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Home My WebLink About6994-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at .220 .Gle~ R~,.. .......... Street Map No .... 51~/48 .... Block No .......... Lot No ........ /~ ......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated . .Np.ye.m..b.e?....2.~ .... , 19 .7.~. pursuant to which Building Permit No... dated ....No.v..eLn..b.eE...2.~ ...... , 19..7.3, was issued, and confo~-ms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...... P~i.vate. One. Family. Dw. elttng ............................... The certificate is issued to ...~ind,~ Way. ~ilding. ~orrp .......................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ....... 7.-. S.0.-.~.'~9 .............. UNDERWRITERS CERTIFICATE No ......... .N.~.9..9.5.~ ........................... HOUSE NUMBER ...2.2.0 ..... Street ....... .2.2..0..G.% .e.~...R. qa..cl ................... ............................................. ~ou~hoiLdo. ~Te~. :Eork ............. ~ .) / .... ..~. ~,-/.~-,. -.// /~.,<~-~ ..... Building Inspector FOR,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTH~I..D, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 699~ Z Permission is hereby granted to: ............. ,~. ~:,.~.,~~.. ~,.~ ........... ........... :.~l~...~___=~j~ ....... lf..~.......~.?So ......... to ....~l~..aw.:,~..t.~. ~..d,~.~,~,,~ ............................................................ '. ................... at-premises located at .~...}~. ......... ]J~l~t,.~eJ,-]Jlt~ljj.t~i ....................................................... .~ ......... ......*::: ................................. ~..Jt~ ............. mmt~e~....~.,,z~ ................................... pursuant to application dated .......................~*O~-.-.-~J ................. 19..~1~,., and approved by the Building Inspector. ~/J/J~cc~ -.- ........... : ....... FOEM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This opplicahon must be filled ~n 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 location of all buildings, property hnes, streets, aha 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. Commercml buildings, Industrial buildings, Mulhple ResMences and similar buildings and installations, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable B For existing buildings (prior to April 1957), Non-conform~ng uses, or buddings and "pre-exishng" 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 cond,hon 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 dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00 ~ Date .......... ?/J~-..~.~.. ........... New Building ....... -- ..~/-.¢~-..~...__,~ ~(~ ~ ~.~ Addition ~._~ .......~M or Pre-existing Budding ................ Vacant Land .............. Location Of Prope~y ..... ~.~ ................................................. ~ ......... ~ ................ = ............................. Owner Or ~ners Of Prope~y ...... ~.<'~....~....~(.~(~ ..... ~?.~..: .................................... Subdiv,sion .~..~~..~Z~ot No ..... ~... Block No ............. House No ............ Perm,t No ..~.~.~Date Of Perm,t .................... Applicant Health ~p,. Approval .~f~/l~..:.Z.~.:/~abor ~p,. Approval ............................................... ~1 ~/~--~ . ~ Underwriters Approval ..~:Z_~....(..X ........ Planning Board Approval ....................................... Request For Temporary Certificate ...................................... Final Certificate .......................................... Fee Submitted $ ................. .--~-~ ~.~~~ ,1~~~/~ u~l~tti~ Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY ~ BB JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE;IFIES THAT o~y t~ e~tdc~ ~ui~n~ ~c~ be~ ~ i~b~ t~ apMl~t ~ o~ t~a~ ~pli~t~n numar in t~ p~m~es of in the foliowlng location; ~ Basement ~ 1st FI. [] 2nd FI. Section Block Lot was examined on A ~L[~ t 21 ~l 1 9 7 ~J and found to be in compliance with the requirements of this Board. FIXTURE ; FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUO4~ESCENT DRYERS 1 Smoke Deteotor !,~otor/s:l-1/2hD ?anelboard/~:l-Selr.-125amp E R C, A' W. G, NO. OF NO' O~aE COND' OF CC. COND. I/0 ¢ A. W.G. NO. OF NEUTRALS OF HI-LEG OF NEUTRAL ~loodale }i, leotrlo ?~at tltuok, [..I. GERIERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant Address I , ~ 2. Property location Village. ~ownship 3. Public Water Company name 4. Lot size: Width .... ~ feet 10. Sewage Disposal System: A. B. Phone Length 5. Subdiv. 6. Section' 7. Lot No. 8. Private w$11 9. Public water Distance to main feet (Enter on center pl~t below) 900 gallon septic tank: Precast.~z Equivalent Block Leaching pools: Number ' Precast Block Special Street If private well in blanks below: Tank capacityw,jGa] Pump G.P.M. Total well depth Depth to G.W.~,. Amount of water in well= Test Hole I i6 The undersigned :ERTIFIES: "Cons ruction of authorized installations wil be in accordance with the Suffolk County Department of Health's current stand- ards thereto." ~} ~ ·.~,.~-, j Date ,/~ ./ ,$ Signed Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented h~ewith, ~ is the opinion of the Health Department, that an adequate and satisfactory Se~ Disposal System can be installed on this plot. Date/./~'/~'"'"> .'~ Signed S-15 Revised 4/3/72 ., ~le ~evage disposal and water s~pl¥ fae~llttes for this location have beec inspected by this department and found / '7_ -~ /~ ~ ~' / ",.5' TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE c(~-~';'/'f'~'''L'''r~z~ $OUTHOLD, No Y. ...................... ............. ........................ _ / / ~~ ~'~ APPLICATION FOR BUILDING FERMIT x/ J ~ _ , , - Mate ................................ a. This applica~an mus~ be completely fill~ in by ~pewriter ~/in ink and submit~ed:n ~p~To Insp~or, with 3 se~ of plans, accuraie plot plan to ~ale. Fee according ~o scb~ule. b. Plot plan showing I~afion of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and gwing a detaded description of layout ofprope~ must be drawn on the diagram which Js c. ~e work c~ered by this application may not be comme~ed be~ore issuance o~ Building ~ermit, d. Upon appr~a[ of this application, the Building Inspector wdl issue a Building Permit ia the opplJcant. Such peru shall be kept on the premises available for insp~tlon throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever untii a Ce~ificate of ~cupon shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to thc Building Deportment for the issuance of o Building Permit pursuant to I Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or aJterations, or for removal or demolition, as herein describe The applicant agrees to comply with alt applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections, ,~ (Signature of applicant, or name, [fa corporaJion) (Address of applicant) State whether applicant is owner, lessee, agent, qrchitect, engi~-eer, general contractor, electrician, plumber or build .............................................~'~'~ 0: .......................................... Name of owner of premises .................... I~ appl~t is a co~orate, signature of duly authorized officer. (Name and title of co~orate officer) Builder's License No ...... T.."'r~ ........ ¥ ................. : ........... Plumber's License No. Electrician's License No ............................................. Other Trade s Ltcense No ................................................. ]. Locahon of lend on wh~rp~sed work w I.be don~ap~o.: ~....; .............................. Lot No., .................... Street and Number ................................................................................................... i .......................................... Municipali~ 2. Sta~e existing use and occupancy of premises and intended use and occupancy of proposed const~ction: o. Exisiting use and occupancy ...................... ~:: .................................................................................................. b. Intended use and occupancy ............................................................... t ........................................................... 3. Nature of work (check which applicable): New Bu~ld~r~, · 4' ~ .... .. ~ ........... Addition .................. Alteration Repair .................. Removal .................. Demolition .................... Other Work ................................................. ~'~ g- ~, :~0, ~ ~ ~ ~ ? 0 (Description) 4. Estimated Cost ............................................................ rea ........................................................................................ (to be paid on filing this application) ~J ~ 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, spec~ nature and extent of each ~e of use ..J~.'JL~..~ ............... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth Height ....................... Numar of Stori~ .............................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ...................... ....................... ~umber of Stories ................................ Depth ................................ Height ~) 8. Dimensions o~entire n~ construction: Front ....................................Rear ............................ D~th ..;Z..~._ ........ ~ 0~ Height .................... Numberer Stories ................................................. ~ ..................................... ~.~ :..,~. ............... 9. Size of lot' Fro t ........................................................ Rea, .................. ........ Depth ...~j 10. Date of Purchase ........................................................ Name of Former ~ner .................................................... 11. Zone or use district in which premises are situated .................................................................................................. 12. Does propos~ consltuchon violate any zoning law, ordinance or regulation: .............................................. : ...... 13. Will lot be regrad~ ......... ~c~ .............. WLII excess fill be rem~ed from premises: ( ) Yes - ( ) 14. Name of Owner of premises ..................... J ............. .,Z ........ f.Z,. Addre~ ................................ Phon~ No, Name of Architect .... ~ .... . .................... ~n ............... ~ .......... Address ................................ ~hone No Name of contractor .................: ......... ~ ................ J....~.[~ .... Address ................................ P~one No. PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate al~ sef-~ck dimensions prope~ li~es. Give street and block number or description according to d~d, and show s~reet names and ind~ca whether interior or comer lot. STATE OF NB/V~YOI~F-~ . · tS S COUNTY~;~..~__ (Name of individual signing contraciO above named. FJe is the ............................................................................................................................................................................ (~ie~.~-, agent, r~-.~ ..... ~.";:.z.,-~'..: ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application ore true to the best of his knowledge and belief, thor the work will be performed in the manner set forth in the application filed therewith. ro before me this i~o. s2.284t400, sutfolk C~nty ~brnmissiaet Exl~ms March 30, ].9 ~ I ELEVAT 1 0 N APFROVED AS ~O~D FKONT NNA¥ EUILI)IN(~ ELC /ATiON cokp. '¸4 t PLAN PLUM D I/I C, R,,.A M ~ ¥ I 0 '0 ¢ L o$ Y H Y J Cl::LO' 5: &Ec.,TION" KNEE NSi,0No