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Home My WebLink About7039-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy h Z6~33 o ............. Date.3 ............. Dec...40 ...... , 194. THIS CERTIFIES that the building located at . I~/S. Bsverl~. (P~.~;). l~a5 Street Map No.~~ ......... Block No...'..x~. ..... Lot No. ~1:~.. l~ollt41Old .... N,~.~ ... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ D~)e 'el , 19.7.3. pursuant to which Building Permit dated ..........~..e....~.l ...... , 1975.., 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 Private one i'a~i!~ ~l'~'elling (Approved by Bd Appeals) The certificate is issued to '~iilia~ Patpas 0~rner : (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~..~.~ .3,..!~7~.... Jt~..~.0. ~7.~. ....... UNDERWRITERS CERTIFICATE No...B.~?.~.7.29 .... ~.u~. ~..2.3,. HOUSE NUMBER ....... ~.~. ....Street.. B~.~.~..~oa~ ........... ../ / .... ........... ......... Building Inspector TOWN OP SOUTHOLD 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? 7039 Z Date ...................... ~e .......... ~1 ............. , 19..~. Permission is hereby granted to: ...~:I.:L1. ~,~...~a,pp,~ s ............ i .............................. .......... ..................... .......... ~'~'~ ...... '~'~';'"!i'! ~66' .................. to .t~&.3.~.. ~e~ ..ea~ ..ge~m4_.]:y'. ~-e ~.~.:t~g ............ ; ........................................................................ ........ .(k ..l~;~.t~..i~]~ll~..~.~..T.~.;l,~.o..O,...b~...~,...~,~.~s....-..~ ~/~0Z1.~3~. ...................................... at premises located at ..,jiTCB..~j~,OZ, i.~F..~..~..~i_.~....C~: ........................................................ .................................... ~o~J,~o'3c~ ....... ~f~.¥.~. ....................................................................................... pursuant to application dated ........................... '~j~15'.-'.? ..........., 19.?].., and approved by the Building Inspector. Fee $.J44~4~ .......... FORM NO. 6 TOWlq OF SOUTHOLD Building Department Town Clerks Office Southold, Iq. Y. 11971 APPLICATION FOR CERTIFICATE OF i OCCUPANCY Instructlons 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 u~e: 1. Final survey of property with accurate location of all ,buildings, property lines, streets, and unusual natural or topggraphic features. 2.Final approval of Health'-Dept. of water supply and sewerage disposol--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Un~derwrters. 4. Commercial buildings, Industrial bui!dings, Multiple Rbsidences and similar buildings and installations, a certificate of Code compliance from th~J 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 ~ses, or buildings and "pre-existing" land uses: : 1. Accurate survey of property showing all property lines, ~treets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, 6ccupancy 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 ' 3. ~ Date .... .7.....~.. ~...~.: ......... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~.~.~.. ....... .~.~..~L.~.)....L~.~. ........ ./~-../~ ........ i.~.O...~....Z../~L...o..~.l~ ............................... Owner Or Owners Of Property ..~....~....t...C:..~L~ ........ .'.~....~..~..~..~,~ ............. Subdivision .J).~.~. ...................................................... Lot No. Block No ............. House No.....~..~ Permit Date Of Permit ~?' -,~/'~..~.Applicant . .~..~L(~L~...r'~k......~...~....~...L:%~ ............... Health Dept. Approval ..~..-.3:~.Z...~......./...~...(. .......... Labor Dept. ~pproval ................................................ Underwriters Approval '~ ~.,I ~ .~../ 7o~. ,~, Planning i Approval ........................................ .......................................... Board Request For Temporary Certificate ........................................ Final] Certificate .................................. Fee Submitted $ Construction on above described building and permi~ meets all a~plicoble codes and regulations. pphcont ... ...~/~.-.,~ ............................. Sworn to before me this ....~.~.! ...~ay of ~x~, .~. ~'?/ t .................. "~'i"~"~",~ ................. ,~,, ts amp or seal) Notary Public ..... ~~.~..~.,~ County J~n',~ -r. ~,~.~.:, ~ /',.~ , ~_r~~ ~,~' ~ ~- Nr~ta~y Public, S,~i~' o; ,,~Z~I~ ~ ~ ~ ~1~. 52-0344963 Suffolk L,~ Commission Expires March 30r 19J~.Z *.' THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW YORK tOOSE ,~ :ul~, 23, ~.~7~, ~,,~,~.~o..~,,. ~N 171729 THIS CE~IFIES THAT in t~ f~l~ing l~ation; ~ B~ement ~ 1st FI. ~ 2nd Fl. 0~ ~ ~ ~ Section Bilk ~t ~t~o. July ~5. 197~ andfoundtobein~mpllancewiththe~quirem~ntsofthlsBoa~. RXTURE FIXTURES 11 11 DRYERS FURNACE MOTORS RANGES OVENS DISH WASHERS EXHAUST FANS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF F~ET SERVICE DISCONNECT E APPAR TUS: °~,~%ex' ~ea~e:': l-f~.Skw S E R V i OF NEUTRAL 2/0 P~lle Elec.Servlee Co~p.~ 170-15 Central Ave., EaBt Paznntngdale, L.I. 11735 GENERAL COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK CO~Y DEPARTMENT OF HEALTH H.D. Reference No. ~U-/~/ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE 10. SEWAGE DISPOSAL SYSTEM 1. Applicant ~t~~ p~ ~ Pho~e~°~30~5. Subdtv. Address ~ - .6. Section 2. Property location 7. Lot No. Vtllage~~nshtp~9. Public ~a~e~ 3. Public Water Company name ~g~e~fOgT Distance to main 4. Lot size: Width[~ feet Length J ]~feet (Enter on center plot below) Sewage Disposal System: A. 900 gallon septic tank: Precast ~Equivalent Block B. Leachtn~ pools: Number Precast Block ~cial Street If private well in blanks below: Tank capacity Pump G.P.M. Total well depth__ ~Depth to G.W. ~Amo~nt of water in well__ Test Hole --Data Feet IO 2 4 6 8 10 12 fill Gals. 14 The undersigned ERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date ~F~7" ~ ~ Signed Owner or~n~/~aer 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 Syste. can be installed on this plo~-~ , ~ V~ Date i, (?_( (~3 Signed ~-~7 S-15 Revised 4/]/72 OWN TOWN ~UTHOLD, Examined ~ te ~ ...... ~ ............................ , .......... ~P ............... [ ........ , ]9....~ Permit No ......................... Disapproved a/c ........................................... .......... ..................................... ...................... b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or arees, and giving a detoilod description of layout ofproperty must be drown on,the diogmm which is pprt of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. Cl. UP°n approval of this application, ~he Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises ~'~ailable for inspection throughout the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Buildino Inspector. APPLICATION IS HEREBY MADE to'the BOi~ling Departit~ent for th~' issuance of a Building Permit pursuant to the Building Zone Or~i~nce of the T-o~-o~ Soc~hold, Suffolk Court', N~w York, ~n'd other applicable L~ws, Ordirmnces or Regulations, for the construction of buildings, pdditions or alterat ons, or for removal or demo ition, as herein described. The applicant agrees to comply with all apph'l~l~le laws, ordinances, build ng co{~, hous nO code, and regulations, and to admit authorized inspectors on premises and i~ building~ for necessary inspections. ' -- - (~igna~U~e of app cant, or name', 'if a corporation) (Address of State whether applicant is owner, lessee, agent, ar~,~hitect, ~'flgineer, g~ene~-~l'~tractor,"al~c~?iCi~, p umber' br builder. ............ .. Name of of owner n~_ i ¢,.r_m.se. ................................. ;,~..,.....-.., ....... ..~,; ...