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Home My WebLink About7044-zI~ORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy Z~/~Z- a~ ~z~ 71/. No ............. Date ............................ , 19. . Iq.~70 ~'OU~l~ W~_~/ THIS CERTIFIES that the building located at ............................ Street 5'r,, 7b~ -- Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................... , 19... \ pursuant to which Building Permit No ......... dated ....................... , 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 J~ OIv£ ,f-,41''~ IL V /~[t/ELI_ ~,~,t ~ ................... ~'/~/);4 ~ ~ .... 7; ~-:i '4'~ ','X)~:~ ................. The certificate is issued to ........................................................ (owner, lessee or ten~') of the aforesaid building. /v )~'i~'~'5 ....................... UNDERWRITERS CERTIFICATe, No ............................................. HORSE ~BER .............. Street...~ ~).~/~;,; L' ~ ....................... ............................................... .......... Bulldog I~pector ?O%9'N OF ~ BUILDING DKpAIt?M~NT TOPW'N CLERK'S ~O4,1~LD, N. BUILDING I~RMfT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) I No. 70 M Z Permission is hereby granted to: aae~ee~..Z4eaea..ee~se~uct~r.e~...-..,/¢ a:Leha~.d Mo;Leh~mo · ..~9 ....... g®te~e~,-.~i~,la~&~ ......................... ...... ~ ....... ~.~......~.1.~.~ ....................... .Bg.tl~ new one flm~l~, d..w..q.~.~ . ........................ at premises located at .../,aa~.~ ....... ][og,~hvo~ds.~t&te~ .......................................................... ...................... aZ.&..., a~,,,,,~..v.l,ev...ave ............ a~14-....N.,.¥ ... .............................................. pursuant to application dated .................... ~}e~.....96.., ............... , 19.r~3.., and approved by the NOTEs See notations on pla~l Building Impector. Fee d.9-1 ~ ~. .......... FORM NO. 6 TOWN OF $OUTHOLD Building Depnr~ment Town Clerks Office Southold, 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 $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $,5.00 3. Copy of certificate of occupancy $1.00 ................ New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property /~/ _~ 7~) ---qO6/~/'~ J/'/'~V/ ~/~ /' ~-OU 7-/-/~ L~...~ Owner Or Owners Of Property ~....I~I4j~IT~ ~ Subdivision/~../J~7/-/ I,~/Idl~ ~-~7 ............ . ............ ............................................................... Lot No. 3 Block No...~.. ........ House No Permit No....Z?...?...~ .7-----O'Ote Of Permit ../...~..2...~..,~Z, Applicant ~...~...,.~,..!.C~,...~.......~..?.,~...~.,5........d~..~...N'...~.,..FO Health Dept. Approva~.~}~ - ~ ........... ~kobor Dept Approvo ~ ~ ..... ................... ........... ............... Request For Temporary ~ertificote ........................................ Finol Certificate lee Submitted $ ..... ~ ........................... Construction on above described building and permit meets, all applicable codes and regulations. Sworn ,o before me this ................ day of ............................................ (stamp or seal ~'z~ Notary Public .................................... County THE NEW YORK BOARD OF FIRE ~ BUREAU OF ELECTRICITY I- se,~e~.~' 10. f¢'~"" BT..T,.EW ¥0.., ~1~9'~"" ,O0.E Date /Ipplicatlon No. on file THIS CERTIFIES THAT UNDERWRITERS N 181583 Block and found to be in compliance with the requirements of this Board. Southold, i~ the followlng locat' · t 2nd FI. Section was examined on fiXTURE OUTLETS SWITCY~S FIXTURES RANGES -OVENS DISH WASHERS EXHAUST FANS UNIT HEATERS MULTI-OUTLET DIMMERS ' SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER AFPARATUS: *Fu~naoe e&l 1-1/Shp, 3-1/12bp 1-5 TonA.C,. Unit 1 OF NEUTRAL 2/0 mis COPY OF CERTII~ICATIi MUST NOT B~_ AL..~..,~_. IN ~,MANNER. S,~FOLK COUNTY DEPARTMENT O~ HEALTHReferenceHealth Department, umber APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant qic!,mrd '~elc},1on~' Phone 732'~23h 2. Property Location :~/u r,l' ~o'm,~,~; ~e, ' 10' ,est of' Lt~ntno~s~ :or Village Township. 