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Home My WebLink About6898-zFORM NO. 4 TOWN OF SOUTHOLD BUILrlING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate Of Occupancy THIS CERTIFIES that the building located at .H.Q.I. ~...D.~ ! ~.u~. ? [... ~.~.~.,.V'... Street Map No.. ~ 9' ~ '~ Block No .... .-- ...... Lot No. -- J~ ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. P..~..S2Fr, 197/,~ pursuant to which Building Permit No. ~.~..?.~..Z._ dated ............[.~..~.~ ?.%, 197,~., was issued, and conforms to all of the requixe- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .../~... O~ £ ..... ~: ~.~ .~ ~¥ .... ]b~) ~. ~. u.J.~,.~.~..-~.. The certificate is issued to ..... .FA ~.g ~.( .~.....~.. ~.~ ~.. ~. a ~ f .~..~.Y.J.~ ............ (owner, of the aforesaid building. Suffolk County Department of Health Approval ?./.q/.~.'5... / UNDERWRITERS CERTIFICATE No .... ~. ~.~ HOUSE NUMBER ..... .~ ~.l..~.. Street .... .-~. ~..~..~../:.- .... .L.~. ?[ .~-~ ............... ............................................ ~..~..~..C ?.~..a. ~ t, ..... ........ Building Inspector FO~ NO. ~ TOWN OF $OIJTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTH'OLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6898 Z Date ..................... J~.O. ~.~ ....... ~. ............. , 1S/'/_~ .... Permission is hereby granted to: ...~'_~_~,.o~ ~...~..e..c. ~X.~.~. ~...J.~... ~....uJ,£.e. .......... ............ ~.~t.~o.~e .............................................. ~cb.~..~...o~..~.~!.l~...0.~:L~ ......................................................................................... at premises located at .... ~O~..-~.~ ....... ~'~'--~-~e~ .................................................................... ................................... ..S.~.~,.d.~.e....~.~ ............ ..C.~.tCI~O~ .......... 1~.~.,. ............................................. pursuant to application dated ........................~0~; .... ,7.}~ ............ , 19.~..~..., and opproved by the Building Inspector. Fee $..~..~..,~..~., .0. ........... Building I spectdr FO~[ NO. 6 TOWN OF SOUTHOLD Buildln9 Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcotion must be filled in typewriter OR ,nk, and submitted in DUPLICATE to the Building Inspector w~th the following; for new buildings or new use. 1. Final survey of property with accurate Iocahon of all buildings, property lines, streets, and unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4 Commercial buildings, Industrial buildings, Multiple Residences and s~milar buddings and instollabons, o certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed stte plan requirements where applicable. B For ex~sting buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-exist~ng" land uses: 1 Accurate survey of property showing all property hnes, 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 formation required to prepare a certificate C. Fees: 1. Certificate of occupancy $5.00 2 Certificate of occupancy on pre-existing dwelhng or land use $5.00 3 Copy of certificate of occupancy $I 00 Dote ~.~.~.%.~:....%. X..q..!..~ ............. New Building .... ~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~.~.S:,.~.%~....¥.~.~ ...... Subdiv,sion ................................................................ Lot No ....%.~ .... Block No ............. House ~th ~p~. Appro~a~ .... ~.~ .............................. ~bor ~ep~. Appro~ .................. &..~ ................... .... ...... ........... ................. Request For Jemporaw Cerhficate ..~ ............................ Fm~l Certificate .........~. ........................ Fee Subm,~ed $ ~~ ....... ~ e,~. arians. Construction on above described building permit meets all applicable codes and r Sworn to before me this (stamp or seal) 4 ~ Ohief of General Engineerin Services T APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address ~ ~¢~ ~T~z~ ..... ',~ i{¢f~ 6. Section 2 Property l'ocation~8¢¢/¢~- ~5 ~' ~ ~¢¢¢~ 7. Lot No. ~f~ ~/~/e-~ ~ ~' ~5~K ~z/ ~ Z~-~r 8. Private wel'l' Y~ Village~j~=~=~g Township ~o~=/az 9. Public water ~ 3 Public Water ~ompan~ name /~/~ Distance to main ~ 4 Lot size: Width 7~ feet ~ength _~ feet (Enter on center plot be~o~) 10, Sewage Disposal S~stem: A. 900 gallon septic tank: Precast ~ ~quivalent Block B, Leaching pools: NnmBer g Precast'~Block Special__ N If private well fill in blanks below: Tank capacity~%.Galt Pump G.P.M. Total well depth Depth to G.W. Amount of water in well Test Hole Data I F~t I 0 I I s I l0 I 14 I 16 The undersigned :ERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date~¢ ~.~ p7 Signed,.., ~. ~ ¢' ' Owner or FOR HEALTH DEPARTMENT USE ONLY. Based on the ~n~ormation presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewa Disposal System can be installed on this plot. Date ~__ Signed~~ S-15 Revised "--~' TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ r ~-~-r TOWN CLERK'S OFFICE~,~ ~UTHOLD, N.Y. ~ Examined ....... . ........................................ . ................................................................ ........................... ..................... ~,t, ................ ~.~..~..