF BUILDING iRES. ~SEAS. IMP. TOTAL REMARKS / AGE BUILDING CONDITION NE-%¥ i NORMAL BELOW ABOVE OF SOUTHOLD PROPERTY RECORD CARD ~.: 2~ DIST. I SUB. LOT '-FARM .... Acre Value Per Value Acre Tillable 2 ~Voodland hwamplc nd FRONTAGE ON WATER ~rushland FRONTAGE ON ROAD DEPTH M. Bldg. I I Extension Extension Extension Porch Porch Breezeway Garage Patio O.B. Total COLOR TRIM Foundation 'Basement Ext. Walls Fire Place Type Roof Recreation Room Bath i Floors i Interior Finish Heat Rooms 1st Floor !Rooms 2nd Floor Dinette K. I LR. FIN. B. ! ; Do rme r , iDriveway TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. SUB. LOT ,~,,, J' n. _. E ~,CR.- FORMER OWNER N TYPE OF BUILDING S SEAS. COMM. CB. MISC. Mkt. Value , RES. LAND AGE NEW FARM Tillable 1 'Tillable 2 Tillable 3 ;Woodland Swampland Brushland ,House Plot IMP. NORMAL Acre BUILDING CONDITION BELOW ABOVE Value Per Acre Value FRONTAGE ON WATER FRONTAGE ON ROAD ID' ) E PT_~_H ULKHEAD OCK ~ ~.~.. :' _ , - ~ JOHN ~TREET, NEW YORK. NEW YORK IOO3. : , THIS CE~IFIE5 THAT ~. examined on M~ ? 3 ~R ] a,~d found to be in co.,pliance wit/, the r~ulrements of this Board. FIXTURE RXTUREE OVENS FANS 2/0 )THEE A~PAI~AT~ , : . 1-~ ~tector ' 137 ~ St., Per · 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 topograph ic 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 . .J. go¢..1.,. 10~.1 ........... New Building Ad.ctJ, t J, on .... Old or Pre-existing Building ............ Vacant Land ............. Location of Property 3765 StiZZwoter Ave~ .... Cutchogue, N,Y, House No. Street Ham/et Owner or Owners of Property Corinne Boos ...... t 0b~'-t ~?L'l'~t ........................................ County Tax Map No. 1000 Section .~0. ....... Block ............... Lot .1 (~ ............. Subdivision..~o~, .lflot3~ .................... Filed Map No...7.3p ...... Lot No..1.~. .......... PermtNo 10167Z D=*oofPe-~* 4/13/7o , ^ - ................... ~ · '...'.. ;..~pplicant .. ?.~.r.~ .F.; .B. ,o.o.s. Health Dept Approva '~- ....... {~ ....................... ~.auu[ uep[./~pproval ....................... ~,~ Underwr ters Approva 3/4/81 ~ . _ ........................ ~anmng uoard Approva .......... Request for Temporary Cert f cate Final ........ ~ .. ' ........ ,; ~ ....... ~er~T cate ~;~U .............. ~ · ~ Fee Submitted $....-~i~t,~....-~'. ~., .~..//. ~~ / Construction on above described bulldl~/g ~rp~m~ets all apphcable codes and regu ,ations' Applicant . (.~-~ Rev. 10-10-78 ?I Examined ........................................ , Approved ........................................ 19 ........ Permit No ..................................... Application No ................................. Disapproved a/c .....................=.~ ............................................. : ..................... (l~uilding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCt'IONS cz. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 set~ aF 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 areas, and giving a detailed description of layout ofproperty must be drawn an the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. ':. .. d. Upon approval of this C~l~llccrtion, the Building .Inspector will issue o Building Permit to the applicant. Such permit shall be kept on the premises ovoiloble for inspection throughout the work. e. No building shall be occupied ar used in Whole or in port far any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depa~ment for the issuance of a Building Permit pursuant to the Building Zone Ordlnonce of the Town of Southold, Suffolk County, New York, and other oppliccble Laws, Ordinances or Regulations, for the construction of buildings, additions or a~teratians, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for nece~Sar7 inspections. J..C~Lcmoture of c~pltcant, or name, if a corporation) ~ddress of opplicont) State whether applicant is~°Wn?r, le~.ee, ogent, architect, engineer, general contractor, electrician, plumber or builder. N~me of owner of premises ' ' ' ' (Nc:ma and title of corporate officer) Builder's License No ............................................ Plumbers' License No .............................../ ................. /t~t~t~) Electrician's License No .............................. Other Trade'*. License No ............................................... 