The URL can be used to link to this page

Home My WebLink About6534-z~ORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, IN. Y. Certificate Of Occupancy No. ~'f~3~ ...... Date ........... Mar.. g ........ , 197.~.. THIS CERTIFIES that the building located at .. l~assau. PoAnt. RoaSt ..... Street Map No.l~ass..Pt .... Block No .......... Lot No, .gCt ... Cntcho.gue.. i~,Y, ......... conforras substantially to the Application for Building Permit heretofore filed in this office dated ........... }:a~r .... 1., 19.7~. pursuant to which Building Permit No..6~3.~. dated .... ¥~y...~ ...... , 19.73., was issued, and conforms to all of the req~ire- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Px'.~.vate. one..famil}~ .dwelling ..................................... The certificate is issued to Angel(; .&. ~ielen..gorh~leta ..... Owners ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~eVt...~0..1.97.~...by. ~....villa ..... UNDERWRITERS CERTIFICATE No..1~..1 (~35~ ~ ..... 4l~e. ?..%97.~ ................ HOUSE NUMBER .~77N .... Street .. N&ssau~ P. oir~t .Road ................... ....... ...... FO]~M NO. 2 TOWN OF $OUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK,AUTHORIZED) N? 6534 z Date ............................... J'~l.~ ....... .'J. ......... ] 9..?.~, Permission is hereby granted to: ...~h%.~..~.~..~.~131~.!.~.~f..A/.C..Angeto..~or. beletta ......... 32..C~.tl~...P. at~ .................................. ......... ~.....l,l~:F~po~ ....... ~T...Y... ........................ to ..... ~l.~..D,~If...OD.~..£am't ~ y,..dwalltl:~ ............................................................................... at premises located at .... ~,J~Q ...... -Ne~Ss~tt-.-Po -'I~t:--'~o~ ......................................................... ........................... .~ZB..~;_-.sa~. ~o_~-~t..Roact, ............... ¢~tehegue.-...~-~-, ............................. pursuant to application dated ..........................~,~ ......... .] .......... , 19..r/.3., and approved by the Building Inspector. Fee $(~i~ ~.~ ............ FO]I~ NO. 6 TOWN OF $OUTHOI.D Building Department Town Clerks Office Southold, N. Y. 11971 APPl.ICATION FOR CERTIFICATE OF OCCUPANCY Instructions A Thru apphcation 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, aha unusual natural or topographic features 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-0 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buddings and installations, a certificate of Code comphance fram the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B For existing buddings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" 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 condihon of buildings 3. Date of any housing code or safety inspecbon of buddings 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 dwelling or land use $5.00 3 Copy of certificate of occupancy $1.00 ... .................. New Building ..... I..~... ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .......... .,C.I.. .................................................................................................... 4-. .......... Owner Or Owners Of Property ..... .......................................... Subdivision ....~/...A.~..~....u'.../.~.f..~./-. .............................. Lot No .....~...~)... Block No ............ House No...'~.-..~..Z~- .......... l~' ~ Permit No /* ~':~...~.... Date Of Permit .... ~.r/.7...~ ..... Applicant ..........,..~......~.~..8...z..'~.~5. Z'..~.~.. ................... Health Dept. Approval ....~'z...~/.z./.....,x.k...~:~.'.~...Labor Dept. Approval ................................................ Underwriters Approval ,.a...4.~.~..~..~, ..................... Plann.ng Board Approval Request For Temporary Certificate ........................................ Final Certificate .~ .............................. Fee Submitted $ ~'~'~ Apphcant .......................... ~.-~' L4-;r:TX ~" '..~ Sworn to before me this ..........-- ~. day of .~f~ ...... Notary Public .......... ~. I~OR~ NO. t TOWN OF $OUTHOLD BUILDING DEPARTMI~.NT Town Clerk'8 Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .l~..#$~.~...]~..S~..t....P,~... ...... Street ......... Lot No Map No.].&.l.S.,..P..~... Block No ................. 1~. ................ conforms substantially to the Application for Building Permit heretofore fried in this office dated ........... . .Na. lr...1 .... , 19.7.3. pursuant to which Building Permit No. 6~'~- · dated ......... ~ ..... 1 ...., 19.~3., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certi_'flcate is is.,ued ~,. ?..~.~.'.:~. ?...~.e...r..,~.. ~ .~..~. !~..u~.. ...................................... The certificate is issued to . .~..e.l.o...65..e.l.e.~...C.o..l~e...~.e.t..tl~ ....... . .l~..e..~.~ ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~pt.. ~0,..%97!+...by. It..¥~.. UNDERWRITERS CERTIFICATE No..~.~ .63~).~. ....... .J.u~..q. ~ .... ~. 9 .~... HOUSE NUMBER.. ~.?~ ....... Street ..... l~&ssiu. Po~t. It~ ................ · ' g n~ec~or { THE NEW YORK BOARD OF FIRE UNDERWRITERS 85 JOHN STREET, NEW YORK. NEW YORK 10038 N THIS CE~IFIESTHAT Cu~ehogue ~ L.I. '~;---- ~ I. / I I I I l 12° s~c~ mSCONN~r NO. ~ ~ S i ' 20 ~.~.. ~ ~--_ . x z ~/o z 2/0 John ~. Lademann, 1200 Harbor Lane, ICO(O(IHG DEOCS [ OVF. NS [ ~SH WAS~RS EXHAUST FANS DIMMERS FOI~M NO. 6 TO~VN OF SOUTHOLD Building Department 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 w~th the following, for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property hnes, streets, and unusual natural or topographic features. 2. Final 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 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 s~te plan requirements where applicable. B For ex~stmg 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: 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 ~ L Date ...... ........ .?.../ New Bu'ilding .....~..' ........ Addition ................ Old or Pre-existing Building ................ Vocont Land .............. Locat,on Of Property .... ..~.d.f.~...~..~ ..... .¢/.~..~ .......... ..~..~ ................ .~...~..~....C/..~..~...cz.~.~ ............................................. Owner Or Owners Of Property ....~..~...~....~.~.~.. ...... .,C-:.e.~#~.6.~..z..r.6 ...................................................... Subdivision ..... ~.~.u...../~.!//.r. .................................. Lot No ..... ~..o.... Block No ............. House No..~.7...7.6.~ Permit No ./...'~...~..~./.....~. .... Date Of Permit .... ~/.7..~ ........ Applicant ...... .~......~..£~..~.~.~.7'..z'..4.. ................................ Health Dept. Approval ............................................ Labor Dept. Approval ..................... ..~....~..!...~... ........... Underwriters Approval ............................ Planning Board Approval .............. .~.....!_.~'.. ............. Request For Temporary Certificote ........ ~.~..:~.x~ .............Final Certificote ......t.~. ................................... Fee Submitted $ .................................... ' ~icable codes and regulations. Construction on above described building end permijt~meet~s oil a Appl,cant~'~ ................ : ...... ~ ................................ Sworn to before me this //',~ I t Notary Public .................................... County (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address~Z 6~7~$ f~T~:£/~r t,]o£1,1Fver /Af. //73, 6. Section /~' 2. Property lo~ation..~b~ ~D ~$~ ~. 7. Lot No. .