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Home My WebLink About7034-zFOltM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. Z~9.~, ...... Date ........... ,I~lne...1~ ....... , 19 THIS CERTIFIES that the building located at 8/8. l~ee~h .l~oa~ ........... Street Map No.. ;~x ....... Block No. ~ ..... Lot No..~... fi~een~ort.. 1~ o~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... De~ .. ll,..., 1973. pursuant to which Building Pemit No.. ?.0.~.Z. dated .......... D®o.. l~ ..... , 19~3., 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~..v&te. olle. family..dweLling ..................................... The certificate is issued to .. Ite~lel~..B.. AgJ~w. ..... 01eller .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval June...~..1 9.F.~ ..................... UNDERWRITERS CERTIFICATE No. ~, .16.3~..8~.,,, .J..uR..e., .~....~.9.7.~. ............... HOUSE NUMBER . 1090 ........ Street ... (Se~udy.)..Beact~ · Road ................. Building Inspector FOB~ 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? 703~ Z Date ............. ~.g ............. 1.2 ................... , Permission is hereby granted to: l>& ~hl~ ..~ .... A~:'G ....~ez~e r...~...A~.m~ ............. ......... ~g,~.....~Lxm:~ ~,~,. A~r~ ......................... ............. ~t~ezJ~aa~....~. ~ o ,....~ .1 .~ ............. to .2~d. Ld...~.ew...oae.. £a~i:LM..d. wal~ .................................................................................... at premises located at .~.~.2~e&o~..~O~l~..~j~..~/~o~...~ ............................................................ ....................................... ~e~o~.t, ......... 1~.~:.o ......................................................... : ...................... pursuant to application dated ......................... ~ .......... :~ ........ , 1~ ...... , and approved by the Building Inspector. Fee ~.-9~ ............ FORM NO. ~ TOWN OF SOUTHOLD Building Department Town Clerks Office Sou~hold, N. Y. 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 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: I. 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 Date · .~..~. · ....~..~i.~.../.'..~.. Z.~. ....... New Building ...... ....~...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property Owner Or Owners Of Property ....,,/~..~'Y}~.~./~. ......... ..~.,.,. ........ ~.K~.Az~.~...~... .............................................. Subdivision ................................................................ Lot No..~...~....~ Block No ............. House No...~:;~..~.. Permit No...~...~.~.~..~.....~.. Date Of Permit ../.2.~;~......Applicant ...~..~...~...I..~..~..~,...~....~....c... ..................... Health Dept. Approval ...... ~...:..~....T..Z..~...~ ........... Labor Dept. Approval ........... ../~/..../~... .......................... Underwriters Approval .......... /.~.,~.~.~...~... ............ Planning Board Approval ...... ...~....~, ......................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .......~.......~ ................... Construct,on on above descr,be / ' ' ~'~ / · ' d buildin~/~3na permit m_~s, OJ' appJicabJ~/,,~J~s/~'nd, rx~lation,. AppIicant .....~_...;.~.~.. k ........... -~, ~ ....................... Sworn to before me tJ~+~ /<' / /~ ~- '7 ........... L.S. day of !.. (stamp or seal) Notary Public .................................... U County '~ ~'7 ~' 7 THE NEW YORK BOARD OF FIRE UNDERWRITERS B.k BUREAU OF ELECTRICrT'Y ~-- 85 JOHN STREET, NEW YORK, NEw yORK 10038 THIS CERTIFIES THAT o~ly the e/ectr/ea/eqt~/pment as descr/bed be/ow and introduced by th~ applicant named on the nbo~ application ~umb~r in tl~ premises o~ E, B, A~news n/w/coz'. Bez'~b Ed. & Wood Lane~ Oz'eenpoz'~ inthefol~o~inglocetion; [] B~sement ~[lstFl. [] e.d FI. outside & Slab. s~tio, mo~k ~t 1090 m.xo.,i.