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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18802 Date FEBRUARY 14, 1990
THIS CERTIFIES that the building ADDITION
Location of Property 6425 SKINK LANE CUTCHOGUE, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 104 Block 4 Lot 5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 12, 1989 pursuant to which
Building Permit No. 18521-Z dated SEPTEMBER 19, 1489
was issued, and conforms to all of the requirements of the applicable
provisions o£ the law. The occupancy for which this certificate is
issued is 2nd FLOOR ADDITION TO EXISTING ONE FAMILY DWELLING
The certificate is issued to RICHARD & MARY BOZSNYAK
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-112825-FEBRUARY 3, 1990
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
roar xo. s
TOWN OP 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) c
N o 1$ 5 21 Z Date ~ 1..~.~e~s...... 14
........;.p.
Permission is hereby granted to: )
:::a.~~......~....:
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ct premises located at ..Sa. ya.~ ................................f~-~,.,..............
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . .
County Tax Map No. 1000 Section .....~.5?.~....... Block Lot No....U~..
pursunnt to application doted ....~9~m:!M.A......~. 14g.~.., and approved by the
Building Inspector.
Fee ~
S
..1..:..'.~'.'~..:.,........
Building inspector
Rev. 6/30/80
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\~~l~s TONN OP SOUTDOLD
~~1 a 5' ' -
f-~~v BUILDING DEPART:ICt7T
Q r TOUN IIALL
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' SOUTIIOLD, NCN YOILK 11971
765 - III02
-
APPLICATION FOR CL•RTIFZCATE OF OCCIIPAttCY p
DATE _ .,~~1°~. .
HEN CONSTRUCTION :~/..,(OLD OR PAE-jE~SZST~I/tiG B/UILDItiG......VACAt7/T LAND........
Location of Property.fP{a~.....:Sl~U:VL~...!t_'~~?~..._. ~u~e"~!'O~}.t(:~?.:-....
UOUSE NO. STP.EERT _ ((~J LiAHL T
Ovner ar Ovncrs of PropcrCy.~~d'1:~~:!;a1'~~_J./V2s~.rfaL~
County Taz Hap No. 1000 Section ~ Block LoC' ~
Subdivision/_ryry((.'..// Filed M/~ap~/_....._.Lot..
PermiC No. !.?Y_y'[....Tlatc of PcrmiC ~~~4.{..ApPLicao~~~~4~.~,_".`.•~ •44'j~
Hea1Ch Dept. Approval Undcrvritcrs Approval...
Planning board Approval
Request for Temporary Certificate Final Certificate
Pce Submitted: $
APPLICANT.. 1d%~~~ _G~~~
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THE NEW YORK BOARD OF FIRE UNDERWRITERS vAUx 1
12I.~iD65 BUREAU OF ELECTRICITY
83 JOHN STREET. NEW YORK. NEW YORK 10038
Date F'FBRUARY 03,).4~C) APPlicotionNo.onjile 66Fi044$<I/$9 N 112825
THIS CEFTTIFIES THAT
only the electrical equipment ae described 6ebro and introduced by the applicant named on the ebooe application number Jn tke premieee of
f
kl',t;NAkD 80'LSNYAIC, 6425 SKDNR [,AN6, CfITf?NOQI76, N.Y.
in ehefolbtcinp bcation; ? Basemen[ ? let Fl. ®Ynd Fl. Section Block Lot k/1''I./.f l/ _
u~os examined on JANUARY 12, 2490) ondfound to be in compliance with the requirements of this Board.
pXTUEE AC1Ef f1NITCllfS RXTURES RANtiES COOKING DECKf OVENS fMSN WASIMRf EXNAUST FANS
OUTIETf INGNDESCFNT. FtUORESCEN; OTNEFI NAT. K.W. AMi. K.W. AMT. K.W. AMT. K.W. AMt. N.P.
5 1
DRYERS FURNACE MOTORS WTUtl AFMIANtf REDEEf f?ECIAL RK9T TIME I,IOCKf RN4 U1KT NfATEEf M
YfT
~pETRT DIMMERS
AMT. K. W, dl H. P. GAS M. P. AMT. NO. A W. G. AMT. AAV. AMT. AMPS. TEANS. AMT. N. I, pG. ~ FBlT AMT. WATiS G
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SERVK4 dSCONNlCT NO.OF S E R V I' C E
AMT. AAIP. TM IMTER 1 P ]W 1 / SW J A 3W ] / IW NO.OF CC COND. A. W. NO. OF NIiFO A. W. G. NO.OF NFUTRAlS A. W. G.
EOW?. PER / OF CC. D. OF nAEO O NEUTMAI =
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OTNM ARARATUf:
WtkING YOk 2ND FI,.BI:DRCkiN t)Ni,Y 2
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GARi3 ELBC'CRIC [~:tC./1$45
27 POk6ST FRAIL s
RIDGB, NY, I].961 eENERAt MANAt7Nt
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This wrtificaro must not be alrorad in atTy manner; return to the office of the Hoard if incorrap. Inspeckirs may be identified by their crodsntials.
