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Home My WebLink About5734-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..zl~.~ ..... Date ............. J-tll7 .....20.., 19. THIS CERTIFIES that the building located at . {}lea~' &v®' I~. & §a~il~S La Map No. ~ ......... Block No..~rv ....... Lot No. ~.. 8~tho3A - · · !~,¥, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............lia.ret~ .... 2 19 .~*~. pursuant to which Building Permit No .... dated ........ 14&l'et~. '9 ....., 19~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pl'i~a'ce ' ~' 'falal'Iy dw~ll~[~ ...................................... The certificate is issued to... R~;ehal,d 'I)o1'~ ....... o~wneeF~,' i~s's~' ~; 't~'a~t') ......... of the aforesaid building. Suffolk County Department of Health Approval ...liar... ~ 5t .~9~2.. bi. R,. UNDERWRITERS CERTIFICATE No ...... ][. ~.~58 .................................... HOUSE NUMBER ..... 900. .... Street ....G&,~Ge~B .:1~, ........ ........................ ................. ~.~ ............... Clearvie~ .Ava..~.est. ....................... ~OltM NO. + TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NV 57M Z Permission is hereby granted to: ...... z~l~.~..~ ....... ~.....~e.l~. ......... Ittddla..(~mmtr~..~mA ......................... ........... a$~lk ......... ~i~.~ ................................... to ..lmt.3A..~ew...eem.. Sm~..i,..4~e.~.~l~l .................................................................................. at premises located at ..........~I~...~III~..A.~..~I,I~..&..GII~,e.~B~..,J41~ ........................... ................................................... &l~t~lle~.-..l;~¥., ........................................................................... pursuance to application dated ........................... J~,J~l~J~ ......... ~ ........ , 19..e~.., and approved by the Building Inspector. Fee $'"'.'.'.'.'~I~' ....... Building Inspector / FOIl[ NO. ~ TOWN OF SOUTHOLD Building Department Town Clem Office Southold, H. ¥. 11971 APPLICATION FOR C:ERTIFICATE OF OCCUPANC:¥ Instructions A. This application must be filled in typewriter OR ink, and submitted Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, in triplicate to the Building 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 fram 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. New Building .........X.. ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ......~#a.r.~.~,~.~..~..~.&r.~ez'.a,...~:>.g.~.bold Owner Or Owners Of Property .......J~....,.....~....,J~..~.,....~....R.~..c..~b~..~..d......D~....~..a. .......................................... Subdivision ...~I~.~L~)~..~DD.X~,],f~...~.~L"~. .......... Lot No ............. Block No ............. House No ............. Permit No....~..7.~.br..Z. ..... Date Of Pen'nit ...~/.?./..7...2....Applicont Zr~Gd~J ~[ol~le~8, ~Tr~oo Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......... X., ............................. Fee Submitted $ ....~.....0...0. ........................ ................ day of ............................................ Notary Public .................................... County Construction on above described building and permit meets all applicable codes and regulations. Applicant . ..~ ~....L~...t!..D. ,...~..0..~.~ ~...~ ~..C. ~/..D..o...]:.o...~..e...~... ~..c..h...o..m...b.~ ~ ....S...e. ,c. ~.~ ~ ~ ~ y Sworn to before me this /.//~ ~ (stamp or seal) ~//~"~Y'?/ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Ma~ 15, 1972 Bldg. Permit No. 5734 Z TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure' located at N/W ¢learview Avenue W/O Gardiner Lane (GSve deed Southold, New York 11971 have been inspected by this department and found to be satisfactory. Ohief of General EngineerinM Services District Engineer Z 50UTHOL, D, N-Y. h.D. Reference No S~ ~/~ No~th Street Capacity ~Sals. G. P,M. ~' The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". FOR k~ALTH 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 7/~)~'~ --~ ~ '- ~ , 4 .~ Revis. ) Signed EASTERN DISTRICT, R1VERHEAD,N.Y. APFLICATiON FOR APPRC~L%L TO CO~STRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date ~ ~. ~.porovai, ~ ~tn. constructc~,~said~s~Y~S ~ ems~is requested,pertinent data herewith:~ ~~. ~-~pp~c~nt Phone 6-Sub div Address -~-~.~. ~J ~,~.~-~ 7-Section. 2-Detailed ~rope~y loc~tion ~ ~ ~ ~ ~-Lo% No,. Hamlet ~ ~~ To~ ~ 9-Private well? 3-~blic ~ter supply name Distance to nearest ~in 4-Lot Size: Width7~ ft. Length;~ ft. (also enter on center plot plan below:) 5-~elling: Single Family ~ Two Family? / /Cellar? /X/Slab? / ~Crawl S~ce? / / 10-Proposed system: Septic tank / /Precast / /Cess~ols /X/Shallow ~ols / /Other / il-Septic ta~ inside dimensions: Vol~e Gals.Lengt~ft. Width ft. Liquid depth ft. 12-Precast sections: / /Number/ /Sq~re Ft. Cesspools: Block sizeL~incs.D ~ins. H ~ins. Total blocks below inlet: ~1 ;~2 P~T PLAN '~ TOWN OF SOUTHOLD ~'x.