~o. June 3m 197" andfoundtobeincomptia.c, mltktherequirementsofth~sBoard. RXTUEE ~ OUTLETS EPTACLES SWITCheS ;sc*so,scum RXTURES °""' I ,...A,=, I ,.,u,,' ,--,4 AMT. K.W.' OP- 'H. P. OAS ~. P. ~T. NO A. w O SERVICE DISCONNECT I NO. Of I S I 200 CB x~ 1 RANGL~ ! R EXHAUST FANS DIMMERS V I 3/O 1 mSpeola! ~eceptaoleag 1-50amps., 1-30amps. Wate~ heatert 1-q. Sk~ Elec.room heate~sl "-l. Skw, 1-1.25k~, 2-1,0kw, 2-.?Skw, q-,Skw El J & J Eleotrle Co., 1378 West Main St., Rtverhe&d, L.I, 11961 COP~ F_OR B~G DEPARTMENT,, THIs COPY OF CERTIFICATE MUST NOT BE .ALT~,, .l~!~..,._J~l',.~ ,.~_ SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1 Applicant Jol~n ¢oucl~ 5. Subdiv. · . . Phone ?2?-?2?9 Address$~l:~ Kzve~'le~.$h Ave,t ~vm~hea ~ · · 6. Section 2. Property Location S.W. Co,er Beach Road ~d 7. Lot Number W~ ~n~ 8. Private Well Village. Greenport Township ~hold 9. Public Water 3. Public Water Company Name Distance to min 4. Lot size: Width BO feet Length. 2~ feet 10. Sewage Disposal System: A. ~O~gallon septic tank: ~,_~ .. Predast× Equivalent Block B. ~aching pools: ~,~, N~.~er of pools ,~ ~ecastlm~' Block Special 11. ~f priv~e well, fill in the :f_~t 1 owi ~ blanks: /~,i; Tank r~pacity.~gallons C. Total well depth D. Depth to ground water E. Amount of water in well (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicate~ bel~ow and may be renewed if a current local Building Department Permit is in e~f~tT~)~ ~ ~ .... ./[_~____<_~__~____?_~__ .......... Signed ~~~~/~/~ ................................... :::::::::::::::::::::::::::::::::::::::::::::::::::: 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 and Water Supply can be installed on this p)ot. APPROVAL DATE SIGNED S-15 Rev. 4/1/73 ~E~ ..... / / ~TOLE COUNTY N~ALT~ DEPAR~M~ The sewage disgosal a~ ~ate~ suD91~ fa~ili~ies for this location have been inspected bM this de~ent~d~ou~ Chief of General Engineering Services TOWN ~ERK'S OFF:~~ ..................... ......................................................................... ~. This ~[J~{i~ must be complete[~ fiJl~ iff b~ ~pewriter o~ i~ i~k Q~d ]flsp~tor, with 3 ~ o{ pl~s, ~ccu~te pJot p[~ to ~[e. Fee ~ccordi~9 ~o ~h~uJe. ' b. Plot p[~ s~owi~9 [oc~tiofl o~ lot ~nd b{ buiJdi~gs on premises, reJ~tio~s~ip ~r~s, and 9Mn9 ~ det~JJed des~rJ~Jo~ o~ [oyout o{prope~ must be dmw~ off t~e c. The work co~ered by t~is ~[ic~tion m~y ~ be comme~e~ be{ore J~u~ce d. Upo~ ~ppro~[ o{ this app[icGti~, t~e 8uJJdi~9 [~sp~tor w[J] issue'~ ~uiJdin9 Permit to t~e ~ppJic~nt. Suc~ permi~ shQU be kept on the premJs~ ~QiJ~bJe {or Jnspecfi~ throug~t the work. e. No buiJdi~9 shGJ[ be ~cupJ~ or ased J~ ~oJe or i~ par~ {or ony pu~ose s~[[ ~Q~e bee~ 9ranted by lhe 8ui[dJ~9 J~spector. APPLICATION IS HEREBY ~DE to the Building Depa~ment for ~e issuance of o Building Pe~it pumuant to flea Building Zone Ordinance of the Town of ~uthold, Suffolk Count, New York, and other applicab · ~s, Ordinances or~ Regulations, for the construction of buildings, a~itions or alterations, or for mm~al or demoliti~, as heroin described./ ~e opplican~Rgr~ to comply with all applicable.la~s, ordinances, bud ng c~, h~si~ c~e, a~ r~ulati~s, and t0 admit autho~ectorS on premises a~ in buddings for n~essa~ i~ectio~. (S~g~re ~f op~icant, or ~me, if a co~omtion) 525 ~ve~[e~h Avenue ~=~e~...~e~...~==~..~[5.~ ................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ,,. .............................................. .G~,,,'a~.,v.