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Home My WebLink About5483-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~.~. ~.6~ ...... Date ............ .t,.lig~;...28 .... , 19. THIS CERTIFIES that the building located at 1/715. lt~tsoll .Bt ........... Street Map No... ~ ...... Block No....~. ...... Lot No. 1~......(1.1~.~..OlalIO!Y.t;...1~,7~.~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ 8~pt; .... 2 .... , 19. ~.. pursuant to which Building Permit No. dated ........... ~p. ti...~ .... , 19. ~.., was issued, and conforms to all of the require- ments of the applicable provisions o£ the law, The occupancy for which this certificate is issued is . Pr. ivat~a .one..f~L~r .dwalling ....................................... The certificate is issued to . .&Izd:e~. &. I4~$a.. lIll~ s ok ...... Ol~l~s ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval P. ob. · .~ .19.72.. by .R.. ~.il~la ........ UNDERWRITERS CERTIFICATE No... tlOll~t.:~kl:kg ...................................... HOUSE NUMBER...~00 ....... Street ........ lOtd&.~911. ~.~; ............................. Building Inspector / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMrr (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5483 Z Permission is hereby granted to: at premises located at ............ ~J~-~.....]J~..~[ ........................................................................... .......................................................... ~ee~t~l; ........... iI~1:. ........................................................... pursucm¢ to application dated ............................... ~q~t, ......... J~ ...... , 19....~J, and approved by the Building Inspector. Fee $....:J~i.~ ........ Building Inspector FORM NO. 4' TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .9/~ .l~a¢t.i. zol~. Si; .......... Street Map ~No..~1~ ......... Block No.. ~ ...... Lot No...X~ ...(}l~e~pO~.~;,. 1~.,~, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... tSel~;-..2.., 19 ~. pursuant to which Building Permit No. ~i1+8~ .. dated ............. 6eD~ ...2., 19.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law, The occupancy for which this certificate is issued is . .p:t'i~t~;e. one. fami~y..¢t~z~_.Zin~ ...................................... The certificate is issued to . AlatlX'W~ .&./a,~t~t. ~l~ .... 0wr~'~ .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~1~.. I~..$9~r2...by. I~, .¥t.l. la ....... UNDERWRITERS CERTIFICATE No...~Ol:l~],.l~l~ ....................................... HOUSF, NUMBER.. ~00 ....... Street ..... l{IMl..'t~Oll. ~.'[; ................................ . : .,. t... . .z_ c : . . .j .... Building Inspector I S-9 $CHD SUFFOLK COUNTY DEPARTMENT Date '~ Bldg. OF HEALTH Nov, 9, 1971 Permit No. ~8~ Z TO WHOM IT MAY CONCERN: The sewage disposal facilities W/S Madison St. at for a structure located (Give deed location) / Greenport, N. Y. have been inspected by this department and found to be satisfactory. Chief of General Engineerin~ Services BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STRE~-~ ~ NEW YORK, NY 10038._//~, -5--'~ // CERTIFIES THAT Upon the application of upon premises owned by JIM SAGE ELEC. INC. P.O. BOX 38 GREENPORT, NY 11944-0036, HAL BLOOM 19 MADISON ST GREENPORT, NY 11944 Located at 19 MADISON ST GREENPORT, NY 11944 Application Number: 2041516 certif[?ate Number: 2041516 Section: Block: Lot: Buildin8 Permit:.~_ t/~:~ BDC: NS11 Described as a occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: C//) Basement, Outside, A visual inspection of the premises electrical system, limited to electrical devices and wirin§ to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulsated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 15thDay of March, 2005. Name QTY Rate Rating Circuit Type Miscellaneous 1-self contained hot tub Wiring and Devices Disconnect Service 1 Phase 3W Service Rating 200 Amperes S¢~ vice Discomaect: Meters: 1 1 0 PooF Spa 1 200 cb seal 1 of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No ~-7~~ APFLICATION FOR APPROVAL TO CONST,RUCT .pRIVATE S .EWAGE ,DISPO, SAL S, YSTEMS Approval to oonst~uct said systems is requested~pe~tinent data herewith: i-Applicant A~NDREW h~JZSEK Phone4??-!,451 6-Sub divDeSor£bed property Address3E5 BOUt]% s~.',Gre~enpebt', N'?' 11~ ' 7-Se iD Hamlet Green?orr 'Town ~OU%hola 9-Private well? no 3-Public water supply, nameGreen~ort Village Distance to nearest main 21~ 4-Lot Size: Width 'fD ft. LengthlEO ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~; Two Family? !