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Home My WebLink About6995-zFOB~ NO, ~ TOWN OF SOUTHOLD BU~I)ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. 'Z7533 ..... Date ........... Feb .... 23 ....... , 19. '77 THIS CERTIFIES that the building located at .Glenn .Rd. & .BaF~.iew. Rd.. Street Map No~iezl; · Ck..E st Block No ........... Lot No.. '1:' · · ~outhold .... N ~Y... ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated .............. Nov.. 2J 19. ?3. pursuant to which Building Permit No..699~. dated ........... Nov · .2t .... , 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 . Private .one. 'famit~r 'dwelling- · '(1 sT 'Fllor) ....................... The certificate is issued to .. Wind sway .Bui. ld ing '¢orp ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ·. Feb · · 23. -. 19'?7 · ' bF .R o. V.~-lla. with not~ ~ ~to be used for of Baby formula OR ,preperation · eon's~tlb~ 'by' 'fnf~t~ · %%h'4~' 5 '~bh't~i 'of age. ~~CERTIFICATE N~ N206798 Jan 30 197~ E r~u~rr5~: ............. 5zree~ .......................................... 301% Bayview Road & 80 Glenn Road Southold FOE~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FUL~L COMPLETION OF THE WORK AUTHORIZED) 6995 Z Permission is hereby granted to: llt~ s...~.. Build~!-~..Ooz,~ ....................... P.,,iI,l~aac.338 ..................................................... ~t..~.~..l~o~, ..... tl.~ ......................... to .................................................................................. at premises located at ..... ~l~-t~..~ ..... ~!.~..~b"~et~. ~.~:1~1~ ........ f ....................................... - ......... ......................................... ~t.~v..l~o~d..&..Gl~uu..~ ............ 8mz.t, ho~....l~,i,, ............ pursuant to application dated ..................... ~ ........ 12t ............. , 19..~., and approved by the Building Inspector. ', FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, lq. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector w~th the following, for new buddings or new use' 1. Final survey of property with accurate location of all buddings, property hnes, streets, aaa unusual natural or topographic features. 2. F~nal approval of Health Dept of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters 4 Commercial buddings, Industnal bu~Idmgs, Multiple Residences and s~m~lar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible far the budding. 5. Submit Planning Board approval of completed s~te plan requirements where applicable B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~sting" land uses: 1. 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 inspect:on of buddings or premises, or other pertinent Jrt- 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 / ....... ........... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... ~.~ ....... ....... ............................................................ Owner Or Owners Of Property ................................................. ;~,~ ................................................................. Subdivision ~.~.~..~....~..J....T.../~r.~.~....~./~....~...-f/.~....'~.....Lot No. ~.:./.. ..... Block No ............. House No ............ Permit No..~..~...~.~......~.. Date Of Permit ..~.'~.......~..~..Applicant ..~./..~..~...~[../..~//~...~.IJ,./.Z(~......~'..~.: ..... Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....................................... Fee Submitted $ .................................... /~'c2~'/~~'/'"//2~? /"'~'-/? ~ ~2~ Construction on above described budding and p~rm~z~meets all applicable co.¢les and reg~ation¢. ...... ..... ........... Sworn to before me this Notary Public .........~.~..f ........... County H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant Address 2. Property location Village _ Township 3. Public Water Company name 4. Lot size: Width feet"~Length 10. Sewage Disposal Sy~%em: A. B. Phone 5. Subdiv. 6. Section 7. Lot No. 8. Private w'~l 9. Public water Distance to main feet (Enter on center ploi below) 900 gallon septic tank: Precast_~fiEquivalent Block Leaching pools: Number .~ PrecePt Block Special__ ? '~'~ Street If private well fi in blanks below: Tank capacity~ Ga Pump G.P.M. Total well depth Depth to G.W. Amount of water in well Test Hole Data I Feet I 0 · -rlT -'""""~ i0 The undersigned CERTIFIES: "Construction of authorized installations wi] be in accordance with the Suffolk County Department of Health's current stand ards thereto." Date / ~"I' Signed ~ / ~ ~ Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, 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/]/72 f! THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY j 85 JOHN STREET, NEW YORK, NEW YORK 1OO;38 z~,. Janue~% 30,%975 App~ic,,,io.n~o.o..~ 767222 N 206798 THIS CE~IFIES THAT,, ~ly t~ e~ ~.ip~ ~ ~cH~ ~ ~ in~ by t~ a~l~t ~ on ~he ~ ~pli~a[~. ~er in t~ premises of ~in~ ~ay Bld$, ~rp, Gle~ Rd. of~ ~ ~yvzew~ ~uC~o~a~ ~.~, i~thefollowing~ot~; ~ Bmemant ~ l*tFl. ~ ind FL ~s~d~ ~tio, Bilk ~t ~ .~i~ o. Januazy 23 ~ 1975 ~o..~ to ~in compliance with the r~uirement, of th~ B~rd. fiXTURE / I I RXTURES RANGES OUTLETS IECEPTACLES SWITCHES tp.,CANDESCEi,iTiFtOO~E~rr ~,~Y A,~T KW 15 ! 221 13/ l.St I DRYERS FURNACE MOTORS RJIURE APPIJANCS FEEDERS SPECIALREC'PT $ SGRW~ mSCO. NECf I.o o; 1 e ~ OTHER ~AEATU~ TIMECLOCKS ~:,l tUNITHEATERS MULTI'OUTLET B.