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Home My WebLink About6313-zFORM NO. ~ TOWN OF SOUTHOLD BUIT~DIN(~ DEPARTM~,NT Town Clerk's Office Southold, N. ¥. Certificate Of Occupancy No. Z .~.~.90 ...... Date ..............Out.. 23 .....,19.7.3. THIS CERTIFIES that the building located at '¥ar~ston. 'Road ............. Street Map No.l~a.s s ~. p~..P~E/~ck No ........... Lot No..6 ..... Cu.t,~h-.gue.. 1~.,~ o ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........L~ee "' '27- 19. '7~ pursuant to which Building Permit No. dated ..........~)ec · .. ~/..., 1972., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which ~ certificate is issued is .... I~r~'vate· .one..£-am~.1.¥ .dwe~././.ng .................................... The certificate is issued to .. ~,ev~n .Har.t~ ...... 0~ner ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approval t~ .et. · .1.8...1.c)73.. .by. ~.,..¥~.~.Z.a · · UNDERWRITERS CERTIFICATE No. Oot...~).. I ~3.. b~, J,..~,~10eot~ .......... HOUSE NUMBER ... ~,~9~ ...... Street .-¥ar~-en. -/teac1-- ~/ ....................... uilding Inspect~ I~ORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6313 Z Date .................. D.e ~ero.~ e~. ....... P-7. ....... 19..7.2.. Permission is hereby granted to: .r,..e,~ ~.~.. ~...~ ................................................. ..,B., .o..x....~L~..-..a.......~!~,~.~...~.~...~. ...................... ...... ~..~.~.~,~...~. ~;~.....~.~.,.~.,. ........................... to ....~.~,~..z~e.~...oz~ ..£~L34:..d.~e~.;~J~n~ ................................................................................. at premises located at ....~.o...~....~. ....... ~..e~.~.Q~'...~,.O.¥~...,,3~...,.~uJ;)......Q£.f. ...................................... .................................. ..v.~..n..s..~.o.~...~.o.~ ......... ~i~.~.s..~.tz..2.o..~.n..~ ....... .c..~.~.~.~.~.~.....~i.,.~:., ............... pursuant to application dated .......................... ~).e,(3 ....... ~ ........... , 19~.2...., and approved by the Building Inspector. ~ui ding inspector / FORM NO. 6 TOWN OF $OUTHOLD Building Depo~tmont Town Clerks Office Sonthold, 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 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 ar 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 $5.00 3. Copy of certificate of occupancy $1.00 :te .............. New Building .~'x ............... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~.~.~.~vm~t~:~T.~..~..~.)~.~.~.~W~l~$~.d.~.~/.~t~~~r~ Owner Or Owners Of Property .~.~..~..(~ ....... .~..: ....... ..4..//.l} .............................. : ....................... Subdivision ..J~J.~.~.,O,.~,.....~(~..~'.l~...../.,,/'~,.,~,,.' .......... Lot No...~ .......Block No ............. House No..~,~.,.~,-.~. Permit No, .~..~./.~,,~,.,,~.. Date Of Permit ~.;~..'],,..-..~.,~.Applicant ~'.~,.~.J./~ ...... /~. ...... /'},,J~...~,~ ................... Health Dept. Approvol .....C~'...?.:..!..,~....!.?..~. ........... Labor Dept. Approval .................. ~....'..~... ................... Underwriters Approval .... ..~..'.,~......~..:.,/..,~-..,.~.:.~..,C~........Planning Board Approval ......... ..~'..../...~?.. ................... Request For Temporary Certificate ........................................ Final Certificate ......... ~. .................... Fee Submitted $ .',~.~........~ .................... Construction on above described building and p~mit ~eet/s/all,,applicable/.~,/,j...,_ codes and regulations. Sworn to before me this Apphcant_.~.r.Z../..~....~... ~/-~x/. ..... ~.. day of (C~"s/- /~ (stamp or seal) Notary Public ................................ x.. County "q/'L'~'~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. ~ ~"/~' APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM o 4. 