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Home My WebLink About6181-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificste Of Occupsncy No. Z' ~07i~ ..... Date .............. &pl.4.1. · · ¶ $ .... , 19 73' THIS CERTIFIES that the building located at · 'lten.,7'l~ .............. Street Map No. Peeo~M.e .lto~ck No ........... Lot No. I,~ ...... Peeon:ie .... !t~¥~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ..... Sept' ' 2~) ', 19. ?~ pursuant to which Building Permit No.6181Z. .. dated ...... 0or... ~llZt~...$6197~., 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~-vat~ .one..fal~l.~.y .~lw~ll~ng ........................................ The certificate is issued to PI'ed .Be,m~ek ....... Ot~e~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval "~,ii~'il' ~'~' '197':J ' 'h~ 'R ;' ?~'lli' ' ' UNDERWRITERS CERTIFICATE No.. ]1 '7~3~ .... Feb" 7'" *[~3 ................... HOUSE NUMBER..~.~00 ....... Street... H~y. '~118 .................................. ................. 7~.~. ............ So..~..d..V.~. e~..~.v..e...~.e....t ......................... g Inspector ~ORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6181 Z Date ....................... ~?,t,.....~ 6 ................ , 19.~l~... Permission is hereby granted to: leac..~.V~......~.~'~e ~ut ....... ~..Y.. .................... to. ,~,~.J..%.8... ne ~'... c.n e...,C a~ ,.-t..1,.~...6~a ;, ~ ~, ~1~ .................................................................................... et premises located at ...... ~,~..L~ .......peeot~.-'~o~e~l"~ee~'~· .................................................. .......................................... lie .~...~ a~e.. ~.. ~o~r~i..~,'.£~',/..&ye..I~ ............ t~eo~ ................. pursuant to application dated ................ ~t......~.~ .................... , 19..f,..., and approved by the Building Inspector. Fee $..~.~.~.~q .......... uuitoing inspector / FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in ~ 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-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. 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. Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ... AFr~LL..S~...L~.7.3 .................. New Building ...XXX ........... Old or Pre-existing Building ............................ Vacant Land ............................ .................................................................................................. Location Of Property V Avenue and Henry Lane, Peconic Owner Or Owners Of Property ...... E~:ed..Baumack..azzd..Bazrbara..Mauma~..hLs...~i£a ............................ Subdivision ~&~.e.....~.~......~.ZLot No..g5 ....... Block No ............. House No ............. Permit No 6181Z Date Of Permit ~.~7.~Z~ App cant Riverside H~es Inc, . Health ~pt. Approval .............. ~ .......................Labor ~pt. Approval ................................................ Unde~ritem Approval ................ ~ .......................Planning Board ~proval ........................................ Request For Tempora~ Cedificete ........................................ Final Ce~ificate Fee Submitted $ ~,.QQ ............................ Construction on above described building an, d'"~rmit meets all appJi,,ca, bte codes~d ~regulations. Sworn to before me this /~'~ ..... ........ Notary P ubl ic~ .~3~.~-~ County T~Ri L~[ pUBLIC, State 04 New (stamp or seal)/~'~ ? ~ 7 ( >o % The Sewage disposal and water Supply facilit.~es for this location have been ~nspected by this department and found to be satisfactory. ~~ Chief of G~neral nE neering Sdl~Viees TOWN OF SOUTHOLD-~'~ ~I:/~/~/ ~ '?'" ~ : ~ TOWN CLERK'S OFFIGE ~,~/~ ~' ~/~ ~ SOUTHOLD, N. Y. ~/~ {/~ ~ ~c~ ~ ~ Examined ..... ~...~...~ ............ , 19..~.~ A ~ / ~lic~tio~ ~o.. ...... ~..,~.. ................ ................ ............................................................ ............................................................................... ; ...................................... &~ off~ - ~e~ ~ d~:,c~ APPLICATION FOR BUILDING PERMIT ~ ' Date ....~.p.~b.e~. ~. ....... , 19...Z~ ..... INSTRUCTIONS a. This application must ~ completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector~ith~ 3 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 prem ses or pub c streets or area~n~, giving a detailed description of layout of property must be drawn on diagram which is part of this application. ~ c, The work covered by this application may not be commenced before issuance of BuiJding Permit. ~ d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such ~rmit sha be ke~ on the premises available for ins~ction throughout the work. e. No building shah ~occupied or used ih W~ole or in ~art ~r any purpose Whatever until a Certificate of Occupancy shall have bee~/ granted by the Building Inspector. ~ ~ Ordinance of t~ ~wn bf ~u~h~d, ~ffotk County, New Yo~, and ~her.applic~[e L~ws, OrdFnan~s 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, and to admit authorized inspectors on premises and in buildings for necessary insp~cti~s. }115"~~/ l~ (Signature of applicant, or name, if a corporation)' ~' [~ ~ ,~dress of applic~;t} State wbeth~r a~licant is owner~ Ios~e, a~nt, architoct, engineer, ~neral contractor, electrician, plum~r or buildor. ~lder ~ame of owner of premiss ~red Ba~ek 1. Location of land on which proposed work will be done. Map No.: ...0,18.]