-- SYSTEMS AMT ./~ TRANS..~T H P NO. OF FEET V ! C E Notore: 1-1/~hp I AWG NO O~ HI-LEG OF HI IrG EXHAUST FANS AY, T H P DIMMERS WA'r~$ -- OF NEU LS O/:ANEUTRAL iL. A. goodale ]~,R, 7,, 3Sox 15A l~tn ~acc~.cuck,~,Z,11952 Ptr D ///// , This certificate must not be altered in any manner; return to the office of the Board ~ incorrect. Inspectors may be identified by their cr~S. THE NEW YORK BOARD OF FIRE. UNDERWRITERS , , BUREAU OF ELECTRICITY i: ~"~ * 85 JOHN STREET, NEW YORK, NEW YORK 10038 .... 168721 THIS CE~IFIES THAT ~Jy the el~t~ ~uipment ~ ~sc~ bo~ ~ int~u~ by t~ appli~t ~m~ on the ab~ appli~t~n numar in t~ p~mises of in ~hefollowlng l~ation; ~ B~e~nt ~ 1st FL ~ 2nd Fl. ~ ~ ~ ~ Section Bilk ~oxami~on ~ ~7~ ~ andfou~tobeincomplia~ewiththerequiromentsofthlsB~rd. SERVICE DISCONNECT r NO. Of I S METER OTHER APPARATUS: RANGES R ICOOKING DECKS t OVENS DISH WASHERS A~, K.w. I *.,~T. ~.w. I ~r. K.w. TIMECLOCKE BELLIUNITHEATERSUNITHEATERS MULTI-OUTLET I I V IC OF CC. COND. NO. OF HI-LEG OF HI-LEG EXHAUST FANS AMT. H.P. DIMMERS AMT, WATTS NO. OFNEUTRALS A,W,G. OF NEUTRAL ~obert ^. Goodale, RR dj., Box .... A, ~sin Road, :~.ttituck, L.~. 11052 m ~N~ 11 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. If applicant is a coa0orate, sig6ature of cJuly at/thorized officer. Bui d~r'~ li¢~se No ..................................................... Plumber's License No ........... / ~r~ ~, .No ~ildi~ ~1~ ~pi~ or ~ in ~le or in ~ ~r any pu~e ~atever until a Ce~ifica~ of ~c~mY~ ~ ~LI~TI~ ~S H~E~Y.~DE to t~ Buildi~ ~mnt for ~e i~e of a Bui~i~ Pe~it p~nt to ~ State whe~er a~licant is ~r, le~, ~ont, amhit~t, engineer, genera[ c~tractor, el~trician, plu~r or builder. 2. Location of land on whiCh prapeeed work will be done. Map · · . t No ..... ,/. .................. Street and Number .~/~..C9..~..~.~.}~iltb/. .~r~.l~V~l~ ~ .~..:LIC'/~I ,L~.....: ,.~..~....~..l~.~.O Municipality State existing use and occupancy of premises and intended me and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ occu o)J t~ e~vl/I b. ,n,,,~ ~,, ond pa~ ............. ~:...~....~ ................... ....~ .............................................................. ~hroperty lines. Give street and block number ether interior'or corner lot. 3. Nature of work (check which applicable): New Building ...~...~... ....... Addition .................. Alteration ............. .~ Repair .................. Removal .................. Demolition .................... Other Work ................................................ ' .... (Description) 4. Estimated Cost .....~.~..~..~...o...?...,....~... ....................... Fee (to be paid on filing this application) 5. If dwelling, nur~ber of dwelling units ........ ..O...~.....1~.. ........ Number of dwelling, units on each floor ............................ If garage, number of cars ......... ..~..~...~. ........................................................................................................................ 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 ........~../. ....................... Rear ............................ Depth ...~...~.. ............. Height ....~...~.!.~... Number of Stories ............./..!~.~m ............................................................................................. 9. Size of lot: Front ........... !....'~.,~..~.~..~.. ......................... Rear ........ ~.~..~. ......................... Depth .....t..~....~.,r. ................ 10.'- Date of Purchase ................ ~ ................................. Name of Former Owner .......... ~-. ............................................. 11. Zone or use district in which premises a're situated .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .................................................... 13. Will lot be regroded ............................ Will excess fill be removed from premises: ( ) Yes ( ~'~o premises .M.:.,'./hlX3~.~...t~....~..t~l.~.~,:.~...._:~?~J A, ~ Address ........ ~,,,..~3~.. Phone No.....~......~...~. ........ 14. Name of Owner of Nameof Architect ~ Address ................................ Phone No ....................... .....~../.~..D/..../~'...j~ ......... . .. Address Phone No. Name of Contractor PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from or description according to deed, and show street names and indicate STATE OF NEW~.ORi~,.~ ..~ · ~ c c?' - ......... ~~--~.~_. ............... ,.,..b~ng ~ ~ro, d~o~. ~nd mW t~t ho i~ th~ above name. He is the ................................................................................................................................................................................. ~r, agar, ~.) of said ~ner or owners, and Js duly authorized to ~rform or ha~e performed the said work and to ~ke and file this application; that all statements contai~ ~-~s ap~icat~ me t~ ~ the best of his knowledge and belief; and that th~ W6~E ~ill ~ performed in the manner ~t fo~h in,the a~lication fil~ therewith. Swam to ~m me this Nota~ Public, . ................... R~ M. ~Y~ ~ ~, ~ d N~ York Ilo. ~-2~414g0, ~ County ~llMlelm Exam Mim~ ~0, 19 ~d Water not to be used for preparation of baby formula or consumption by infTts under 6 mos. of age. / Chief of General Engine/ring Servleel / i.O~ ql.t. ,S o,,e',c.'oz. K COUN ~ z,v:. y. C ~ U~'OL K COUNTy,/~. ~. NOV. .t ELE¥ AT ~ i'~ £ ELLAg,. ~o h F PLAk PLAN