~ Village Township ~~ 9. Public water ~P 3. Public Water Compan~ name ~0~ Distance to main~z ~t~ff~ 4 Lot size: Width/~ feet Length~ feet (Enter on center plot below) 10. Sewage Dispos~ystem: A. ~00~gallon septic tank: Precast ~uivalent Block B. ~ching pools: Number ~.Precas~lock.. Special N Street If pri,vate well fi] in bl~ks below: Tank ~pacity~. Gal Pu p ept -to 30 Amou~ of ~ter in Test Hole Data , 6 8 18 Feet The undersigned CERTIFIES: "Construction of authorized installations wi be in accordance with the Suffolk County Department of Health's current stand ards thereto." ~ ' Owner or Bui~r , FOR HEALTH DEPARTMENT USE ONLY.~Based on the information presented herewith, ms the opinion of the ~eal-~epartment, that an adequate and satisfactory S Disposal System can be installed on this plot. S-15 Revised 4/~/72 SUFFOLK COUNTY HEALTH DEPARTMENT The sewage disposal and vzater~s~ppl¥ faeilitles for this tocat_on :~:~;e been inspected by this depac~cnt z~ud found Se~ee~ fret Lo¢ y ~O /PS.00' RIC~-IAI~D ~¢I-tLUMP'F 'P. E", 32 COR'n$ ?AT0~, F, NC~RTI..)YO[,:[T, ~,"t", li7~1 LOT NO, %0 - "~ASsAU Fo~NT ~v NASSAa POINT 'oWN OF ~ 5ouT~oLD 5UFFOL~ 60,~ N, Y, SEPT I0, 1~74 -Tot' EL 42,z t~$'~ 3, WaLL T~e ~'L ~1,o~ ............... .... /~ ~ ~ x~ ~r~ 1~ ~. Pemit No. ~.~...~.~..,~~ ~q ~ ~ ~ ~ APPLICATION FOR BUILDING PERMIT 3 ~ of plans, a~urate, plot .plan to scale. Fee a~rdin., g to schedule. ~,~-~b '~ ~ b. Pict plan showing I~at~on of lot and of build~n~ on premises, relationship to adjoining premises or public st~ or areas, giving a detailed description of layout of pro~rty must ~ drawn on diagram which is part of this appian(ion. c. T~ wo~ ~md by this appli~tion may not ~ ~mmen~d ~fore issuan~ of Building Permit. d. U~n a~roval of this application, the Building Ins~ctor will issue a Building Permit to the appli~nt. Such ~rmit,shall ~ kept on the premiss available for ins~mion throughout the work. e. No building shall ~ o~upi~ or u~d in whole or in ~ for any pur~ whatever until a ~ifi~te of ~u~n~ shall ha~ ~n ~an~ by the Building Ins~mor. " APPL~ATION IS HEREBY MADE to the Building Depa~ment for the issuanm of a Building Pprmit pu~uant to t~ Buildi~ Zo Ordinanm of the To~ of ~uthold, Suffolk County, New York, and other appl~ble L~, Ordinanms 0r Regulations, for t~ ~nltrumion of buildi~, ~diti~s or alterations, or for removal or demolition, as heroin d~i~. T~ appli~nt agrees to comply with al~ appli~ble ordinanml, building co~, housing ~, and regu~tions, and to admit authoriz~ ins~om on ~emi~s and in buildin~ for ~a~ Ship,ions. If applicant is a corpora, signa~re of duly authori~ officer. ~ ~ u ~ W~-~ (Name and title of corporate officer) Builder's License No .......................................................... Plumber's ,L_icense No ......../~¢k~..~..~. ........................ E ectr cans L cense No......~.~ ,.c..~......~..~....?.?.Z..,~,.¥..~ ....... '~IX. HILL,-~ I/'7 '-lC Other Trade's License No .................................................... · /~ ~-- 1. Location of land on which proposed work will be done. Map No..~.~.......~/.~...~...~..~. ................. Lot No..~....~/.. ................ Stfee't and Number ....... ..~...~..W'..~... ....................................................................................................... ,.,~..~..../~,.. ........ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ ~..~.../~..~:.. .......................... ~ ............................................................................... Intended u~e and occupancy ...... /_~.~....~:.......~.. ~/~/~ .~........~. ~./..~. ~...~/~ .......................................................... b. / work (check which apphcable). New Bumld~ng ............... Addition ................... Alteration ............... · ~ ~ Other Work Repair ........... Removal ................... ~ ..... Demolition ............. ~ ...... · ~'~, (" ~-~'~ (~ ~O (Description) Estimated Cost .......................... ...,~,x.l~.r~,~. Fee ..