730 19 1. Location of land an which proposed ~qr~,~v~ill~b,C~.dcn~ Mop ~-~c~;~O~lZe~' ~,~., ' Lot No. ~ r~.,c.w~.~l~&- '='~Vf,)ll ~" '~ ................ *""~ ...................................... Street and Number ....... 2. State existing use ~nd occupancy of premises and in:ended use and occupan~ of proposed construction: a. ~isiHng use and ~cup~ncy b. Intended use ~nd occupancy ' N:ture of war[,. (check which a2plicab[e}: fqew Building .................. Addition ..~.~ ......... A[t~rot~on ... Repair ................... Removal .................. Demolition ..................... O~her ~ork ae~ ..... ; ............... ~g;j~.~.~- ........ 4. ~t~ma~ed Cost . . ~000,~0. - ..................................................... (to ~e' paid an filing lhis applicatianj ............ 5. IF dwelling, number of dwe[Hng units .......... ~. .............. Number of dwelling units on each flor ..... ~ ............... If g~rage, number of ~rs ... 6. If business, commercial or mlx~ occupancy, spcciFt n:~ure and exlent o[ each t~e of use ...................... 7. Dimensions o~ existing s~ructures, if any: Fron~ . ~0~ Rear ....... ~0 ~ Depth ~ ........ ~.~ ......... ~u~b~ ~ S~o~ ..... ~ ................................ Dimensions of same structure with ~lteratlans or ~d,~ h: ,s- Front ...... ........ Q .................Rear Depth .......~.~.~...~ ........... Height .........~ ............... h, umb~ o~ S~ories ........ ~ ..................... 8. Dimensi:ns o~ en~iFe new construction: Front ........... .~Q... Rear ...... ~O..J ............... D~h ..... ~. .......... -~.,~ ---: ................ Number o~ Stories .......... ~. .................. 9. Size a~ a~ Front .... ~ R ~ ' ....... ';~ ................................................................... lO. ' ................................................... e~r .......... ~ ........................... Depth ' ~00 Dele o~ Purchase ........................................................ {Name of Former 12. Does praaosed construction vialate an zoning law, ordme ~e or re ulahon ~D. ...... 13. Will let be regraded ~es ............................ Will excess fill be removed from premises: ( ) Yes 14. Name of ~ner of premises --~-.~o~ ............................. Addre~ ................................ Phone No. N~m~ of Arch/tec~ .............................................................. Address i ' ~ ............................ :... Phone No. ............... Nome of Contractor .~,~.~...~.~se MoVe~ inc, Address Ma~t~t~ck Phon~ No.~.~.~.~ PLOT DIAG~M ~ccte clearly and disfin~ly all buildings, whether existing or proposed, and indicate oll set~ck DraD~ lines. ~ive street and black ~umber ar description ~ccording ~o de~, and show ~reet names and ind~ ~hetner i~terior or com,r lot. 'ATE (DF N~,V YORK, ,UN .'-Y CF ................................ fS.5 ....... lvz'ank R. Zaleskt (Name of individual signing contrect) Ove ........... ' · p - s and says that he is the appli4:: ~is the ....................... .Ga~t~. az:.t~oz,. ........... :: .......... '; ............................................................. L ............................. (Comtrc~tor, ag.mt, corporate officer, etc.} ........ s¢id cwner cr owners, and is duly authorized to oerform or hove performed the said work and to n-~ke crud s applice~icn; th.=t ¢1I statements contained in th'is app!iczticn are true to the best of h.~s knowledge and belief; Ir the w,:rk will be performed in the manner sol~ ortn in the ~-~" ' :, ~ ' ~.l:,.~,,~catmn filed therewith. :rn to be~are me this ................... ................ .,, xxC/ · ' ......................... i ...................... ~a~i~ . _ ;;';J;;";;~'~=';'"~'"~':"~ ..................... ~' ~ , · ~ ~x~ion=tu[e oF o,~pUc=;j~'- ..................... JAMES LOT ZO LOT t9 I- I APPROVED AS NOTED -- FEE: BY: NOTIFY BUILDING AT ~ 9AM to 4PM FOR REQUIR- ED INSP~:CTIC NS: 1. BEFORE BACKFILLING FOUNDA- Designer = Dealer Date I Client I Approved Date Da te ;jr Int. Designer = Dealer Iht. Designer = Dealer Client ~ Approved Int. Designer = Dealer Job no. DDiI:e te IDate Date ~ cl rune 3oos 17/13/79