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Home My WebLink About5680-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z.Y..~..'~..~. Date THIS CERTIFIES that the b~g locat~ at ~ .... ~. ~.. ~. ~... Street Map No ..... ~ ..... Block No ..... .~ ....Lot No .................................. confor~ su~t~ly to the Application for B~d~g Pe~it heretofore ~ ~ ~is office dat~ ........... /~..~.~ 19.~~t ~ which B~g Pe~it No. ~.~ dat~ /~ D[~ 197~ was ~su~, ~d confo~s to all of the ~e- ments of ~e appl~able pro~sions of ~e law. The occup~cy for which th~ ce~ificate is The ce~ffica~ ~ ~su~ ~ ~S~ P~ ~0~ of ~e ~oresad b~ld~g. S~olk Co~ty Depa~ment of He~ Approv~ ~ Building Inspector FORI~[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 5680 Z Permission is hereby granted to: to pursuon,t to application doted ~" ~'~' ' i; ", 19:~fJi"'; and approved by the Building Inspector. Fee $...JJ0.(~) ........ FORM NO, 6 TOWN OF SOUTHOLD Building Depmtment Town Clerks Office Southold, H. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructiona A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: !. 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 dispcsal--(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 installations, 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 property showing oil 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 ................... .~)ld or Pre-existing Building ............................ Vacant Land ............................ o, ....... Owner Or Owners Of Pro/perty-- ' ' -- -- .....~../..~./..~..~....~'.......'~...~...~.~...~.~........[...~.,~..~.~X'~. .......................... Subdivision .... ,,...~ .................................................... Lot No ............. Block No ....... ,..... House Permit No ..................... ate Of Permi ............... plicant ................................. ~ [/~:~,~' .,,~..-,~.,....... ...... Health Dept. Approv?~ .'~...~...T..~..-~....~.....~....Z./../....~a~or Dept. Approval ....... Underwriters Approvbl ,~..~i~.~...~.[ ............................. Planning Board Approval .... ~ ............................ Request For Temporary Certificate ........................................ Final Certificate ...~ ............~.....~....~....~...'.?.,. Fee Submitted $ .....~...~'. .......................... //~ on above described building and permi~ts aly'a~licable ~and regulations. Construction Applicant ........... ../....~.~.. ~........~..;...~....~. ~~t--/ ~] //~'~'~' ............................... Sworn_,~/~before me this/x~ ../,~,Z......~.. day of ......../,,~/~r_, -~-~~........./..~x~2__ (stamp or seal) NotaF~ Public .......... ~../~.. ....... ~County JUDITH T. BOK~N Ornmlssion Expires March 30, '-7-- FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office SonthoJd, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 dispcsal--(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 installations, 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 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 3. Copy of certificate of occupancy $1.00 $5.00 Date .../~'~..~ ........~..~ ....../..?...~..~- (stamp or seal) ~u~m~ T ~O~N N~lary Public, Sqate of New York No. 52-0344963 Suffolk County~.,~ Commission Expires March 30, ]9~ v' New Building .................... O~kl or Pre-existing Building ...................... ..~.. Vacant Land ............................ Property ....~./~.~.....~....[.~..........~...~.~....~.....~...~........`~/~...~....~..~`~/ .~......~...'~x'~ ~ "*/ /x~'- -- / .... Location Of Owner Or Owners Of Property ..~../../~./~.d~....?~.~..~.~..~ .~-/~...'~... .............................. Subdivision ................. ...~.. ........ ~ ............................ Lot No ............. Block No~ ........ ;... House No.~..~.~,~'"" Permit Noc~..~..~.....~.... Date/~../3.,Of Pe,.r. mit/~....~..:~/..Applicant ..~ .'~....°~..~....~...4-f~/~ ....... ./~..Z./,~.~'.. ......... Health Dept. Approval .?...~:.~ .~..~-~..~....,./~.//.¢....&.~...~..~oor Dept. Approval ........ "...'.: .............. ' ................... Underwriters Approval .~.....'~...~....~...Y~.~ ................... Planning Board Approval ...... ...~.. ............................. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ · Applicant '~"'"~:~ ~'-"-~V "" "~""('~ ............................ TOWN OF SOUTHOLD Building Dsparl~ent To~n Cle~s Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: !. 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 dispasal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, /~Aultiple Residences and similar buildings and installations, 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: I. Accurate survey aT 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. Dote of any housing code or safety inspection of buildings or premises, or other pertinent 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ...,~...~ -~.~. /~','~-.~..~.. New Bu dng ~x/ ^d or Pre ex stn Bu dn ~ -- Vacant Land .................... ~, - g g .................. ? .................................... Location Of Property .//~....~.;/~.......'~.....?.....~......-"~......~./.~......~.....~...~....~..~......~.~... ...... Owner Or Owners Of Prope/ rty ....~.'/./~..~./.....~.......~..'~...~...~...~ .~.......'' ...~...~...~.~............'. ...... Subdivision ......~,.........--~..........~... ..................... , ........... Lot No....~ Block No..' ........... House No .~.~.~~- Permit No.~..'..~.'.6~J.~......Z.-.... Date Of Permit/.~.....~...~..Z../Applican, .~..~....~./~. ...... . .~.../../..~...~'~. .......... Health Dept. Approval ...... ~ ................../..../....or Dept. Approval ................................................ Underwriters Approval ........................................... Board Approval ........ ~ ......................... Request For Temporary Certificate ........................................ Final Certificate .............. ~ ..................... Fee Submitted $ ....~. ............................ ermi~e~, t~otl~ Construction on above described building and p~e I s and regulations. Applicant .....i.....~c........;....'~.....~.y.......,,~..~. _ .~ ................................... Sworn t~,~efore me this d - (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY · ad B5 JOHN STREE'!r. NEW YORK. NEW YORK 10038 ~1~. OERTiFI~A$l' 1972 579822 , :-:_. Joseph Cornacchcia n/s of ~y Ave. 205~w/oHagNeck ~Y ~ :=' C~tcho~e, L.I. ~ ~ ~ ' . 3 ~ :1972 and found t~ b~u~li~e requiremontsofth~s Board. ~ /~1~/' 29 15 ~11 ~ 1 10.~ ~RYERS FURNACE MOTORS I FUTURE APPUANCR FEEDERS SPECIALREC'PT ; ~ 1 30 COOKING DECKS OVENS DISH WASHERS EXHAUST'I:ANS ~RVlCE DISCONNECT I"O.OF[::¥ $ ~ . E R V ,f_ -[.C ..; E HER APPARATUS: Motors: 1-l/2hp., · ~ter Heaters: 1-4.5kw Elec,RoomHeaters: 2-2.5kw 2-1.Skw 1-1.25kw 1-1.0kw ~',Skw~ Custom Elec. il2 Manor Dr. GENERAL MANAGER Shirley, N.Y. 11967 \~ t'-~ ~'/D Per ,is certificote must not be a,tered in any manner; return ,o t,e offke o{ the ~oord i' ~ncorrect. Inspectors mo;be identified by t:~m~nti~s. 1 $. 8'1'01' ZB* \¥. S. ST'OI'ZO"\V. "-' ~EHUE MAP OF PV. oPr:~Tv, SURVEY~:D t:O~. J,OS EPW /~.. $1'ru~TE PECOHIC ~'"'.'~"'"" D N.Y. TITLE N SCALE' 50': t" GR. EEI, tE'OIZT, HE~V ~bg-v t' DATE AUG 2 The severe disposal and wate~- supply ~'aq~,[LtLe~ for the structure located at . h2ve been ~n~ected bu this Depar~ent ~d ffo~d to be satLsfscto~, ~ief ~ ~enera~ ~ineerin~ Services SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No~-~J~ APPLICATION FOR %PPROFALTO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pertinent data herewith: Dar Addres ~ ~ ' . -~ 2-Detail~'~.rope.~ location ~ Z- ~e~' - A~g: - t No. ~et~~ ~Private well? ~ ' ~~ To~ ~ .... ~-Pr ~s~nce to nearest ~xn 3-~blic ~ter noisome , ~ . Size, Widt~ft. L~h~t. (also enter on center p%~t plan below.) 5-~11i~: Single F~ily ~ ~ F~mtly? ~ellar? Cmwl 10-~s~ ~st~: Septic ~~cast~Cess~ols~Shallow~ols ft. Liquid incs. D il-Septic tank inside~ensions},.~o_lu~,,e ~als.Length ft. Width 12-Precast sectionS: ~Number~Squlre Ft. Cesspools: Block sizeL Total blocks below inlet: ~i ~2 ~3 PLOT PLAN Bom Capacit~__~Gals. Street NoPt] Data Feet 0 2 6 8 10 12 18 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, amd amemtment~ thereto, covering Private Se~e Disposal System~% · Date-~---- Signed~ ' Owner or Builder /~ Based on the information presented rewith, it is the FOR HEALTH DEPARTHENT USE ONLY. h~ opinion of the Health Departmbnt, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. (io/65 a~is,) .