~,],,...~.9tL't;.~.a...q~.o..~ .......... Nl~me of owne.~..~~~:.~...~..,.....A..G..~...~.~. I f o~Jic.~_ _d~o~t~/~r~t u ~uly a ut. horizecl of ficer. * .... // Builder's/{.icense No ..................................................... Plumbers License ao ......... ~..~.z.z~ ............... ,..~,... Electrician's License No ............................................. -T ;~ '- ~ b'--' Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ' Lot No ........................ Street and Number S.W. Corner Wood Lane ~ Beach Road Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............ ~a.ca.o.:l: ......... . b. Intended use and occupancy ............ SJ_ng,.].~...['arai.]~r....~W.e.~,,],.~,D~z ............................................ : .................. ~.~ ~ I~ture of work (check which applicable): New Building :.~.X..~ .......... Addition .................. AIt~e/ation ' Repair .................. Removal .................. Demolition ................. ;.. Other Work ................................................ . .... ee . .~..,..~.~. ~'~..~.. (Description) 4. Estimated Cost $3~.?3u''00 F ,. . (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 ............... 2 .............. 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 .......... .3...~. ..................... Rear ...... .3..§. ................. Depth ....5...0. ................ Height lu' Number of Stories 9. Size of lot: Front ........... .8..0. ......................................... Rear .............. .8..0. ....................... Depth ...... .2..2.0. ................... 10. Date of Purchase ........................................................ 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: ........... ~..o. ........................................ 13. Will lot be regraded ...... .Y...e..~ ............... Will excess fill be removed from premises: ( ) Yes (x) No 14. Name of Owner of premises...~...~TL~.W ...................... Address ..~..~.~.~.~,.o./). ............. Phone No. ~..g.~.7.0...0..g. .... Name of Architect ...............~.~....C...o~..~..~ ..................... ; ..... Address ...N..*...~.....s....~.*..~...* ....... Phone No ....................... Name of Contractor ............ ~.~.~.~,~,~,.~...~.s ............... Address ...~.~..v..e...~.~.e.~..~.. ........ Phone No...?..2.?..~.3'..3.~..3.. 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 whether interior or corner lot. COUNTY OF/~'~',~'~.~;*'~'.~' ' ................... /.. ....... ; ................................................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................................................................................................................................................................................. (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 ar~4~i~l ~f his knowledge and belief; and that ~e work will be performed in the mann&~ Set forth in the 6ppJJ~ation fjJ~d . . Swam to bef_gr~ me this ~ ,, ......... _.ZZ/ ( ,~'~ ' JUDITH ?. I~OICEN ~ ~'~ nature of applicant) ' Nola~/ Public, State of New ¥~ ~o. ~,-o~4,,,~,~:~ s~,~ol~ c~~' Commission Expires March 30, 19-.L'-'~ ' 9, L~ '/ I 1~"'1 i ~ [ [] .~[ [ J.,; I I . ,1 I -*. ,~,[ ' ~. ---~---~,~ .............. I~ , ~ I][I i ~ - ~ I'-:~1 ~t J , . ~ll-I , , iH ~E'[- ~'~1 ~ t I . IH . ,,¢ ii1-, I ', ' 1'1 o ~.s , .t~ i l'l iL1 ........ ~,~,~ ~-~./ ~,~ , .,. ~ · - ~ ~.~l.-i ~~ ._~ '~ ~ ' ~ ~ ~ , '~[ / iI ~ ~ [ ~ ill It =' : "~ - ~ ~ [1'-1: . ~l,:l~ ~. : --.. , ' = : _l1 I[' ', ., I.'l ~ : ",. ~0~ o,o, I \ thru copg~er o,r ven~' opt IJt~hf,g', . k'/tchen ',i root f/oo'r' line off ¸%]