10. Address~7_~o ~ ~u~t~-~P, ~tp~L6 ~O ~-~, 6. Property location LoT ~ U~MSW~ ~ 7. Village' CuTo%%0 ~UU Township ~oV~O ~m Public Water Company name Subdiv. ~fg~U Section ~?~ ~g~ Lot No. ~ 8. Private well ~g~ 9. Public water Distance to main t Lot size: Width ~q,~Sfeet Length ~2,o,oO feet (Enter on center plot below) Sewage Disposa/l~ystem: CE.~R A. ~0Jy gallon septic tank: Precast ivalent Block B. L-~aching pools: Number ~ Preca~t~q~,fBlock Special__ If private well fill in blanks below: Tank capacity 9~Gals. Pump G.P.M. J- Total well!depth Depth to G.W. Amount of water in well Test Hole Data Feet L~e~r l~P~e~t., ~ 0 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- '' ards thereto~/~ , ~. /~ Date % '; / 1';/'' Signed Owner or ilder 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 /~/~ ~/~__ Sign~~ ~ S-15 Revised 4/]/72 I GINA~ SCALE- 50', I" O:~.L ~ ~ = CIg,Ii.SPOOL h'IAP OF PEOP:E'i2,TY ® ~UP_..VEY~-L) FO ~'.~ · THE NEW YORK BOARD OF FIRE UNDERWRITERS tS.b BUREAU OF ELECTRICITM~' ---85 JOHN STREET, NEW YORK, NEW yORK 10038 ~,. October ~5. ~973 -~p,,,,cat,o.~o.o..,',,e6"9790 N 122904 '11-11B CERTIFIEB TNAT oflJy t~e eJectr~aJ equ/pment as descd~ed below ~ i~trodaced by the applicant named on the ~bo~e application ~umber in the p,~fses o~ Kevln Hasty. Vanstrom Rd., off Little peconlc Rd., Cutchogue, L.. in the following lo. at'on; ~ Basement ~] let Fl. ,~,.,..,.i,~ao. On~ober' 22, 1973 ~2nd Fl. OutBide Section Block and found to be in compliance with the requirements of this Board. RANGES 1 30 SERVICE DI$~ONNECI' [ NO. OF ~ 200 CB OTHER APPARATUS: COOKING DECKS [ OVENS {DISH WASHERS SYSTEMS HO. OF II'ET V ! C 4/0 NO. OF HI-LEG Lot EXHAUST FANS DIMMERS E 2/0 'Pu~naoe/st 011. 2-1/8bp ~-l/12hp Robert Harris Oabrlel N/lis Rd. Wading River, L.I.11792 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN OF SOUTHOLD /- BUILDING DEPARTMENT TOWN C~'S OFFICE SOUTH~D, N. Y. 19 ....../..~.. .,~ Appligption No...?...E...'.~..~ ....... ro.d " " ¢ ........................................ , 19 ........ pemit No .... ~.~....~... i~ppr~ed o/c ........ ~ ........................... ~ ;~ &~ . , ......................................................................... ~ .............. ~ ~~ .................... ................ (Bui di~ Ins~tor) ( ~ - "'"' ":": ..' A,'LI~ATION FOR BUILDING ,E~~: ~. This apPli~tio~ ~U~t ~ completely filled~i~ ~by ty~writer or in ink and submitted in tripliC~t~ to the Buildin~ Ins~or, wi~ ~ts of plans accurate plot plan to s~81e. Fe~ ,~rding to schedule. . b. Plot ~an showing IocitiOn of lot~a.d,~f ~u]~[~ o~ prem~ relationship'to adjoining premiss or public streets or areas, an~' dying a detailed des=iption of layout of pro~rty must ~e dra~n on diagram which is part of this appli~tion. c. The work covered by this application may not be commen~d before issuan~ of Building Permit. d. U~n ~proval o~ this application, the Building Ins~ctor will issue a Building Permit to the applicant. Such ~rmit,shall be kept on he ~rem~es available for ins~ction throughout the work. e. No building shall ~ o~upied or u~d in whole or in pa~ for. any purpose whatever until a ~ificate of ~cu~ncy shall have · ran~ by the Building Ins~or. APPLICATION IS HEREBY MADE to the Building Depa~ment for the issuan~ of a Building Permit pursuant to the Building Zone ]rdinan~ of the Town of ~uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the ~nstru~ion of ,uildin~, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable la~, ,rdinan~s, build~ code, housing ~de, and regulations, and to admit authorized ins~ctors on premise~ and in ~ildin~ for ne~ar~ ins~ctions. ~ta whether applicgnt ia owner, le~, a~nt, a~hitect, engin~r, ~neral contractor, electrician, plum~r or builder. . ...