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Home My WebLink About1494-z~OP~v~ NO. ~ TOWN OF $OUTHOLD BU'ILDING DEPARTME~IT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY ........... oote ............... ............. THIS CERTIFIES that the building located at ........... W/~..~8,&rc.l~e...D~...&..~.S..~lv~ltreet Map No....:~: ......... Block No ........ ~ ....... Lot No....X~1L...~.t~.~UO~t.....~.~ ............... conforms substantially to the Application for Building Permit heretofore flied in this office dated ............................... ~l'~,l~/'. ......... 29 ............ t9..61, pursuant to which Building Permit No...~..],~.~.~ dated ..................~',Z~. .........31 ........... , 19.~..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate Js issued is .......... ... Pi~. ~.~.~.t.~,...on~ .. f.~mi~... ~w~.l lir~ ........................................................................................... this certificate is issued to ..... ~wr.c:~(~c...]~.'t.e.lt/l~ ............... ~:17. ................................................ (owner, lessee or tenant) of the a.foresaid building. NOTE~ Health dept warns there are l~pts nitrates in water - not to be used for infant formula. 10 pts max safe faetor, H.D. Approva~ Jan. S, 1961 subJaet to abovet P.Ma~kow~ski .......... ................... Building Inspector FOI~M NO. 2 TOWN OF soUTHOLD BUILDING DEPART/v~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS F~ERMIT MUST BE KEPT ON THE PREMIS~:S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°, 1494, Z Date ........................... Permission is hereby granted to: Chef 0.~ 1~ .w. ski.. AZC..... L~.ene e...B~.e.~er:. .......... ............. Cut~hc~u~ ............................................. to ..... Build..mew...o~e.. ~a~il.y.. c.l~¢~ll, tn~ ................................................................................ at premises located et ...~a.~li. ne.. -~.r~e..~c..P~eoni. c...Ba?'..]~.~ ............................................... .......................................................... ~;~t.¢,.uc~, ................................................................................ pursuant to application doted .................................... ~.~.~ ....... ~ ...... ]9..~.~., and approved by the Building Inspector Fee $.lO. aO ........... ' Building Inspector FOI~M NO. 6 TOWN OF $OUTHOLD Bu~(ding Deparfment Town Clerks Office Southoid, 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 Inspector 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-c) form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit P~anning 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: I. Accurate survey of property 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 in- formation 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 New Building ................ Addition ................ Old or Pre-existing Buildina ................ Vacant Land .............. 9)~er Or Ow~n~ers ~ Property ~~....~.~-~.;..~;.~...~....~...~..,.~.~.~.~.~2~- ~ J~'/ ~ ., ~;~- ~-~ ~ ~///~//Z o / Subdivision ............................................................... :Lo(No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. 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 oil applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County Chicago Title insurance Company 1 ] 7 East Main Street t17 East F/z~ ~ S~eot P. O. ~l~eer seal) Riverhead, N~ N~~q/ LAUMAN LABORATORIES ANALYSES OF WATER, 100 LAUMAN LANE WEt,.LS 1-2305 WASTES AND SOILS ~ETHPAGE, N.Y. P. O. Box 235 TO .... ~[~a...~le.t...O~WYak~ ........................................................................ .... ~e~aa,~h..A~e,. ..................................................................................... .... ~u~a h,.~,..-~.,.~t,, .............................................................................. Cl~TI~CA.TF.. OF BACTI~:EOLOGICAL ANALYSIS Date .......... ~.~....~...[~. ........... Sour~ of Sample ...................... ............... DATE: Collected......g~,.--~,.-l~J[1 .............. Received..l~.,...3{}~..:l.~16! ............... Reported.Bee.,...t'~,~....[06[ ........................ Sampling point .......... .~l&..-3~ ................................................... Co lected by ................................. ~.~,-t'-~ ....................................... COLIFORM TESTS LACTOSE FERMENTATION CONFIRMATION ML 24 hrs. 48 hrs. 24 hrs. 48 hrs. IO 0/$ 015 1. 0/x o/1 o.1 Ol~, 0/~ "Most Probable Number" (MPN) of Coliform Group per 100 ml...3,~l~_.l:haa ~,:~ Standard Plate Count per mi, 35°C., 24 hrs ......................................... Chlorides as CI ......... ,22......ppm Nitrates as N...I& .................... ppm A~Lo~l$.g eyncheC~.c de/g~.~egenl:s a~ ~$ leas ghee 0. I REMARKS: when tlm saeple was collected. Due Ilo M. Sh n~t~ate eeaten~ . Note~ Not recommended for infants formula. ....................................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD', N. Y. (/ Disoppreved a/c ...............:,~; ............ t ................................ (Building Inspector) Application No..l..~.k.c~'..!7~. .......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 location. 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 progress of 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 and regulations. ..... ................................ ~[Signature of applicant, or name, i a corporation) ~ad~ess or applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, g~neral contractor, electrician, plumber or builder. .............. ...... ............................................................................................................... Name of owner of premises... ¢,,~ ........ ~zur~"' L'~ ........ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wdl be done. Map No.)l,~.~.~..~...~,~ ~.w,~.,. ot No../. " ...." .~I...:~.....' ' " ~ L ' Street and Number. r:~;.'.~;~ .¢~.4~, ...... ~.. ~,,~.'