~/..~,~./ V~.~,~ ~.'~. ~ ~ ~ ~ BUILDING DEPARTMENT ~ TOWN CLERK'S OFFIGE~ /- ~ ~ .~ ~ - -* ~ soum,oc , 7.,, . , ...... ........... . ............ ................................ ..................... ~LIC~TIO~ FOR BUILDING PER~IT ~ ~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildir~,~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets c~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this opplicatio~i,- c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permi~,~ shall be kept on the premises available for inspection throughout the progress of the work. ~- e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc~f~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ ~,e. n..e...~.~ ~.., ~..o..n...~ ~. ~ ~ ~.Qr. .............. Name of owner of premises ...................R..i.~.c~.h.~.a..r...d~.D.~9~.r.~.s~x~.y.t..~..i.~.R.~.d.^~.Q~.~z/~ ......................................... ~ If applicant is a corporate, signature of duly authorized officer. -7~ ~- - / 7 (~ (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No.h~.°...qJk.b..q~-..d.....~.f~.~....~.Q~'.~. Lot No ....................... ..~ Street and Number ..~./...~.~..q..~..~...~..e..~...~.~..~.....C..~.~9.;~.~.~.~.~.~`~.~.b/~.~£.~.~)ke...~. ................................ c~ O 0 ~.A ~.b l N E: 7~ ~ I_.1~ I... .~ ~/-~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy None b. Intended use and occupancy ............ .1.....F..a.~.i...1.,V....D...w..e..]~.~.Ttg> ........................................................................... 3. Nature of work (check which applicable): New Building ....... .~. ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............ ~.~..~..0.0...0. ............................... Fee ....~..~..M~...~ ..................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~..~...~..~..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 t~pe 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 4'0 Rear .... ~,o ~R~ 8 ............................................................ Depth ........................ Height ].8 Number of Stories iL 9. Size of lot: Front ...],..0.~.,..~..~ ............ Rear ....Z..C).~....~.9. ................... Depth ..3r..?.?..:.~.7. ................ 10. Date of Purchase ........................................................ Name of Former Owner ..~..o.~.~..~...o..]:..~...D...e..v..:....~.o..~...p.:. .......... 11. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises~..a..~....e~...~...~..°.~..~. ............ Address ........ .0.~..e..~.~..s....~:..Lr...* ........ Phone No ..................... Name of Architect .~]./~u~...~.OJ~.~.~...,~.~.a.., ............. Address ........ ~R..e.]~ .~..e...~.~...~:...~... ........ Phone No...7..~R.~.T..~..]:.?.~ Name of Contractor .....Z..~..~.~.~....~..9..~..e..~..~.....Z..~..~'......Address ........ ..~..e..]:..~.e...~.~....}.{:..~: ........ 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 black number or descripti )n according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~/~YOJ~J(, /]/-tS S cou.** OF · ~ ~ beln ...................................... ~Y,,,r~.~..U..~ ............................ g ..... .(~..~.~.~j~-.. duly deposes and says that he is the applicant (Narne'o~ i'nd;Vidual s,gning apphcat,on) above named. He is the ............................................ .(~.gX'3..t,..~.~.~.9.~ .................................................................................... (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 all statements contained in this application are true to the best of his knowledge and belief; and ti,or the work will be performed in the manner set forth in the application' filed therewith. .S..w..:.;:..:.o...b.e.~..o.:: dmaeyt;~ ........ ~...~.~..~... ............ , 19.~..2?........~~~ ....................... Notary Publi . ....... County~)~/~ (S'gnature of applicant) i 100 !CB THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY as JOHN STREET. NEW YORK, NEW YORK '10038 ""'" July 17, 1972 ~""'~*"""'~"'*"f'* 576603 N fdiS CERTIFIES THAT ~Lc~ Do~s, n/~/co~. Cie~v~e~ Ave., G~e~'3 ........... ,.~,,~d.. July 13, 1972 a"d~°"nd~°helnc°mvliancewlththereq~ireme"ts°J'~hi~B°"rd' DRYERS FURNACE MOTORS : FUTURE APPLIANCE FEEDERS ISPECIAL REC'PT T ME CLOCKS J BELL J UNIT HEATE~UL~ [0UTLET-~ OIMMEk~ ..... ! ~ i" '! ' ~'" ~l J~Ule. 1~2W '~SW 3~3W 3~4W NO O~E~CONO' OF A. W. G.CC. COND HO. OF H,-LEG oFAW'G'HI-LEG ~,NO OF NEUTRALLY- O~* NEUTRAkW. ~ , ~ j x 2 *Furnaces: Oil 1-1/8hp, 1-1/12hp Motor/s: 1-1hp 4 Park Place . Patchogue, L.I. 11772 SENERA[ ~ANAGE[ / , , ~ert~f~cate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors mo h ~DO .6 '0 T ,',',Iv,