~.~.S.E~../..~.~....~.~.m~.....: ..................................................................................................... o, s ................. ,. ............................ a~lieant i~ corporate, si~naturo of du~ authorized offic*r. Plumber's Licen~ No ......................................................... [ ~'~ ., , E ec~r c aris L cen~ No -~ ~ ~ , · .................................................... /~. ~** ** O~her Trade s License No .................................................... :..:..:~......'....Lot/~ ~~ 1. L~ation of land on ~ic~ propo~d work will ~ done. Map No .......... No .................... .~. V~I ~o~ ' C u ~ F st~t..~ ~.~ ............................... ~ ........................................ ~.8.~..~.U ........................................... ...... ~.nici~li~ 2. S~te exi~i~ u~ and o~u~ncy of premiss and intended u~ and ~cup~ncy of propo~ con,ruction: ~. Exi~i.~ u~ and ~u~ncy ................ 3. Nature of work (check which apolicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) (to be jSa~ on filing this application) ~ j 5. If dwelling, number of dwelling units ................. Number of dwelling units on each floor .......... t .............................. If garage, number of cars ......... ~ .............................................................................................. ; ................................ 6. If business, commercial or mixed occuDancv, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .......~... ....... S.. Rear .S .......... 7.....~. ...... Depth ..; ................................ Height ...7 .............. ; ........................................ Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front ..~ ................ Rear ......................................... Depth ...... ;.. .................................... Height ................. ~ ....... Number of Stories ........................................ Height ....... .~...~. .................................. Number of Stories .................. !...~'~.. .............................................................. 10. Date of Purchase ...~..~.T.-.....;.9...,..[..~.¢-... 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: ....~[~., ................................/" ............... 13. Will lot be recjraded ..... .~.b...;.~ ................. Will excess fill~be removed from premises: [ ] Yes [~J' No 14. N P~ ~ f'~ ,~, ~- .~ (Address) ~ d (Phone No.) ~ / , ~ I (Address) ~ __ (Phone No,) Name of Contractor ..p,~.,., ...... .......... ................. ............ ......................................... {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 street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK G'~ .. ) COUNTY OF ...........~ ......................................... ) ........................ /~.....~...~.~/~¢//,¢1¢////- ....................................... (~/IN' A' ~tl~TY--~... being duly sworn, deposes and says that he is the applicant above named. · ~q~Tame of indiv~du~dl signing contract} He sthe ......[~...~....-~..~.~./..~..LlJ~-'r~. ~ ................................. / ....................................... ................................... said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that al tements contained in this application are true to the best of .~<nojvledge and belief; and that the work will be performed in the manna forth in the application filed therewith. ., ...................... .r/.day ............ **..,,.-,...= ..... ............. /.. .// /?, ~ta r y Pu b,,c. ~..~...~,..., 9,.:: ............ County .................. .~} ........... ~ ...................~... ................................ Or {-'/ ~ 4" ': (Signature of applicant) ..J J t ~'~T J I __.J ia, [ I A t ~