~,~,.. ~,~.'. .......................... Municipality / 2. State existing use and occupancy of pr,emises, and in!ended use and occupancy of proposed construction: a. Existing use and occupancy ............ ~ ............. .. ...................................................................................................... b. Intended use and occupancy ...... :!:~......~..~!..~....:,.~..~..:{:~..Z..~.~...::.:.f~..~.'~:.[L..~.....:- ......................... ? 3. Nature of work (check which applicable): New Building...., .Z~... .......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... .~.$.2..~..fti~. ................................ Fee ............... /....O....r...~.-~.. ........................................................ (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 .................... .'T. ..................................................................................................................... 6. If business, commercial or rnixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, 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 ....... .~.:.,~ ............. Depth ~._..~....~......,.~/~.,~ Height ........ /.~,..~. ........... Number of Stories 9. Size of lot: Front ........ ]....~..~.~.. ...... Rear ...../.,~...~.. .......... Depth ........ ./...c.../....~..~..., 10. Date of Purchase ........ /-~.: ....../...f...6.. ................. Name of Former Owner ..~.v....,:~..~....(.~..~..-~.. ................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of prem.ses)~.,~...~ ......... Address .................................... ~.. .... hone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Nome of Contracto~,~2..~..~,~.,~: ....... Address. ,~,~..~.~,~.~2...~...:./~'.Phone NO.~..V',.~..4..~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lides. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. q STATE' OF NEW~/OI~._/' ) ~ ~ cOUNTY OF ~....) --' ....... ~.'.~:'....~.~. '-.~,,Jl ..~, .~..~.~..~.; ................................. being duly sworn, deposes ,and says that he is the applicant ~N~ ~{ in~5'l' ~i~n~g~pplication) 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 a:p c~ton; that al 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 f ed therewith, Sworn to b~for~ me this ~., JU _ f~ _ ~'~,, D ~ , ...... ............ ........ Not~ Public, ~ ..... ~..;.~4~.~.w~.:;~ ....... ;~ o r~, ~ar~ ~0 ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUT,OLO', N. ¥. Examined ...... 7,e .~..~ ~'1 19 ~ ( Disapproved a/c .......~...7~.~.7:....t~. (Building Inspector) APPLICATION FOR Bt~ILDING PERMIT Date ..... ..z~.........F...: ................................. 19.~..~. INSTRUCTIONS a. This application must be completely filled in by typewriter or Jn ink and sub)mitred in duplicate to the Building Inspector. 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 location. 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 progress of 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 g?anted by the Building Inspector. APPLICATION 'ISt HEREBY MADE to the Building Department for the issuanoe of o 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ..... >~<~.¢~-, l~a.... ;:5~,: aa ..~?~:. :a .................................... (Signature of applicant, or name, if a corporation) .............. g.>xf.~rX ~.~=~:~. ~.%?.../..... ~ ..;..:~ ........................ (Ad'ss of aDlic~nt) [/ , State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ....... Name of owner of p remises ~f"s'.~' ~ ~4~/,/.~.~4~'~ .~J'&'a.&.~.,.:,~.%/.~..~.. .............................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ' No:~t't 'i l'~'?''¢ r.~.Jm'~.~a~.%=.. Lot No: .Z '~ 1. Location of lend on which proposed work will be done. Map ¢ip Street andNumber.. ~,¢.,c~x.k~...C',:~..~,,,.,,,¢~-....~:. X:g.:.i.D,,~a~q... ~tr,~e~,.~:c~ .......................... Municipality / 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: ........................... .............................................................................. , ~ - ,, .. ~ :..[~ ~ .......................... ,J 3. Nature of work (check which applica'ble): New BuildJng....../~ ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... /. ....... .-,~....~...Z ............................... Fee ................ /..;..~....¢...~...x~.. ....................................................... (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 structures, 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 ........ .~].~ ............ Depth ?..-..?....,4,.....~..~.. ...... Height ........ ./~; .............. Number of Stories ............................ 9. Size:of lot: Front ........,~ ~,,/"~'~'"",' Rear ..... /.~.~ ......... Depth ........ /..~.~J~... 10. Date, of Purchase . .~.:.......[..~..~.~ ......... Name of Former Owner ...~.57....~.~= ................. 11. Zone or use district in which premises ore situated ....... r~ .................................................... 12. Does proposed constructioh violote ony zonin~ Iow, ordinonce or reOulation? ....~ ........................... ~ ............ No. 13. Name of Owner of premise~..~/.~.~.~.~.~: ......... Address ~. -.. e . ................... Name of Architect ................................. ~i ...................... Address .....¥ ................................ r:~l.~...['"'Ph°ne NO ..................... Name of Contracto _- .¢~.__~ ........ Address. ,, Phone NO.~..__z.~...I~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property li~es. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~,N'~O~.I~, .,/~; ) S S COUNTY OF .~....) ' i i............... being ...... ~.. duly sworn, deposes and says that he is the applicant 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 fi~e 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 appJ, ication filed~er~with. Sworn to befor~ me th s · (~ da~ of ~ ~1~ T.~0~~~~) ..................... Notary Public,