The URL can be used to link to this page

Home My WebLink About6291-zFORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z$~kJ~ ...... Date ..............~-~£... :~ ..... , lg. 73. THIS CERTIFIES that the building located at .. lB.~ddS..P.o.I~I...P~ .......... Street Map No.W.11.~-0~ .P..ellll~lock No ........... Lot No.. ~. 6 ...... .S. qu..t.h.o.~.d... ~ ?.~.~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... .D.e.e....~ ..... , 197a. pursuant to which Building Permit No. 62.91Z- · dated .........D..c.c...~2 ...... , 19.7.~., 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.r..i.v.a.t.e., 9.n.c., .f.a.m.i..1¥..d.~..e.l.~.i. ng,, .(.a.p.p.r.o.v.?d...by..B..d..A.~p?.a.l.s..) ....... The certificate is issued to . .~.d.~.~'.d..P. el~e.~t$.e.~. ~ .Wife .... O~ner., .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ug...~...~ 97.~ .. by .i~...V.~la ...... UNDERWRITERS CERTIFICATE No. 1~. J01~9.0.1... J.%l~.y...2~.. J.973 .............. HOUSE NUMBER ...~)..0. ........ Street .... .B.u~d..s..P.o.n..d..R.o..~. .................... FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6291 Z Dote ..................... . .D..e..g.~.~.~. f~ ~. ....... .12 ....19..22. Permission is hereby granted to: E a s two~J ..~u.i.!.d~,e.-.l.~e-.-~./~ .. &dw ,-. &...Ph.i.~ omena Pellettieri .......... ~,~*,~a~...~v,j, ............................................ · . ~amp4,'orr"B~'ys' ......... ~'Y-~ ............................. to., ~.~!~,...n..~....o. ~..e....~:~m~ ~....¢~.~.~.1 I~ ................................................................................... ot premises located at ..1'.0~,...~ ....... ;~,~l:~ow...~.'c. ....................................................................... .............................. RUzlcL !.s...P.o,nd...iLoa d, ......... So~th~l~ ....... ~o~f.- ............................................. pursuant to application dot~ ...................... D~!.....-~ .................... , 19.~p..., and opproYed by the Building Inspector. Fee $.~.1.~Q ........... Building Inspecti/ 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 end 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 end 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 nccupancv $1.00 Date /~ttJ~ '~ (~ ~ New Building ....... ~ ...... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..~....u...~....~....~.....i~....O...~....~...........~.....~.~.. ............... .~.~....~....~...T....~...~...c...~. ......... ..~...-;../~..:... Owner Or Owners Of Property ......~.~.~..~..:....~.~,-~...~..~..~...~....L.~....~...J. ..................................................... Subdivision ....~....L..L:....L~.Q..c-.~......~...O...L.....~...~. .............. Lot No....~.~.... Block No. ............ '~' House No ............ Z/O..~. Permit No..~..~...~...!.."~-.Date Of Permit .~....e~.../..~.~'7.~pplicant .....~..~..S:..T'...(...~...O...O...~......~..[.~..~.~.../...~....CT.. ........ Health Dept. Approval ............... :/ ........................ ~-aaor Dept. Approval ............~ ................................ Underwriters Approval ~L;.~......~.....~..../..?.~...~.. ........... Planning Board Approval .... .~....!..!..~.. ....................... Request For Temporary Certificate ........................................ Final Certificate ........... ~.. ........................ Fee Submitted $ ~ Ou Construction on above described building and permit meets all applicable codes and regulations. Applicant ............................................. Sworn to before me this ........ ~.... day of Notary Public, Slate of New York No, 52-0344963 Suffolk Count~,~ Commission Expires March 30, 19~.,.~ (stamp or seal) SUFFOLK COUNTY DEPARTMEHT OF HEALTH H.D. Reference APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Phone));,o 5. Subdiv. 6. Section ?. Lot No. 8. Private well 4. 10. Village% ~; ',~ i~=(--- Township ,,:' ~. ~ 9. Public water_ ~ Public Water Company name~/ ~z ~,~,,:, ~ ,. ~ Distance to main '~'~: Lot size: Width/~/ feet Length ~ feet (Enter on center plot below) Sewage Disposal System: A. 900 sallon septic tank: Pr.cast / Equivalent Block B. Leaching pools: Number~ Precast~ Block Special__ N The undersigned CERTIFIES: be in accordance with the Suffolk County ards thereto." If private well fill in blanks below: Tank capacity Pump G.P.M. Gals. Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet 0 2 8 10 12 18 "Construction of authorized installations will Department of Health's current stand- Date.,.,, 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 this plot. Date ~-~ ')'-'/ Stgned~/~~-~ S-15 Revised 4/1/72 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NIE-~N YORK. NEW YORK IOO3B ;' ..,.,,,~, 25. ~ ~..,,~,,o.,o.~.~,. ~0~ N 1()4091 THIS CE~FIES THAT ~d~e ?e~le~tle~l~ s/s ~u~l ?o~ ~a. ~ e/ o Bay ~e ~d.~ ~u~b01~ ........ ,~.~d~ ~uly 23 1973 16 40 23 16 ~N~ ~C '~G r ~S~ OVENS 1~ WA~ 11.9 1.3~ · ORYERS ~1 FURNACE MOTORS SERVICE ~HNKT---~. M~ S E R V I 150 CB x I 2/0 ~-q ]/2hD Air Conditioner Unit. *Furnace/s: Oil, 2-1/Shp 1-1/2h~ 2/0 ~i Custom Electric qOManor Drive ~ Shirley L.I. =~L MANAOea l~ his cerfifico~ must not be oJtWl(J in any monner; return to the office of the ~oard if incorrect. Inspectors may be identtfied by thetr c~edenhats. iiiil"Ji liii/l'i'liilllllllllllll SUFFOLK COUNTY HEALTH DEmA,~T,~.