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Home My WebLink About6503-zFOB,M NO. 4 TOWN OF SOUTHOLD BUII,rHN(; DEPARTMI~.NT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy No. Z~ ...... Date .............April....1.1~..., 19.?~. THIS CERTIFIES that the building located at . .F~a~e .Bird ............... Street Map No.. ~ ....... Block No... m .... Lot No..xxx .... .~reenport. · I~,¥, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........Al>rll. ~'3 -, 19. -7.~ pursuant to which Building Permit No. dated .........Aprl.~- .. ~-~ -.., 19 '7-3., 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 .. J~rivate. one. family. ~twellJ.lng ..................................... The certificate is issued to. Pluz, ray. Jaeobs ...... g~rner ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval J,l~ll.. a.. 1.~7~.. by. R~..Vii.la... UNDERWRITERS CERTIFICATE No.. Ii$9670.~ .... Dee. 2.. · 1 !)71~ ................ HOUSE NUMBER ... 1.180 ...... Street ...Sage .l~lVct ............................ ......... -- Building Inspector( l~OR1~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT N°. 6503 CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z Date ....................... .~. ]~.~.~ ........... .~.~. ...... , 19...2~ Permission is hereby granted to: .:..~..o.~..~.a..t..~..,.~.,.. ........................................... ........... .$.~.~....~..a.~.~..~.~.... .......................... ............. ~J..-.eo~ ................................................ ~o ~ ..%.:.z..a....~.?.~...?.~.~ ..~-~..t..z.z...a.~.e...z.~ ..................................................................................... at premises located at ....{~/**~.....~.ge..~,~,~*~ ......... J~31~,~..P,~ ..... '. ..................... ~ .............................. ............................................ .qr.~.p.~.~.~ ....... .~..,.~., ..... , ........................................................................ pursuant to application dated .......................~l)/~.~l....:...~.,.~ ........ , 19..~., and approved by the Building Inspector. _ Fee $~l~.'~.~;J~ ............ THE NEW YORK BOARD Of FIRE UNDERWRITERS [DC BUREAU OF ELECTRICITY I 85 JOHN STREET, NEW YORK. NEW YORK 10038 ~,~Dece~ber 2, 1974 Ap~,nca,o,~No.o,.m~ 735251 N 196703 THIS CERTIFIES THAT only the el~t~al equlp~ent ~ ~sc~b~ belo~ and ~ntr~uc~ by t~ appHca~ ~med on t~ able appllcatio~ ~u~ber i~ t~ premiss of Mr. Mu~ Jacobs, Sage Blvd., s/o Old Co~ ~d., ~oute 25, Soul, old, L.I. inthefollowmgl~atlon; ~ ~.~ ~ ~tn. ~ ~.d n. outside s~t~o. w~examlnedonNovember 25, 1974 and found to be in compliance with the requlrernents of thls ~oard. RANGES COOKING DECKS OVENS ~O~SH WASHERS fiXTURE FIXTURES ~T '[ W ~ ~ W ~z [w , ~T ~ w ~ EXHAUST~z ~ HFANSp OUTLETS v~ SpEoAL REC'PT~ TIME CL~KS BELL UNIT HEATERS ~ULTI~UTLET DIMMERS ~TURE A~HANCE FEEDERS DRYERS MOTORS OAS ~ H P . ~T ~P ~ ~T ~PS TRA . ~T H P NO OF FEET SERVICE DISCONNECT >. OF I S R V I C E 1~2W l~3W 3~ 3~4W ~ ~C~O AWO HIEG ' x 4/0 1 ~a~er Hea~or/s: 1-4.5~ Elec, Room Hea~er/s: 3-1.5~ 2-1.0~ 160 Norther_n B_lvd.. This cedificate must not be alter~ in any manner~ return to the office of the Board if incorrect. Inspectors may b~ed by t~denhals, ]IFOP,.M NO. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 AFFLIGATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewr.ter 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 comphonce 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-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 inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: ]. 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 / ,~, Date ........ ~..~-.. :~,. ~.~ ....... ~ .... New Building ...P:. ......... Addition ................ Old or, Pre-existing Building ................ Vacant Land .............. Property . . /, [, j~.~. ~.,. ~ ~ ~. , ,~.L~.. .~ . ./. ~? . .?, . ,~.~. . ,~. ,~ , ,~, . .~. . , , . .O~. .~ .~. . , . ,:- l/ /~ J, ,, /. ~ ........................................ Location Of Owner Or Owners Of Property ...,!~./.x-~....'./:Z...~..:~.....U.~.C(.~...~:.,,~ ............................................................. Subdivision ...................................................... :......Lot No ............. Block No ............. House No.../'.~..".~,. Permit No .~....~......~....Zz.. Date Of Permit .~,'__ .Applicant Health Dept. Approval .............. .~.': ......................... Labor Dept. Approval ,"~'/' /..~. ............................ ............... ~,....,¢~.t:.~t.~.~'~.(,.,...M,. Planning Board Approval .... :'~...'.../..~....~. .................... Underwriters Approval :~>'/I1,? 'L) '-' - ~ ~. · Request For Temporary Certificate ....... ~ ....................... FinaJ Certificate ......................................... Fee Submitted $ ..~..~ 6,0 Construction on above descnbed budd,ng end permit meets all~.apphcable code~ and regulahons. (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. ~PLZCAT~ON FOR APPROVA,. TO CONSTRUCT A P~VA~ ~WA~ ~SPOSAL 1~. Applicant.