~ ....... , ~¢,~...,.m I o. This ~pplicotion must be completel~ filled in b~ ~pawr ter o~ in i~k and ~m tt~d Insp~tor, with ~ ~t, of pl~n~, accurat~ pl~ plan to ~1~. F*~ ~cop~in~ to ~chedule. b. Plot plan ~howin~ I~tion of lot ond of buildin~ on pr*mi~os, r~l~fionship to edjoinin or~, ~nd ~ivin~ ~ dot~l~ do~cription of la,out ofpr~ must be drown on the dio~mm which c. Th~ ~ork c~red b~ thi~ o~licotion ma~ n~ be comme~ beforo i~u~nc~ o{ 8uildin~ P~rmit. d. ~pon ~ppmwl of thi~ ~pplic~tion, th~ Buildin~ In~p~tor will i~ue a 8uildin~ Permit to th~ opplic~nt. Such permit sh~ll be k~pt ~ the pr~mi~ ~ail~bl~ for in~ction thr~h~t th~ wor~. e. ~o buildin~ ~hall be ~cupi~ or u~ in whol~ or in pa rt {or ~n~ pu~ whatever until sholl h~v* ~n ~mnted by th~ Buildino Inspector. A~PklCATIO~ IS H~R[BY ~Dfi to th~ Buildino D~pa~mont {or tho i~suanc~ Buildin~ Zone Ordin~nco o{ th* 1o~ o{ ~uthold, Suffolk Count~, ~w York, ~nd other ~pplic~b ~ L~, O~ n~nce~ or lb, oppfic~nt ~Oro,s to comply with ~11 ~licabl~ I~w~, ordinonc~s~ buildin~ c~, edmit ~uthori~ed in~octom ~ premi*e~ ~ i~ buildinO~ {or n~e~m~ · ....... (Addm~ of ~pli~a~) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electriciOn, plumber or builder. owner of premises ~.,,.~...~.,..~...~~~.., ~.4~.~..~/~. ~. 4~. ~f ~..~'.,~...~..~, Name of If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electric,ohs L,cense No ............................................. ~ ~ Other Trade's License No ................................................ / Location of land on which_ proposed work will be done. Map Ng,: ..~"~.h~.....~.. ........................Lot No ..... /.~.. ........... 1. Street and Number ~'.~./..~..~.~.',...~..~..~'..~. ..... ~.~ ........... ../~'...!/. ............... j ................ iii. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~xisiting use ond occupancy .......... l...~..~..: ...................... . b. Intended use and occupancy .......................... .~.. ..................... ~ *'g~'" Nature of work (check which applicable): New Building .................. Addition .................. Alteration Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ..../.~.~....~....~..~ .................................... Fee ...~..../.:..f...O. ..................................................... (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 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 ....~..~...~. ........................ Rear .....~. ..................... Depth ....~....~. .............. Height .................... Number of S~;I's ................................................................................... 9. Size of lot: Front ....... Z,.~... ........ ,,i .......................... Rear ......... Z.~.,~.. ........................ J ~ tltDepth ..,~..~'.~. ................. [.. 10 . Date of Purchase../..~.~.~.~....~..~. ............................ Name of Former Owner~.~..k~.~.s~...~.:..~....VL~..u~.Z~..~t..~.~.~.~ 11. Zone or usa district in which premises are situated ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...../~....o. .............................................. 13. Will lot be regraded ............................. Will excess fill be removed from premises: (~"~'Yes ( ) No 14. Name of Owner of premises ...~...~.~.c/..-f....~.,..~..~.'~'~...~,,~..?.~Acldress'~g~ll~.. ............... Phone No...~...~...~..:.~...~.~..~ Name of Architect ................................. : ............................ Address ................................ Phone No ....................... Name of ~¢~..~..~_~../~'.:..~...?~.~'~/_~e..~.~......~'~, ......... Address .~..e;F~../..~.~..~. .......... Phone No. ~...~..::.~ .~..~./' Contractor PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according t° deed, and show street names and indicate whether interior or corner lot. ~j5~/ I? STATE OF N EW.~Y.~I~ · ..................... ~Z/Zf/4f~/.~:~. being .duly sworn deposes and sa~s that he is the a*"licant (Name of in~lividual signing~-/'j;~ract0 ............... ' above named. He is the .................... .... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to per{arm or have performed the said work and to make and fife this application; that all statements 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 therewith. Swam to b~,.~me this ................. of ............ , Notory Publ~~...~.~ County ...~.......~..~..... (~ i ~,~f.,~ ii c~ .......................... g appliclaht)'~ JUDITH T. BOKEN Notary Public, State of New Yo~l No. 52-0344963 Suffolk C~mmission Expires March 30, THE NEW YORK BOARD OF FIRE uNDERwRITERS BUREAU OF ELECTRIc~ ;: ::~ ,., :, 85 JOHN STREET, NEW YORK, NEw Y,ORK 10038 ' [- ,,,.,~o~ob.~- 3, ~.97~ ~,,,,.,J,,o. No o.~ ~5~'~ :: ~::~ '~ N 185875 THIS CE~IFtES THAT in the fotlowin~ Ioc~tlon; ~ B~en~nt ~ l ~t FI. w....,~o. Septe~:~ev 30, 197~ RXTURE OUTLETS Fl. 0 ~ E ~t d~ ~ctio~ Block Lot a~i foumt to be in eomplim~ee with the requirements of this Board. SWITCHES FIXTURES RANGES OVENS FANS 31 21 9 SERVICE DISCONNECT Eleo.voom he&~ez'8: Noboz*/s: 1-1hp S E R v I ¢ O~ CC, COND, OF HI-LEG 1/0 1-2.Skw, 2-2.0kw, 3-1.25kw Fl"anols B. NcOaffl*ey Contl',., Bridge Lane, Cutchogue, L.I. 11935 11 UMNG THIS COPY OF