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Home My WebLink About13645-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1.3..9.3.6. ......... Date November 6 ., 198..5 THIS CERTIFIES that the building ...0..n .e..~ a..m .~.l.y...d .w.e.~. ]:..~ .n.g. ...................... Location of Property 1547 R,O.W. OFF STILL~/~TEB AV.E. CUTCHOGUE House No. Street Ham/et County Tax Map No. 1000 Section ,. ] .0.3 ....... Block . .1. ............ Lot .... J.9..,9. ........ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... N.o.v. :..3.0. .......... 19.8. 4. pursuant to which Building Permit No. 136 ~ 5 Z dated .. p.e.q:................20 ...... 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 ......... .... o.~. ?. Aa.m..~.z.y...d.~?.~.~. $.n.~... .................................................... The certificate is issued to BENNETT ORLOWSKI AND WIFE. ..................... ?ol;,,,'~;,~'~'~'~X × .................... of the aforesaid building. Suffolk County Department of Health Approval ... 1 ~ -S0.-223. 10/31/85 N682389 3/12/85 UNDERWRITERS CERTIFICATE NO ............ .N. 6. .9.0.7 1 6. 5 / 8 / 8 5 Rev. 1/81 Building Inspector FOR~f NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13645 Z Permission is hereby granted to: .... _ ...~~..~....~....~~"~ ...... ~.).~.~...' .... , ,o ............... ~'~'"~"~ ..................... x-~""rrw':";-"'~ ......... : ........ ~-....~...h....~.~ ............. ~ ~,.~,~ ......... :......~.~ ...... ~..~..:....~~~ pursuant to application dated .... )~...~';!~:~.....L~:~4~.....~...~.. .......... , I0.~...~.., 'and approved by the Building Inspector. Fee ~ II 6,:: ~ Building 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 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--iS-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 p~operty showing all property lines, streets, buildings and unusum 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 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ..~.....~..c~.~ Date .. ~ '~ New Building ....~ ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ............ ,.0.. . ................... ~ ......... House No. Street Ham/et Owner or Owners of Property . .'~..~.. (~..'~.~...~A~...q .~.'...¢'...~. ~ .......................kC County Tax Map No. 1000 Section .. 1..O..~. ...... Block ..... .(~. ! ...... Lot...~.~....].?.'..~.. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~.~.~.~.~.~... Date of Permit I.~-!~.o. [~ $...Applicant..~.~.~.~..~.....~ .~..I,~..~).~.~.~ ..... 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 meets all appfi~ble codes ~nd regulations. ............... Rev. 10-10-78 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 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 1957), Non-conforming uses, or buildings and "pre-existing" lan;d uses: 1. Accurate survey of p~Coperty 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building ....,~ ....... Old or Pre-existing Building $15.00 ............ Vacant Land ............. Location of Property ..... /~- ~/Z ~' O. ¢/ ,~ ,~,~ ~;~ ~,/-,~,~,, House No. Street Hem/et 0 w ner or 0 whets of Prope rW .~ .~.. ~.~.~-~.q ~..~.. ~ ~... ...... County Tax Map No. 1000 Section ../.~ .~. ...... ~ock ..... .~. ~ ...... Lot. . .~. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No, I,~ ~- . Date of Permit . }~. ['~ ~...Applicant..~.~2.~.~. ~.~i. ~ ~..).~. ~.~.~.~.,, Health Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval · Planning Board Approval for Temporary Certificate Fi~al Certificate Request ............................................ Fee Submitted $ ............................. Construction on above described building and permit meets all appli~ble codes 9nd regulations. ............................... ~ ~ .. ,_'_ '~ FORM NO. 6 TOWN OF $OUTHOLD 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: I. 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 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of peoperty showing ali property lines, streets, buildings and unusual natural or topographic 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: I. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/landuse--?re-]~×±sf,±z~g C.O. $15.00 3. Copy of certificate of occupancy $1.00 Vacanf, ~_ana C,O. $ 5.00 Date .~..~. ,~. · .~.~'..~/.Vacant Land ~Y New Building ............. Old or Pre-existing Building ................~'-. · · · · .' z Location of Property .... )~ ,4~ .~'~..~//. ~'/~¢-~...--~~//~'. ,l~~./~/.~]~-- House No. /~ ^ ~, / Street a et Owner or Owners of Property ............... ~. ................. .fJ~. ~. ..................... County Tax Map No. 1000Section ../....~?...~. ..... Block..,~. · .t. Lot .... /..~¢v. · .~.~. · · ' .X ~ ~ ¢~ ~'/~ ( .... ~ Subd v s on . . . .1~.O.~,~_.......~...t~.. .... ~ M,c,p No... :~...~..~...Lot No....~. ....... Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ....... - Underwriters Approval ........................ Planning Board Approval .. i~,~ ........... Request for Temporary Certificate ..................... Final Certificate ... '.~. ................. Fee Submitted $ ............................. Construction on above described building a..