The URL can be used to link to this page

Home My WebLink About6195-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi{icate O{ Occupancy No. Z~. 8.11:. ...... Date ........... 8~l~l;...~.~ ....... , 19.73 THIS CERTIFIES that the building located at . .8/.~..~.~1'..~. ~....I4>~.. ......... Street Map No.. :~[ ........ Block No. l~. ........ Lot No. ;1~... p.000!a.:[C .. N.'~? ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 0C'~...2If ..... , 19.7.~. pursuant to which Building Permit No.6tg~'Z... dated .......... 0¢t;,..21f ..... , 19. ~2, 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. ri.?a~...ma.~ .f.~. i.l.y., d.w.e.~..1.~, g ....................................... The certificate is issued to . liable. 1~¢I¢d ........ 0k~l~l~ .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . J.U~. ~... 2~ ...~ 97.3.. bY. .8~. ~!!J-. &... UNDERWRITERS Ct:.RTIFICATE No.. !~867.~., aP~;.%. Te~..~./9./.73 ................... ItOUSt: NUMBt!R .... ~ ..... Street... ~l~:l;'ll-IBl~...L~. ~ ................................. ...... Building Inspector / ~OEM NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6195 Z Permission is hereby granted to: Ca,'l* s ~h~lt..~ees.-'"A'~" t~tt~le-'Woe~ ............ ....... --I~..../.~. ............................................................ ................... t~'~e~e~ ....................................... to 3;lllLt~lJ... mm...mae.. ~'ma,1,.',,~,-.. f,~ :.~ ~..~;i,n~ ................................................................................. at premises located at ...... J~/~.....'qp~.;[&S..~Ue-~ ............................................................................... .................................................... ~; 4~ ~ ,,:.~.~..,~ ........... '~'d~'- ...................................................................... pursuant to application dated ..................... ..O~....t.. ......... ..~..~. ............. , 1~....., and approved by the Building Inspector. Fee ~.SeO0 ............ / ............................ · , ~ui~a~ng Inspect'or FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. ¥. 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-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. §. 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. 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 Date .... .~.......~...... ..~.......~'.. ..... ....../~' .?....~. New Building .......~... ......... Old or Pre-existing Building ............................ Vacant~nd .......... i ................. Location Of Property .... ..~Z.~. ....... ~..~..~~..,,;.~ ............... ~..~.~ .... Owner Or Owners Of Property ...... ...~.~.~...~.~ ...........~...~...~.......d~. ....................................................... Subdivision ......................... ,~,,,. ................................ Lot No....~,... Block No. ,~ ..... House No....,~,,.,O,.,.0 Permit No ......~L.~..~...ZD~e~Of Permit ...~...~...~.?/.~.~;Applicant .....~"...~........~.~.~.; ..... L bor Health Dept. Approval {../~....f~).'/ ............................. Dept. Approval ............................................. Underwriters Approval ~.~..~...~'.~.~..~...7~ ........ Planning Board Approval ..... .~...~.~T..~ ............. Request For Temporar~ Certificate ........................................ Final Certificate .......................................... Fee Submitted ~"~ ................ Construction on above described building/~, pe?~it 2~ts al~codes and regulations. Applicant .~ .......................................................................... Sworn to before me this ........... ;.... aay OT ....~.e_./~ ............................. Notary Public .......................... ~. .......... County (stamp or seal) ~f~ ~. ~/'o~t 57F ING ~ho ~o~age disposal and va~er supply facilities for this location have been otnspected by this department ~d found ~:be sa%lsfactor~~ ~ ~ ~ ~/~~. o Chief of General Engineering · = MONUM~ ~ 'z.~ formerly ~ or $oCCo O0~ REV'S,ONS YOUNG & YOUNG 3UN£14,197~B 400 OSTRAND£R AV£NU£, RIVFRH£AD, N~W YORK ALDEN W. YOUNG HOWARD W. YOUNG PROFESSIONAL ENGINEER AND LAND SURVEYOR SURVEY FOR: MABEL WOOD PECONIC 1 ,ow. SOUTHO.g SUFFOLK C0., N.Y. SCALE: I" = 40' DATE: OCT. 12~ 1972~~813 DRYERS I FURNACE MOTORS I FUTURE AllIANCE FE~D~RS ISPECIA(REC'PTI. · .___.TIMECLOCKS tSEL ~ SERVICE DISCONNECT t HO. OF I S E R ' V I; - C '1_ ]k 0 0 C~ METER X "{ ~ OTHER APPARATUS: THE NEW YORK BOARD OF FIRE ;UNDERWRITERS BUREAU OF ELECTRICS*. ['-- I)~ 85 JOHN STREET, NEW YORK, NEW YORK. i0038~ THIS CE~IFIES THAT o~y t~ ~ ~u~mnt ~ ~sc~ ~ a~ int~ by t~ ap~nt ~m~ ~ t~ ~ ~pli~tbn numar in t~ p~m~es o~ ~bel A. Wood, s/side Spring Lane, 365' e/o Indian Neck Lane, Peeonlc. b2 in the f~l~ing ~ation; e~nt ~ lst FL ~ 2~ FI. outside ~ction BIlk EXHAUST FANS DIMMERS NO. Of NEUTRALS OF NEUTRAL Carl Bosehett~, P.O.Box 523, tiS0 E.Main St., RtverheadR L.I. 11901 Per ' COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANN':'I. TOWN OF SOUTHOLD ' '/~ TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ~ ~ ~ Examined ~ ~ L~ ..., 19.~.~ ~ ~ ~ ..................................... .o. ................ ~p~ed ~ ........................................ , 19 ........ ~mit ~o .............. ~' ~ Di~pprov~d ~/c ............................................................................................ ~ ~/~ ~ ................ .................................... ¢"7 .............. ~'~ / ~ - ~-~::::.:.:~.~..~ ........ ~.~; ....... ~ ........ '~ ~'~/~. ,'l~ ,~ /~ ~ ,~ ,, ~ , . ~uilding Insp~tor) ~ L ~ / ~ ) FOR BUILDING P ~:~ ~1 ' A ~,~ ~ ,~/,~ ~STRUCTIONS _ ~ a~his application must ~ completely filled [n by ~y~writer or Jn ink and submitted in triplicate ~o the Building Inspector, 3 se~s of plans, aaaura~ plot plan to scale. Fee aaaording to schedule. b. PIct plan showing location of lot and of buildings on premises relationship to adjoining premises or pub ~ streets or areas, ~d giving a detailed description of layou~ of pro~r~y must be drawn on diagram which is part of this application. ~. The work covered by this application may no~ be ~ommen~d before issuance of Building Permit. d. U~n approval of ~his application, ~he Bdilding Inspector will issue a Building Permi~ ~o the applicant. Such ~rmit shall be ke p, n the premiss available for ins~ction ~hroughou~ the work. e. No building shall ~ occupied or u~d in whole or in part for any pur~s~ whatever until a Certificate of Oaaupanay shall have been gran~ ~y ~he Building Ins~ctor. APPLICATION IS HEREBY MADE to ~he Building Depa~ment for the issuan~ of a Building Permit pursuan~ to ~he Building ~n~ Ordinance of the Town of ~uthold, Suffol~ County, New York, and other applicable Laws, Ordinances or Begulations, for ~he construction of buildings, additions or ~llerations, or for remowl or d~itio~ as herein described. The applican~ agrees to comply with all applicable laws, ordinances, building code, housing ~de, and regulations, and to admi~ authorized inspectors on premises and in buildings for ne~ssary inspections. (Signature of applicant, or name, if a corporation) Rt ~8 Riverhead (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ ...................................... ~A ~.,~..s....~ ~.e..~ ~ ................................................................................................................................ Name of owner of premises .... ~,&~].~...'~ .................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) -FT- / 1. Location of land on which proposed work will be done. Map No.: ...,7~;:~ ............ Lot No ........ ;T~ ................................. Street and Number ....... ~/...~......~:p~.~,~..%~,¥~¢. ................ ~.~C.ot~ C .......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~.~.¢.P,D.[...].~,~O. .................................................................................................. ~i~- b. Intended use and occupancy ........... OT~9...£,.n,~].~;..~L~.~,.~.~.~g, .............................................................. ~ .......... ~ 3. Nal~'~ fe hr'work (check which applicable): New Building ...~ ........... Addition ..................... Alterat~on[.;,..,~ ....... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... { Description) 4. Estimated Cost ........... .1.;~.~..6..0...0. ..................... Fee ....2..~.~.Q.0 .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... o~..,.. 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'~tructures, if an~r: 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 ........ ,1.~,?...~ ..... Rear ..... ~.;~,Z.8 .............. Depth .....~.~.../.12. ............. Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front .....1:.0.**0. ........................... Rear ......... ~.DQ .......................... Depth ....... ..2.~0. ................................... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ......................~.~.~.........T....'[..-....!..~. ........ 11. Zone or use district in which premises are situated ...... ~.~..~l....~..~...s.~ ......................................... .~ ................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... D,O ............................................. 13. Will lot be regraded ..................................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ......... ~a]3~e..:~:~c~G ...................................................................................................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ....C.~..~..s....~:~.o..~..~,~,.~....~.~.~..~..s. .......................... ~,~.~.~.~.~.~,~. ................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all building, 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 wheth- er interior or corner lot. see filed plan STATE OF NEW YORK, ) ~S COUNTY OF ........ S.1AJ~ ........................... ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name o£ individual signing contract} He is the .......................... ..~...8:.~,.~...S.....~..~.~.~..'~ ........................................................................................................................................................ ~' (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 ali .~tatements 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 filed therew[th, ................................. {Signature of applicant} Z or 5ocCO r~OvI Ail~erf .EV.S,O.S YOUNG & YOUNG.~ 400 OSTRANDER AVENUE, RIVERHEAD. NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: MABEL WOOD ~ ~ AT PECONIC a ~ ~NT~ ~0¥~¥~ J ~ ¥., ~ ~,.-~%.~:?-'~ /~ · ow. o~ SOUTHOLD ~x ~ · ~ .. SUFFOLK CO., N.Y. eY '";~.,~ ~*' SCALE: l" : 40' I DATE: OC~. 1~3' MASTER I]EDHOOM 166" BATH 78" CENTER BEDROOM 132'~ HALL Model 65 FKCD 2-12 CENTER BEDROOM 132" ~ ING RM. lq' 9~ LFVING RM. Model FDR 2-12 DINING RM. KITCHEN 75" KITCHEN 79" DINING RM, 78" BEDROOM 132" BATH 78" HAL~ Model MK 2-12 KITCHEN 144~ Page 8 CENTER BEDROOM 114" KITCHEN 81~ } 100" l LIVING RM 17' 9~' Model FLCDMK 2-12