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Home My WebLink About6251-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. J~21t~ ..... Date ......... '... J.ul~r .... ~ ...... , 1973. THIS CERTIFIES that the building located at 1~o .O, oW., .$/,% .New. 5uf. fot~ ./O~eet Map No. ~ ........ Block No..XX ....... Lot No. ~... Eatt&.tu~k...N,Y., ........ conforms substantially to the Application for ~Buildin~~ permit heretofore filed,in this office dated ........... l~e~', · 13' ' 19. ?2- pursuant to/which Building Permit No. 62~1Z " ,' ~;252Z' ' dated ..... N~ .... ~ ....... , 19. '7'2, was issue(i, and conforms to al~ of thel~/l~ellO~; ~lp~l~ ,' ; rex' ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P. rivato, ene..f, amtty, dwelling, with. acee seo~¥, buil~Li, ng. &..f.e~ee The certificate is issUed~ to .. Ii....Alvi.n · ~mt. th · ...... Owne.l, ........................ of the aforesaid bulldog. Suffolk C6unty Department of Health Approval . (owner, lbssee or tenant) UNDERWRITERS CERTIFICATE No..N. 'O9~61'9 ' ' · lc. ay.. 2' '~973 .................... HOUSE NUMBER...7690 ...... Street .... ]~hitW' SI~;~O].~' 'AV~';i: ........................ Building Inspector FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING P, ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 6251 Z Permission is hereby granted to: Flo~el,.. ~i.~.l.t-..B~.!tt.~ag.- Co.rp..... A/(~.....1~ ~ · ..Alv~ 8m~h '"'8~3'""'~i~h~"~l~ .................................. ........... Ym2dbur3r ......... ~.~. .............................. to ....~uf~.~d...~.~.,.ol.~..T~/~j3.7..~,~,t~.~.~.~t~.....&...Ae~e~el,.~..~;L.l~.4~g.~.-Z~..ey,,4.-s~:J~tg · ..aoeees olT..bul.l~ f~g.. ~ ..&ppt'oved.,..l~' ])o~,rfl~" cff":kppl'e~l:"lleV"2i'"~)~ ...... pursuant to application dated .,,~,,~,,..,~,~.~,,~.~.,...l~..,.~..,&[;)~,,~,a,~...., and approved by the Building Inspector, Fee $'"~'~'~0' ......... Building Inspec~r ( FO~,M 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) N? 6252 Z Permission is hereby granted to: ......... .Sk~3.....,z.e~c~Q...T~ ............................. ............ .U...o..o..d...b....u~ ................................................. to BuSed ne~ aecesso...~.. ( ................ ~..~.~?.d.....b..~...~....,.~.~.?..,..Z...,......,..,.~..~ ............ .!..9.~ ............................................. at premises located at ...... ~.~.Q~[~...~£~..i~L/IL..~¥...31~£~3J:..A~I. .......................................... .................................................... l~a.tt£tuek.....I¢,~.o ........................................................................ pursuant to application dated ................... ~ ........~ ................. , 19...~., and approved by the Building Inspector. Fee S.li~.e.(~ ............ Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6253 Z Date ................... ~i' .......... P~. .............. , 19.~2... Permission is hereby granted to: Fl~w.e~..~lll.~uil~ ~&..~ or~...A/.C..~.Al.v~n $~th ...... ~2~t....~.ericho...TT~k ................................. ............. lloo~,~.~....l~o~.o ................................. to ...... ~. ~ I~,a. te...ez:J,e.ti~...~ue,~..oo~.~e ............................................................................ at premises located at ..... ~eO.,W...oJ'.~...~/~..l~ew..&~.z.~=Z-i~...~2~e ................................... ..................................................... ~.~tl.tu~k.....~to~:. ....................................................................... pursuant to application dated ............ ,11Jl~' ....... '%'3 ........................ , 19.~/~..., and approved by the Building Inspector. Fee $.~J~ieDO ........... FOB, M NO. 6 TOWN OF SOUTHOLD Building Depmtment Town Glerks Office Southold, N. Y. 11971 APPLIGATION 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: I. 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. 