~m/f°~$eV C~( P.h, one~-~CgJ Subdiv. Adar~ss~,~g~'~ ~v~ '~,'~ ~.~ f/~/ 6~ Section 2. Property 1Qcatio~ ~. f~f ~',~g~D~U~7' Lot No. /~ ~/f'. MOC,~< ~,~ ' ' 8. Private well ~ Village ~ Township ~ p~A~/~ 9 Public water ~' 3. Public Water Company name ~g~~k~C~ ~ Distance to main ~' 4. Lot size: Width feet L~th feet (Enter on center plot below) 10. Sewage Disposa~System: A. ~00~gallon septic tank: Precast ~Equivalent Block B. ~ching pools: Number ~recast~Block Special If private well fil in blanks below: Tank capacity~ _ Gal Pump G.P.M-. "' Total well depth Amount of water in well Test Hole Data I Feeto 10 12 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date ~/~/- ~3 Signed, .,¥. ~ O~ner o r"~fi f~i der FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith/ it is the opinion of the ~ealth Department, that an adequate and satisfactory Sew~ Disposal System can be installed on this plot. ,JOHN ~ T~ NE ~ E Examined ..~.....~.......~.. ......... Approved ~ ~ ~ I OWN OF $OUTHOLD:~. B I U LOING DEPARTMEN~ · ow. CLERK'S ~UTH~D, N. AI~PL~CATION FOR BUILDING PERMIT I NS~i'RJLICTJON~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. ~--~ d. Upon approval of this application, the Bui dng nspector w ssue a Bu Iding Permit to the applicant. Such permit shal be kept~ · the premises availbble for inspection throughout the work. e. No building ~hall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS H£RF:B¥ MADF to the Building Department for the issuance of a Building Permit pursuant to the Building Zo Ordinance of the ToWn of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or B~.~luletions, for th~ cunstruction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable law~, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildinff* f~r necessary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ .......................... .................................................................................· Name of owner of premises .-'~.Q.J~zI. 0Z~.~..t~...~...~ ~..~ = ........................ ~ ............................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........ ,~ ....... Lot No ........ ...~,'.. ................................. Street and Number ...... ~f~B~L~~[~-?-F~~~t(~~q~~ ............ ~ ( { oc~ ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~.../~..(~ ..~..A,/~ ............... ntended use and occu anc b. p y ........ .y. ..... ~ ...... /. .............. ,...; ............................... ~"~ .......................... ~. =~J~'ure of work (check which applicable): New Butld,ng ......... ~ .......... Add t on ..................... Alteration ............... · ~, Repair ......................... Removal ......................... DemOlition ..................... ;.. Other Work ............... ; .................... (Description) 0 14. Estimated Cost .......... 0.~:..~1~. ............. Fee .............................................................................. :-=~1, (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 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 ................... i ...... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ Height ............... t.~. ...... ~ ................ NUmber of Stories ...... ..,.~ ........................................... , ................... 10. Date of Purchase ....~/.?..~..., ................. Name of Former Owner ................ , .......................................................... · 11. Zone or usa district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ........... ~..~.. .......... , ...... Will excess fill be removed from premises: [ ] Yes No ! (Phone No.) (Address) Name of Architect ................................. (Address) (Phone No.) Name of Contractor ................................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM ~/~ Locate clearly and distinctly all buildings, whether existing or proposed, an~i~dicate all set-back dimensions from property lines. Give street and block number or descriptioG, according to deed, an~aVshow street names and indicate wheth- er. interior orcorner lot. ~//~.plu~' ~_~o~p~'~ t~// ~ , - .....~" '~ r'~ -- ~q..~.....~........~..........~w~.....~..~..~..~...~...~...~=. ............................... being duly sworn, deposes and says that he is the applicant above named. (Name o£ individual Signing contract) He is the ..................... .~..~..~.0,._~.. ................................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to ~rform or have I~rformed the said work and to make and file this application; that ell statements contained in this application are true to tbe best of his knowledge and belief; and that the work will be berformed in the manner set forth in the application filed therewith. TERRI LEE EL~K .n o~:~ ~ ' II~ PUBLIC, State of ......... ~,~...Q ................... day of .....~..a,,.azLca.,r~z~9 ...L~ .... ^ ' ~ N._ ~slifi~d in Sudolk County Notary Public, ~.~.~...~_~.~...~.... CounW ......... ~.z.~......~..~.....~a..~.a....= ..................................... _ ~ (~ of~pli~t}