/¢ellar? ~V/.Slab? ! ;Craw~ 10-Proposed system: Septic tank ~ /Precast ~/Cesspoo~s /V/Shallow pools ii-Septic tank inside dimensions: Volume Gals.Length ft. Width .ft. Liquid depth 12-P~ecast sections: /2/Number~sqUare Ft. Cesspools: Block sizeL . incs. D ins. H Total blocks below inlet: ~1 ~2____~ PLOT PLAN Capacity Gals: I. Date AU6.1?,IP?i , Street M~DISON ST, The Undersigned CERTIFIES: I e No~th Water S "Const~ction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, coverin~ Private Sew~Ee Disposal Systems". Date A~g,l~, 1971 Signed ~.~a<~Y-'~/~ Owner or ~er FOR ~ALTH DEPART~NT USE ONLY. Bas~ on the info~ation presented here~th, it is the opinion of the Health De~rtment, that an ade~satisfacto~ Se~ge Disposal System can be installed on this ~ot. Date ~~ Sign~ ,.~~ , ~. (10/65 Revis.) TOWN OF ~THOLD BUILDING DEPARTMENT/~ ~UTHOLD, N. Y. .......... , ~p o ~ .......... ~ ...................... ........................................ , ~9 ........ P~i~ ~. , DisoPprov~ o/c ............... ~ ........................................................... .... ' .. ...... .A 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 ofproperty muSt be drown on 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 application, the Building inspector will issue a Building Permit to:the al:~licant. 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, building code, housing code, and regulations. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Municipality State exiSting use and occupancy of premises and intended use and occupancy of prpposed construction: Intended use and occupancy ................................................................................ [... 3. Nature of work (check which applicable): New Building .................. A~ddition .................. Alteration .................. Repair ............ ~l~,l,~poval ..................Demolition ....... /..0 ...... Other Work (Describe) ........................................ 4. Estimated Cost ............................................................ Fee .......................................................................................... ~ (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, spee_ify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimehsions of same structure with alterations or .a,.dditions: Front .................................... Rear Depth ............................. ~..' Height .................. ..~.~'.~..Number of Stories ..,,.~.... ................... '"~'~'~' ............... 8. Dimensions of entire new construction: Fror~ ................................ .t.. Rear ............................ Depth ........................ Height ...,,....: .......... N~,r ef Stories ...... ..~.~. ................................... /~ ........~...~,.~.,. ................................... 9. Size of lot: Front ..... ...~.le~ ....... Rear ........ i ........................... D_epth.~ .............................. 10. Date of Purchase ........................................................ I~ql~e of~'~ner ...........................................: ............ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction vio~,tq,9.ny zog'~ngJa)~ ordinance or/~gulation? ........................................................ · ame of Owner of rem,ses ~l'N'/~l*b') /'IU-~(- '~ Address ~"'~ .... 13. N p ' . ........................ ...................................... · ................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from ......~ ........ ~ r~' J~-J .,.~-- show street names and indicate property lines. Give street ~.4 whether Interior or corner lot. ...... ..~.~ ....................................................................................... ~emg duly sworn, deposes ond says that he i$ tho (Name of individual signin~ above named. He is the ..., ........... ~ ........................................................................... : ............................................................ (Contractor, ag~t, co~orate officer, etc.) of said ~ner or ~ners, and is ~ty authorized to perform or have performed the said work and to ~ke 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 ~ performed ~e manner ~t foffh in the applicatJ~ filed therewith. Sworn to ~re me this ~ - ~- ~1 ..... , // Nota~ Public,~ .............................~u m ~. ~ .............. . ~ (S~gnatum' of applicant) ~'b~c, 5tote of New Ne. 52-0=~. ~ March 30, ~9~