~ ................................... ; ............................... If applicant is a corporate, signature of duly auth. Ori~d officer. (Name and title of corporate officer),. ~ · Builder's License No ............................... '. ..................... Plumber's License No. r' ,.. ~.~,~:: Electrician's License No ..... l~ ~ ;c. Other Trode's License No. ~.,_.:.!~ ............................. ' ....... , ..~.f 1. Location of land on which'proposed work will be done."Ntap No.: ............... Lot No ..... v /3 I o, ' ' / ' ........ Street and Number ..... ~..~....~/~...~.. ....... ~....~.....~.'.~...~.....p..~.. ....... ___________________~.: ....... ~..~. ?~'...~...~....~.. ......... A m-~' I-be. ~o PI~E'M u mc.' ipa ty 2. State existing use and occupancy of premises and intended use and occupancy of pr0posed.c~strUction: a. Exisiting use and occupancy I/AC/::~/7' //~J~) , b. Intended use and occupancy ..... ./.....~.....~'..~..../~./..~.~.......x~..~:~...~.....~....Z~..~....C`~...~x~.~.~...~.~~ Nature of work (check whi' ~licable): New Building .................. ition .................. Alteration Repair .................. Removal .................. Demolitian .................... Other Work ~.... /~z/~ ?_.~.~-- ~ (Description) (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 ~ature and extent of each type of use .....'~.. ..................... structures, if any: Front ........ ~.//~'~ .......Rear ................................ Depth .................... 7. Dimensions of existing 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 ...... ...'~......c:J...T....I...O.. ........ Rear .....~...7...-..!..O.. ....... Depth...~.....~...'.-....4T_.'.' Height .../..~.....~..._4:.. ..... Number of Stories / .~....~.~.. · -9. Size of lot: Front ......./...~....~.....'....~..~.~ ....................... Rear ....... ~.....~...-...~....47....~, ............. Depth ~/J.~.r...O..~.../..~..~,.~.~, 10. Date of Purchase ........................................................ Name of Former Owner 1 1. Zone or use district in which premises are situated ~..~'...~.././~..~...7~.!. ~/~.,....C_~. ....................................... ]2. Does proposed construction violate any zoning law. ordinance or regulation: ../~....o. ..............................z. .............. '""'7- 13. Will lot be regraded ...... .............. Will excess fill be removed ;~.~m_ ~.j~s,~:~ (e~) ~.fYe~. c.~ (~N° 14. Name of O~.?~[~f premises f~../..~...~../.~.....~...~-..~..~.....~..~ ...... Address ~...E)~,.~..~...~...I~..3...~..~:... Phone No. Name of .'~.rc~'.."~.*~:t .~.~..~......x~..;...~..~..~ ................ Address...~.....~...O~V~hone No. I..?'...~...~.~....~...'~....~ Name of Contractor ..6~J.../...L~...~....~4~ ....... ..~....~...~...~:.....~.. .............. Address~.~..~.~t: .................. Phone No, ..~...~,..~..~,.~..°..~- PLOT DIAGRAM I'le~l ~,.~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-Ex3ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot. /WI 00/..~ ,e'O,~ I~ -.~'~ ~ I/.-~ ~ .~../~. t°~:.~) being duly sworn, deposes and says that he is the app[icam (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 0r 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; add thru the work will be performed in the manner s~t forth in the application filed therewith. Sworn to before me this ~ ~~,~r ,. ,~ (Signature of ~ ~UIA~Y PUBLIC, State 0f New York ~)T~ .... '" N0. 52-1]]~41 ... , ~ 0 0 EDUCATION LAW. ~oJer~'~k V'~. Fu~ji, lJ ?! S H IN -F I FLOOR Ft, /.-EVE:i,- APPROVED AS NOT, ED DAVE: FA~ FEE:HO ~ NOTIFY BUILDING DEPARTMENT /, ED INSPECTIONS: ~. BEFORE BACKFILLING FOUNDA. ?R~,IqK L~. Et,,IOEL S~O JE~USZ~LEM AV~. ~,,c/ o N 'L{. .' I V -'Z. - e, E~ 3 ~ ~y; W, S?OR,TDHZ~IgtN 6tlEg. T I OF ,~. % I 1%6" /0.(0n / ~ --II __.3 7 L t d.'.. ,