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Home My WebLink About6975-zFOF~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~I,~0 ...... Date ............ 8?P.t...2?. ...... , 19. ~+. .. THIS CERTIFIES that the building located at .~.e..n~.®C.°.t.t.. D.r.i?' .......... Street Map No.~e~O~.. Block No ........... Lot No.. 3.~ ...... ~gU~q~...~ ~Y.. ........ conforms subst~tia~y to the Application for Building Permit heretofore filed M ~s office dated ............ NOV...7..., 19..~ pursuant to which B~lding Permit No.~?7~... dated .......... N?V.. 7 , 19.. ~ was issued, ~d conforms to ~1 of the req~re- ments of the applicable pro~sions of the law. The occup~cy for which this ce~ificate is issued is .. rr~,$~e..qn? .~.~. ~.~$ ...................................... The certificate is issued to .~h~. ~. ~ .~ ....... ~ ................. (owner, lessee or ten~t) of the Mores~d building. Suffolk County Department of Health Approval .PeP~.. ~...~'9~.. b~ .~. Y!!la... UNDERWRITERS CERTIFICATE No..N~ ~79 ..... SeP.~.. ~.. ~?.~ ............. HOUSE NUMBER . .].~ ........ Street ... ~.~. ~$~ .................... Building Inspector ~OUTHOLD, ~. Y. BUILDIN~ Prr, lMrr (THIS PERMIT ~IJST BE KEPT O~ TI-LE P~F.J~ISES U~'I'IL FULl- O3MPLE'I'I(~I OF 'THE ~ORK AUTHORIZED) 6975 Z Perr;,;ssion is hereby grafted t~: ...................................................... Zez~e~o.~l~..D~.l~ ................. &ImM~A. ................................. pursuant to application dated .......................... II.It ......... ~ .......... , 19..~t~., and approved by the Building In.pector. F.E $4.Agk.90 ......... APFLICATION FOIt BUII,.I~N~ I~RMIT INSTRUCTIONS a. This application'mustbe completely filled in by t~/pewriter o~. in ink and submitted in triplicate to the Building! Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plo{ plan showi~ location of lot a~d of buildings on premises, relationship to adjoining premises or public st?ets areas, and ~ ,a ~led description of layout ofpmperty must be drown on the diagram which is past of this application. c. The work covered by this application may not be cOmmenced before issuance of Building Permit. ' d. Upa~ approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises ~lloble for inspection throughout the wo~k. e. No building sh~ll be occupied or used in whole or in part for any purpose whatever until a Ce~tificx3te of Occupancy shall have been granted by the Building Insp~tor. 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 appl~ 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name; if a corporation) (Address of 6pplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ............... ...................................................................................................... Name of owner of premises ....... ~.~.~...~....~..,.~......A....N~..~.. ....... ~'..~...~...(<.~.. ...... .~.../...~...../~....~..: .................................................. If applicant is ,a corporate, signature of dply authorized officer. ' t~lame and title of corpo~6te crfficerY~/ Builder's License No ..................................................... Plumber's License No ....... ~...~..../. ...... ~ ................... Electrician's License No .... ./~..~..~....~. .................. Other Trade's License No ............................................... 1. Location of land on which/or~3sed workc:~be c~. Map No.: .~..~...~.../~..~'...~..~..~...~:...~.....~'~.. 'l.'ot No ..... .~...! ............. Street and Number ..... ~ ................................................................... '~'d.~,~.~l~..~...Z:...-~.. ....... /' Munidpality State existing use and occupancy of premises and intended use and occupancy of proposed cqnstmction: a. Exisiting use and occupancy ..~....~ ~ b. Intended use and occupancy ~ ~' ~/...~.. Z' A/c ~-- 3. Nature of work (check which applicable): New B~lding .... .............~'. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition ........ ............ Other Work .................................................... o-~ . c~' 0 (Description) 4. Estimated Cost ......... .~..~..~ ............ ~ ..--....~. ...................... Fee ../.....~,.~ ..................................................................... ... .. (to be paid on filing th~ 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 occUpa~c'y, specif~ nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Pear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure wiff~ alterations or additions: Front ....................................Rear ......................... Depth ................................ Height .......................... Number of Stories - / 8. Dimensions ~ entire new construction: Front .......... ..~....~,.~ ................ Rear ........ ..'~.....~.../. ......... Depth .....~....~. ............. Height ~. ~ Number of Star es ..'~'... ................ · _, .... 7' ':~ ......................................................... ;'*" 9. Size of lot: Front ......J...~..~ ........................................ Rear ..../...~'....~.. ...... ..'T ................... Depth .....~:......7...~:...~....~. ...... 10. Date of Purchase ....... /..~....7....~.. .................................... Nome 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 lat~be_regradec~............................~V-~3 Will excess fill be removed from premises: (~) Yes ( ) No 14. Name of Owner of premises .~.~ .~J...~....~..~. /4/~/- ~'$ '.Address ~..~ Phone No ....................... ................................ o ' Name of Architect /~..~.~.......~..~..~.A/& ....................................... ,~........ Phor~ ................. .~.... Name of Contractor ................................... .~.. ................... Address................................· · Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether'existing or proposed, and nd cate all set,back dimensmns 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~;~_~ COUNTY OF ......... ~'~.~':~..~o.~_~,~ ~ ~"~ ..... . . . .................. ;;.'"'"'~ ' "~~/' 7'~ ................. ;.' ................. being duly ~orn, d~oses and ~ys t~t he ,s the apphcam t~a~e/of ind~idual si~ing c~trac~ above name.. He is the ..................................... ~~ ......................................................................... : ....................... (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e perform~ the ~id work and to ~ke and file this application; that all statements c~tained in this a~lication am tree to ~e beM of his knowledge and belief; and that the Work' will 'be 'perfOrmed in'the manner set f0~h inthe appliceti~ fil~ ther~ith. ~:]--.Sw°m to ~f~eme this Uato. ~ublic~~.~~n~ ...~.~~ ........ ~ ....... ~~ ............ ~ ' Ne~ Public, State of Ne Yo~ ~DITH ~. BOKEN Ne~=0~44963 5uffo w ~'~ March 30, I~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. ~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~ ~D,~]g~ / ~/Vc. Phone ~/qZ7 5. Subdiv. ~/Z'C~FT'- ~ Address ~-7~ ~f~ff f~ ~/~;{Z~D ~i~6. Section 2. Property location ~v/f ~'~£ c~ ~;V~ 7. Lot No. ~/ 7~ z ~,/~ ~/c£ ~ ~ 8. Private well Village ~DCT~LO Township ~ ~D 9. Public water / 3. Public Water Company name ~f~ ~d ~ Distance to main ~ ~ 4. Lot size: Width_~_feet Length, ~ 7~ ~ feet (Enter on center plot below) 10. Sewage Disposa~ystem: A. ~00/gallon septic tank: Precast ~ Equivalent Block B. ~ching pools: Number / Precast~OBlock Special If private well fill in blanks below: Tank capacity Gals. Pump G.~.__ _ Street Amount of water in well Test Hole be in accordance with ards thereto." Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned ERTIFIES: "Construction of authorized installations will the Suffolk County Department of Health's current stand- Date //-7-~ Signed .Z"/~/~ B~u~de'/~/r~z"~ 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 can be installed on this plot. Date /~/~/~ Signed(__ __ S-15 Revised 4/]/72 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ &¥1 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..,e Se~te1~;er Z~,~?~ ~..,ic.t,o.N..o.~,,~ ?73~ N 183370 THIS CERTIFIE~ THAT krthur' WllksEn/sYennecott Dr.,1500~e/oBoisseav Ave. ESoutholdRL.I. inthefollowinglocation; [] B~sement ~ IstFL ~ 2nd Fl. outside Section Block Lot was examined on ~ ~'~ t (}lTlb ~ 1~ ~. (~ ~ 1~? 1~ and found to be in compliance with the requirements of thls Board. 3;, ~9 ~o [ 3') DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS AMT K.W. OIL H.P. GAS H.P. A.~T. NO. A.W.G. . RANGES SPECIAL REC'PT SERVICE DISCONNECT NO. OF METER AMT. ~p ~PE EQUIP. 1 ~50 CL OTHER APPARATUS: COOKING DECKS OVENS DISH WASHERS J 1 7.~ R V I C NO OF CC. COt, ID, A.W.G. NO, OF HI-LEG A.W.O. PER ~' OF CC. COND. OF HI-LEG 1 2/O EXHAUST FANS H P DIMMERS A~T. WATTS NO. OF NEUTRALS OF NEUTRAL 1 2/0 ~Fu~naees: 2-1/Shp E ~-l/~hp Hallock N. Young Reeves Park glverhead,L. I. 11901 11 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. i L o ? .! ' I ,5c,~z. 6.- 5'4" - _r i I I _ ? b ::d]" . I t r 1 ...... 154 ...... c 2.4. ~- _~0 UIK~_~ TZOI~ $6 ~ rH ,OZ D ~ ~r, K. tKb/~4Y'~*p, z~PB~ /~$ ~t~IN' i! I' 7 '[ 2 × 20 , ~"o.¢,