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 dwelJing or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ......J..u..n..e.,, .! .2..,., .! ~..7] ................. New Building .........~( ......... Old or Pre-existing Building ............................ Vacant Land ............................ I~Z~..P.F. iy.~.~.e. Rla,..h.t of .~..a.y.a Vii l..a.9.e....o..f....H..e..t..t..[.t..u..c..k..,. Tow.n...o..f...S..o.u.thol~.. Location Of Property ........................................................... Owner Or Owners Of Property .......... .A.!..v.!..n....S..m.!..t.,h. ....................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No....6..2.~.!....7.. ...... Date Of Permit ..!.!./..2./.Z.2,....Applicant ..F..1...o~...qF....H..i.1..[...B..u..[.!.d..i.n.g...C.p..r.P..: ............. Health Dept. Approval ].r)./.].0./.7.Z...-...~;.~I.Z~.~ .......... Labor Dept. Approval ................................................ Underwriters Approval ..~;../..2..2../.7.~...-....N..0.~.!..6.!.~ .......... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........X.. ................................ Fee Submitted $ ~.....0..0. ............................ Construction on above described building and permi~codes and regulations. ~t=',e of tCew York Sworn to before me ~'~'~'~ Applicant .................................... ~,.... ....... ~ ......................................... th~. ........ dJ~roq/n..t o..befo~e- s ............ .Lt day of ..... Notary Publi~~ounty Yor~: NOTARY pUBLtC, Sta~eT.~ New SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Applicant Flor I~lll Buildln~ Cor'p. 1. Phone~92-%5%~. Subdiv. Address 821~3 Jerl~ T~., W~bu~, Ne. Yo~ 6. Section 2. Property location E/$ Private Right of W~, 7. Lot No. 8. Private well Village ~ttl~"¢k Township ~u~ho~d 9. Public water 3. Public Water Company name Distance to main 4. Lot size: Width ~}~ feet Length ~9~ feet (Enter on center 10. Sewage Disposal System: A. B. × plot below) 900 gallon septic tank: ~r, ecast ~' .E~valent Block__ Leaching pools: Number~l__Precast ~ Block Special If private well fill in blanks below: Tank capacity~ Gals. Pump G.P.M~6~ Total well depth 5~' Depth to G.W. Amount of water in well /fO' Test Hole Data Feet SANv ~ 0 L~ 2 ~ 4 6 8 10 12 14 16 lB The undersigned CERTIFIES: "Construction of authorized be in accordance with the Suffolk County Department of Health's current stand- ards thereto." i~'L0~BU~0]~- Date Soptembar 20, ]972 Signed ~ or Builder installations will FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the 'Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on th ts plot.Date ~0/~0/77__- S igned~~ ~_?/~ S-15 Revised 4/1/72 Pflu$T TOWN OF SOUTHOLD , j . /' ~, F~ ~ BUILDING DEPARTMENT Y~P~..~; _ ~--(--~'~ TOWH CLERK'S oFFI~ i. ~ ~ '~ , ~~t~n ~o ................................. ........................ ............. - . ,&-It 1~ ~ *1 (Building Ins~tor) I ~ ~ t .... t 0 ~ ~~ APPLiCATiON FOR BUILDING P~lT ~ ~ ~~ ~ ' Date ............ ~.,~.~ .............. , lg,~.~.. . ,sT.U O,S ~. lhi~ ~pplicofion must bo compl~t~l~ fill~ in b~ ~,writer or in ink *nd ~ubmitted in ~lie~ to Ih* Buildin~ In*p*ctor. b. Plot plan sh~in~ Iocotio~ o{ lot ~nd o{ buildinO~ on pr*mi~*, relationship to odioinino pr~mi~e~ or public *tre*t~ or ore,s, ~nd flivino ~ dot~il~ description o{ l~yout o~prop~ mu~ b~ drawn on ~he dio~ram which i~ ~d o{ thi~ ~pplieotion. c. Th~ work cov~r*d by thi~ opplic~fion moy not b~ comme~ed b~fore i~uanc~ o{ Buildin~ P*rmit. d. ~pon approval of thi~ ~pplic~tion, ~ Buildino Insp~tor will issue o Buildino P~rmit to ~ ~i~ont. ~h p~rmlt~ ~h~ll b~ kept on th~ premi~ ovoil~ble {or inspection thr~hout th~ p~re~s o~ th. work. ~. ~o buildin~ ~hall be ~cupi~d or u~d in whol~ or in pa~ {or ~ny pu~o*~ whatever until ~ ~i{icot~ of ~hall h~v~ be~ oranted by th~ Buildin~ In~p~tor. APPklC~TIO~ ~S H[~fi~Y ~D[ to th~ Buildino Dopo~m*nt {or tho i*~uanc~ of ~ Buildin~ ~it pu~uonI Buildin~ Zon~ O~inonc~ o{ lh~ Town o{ ~utho~d, Suffolk Count, ~w York, ond other ~plic~bl* ~w*, O~in~nc~ or Regulation*, for th~ comtrucfion o~ buildings, ~iti~ or a~t~ration~, or for removal or d~moliti~, ~ h~in ~ opplic,nt ~Ore,~ to comply with ~11 ~pplic~bl~ l~w~ ordinances, bu~ldln~ c~e, housln~ c~ ond r~ul~ion~. .................... ......................... 