~ Examined ...................... ~ ............... , APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink an~l submitted in duplicate tO the Buil~ nsmctor. . b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street.., or areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram Which is port of this applicatJon.'~ c. The work covered by this application may nat be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permi~..~. ~he .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 O¢¢Ul~nCy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southol~,I Suffolk COUnty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, addit,ons or alterations, or for removal or demOlition, os herein described. The applicant agrees to comply with all applicable laws, ordinances; building code, housing code, and regulatlon~ (Signature of applicant, or name, ifa corporation) State whether applicant is owner, lessee, agent, architect, engineer, general fi6r~tractor, electrician, plumber or builder Na me of owner of premises ~9~,G.~. ~......CO~.)J~/.~......~.....~. ......................................................... ..... .... If apl~.licant is a corporate, signature at duly au icer. -~'/~'~' ~ - . ~ n~ ....... -- (Name and title of corporate officer) Location of land on which proposed work will be done. Ma,p N~.: ........................................ LatVia. ,,.., .................. mber ~. ~' o I~,) ~ Street and Nu ....... .~...~-~ ......... ~...?~.,~ .......... ./.../...~..~).~.....~4z~.....~ -- ../Q_~O 6-- -- Mun'c,poli~' ........ :._,...~.... ........... State exist!rig use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................................................................................... b. Intended use and occupancy ........... .~.......~..~j~/.~..~...,...'.~..../~I~..L:/.~.~.. ............................... .................. .~ 3. Nature of work (check which applicable): New Building ..... A. .......Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ....... ~ ................................ IL____ ! 4. Estimated Cost ..... .~1....~...~..o...o....~.. .................................. 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 ...... .~. ................................................................................................ i ................................. 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 ...a~......~.. ........ Depth ~...~.. ......... Height .................... Number of Stories 9. Size of lot: Front ../.~.~.,..~...~ ....... Rear ..../.~..~.. ..................... Depth ...~..~...~..O.. .................. 10. Date of Purchase ...,j~j~..o..~.......~.~.~./. ...... ~ .................... Name of Former Owner ........................................................ 11.' Zone or use district ih .which:premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~..~. ............................................. 13. Name of Owner of premises ........................... :...: ........ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~../~..~.lA~,~.....~.L)l..~.~f~ddress ............................................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 show street names and indicate whether Interior or comer lat. , . STATE OF NEW YORK, )'S $ COLLNTY OF ..... ;. ......................... ~ ' , . ..... /~I.(~L~C~......~:.......~../.~..~.~./~..~.' ................. '. ....... being du y sv~orn,'deP°~es and soys that he Is the applicant (Name of individual signing applJc.~ion) above named. He s the .~..~...~ ...... , ......... ;.,~....o...A~,~l~.J~...~ ............................................................................................. .(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 application; that all statements contained jn this application are true to the best of his knowledge and belief; and that fha Work Will be performed in the manner set forth in the applicati°n filed therewith. Swam to~,A~re me this ............-- , ..d v of ....... ,, .... 7./.. ...... ...... /× ............ ........ NOTARY ?UILIG~State of New York SefTo~ County No. Commission b~pi~e~ Mardt 30, 197~ E ,LE:N,,-,, FI O,Ni ~mAWN~ I.[ rI i L I,-; .... L-___L DO NO'/' ec~,~l~.l:, UIi: ~IVI'N oiiMIl'NlllC)N~l 01<tLY. I SPAC IVlAKERS:IHC I WILL DRIVE: CANTQN MASS. ,SPA, C J4AKERS. !N..c. SPACEKAKERS !!HC DO NO(I' ItOAI..E:. d138E (~tlVEi(Ii' DIMEN$1ONiIi ':' '"t 12 SCALE:, I/~ - I ~9 ~ DRAWN BY, H,~I. DO NOT $OAI-I'''. USE GIIVE:N' OlMEN~ION~ ONLY. I J