~er~t meets all applic.~p~ an_d.~,~ guyons. ~o~o~z~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU' OF ELECTRICITY ~- O1 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,ate;'~..~' ~, '~-~' ,~p,,l,c,t,o, No. o,,f,e ~.~'7~/~ N 6 9 0 716 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of in the followlng locatlon; ~ Basement 2~ 1st FI. [] 2nd FI. Section Block Lot was examined on ~ ~ s )',;')~ and found to be in eompliance with the requirements of this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS TIME(;LOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF ESET SERVICE DISCONNECT OTHER APPARATUS: 1-GFi S R R V I C E 1 Per_ 11 This certificate must not be aJtered in any manner; return to the office of the Board if incorrect. Inspecto~ may be identified by COPY ~OR BUILDING DEPARTMENT. THIS OOPY.O Y ANY MANNER, eogz= THE NEW YORK BOARD OF FIRE UNDERWRITERS O]- BUREAU OF ELECTRICITY ~ ~'- 85 JOHN STREET, NEW YORK, NEW yORK 10038 THIS CERTIFIES THAT only t~ e~ctr~c~ equipment as described below end introduced by the applicant named on the able application number in the prel~ises of ~le ~1~1, E/S Sttll~ter Ave. -2~' ~/0 Willow ~t. ~tc~, N Y in the.following locatlon; ~ Basement ~ 1st FL ~ 2nd FL O~tSi~ Section Block Lot was exa~ni~ed o~ a~td ~ound to be in compliance with the ~equirements of this Board. FIXTURE ~ANGE$ OVENS DISH WASHERS EXHAUST FAN$ OTHER APPARATUS: E R V I C E John Wana~ Inc. 136B ~in S~ree~ We~c giverhea~ N Y 11901 T~i.c 923 E This certificate must not be altered in any manner; return to the office of the Board if i~cortect. ! be identified by their credentials. COlI~Y ~POR~ I~UILDING.,, DEPARt'Mt'NY. 'l~l-IlS COPY, · [ ANY MANNER. FiELD~INSFECTION COMMENTS 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: "it should be note6 that si~ce this property is located in an agricultural area, the possibility exists that the water supply ..may contain, trace amounts of pes. hcldes and/or mtr. ates. Spec~o~ ~nal¥s~sT~Ol~llj~equ~re~L 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ,~..~..~ .~.., ¢k.o..., 19 ~.q.. Appro~~..3..~.., 19.3.~! Permit NoJ..~..~..~.~.'. ~ Disapproved a/c ..................................... ..... ....L) (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 issued 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 building for necessary inspections. -- / ' ' ' .... (Signature of applicant, or name, if a corporation) (Mailing address of applicant)// State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......................................................................... (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 .... /~~ ...... ~" 1. Location of land on which proposed work will be done .................................................. ................. House Number ....... ~"' ~;r;;i .................. [ q, ~ County Tax Map No. 1000 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 ..... [.~..~. '~''' .~...~ ............ c ............................ b. Intended use and occupancy .../..~ .... ~ ............................ 3. Nature of work (check which applicable): New Building....~.'..... 'Addition.. i ........ Alteration ........... Repair Removal Demolition ' Other Work 4 Estimated Fee ~' (to be i~aid 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 structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ............................ i ............................ Dimensions of same structure with alterations or additions: Front ............ j .....'Rear .................. Depth ...................... Height ...................... Number oflStories ...................... 8 Di ensio ore ti st ti Font Rear D pth · m ns n re new con ruc on: r ....................... ~ ....... e .............. Height ............... Number of Stories ............................ ! ........................... 9. Size of lot: Front ...................... Rear ...................... Deptlp~..,,o .................. 10. Date of Purchase . ~--t'~ · · ·/t..~..~. ~.~. ....... Name of Former Owner .!...~ ............ 11. Zone or use dlstri~n which premises are situated ......................... i .......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... i ...................... 13. Will lot be regraded ...... ~ ............... Will excess fill be removed from premises: Yes ffNo~ Name of Ownar of premises t~. Address Phone No Name of Architect Address ' Phone No Name of Contractor .......................... Address ............... i .... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and sho~ street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. .................................................. being duly sworn, dope,scs and says that he is the applicant (Name of individual signing 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 s~id ~(ork 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 WOI'ARY PUBLIC, State of New York ...... · Ne, 4707878, Suifolk C0uat~r~- ! (Signature oT applicant) '~rrn Expires March 30, ltg,,~.~ " I~ be noted that since t~s ~, ' ' '<'~'~ .... "~ ~- the oossib~li~ extsts tnm iclaes O~O/l u,== t ~. ' amounts of pest ..~ '.. ~ , ~.~ .t mC CO~ <0 ~0~m~ m ~ m o -r :Z m Z 'T