82~,3 JERICHO TPKE., W0ODBURY, NEW YORK (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general, contractor, electrician, plumber or builder. Name of owner of premises ........................... A.l..y.).n...s. ml. h .................................................................................................... If applicant is a corporate, signature of duly authorized officer. _~- (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ........................... .E../.~S~.~.P..r.~..v..a.~t.e....R..[..[....R.!.c~.h..t..~f..~.a.y.x~.~.t.~t`~..t.~...~R[~.~..~... 2. State existing use and occUPancy of premises and intended use and occupar~rc'y bf'prop~edr'c'onstmction? a. Exisiting use and occupancy ........................V..a...c..a..n..t....~.s~nd ................................................................................... b. Intended use and occupancy ....................... ?..r..l.v..a.t..e....r...e.s..!.~e.n..c..e. ...................................................................... 3. Nature of work (check which applicable): New Building ...... .X. .......... Addition .................. Alteration .................. Repair .................. Removal .................. Demalition .................. Other Work (Describe) ........................................ 4. Estimated Cost $/~b~t000,00 Fee . (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .0..n..e ................. Number of dwelling units on each floor ............................ If garage, number of cars detached two car garage and detached guest cottage 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 ................................ 6.zt,8 ' , ,, 8. Dimensions of entire new construction: Front .............................. Rear ....... 6./{..{~ ............. Depth ....~.~:..8.'.'. .......... Height ......... ].P~! ...... Number of Stories ..............~nf~ .............. .. 9. Size of lot: ~ ..~D.,DDDD...s.q.....f. tpdl~Let..I.r.£egtll~r. ................ I~,pt~. ............................... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated I{es Ident la i 12. Does proposed construction violate any zoning law, ordinance or regulation> No 13. Name of Owner of premises ...A..I..v..I..n....S..m..I..t..h. ................ Address ............................................ Phone No ..................... Name of Architect Flower Hill Bulidlng Cbrp. A,~,~ 82b'3 Jericho Tpke. . ..............................................................,, ,, ,, ,, ~{fSb. fH,~, .,. · .N ~;dily~ t,k ...... Phone No.69 ;t.~ .Zt5./t5 ...... Name of Contractor .................................................... Address ............................................ Phone No. ~' ~' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. ,NO'fART' PUBLIC~, State of New Yo~k No. 30-2622700 Qualified in Na~au County Tm*m Expires M~:ach ~0, 1973 STATE OF NEW YORK, ~- c c COUNTY OF ........... ~li~e~ ......... $~'~ THOHAS E, UHL- i : . ............. ~: ............ .................................................................. :..being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............ P.r. MJ.d~nLgf...F..tg~.~.r..H..! ~ ~ ~J ~.g,..~.~.F.R~..Vi~l.i..qh..J. li...~l~..~FJ.1;£~.~.l~g~ ................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sgid Work and to make and file this application; that all statements contained in this application are true to the be~f~f his knowledge and belief; and thc~ the work ~will be performed in the manner set forth i~ the application file~. Swam to before me this ~ ............................................. ,I ¢7;°" ;J r FLOF~ , HILL BUILDING 8243 JERICHO TURNPIKE WOOl)BURY, L. I., N. ¥. I I 8243 JERICHO TURNnPIK~ flVOODBuRY, L,I.,N.¥, 11797, I I