. ......... Lot No...~ ....................................... Street and Number ........... .~,/.~,/...~'~¢~....Sg.~,~d.,.~5~...~..~p~..e~d..~e~s..~eae ...........~...~ ............... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... Y.e,¢e,~t~;..~e.t~(t ........................................................................................... b. Intended use'and occupancy One ~'azaf.~ 9wellf. t~ ....................... ............... ........................................................................................ 3. fu?e'of work (check which applicable): New Building XX Addition e Alteration ............... Repair ............. · ............ Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ............................................... Fee ................................................................................................. {to be paid on filing this application) 5. If dwelling, number of dwelling units .,..3, ..........Number of dwelling units on each floor ......... 1 .............................. 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 .....2.~.', ...................... Height ........................ %5;. ................... Number of Stories., ............,~. ....................................................................... 9,' Size of lot: Front .~..;.2[}3~3,.~, .................. Rear .......... [~.[.,...8.~:. .................. Depth ........ ~ ,8. ,6. ~. .Z, .8. ~ ............................. "Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ...... ~,o. .................................................. 13. Will lot be regraded ...... __'~'J[~... ................... Will excess fill be removed from premises: [ ] Yes [-,~ No 14. Name of Owner of premises ...... ~x~...B.~31~,~k .......... ~aX..~,3~.~'.~,C.~,."_~,~....N~...Y.~'~, ....... 29J~.-.~,0~ ...................... (Address) (Phone No.) Name of Architect ..... .H.~.vg.l..d....F..q.s..t;.e..~ .................... ~,..~J,i;~Ye....E.f,Y.~X~q.~,~te....N.,.Y.a .......... ]~2.~.q-~ ................... (Address) (Phone No.) R've d H e Inc P 0 B R' eK~].9~d N~Y~ 7.~7.'~,~, Name of Contractor ....... ~,....~;~.~..~....9~....~ ......... ,.....,...,.....9~...~....,~.~ ..... ~ ..................................... (Address) (Phone No.) · PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give ~treet~nd%lock n~umber or description according to deed, and show street names and indicate wheth- er interior or corner lot. See at~ached survey STATE OF NEW YORK,, .Z~ f--,,/~ ) '- COUNTY OF,~ ......... ,,Z.~...~'.., ./,. ,~,..[,, .~ ......... ) ~ .. ,, .... .... .................................. ............ ................................................................ of said owner or owners, and is duly authorized to ~rform or have performed the said work and to maks 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 be ~rformed in the ~nner set forth/~in the application filed therewith. --~ , .~ Nota~ Public, Sta~ of ~ ~~~[~......~ ~ .V,~ .~ .. CounW ~~.~ ~:Z .................................... _ - ' ~0 ~ t" !;UF]qL;~ COUNTY-DEPAPTMENT OF HEAlTh s]rs~{~::; !~ rcquested~pertincnt d.4,.a nc,r,'.~ l,ength~-J;:, fi, (also enter on con .~., ~ Two Family? ~yCellar? ~2y]/~labY tank .,'. ~ Precast. ._~/~.:~Ceospoolo ~_~..'.~h :i ~o.-r _.~. ~OT PMN -- F'~TCT~'''* 'C~nstmlCt~on of autbor4zed ir~f,! ,ki Co~znt;,' Health Dc[~:~rtments' Private Signed "~'~ ~mor or P.u i !',-' · ".:" '"'~ '*, U~'~c:" O!d~Y,'" l:a-'.c~d-' on thc b~-fon;:~tion prose':~ ~ ,'~ ~"' .... "~- '.;.: k*'~",,r, gqoartnent, that an adequate and satisFacltoi ' '* .-Cc. this Plot. ,~.~.ta/~_-.___ Signed ~-~____... THE NEW YORK BOARD OF FIRE UNDERWRITERS tab BUREAU OF ELECTRICITY ' 85 JOHN STREET. NEW YORK. NEW YORK 10038 THIS CERTIFIES THAT Fred B~umack, n/e/c Sound View Ave., w/& Henrys Lane, }'econlc, N.Y. ~;X~ "E T fFXTURES ~ ' RANGES COOKINGO~KS OVENS__ D[SH~ASHERS~XH~ST [AN~ O.YERS FU"NA':E MOTORS } FUTMRE APPLIaNcE FEEOERS SPECIALREC'PT TIMECLOCK$ BELL ~NI~ERS A~LET: DI~ME~~ 1 200 CB Water Heaters: 1-4.5KW Motor/s: 1-1/2hp Electric Room Heaters: 1-2.0KW 2-1.5KW 2-1.25KW 3-1.0KW 1-.75KW To wle & Sons Inc. 33 Lincoln Ave. Mastic Beach, L.I.11951 p~ T~is certificate must not be altered in any manner; return to lhe o~fice of the Board f incorrect. Inspectors may be idenhfied by