~.~. ~TE ,J~-, ''~ 1973 ~. o. ~ ~-/~ r~EF. faci!~t'~s for 'th[:; ~ Chief of General Engineeri:~g' Services ~ ~ TOWN CLERK'S OFFICE 4,/'9/~ ~ -/ -~' -- ~TH~D,N.Y. ~ ~ /7,~ ~~ ? ,~ ...... ~ 19...~.~ ~ ~ A lic ti ~ Examined ..... ~.~ ........., pp a on No .................~ ............. .(.~,--,-~ ~ ~ ~ ~pr~ed ............... ~. ....... ;.~. ............ , 19..~ Pemit No ..... ~.(..~ ........ ~ ~ ~ ~'~ Di~ppmved a/c ............................ .. ~- ~_~~7~ ~ ~ ...... ~....~ ~ ~ ~.'. ................................................................... ~-~.~ ~ ~: ~ ~ Date ........./.. ......... , .................... , 19......~ . INSTRU~IONS a. ~is application must be completely fill~ in by ~ewriter or in ink and submitt~ in d~licote to t~ Buildi~ Insp~or. b. Plot plan showing I~ation of lot and of buildings ~ premises, relationship to adjoining premises or public stree~ or areas, and givi~ a detail~ description of layout ofpr~e~ must be drown on the diagram which is ~ of this applicati~. c. ~e work covered by th~ a~licati~ may ~t ~ c~me~ before issuance of Building Permit. d. U~n approval of this application, ~e Building Insp~tor will issue a Building Permit to the applier ~h ~it snail ~ kept ~ the premiss available ~r in~ecti~ thr~gh~t the ~m~ of the work. e. No building shall be ~cupied or u~d in ~ole or in pa~ for any pu~se whatever until a Ce~ificate of ~cupancy shall have ~en gmnt~ by the Building Inserat. ISSUO~C f ~ ~ ' APPLICATION IS HEREBY ~DE to the Building D~a~ment for the ' e o a ~uilding ~e~t pu~uont to the Building Zone O~inance of the T~ of ~ld, Suffolk Count, New York, and other applicable ~w~, OMinances or R~ulations, for the constructi~ of buildings, a~itims or alterations, or for mmo~l or demolition, os heroin d~rib~. The applicant agrees to comply with all a~licable Io~, ordinances, building c~e, housing c~e, o~ ~uloti~s. .............................. ~...b ........ I~ ........................................... ..................... ~ ......... .:....~....P~Xz St~t~ wh~er applicant i, ~n~r, I~,~ ~nt, o~hit~ct~ en~in~r, ~n~rol contractor, el~ctricion, plumber or builder. ... G0i~.~.~ .... . ......... ~ o, o~ o, ~,~ .~.~.~.~....~...~..~i.l~.g~ ........ ~g~ ~ig~ ......................... I{ a~ic~nt i~ ~ ~o~~r, o{ duly ~uthori~ officer. ....... ~ (Nam~ title of corporate officer) 1. L~ati~ofla~onwhchpr~o~work~llbed~e MapNo'~[~;~ LotNo ~,r., .n, .=~.r ~ ...... ~.~.~.~..~ ....... ~;;;,.= ...... ~2~]; ~ ~..]][[[Z~L~ ...... '.'~;~'.."~]~]~'][~ ~ O 0 Munic~ali~ 2. State ex~fing u~ and ~ancy of promises and intended use and ~cupancy of p~o~ c~stmcti~: ~isiting u~ a~ ~cupan~ ........... ~.C.~M. .............. ~.D. ....................................... b. Intend~ u~ and ~cu~ncy /. ~ ~"~tZ. ~ ~ {]~ ~ 3./~ NatUre of work (check which applicable): New BUilding ..... ~ ..... Addition .................. Alteration .......~i ...... Repair .................. Removal .................. Demolifien .................. Other Work (Describe) ........................................ · 4. ~'E~timated Cost .......... ~.. .............................................. Fee ~.l(.Q.~...~.. .................................................................. ~,.~... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... i..~.ii ............ 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 .................................. a ........................... Depth ........................ Height ......~.....O. ........ Number of Stories ...... ...~, ........................................................................................................... 9. Size of lot: Front ...... /..I~....~. ........... Rear ...... ~/.I.....~... ................... Depth ....... .~...~......~... .......... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 i. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation. ............................................................ 13. Name of Owner of premises ~...~..J../.~.~'...~...~ ............... Address./..~/~.~'..../..~.~.........J~/..~..?~..~"..~..~....~'.. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~....~.....?....l~....~..~...~....~.,.~..°~./...~.~..~.~...Address .,~XS/~..~./~.~..~.-.~....-~-...~.~.~..... Phone PLOT DIAGR,adV~ 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 shew street names and indicate Whether interior'or comer lot. STATE OF NEW YORK, to: ¢ COUNTY OF .............................. .~.t'"'""., bein .................... ~ .............................................................. g duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .................................................... /~.~.~..e.~.~. .......................................................................... .. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have p~rformed the said work and to make and file this application; that all statements contained in this oppliooti6n 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 therewith. Swam to before me this ........................ day of ............................................ , 19 ........ Notary Public, . ........................................................... County applicant)