COPY FOR BWLDING DEPARTMENT. THIS COPY OF CERTIFIGTE MUST NOT UE ALTERlD NtANY MAlRIER.
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BUILDING DEPT.
INSPECTION
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REMARKS: ~~J
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B0,1RD OF HE 1LTH .
3 SETS OF PLANS
FORM NO. 1 SURVEY .
TOWN OF SOUTHOLD CHECfi o' 3.3 .
BUILDING DEPARTMENT SEPTIC POR~t
TOWN HALL
SOUTIiOLD, N.Y. 11971 NOTIFY
TEL.:7651802 CALL
Y'YrrV'N , i, 19~7Q MAIL T0: (pr"lo"~ S ~0.-'
ENamincd q Vc~1 2 it .
Approve 4^'!+~~ .4, 19~ .1 Permit No~.~~.~y-~.~ ~ ~ '5, ~
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4
Disapproved a(c ~~5 ~f_la ~ 2 ~Q8~~1 ~
9
-i. ~t
A~!'!"...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT /j
' Date . ,f.'J.t.L.~..,~~+......., 15&'
INSTRUCTIONS
a. Tlus application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
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 stree
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app
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 pear
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 far 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 of a Building Permit pursuant to ti
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances <
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe
The applicant agrees to comply with all applicable laws, ordinances, building code, hausin~ code, and regulations, and
admit authorized inspectors on premises and in building for necessary inspectio
i
.
(Sign ure of applicant, na , if corporation)
. ~'{~,~.SXt~NK.~A~r~..C~.tT4~tafd e~.NY 114,:
(Mailing address of applicant) •
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde
................~,w g?c3:'............................................
y1 xt
Name of owner of premises . ~~.4~id!^tl . ~9k'. M . ~ 02 $N~, r3~ .
(as on the tax roll or latest deed)
!f applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. .~.~.g.Q.'~'Z .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done. ~ .
(louse Number ~~S//treet ~j// Hamlet
County Tax Afap No. 1000 Section ....~C.T.......... Block .....T Lot .
r
Subdivision Filed Ala No. Lot .
p
(Nance)
2. State existing use and occupancy of premises and in [ended use and occupancy of proposed construction:
a. Existing use and occupancy ~ie~eytg, , ,G,d1 r; /-d.+f! ~ ,._y r.'.; .
b. Intended use and occupancy ...4 e S M d~Jl.~~, : ~ .
?
A +
3. Nature of work (check which applicable): New Building , Additicn Alteration .
Repair Removal Demolition ..............Other work , .
9 (Dcscriptio,
2:: p o
4. Estimated Cost ,,~jOOt9 Fee ..~jq:.~.............. .
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each lloor 1. , , , . , .
If garage, number of cars . . .
6. IC business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front , .3.5'~ Rear ..•..TS. ~ , . Depth . 5~i$.: , . ,
Hcigltt ....~,2! , Number of Stories . . .................1 .
Dimensions of same structure with alterations or additions: Front ....?.a5'... , , Rear ~y?......... .
Depth ....'~8! Ilcight , .....2~' Number of Stories .
i -
Dimensions of entire new construction: Front , .~,G~~4". Rear 13f d.". De, th , 6..... .
Hcight 7'-R~~. ".F,npN?~Number of Stories
p
9. Size of Iot: Front . , 7,Q Aear ....7,4 ~ , Depth i~~'ll'
10. Date of Purchase .............................Name of Former Owner , .
1 1. Zane or use district in which premises are situated .
1?, Does proposed construction violate any zoning law, ordinance or regulation: 1~~? .
13. 1Vi11 lot be regraded will excess fill be removed from premises: Yes
14. Name of Owner of premises .~!e~ati,d Ft9P~SJk`~4.~Address ...................Phone No.73'~ :~:~G 7.. .
Name of Architect ...........................Address , .Phone No, ,
Name of Contractor ..........................Address ...................Phone No..
15.Is this property located with in~00 feet of a tidal wetland? *YES....NO.?..
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr
property lines. Give street and block number or description according to deed, and show street names and indicate whet
interior or corner lot. C W BtfS
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STATE OF NE O1~ ! S S 6t/.?S SKkNK ~$9/E
couN of . `1~a.1.. ,•Q
, t~ir~.:~%...VJ.U
~S~ being duly sworn, deposes and says that he is the applic
(A'amc of individual signing contract
above named.
fie isthc ........................~.C-'l~J~;~.~.................................,........,.......
(Contractor, agent, corporate officer, etc.)
oC said owner or owners, and is duly authorized to perform or have performed the said work and to make and f71e i
aPPlication; [hat all statements contained in this application are true to the best of his knowledge and belief; and that
work will be performed in the manner set for[lt in the application filed therewith.
Sworn to before me his c.~-~
~1 \ .day o ..z 19b.
Notary Pub[ic~`~. County ~i
CL/NRE 1. a1,EYY . ~ • .
~MrrNMrYorlt i~ atwe of applic: