HomeMy WebLinkAboutPuskarz, EugeneSUP~RVISOR'S OFFICE
16 South Street
C~reenport, N. Y.
Tel. Greenport 7-0~0
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
TO~VN CLERK'S OFFICE
Southdd. N. Y.
BUILDING I'NSPE~TOR'S OFFICE
CERTIFICATE OF OCCUPANCY
al~rtment :L~ west tgide off bulld~i~ ~ ~apert~ent on Beoo~d
No. IA~ Date Amm~t, 20 19~.~
THIS CERTIFIES that the building located at II./~, ~l~aml~nm Ava Street.
Map No.~acz , Block No, :xz:x:x , Lot No, xx ~'~.h,~a Z.ln~,
in the Town of Southold. conforms substantially fo the approved plans and specifications heretofore fi~d in thls
o~ce with Application for Building Permit dated. 19~, pursuant fo which
Building Permit No.~, dated ~ 19 ~, was issued, and conforms fo all of the require-
ments of the applicab~ provisions of the law. The occupancy for which this ~Hiflcafe is issued is
Th2 ce~ificate is issued to ~e~l ~e~ (o~er)
(owner, lessee or tenant)
of the afore~id building.
Building Inspector
(The Cer~iflcete of Occupancy will be issued only after the Building Inspector is convlnced of the completion of the
construction in co~pllance with the Multiple Residence Law and w~th other laws, ordinances ,or regulations affecting
the premises, and in conformlty with the approved ~lans and specifications.)
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Di~t~ ict Engines,-
TOWN OF $OUTHOLD
APPLICATION FOR BUILDING PERMIT PURSUANT
TO MULTIPLE RESIDENCE LAW
Altered or Converted Multiple Residence Building
APPLICATION NO. 128 Januar~
LOCATION N/~ Iv~delin~ flv~_~ apx
House Number
Height: 2~ stories~ apx $~
feet west of C~ntral Ave. Fimhers
Streef Di~ence Scm Ne~re~ C~ner
feet Aren
mac
(I) Type of Occul~ancy of Building
to be altered or converted
two family private dwelling
(Permanent, Transient, or PrivMe)
(2) Type of Construction
Frame, Non-fireproof
(Fireproof or Non-fireproof)
(3) Use and Occupancy after Alteration
or Conversion t~ee Dermfnent occup~ne_v apaz. tm~nt.
new C of O (will) (~e required ?'es
.Story
(include EXISTING OCCUPANCY PROPOSED OCCUPANCY
Cellar &
Basemenfl Persons to be
Apb. Rooms Apb. Rooms Accommodated
Cor B
First ~0 ~
Fourth
Sldh
Seventh
TOTAL J" ~
(s)
State generallyin what mannerthe Building willbe alteredorconveded: East half of dwelling
to be made into two apartments - one on first fl~or, one on'second
floor & attic
(6) Estimated Cost of Alte:a+ion or Conversion $//-"~ 0 0
(7) Is Application made to remove violations? If yes,: State Violation Number ~) nu~mber issued
(8) ~Stete what disposition will be made of waste and sewage B,p_~'c~v~d ~f Ynt~_ clt ~r~s~l
(Public sewer, private sewer, cesspool, etc~J s~stela
Page I
STATE OF NEW YORK
COUNTY OF SUFFOLK
1~n~ Puskarz
( Type~Hte Name)
being duly sworn, deposes end says: That he resides at 22 silver St
in the Cify of New Brittain in the S+efe of Connecticut ·thef he is making this
eppl;cat;on for the approvel of architectural and structural
(Architectural, structural, mechanical, etc.)
plans and specifications herewith submitted end made per+ hereof, and fha+ to the best of his knowledge and belief,
the work or eons+ruction will be carried ou~ in compliance with such plans end specifications, end fhef Jf will conform
fo ell applicable provisions of the laws governing multiple residence consfruc~ion.
(SI~N HERE)* ~ ~ ~~ ,Owner
Sworn fo before me, this
Notary Pu bli c .e.~.-G~mmk, s~e~
day of.
If application is to be executed by someone of her than owner, acting in his behalf, the following additional inform-
ation should be supplied:
Address ~
(If a corporation, give full name and address of at least two officers)
(SIGN HERE) , Applicant
Sworn fo before me, this
day of , 19
Notary Public or Commissioner of Deeds
FOR OFFICE USE ONLY
Examined and Recommended
for approval on
19
Approved on 19
Superintendent.
Work commenced on
19 Date Completed 19
I HEREBY CERTIFY that the above report is true in every respect and +hat the work indicated has been done
in ~ne manner required by Jaw and Rules and Regulations of this Department.
Signed
Page 2
TOWN OF $OUTHOLD
Multiple Residence Law Permit
PERMIT NO.
LOCATION
19jji)i...=APPLICATION NO._~I.
~ 1gm
Application having been made on
covering construction on a i]t.l~ml mu~t.J.fl3n
(new, altered, or conveded)
multiple residence building, by or in behalf of
~-.--..? .~..~,,.,~_
(owner)
, for a dwelling located as above stated, and the said
application having been examined and recommended for approval on
is hereby issued for the performance of the
(archifect~rel, structural, mechanlcel, otc.)
Approved
work described in the above numbered application and any accompanying plans and specificatlon~
If no work is performed w[thln one year from the time of ifs issuance, this PERMIT shall exp're by limitation.
V..~*hnse ftuaf4d b./ ~o Bee3.dof apl~o.b eeve~-! t~e writ on rM., i~z~t
! Enforcement Officer I
I
2"~ TLO~7~
7'~d 7~oo ,,-,
PR~'$ENT F'LO0/~ 'PLAN ,.S'NOWJNG EA,ST 3]DE OF DUI~I.E'X
2 'Y/ ~,-j
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