3. Public Water Company)Name 4. Lot size: Width 1~ feet Length ~Ah-2~ feet Sewage~/~isposal System: A. ~gallon septic tank: Precast × Equivalent Block 10. B. Leaching pools: Nunt~er of pools 1 ,~ Preca~ B1 ock Special ll; If pr~ate well, fill in the ~' ~ follo~ng blanks: A. T~ capacity, h;' sallons B. I~Jt~lp G.P.M. C. ~tal well depth, D. Depth to ground water E. Amount of water in well 5. Subdiv. ~t~.wooe 6. Section 7. Lot Number 3 8. Private Well ~-~s 9. Public Water Distance to main (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 indicated below and may be renewed if a current local Building Department Permit is in effect. Date 1°73 ,, ce~b~' 11~ 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 pl~ot. APPROVAL DATE ~'~,/~2 SIGNED C ~ ~ S-15 Rev. 4/1/73 I~ ,~Z~ __,,~_.~. c. ~ ~ ~ ~ ~is ~l~tim ~ ~t ~ ~ '~f~ i~e of ~lldi~ ~. ~it ~- d. U~I of ~i~ ~1~, ~ Buildi~ I~ctor will 1~ a Bui~l~ Pe~it ~ ~ ~t. ~h ·all ~ ~ m ~ p~im ~il~le ~ i~tl~ ~gh~ ~e p~ of ~ e. No ~lMi~ ~1 ~ ~ m ~ in ~le or in pa~ for any pu~ ~ate~r until a Ce~if~ of ~y shall ~ ~ g~ by ~ Buildl~ I~r. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of ~he To~n of So~thold, Suffolk County, New York, and other applicable La~, OMinancal or Regulatlam, for the comtmction of building~, additions or alterations, or for removal or demolition, al hez~n de~ribed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) Yq YdT~/e,~,,VS.- M'~v, t~o,,,,.,,e¢~''. ,.~.'4, ............................... i;~;J;J;~';F'~ico,-'"'~i ............... ' ....... ~" State whether applicant is owner, levee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~.~.~r_._r_.~o~ ~,~o~. Name of owner of premi~ee : .... If applicant is a corporate, signature of duly authorized officer. ~ (Name and title'of corporate officer) -~/,~ ~ I. Location of land on Which prppaled work will be done. Map No.: ...~6.?.~ ........................... Lot No.: ...... ,.~ ............... Strm and Namer ........ ~/~...~.e...~.~.~.v.J,~...&~..~., ..9.~.9 ! .~.~. ~.~.o.g..e..e...~g... ................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propaeed comtructlon: a. Existing use and'occupancy .............................................................................................................................. ' ..... b. Intended use and accupan~; ............ .0..n...e.....~...~...~.~......~f....e.~.~.:~g~ ....................................................................... Nature of work (check which applicable): New,6uild~g .... X .......... Addition .................. Alteration ............ : ..... Repair .................. Removal ............. ;.:;. Demolition .................. Other Work (Describe) ............. ' ............... ~.. / 4. Estimated Cost ....~.....~.1~1~ .............................. :,....Fee ..~.~ ....... ;;., ...... :. ............................................. (to be paid on fi!ing this application) §. If dwelling, number of dwelling units ..... ~1~ ................. :Number of dwelling units on each floor ..~.~...~..-...~ ...... If garage, number of cars 6. If busine~, commercial or mixed occupancy; specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...1[<11~. ............... 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 ..]ll}.e. .............. Height ....~.~..~ ....... Number of Stories ...... ~ ........... ... 9. Size of lot: Front ..... .~.t.~. ........... Rear ....~-...1~.~.~. ................. Depth ..~1~1~.. ................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ..... ~.. ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... R of nremises S.e~ Ne~ohl. ael~u~,..,~ 8~ Rul. end Rd6Setdog~ 13. Name of Owner ~ · ....................................... ~ ............................................... ~none N ...................... Name of Architect ...... .~....l~....l:....~ ..................... Address ...~.....~.R,...~.~.~...R...~..~L.~...I~.' .... Name of Contractor ... ~...l~.~.e.~a lt..a~...~ Col~ ~ ~1 V t; n .............................. ....... 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. STATE OF NEW YORK, tee C ~'~ o u r,3,tg gF ............. .................. · ....... ;~'~~.....Z.~.t2~.xT./~4~.~'r~ -- .............. ~ing duly sworn, d~,, and says t~ he is the applicant ~ individual Signing applicat above nom~. He is t~ (~nfr~tor, ~t, co~r~e officer, ~c.) of said ~ner or owne~, ond is duly o~horized to pe~orm or hove perfo~ed the soid work ~ to ~e ~d file this a~lication; that all statements contained in th s applicati~ am tree to ~e ~st of his ~l~e a~ ~1i~; and that the work will ~ ~o~d in the manner ~t fo~h in the a~licati~ fil~ ~i~. S~m to ~re ~ ~is ~ . .... ......... Nota~ Publ '~::~::':-' ~ ........ :~~ ff~~"~'"~~'.' r- ~ '' I :! tl~" Iw2~ ¸'1