[[..t.:......~.... .......................................................................... ·., ..~ _ ~ (to be paid on filing this application) If dwelling, number of dwelling u nits'~..,~[~..~.. Number of dwelling units on each flo~r .....~...~...,4~.~/..~..~... .... If garage, number of cars ....... ...~.. ................................................................................................................................-- If business, commercial or mixed occuoanc% specify nature and extent of'each type of use ~.~....41~/~.~/~.~...~...... 7. Dimensions of existing structures, if any: Front ~ ......... Rear ......~;.. ................... Depth ............... :. .................. Hmght ........................................................ Number of Stories ................................................................... .. .... . .. . Dimensions of same structure with alterations or additions: Front .................... '.'..... Rear ......................................... Depth ......... ; ......................... ~....~.... Height ....... ~.. ............. Number of Stories ..~... ................................. ,. · ' . ./ " £ ,, t 8 Dimensions of entire new construct.on: Front ....~..~,.,~ . Rear ...Z~...~.. -. Denth .~..~.~.~. ......... · .~.1.,. r~, ' ........ x//.. .. · ......... ~'; '~ - '[' ........ Height .............. ~.d.5~/. ....................... Number of Stories ....Z~'.~.......~J~..~d~ ....... ~..Z.,~.~'.~..;~....~-w~'..J ............. 9. S,ze of lot. Front ......... .~...C~...~... ........... Rear ....... ~.~.-.~..~. ...................... Depth .....~..~..~....~' .~..~.~. 10. Date of Purch .............. ~,, ........... Name of Former Owner ..~..:....: ......... ~.('.....[~. ......... [,~.., ........................ 1 1. Zone or use district in which premises~are situated ....... ~.~....<~.~..~ ........................................................ constructed_ ? vi~lateJ_ny_.zoning law, ordinance or regulation: ....... ~.. .......... ~, .................................. 12. Does proposed ~3. Will lot be receded _~-~~..~..L' ..... Will excasa fill be removed from, premises: F,R~es [ ] No , 14. Name of ~wner of prem'?s, ...... ,;.,~f,~.~ ,~ ........ ~.~-~....~'~........~...~..~(~,.~,....~..,,~)~..~/~/~.~.~...~~// ~_,',. ,~ ~ (:~d m~/.x/ .~* .,,. ~Js6..ne_ ' ( dm ) -- No ) Name of Architect ..... ~NZ~...ZZ..:~../?.......~..~....(,~r.~.~..~....,~d~,..~.,...~..~£g'~.~...Z~ ..~..~;~.~ (Address) ~' (Phone No.) Name of Contractor .............................................................................. ' ........................................... (Address) (Phone No.) Locate clearly and distinctly ell 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 wheth- er interior or corner lot. STATE OF NEW YORK. ~ ) COUNTY OF ................... ~. ~.. ,~, .~A~-. ~ ......... ) · "~.~. '~'..~.....%~-.~-..~ .~'.~ ..~.~.~.~.~.~.~.~.~......~. k .................. .~...,.~....~...O,~,~ing duly sworn, deposes and says that he is the applicant above named. fN~rne of individual signing contract) He is the .......................... ~.~.........~...~.,~..~..'-:~... .................................................................................................................................... {Contractor, agent, corporate officer, etc.] of said owner or owpers, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and b~lief; and that the work will he performed in the manner set forth in the application filed therewith. ................. ~ ................ day of ........................ ,No...5~,,6t653~.., 19 ............. Notary Public ~ DRIV£WAJ NA/L IN "N, .,2e'9 ¢0', [~E-r ~. 7~)° 4/ \ APPNox, A~l¢ ,P/OF APPROVED AS NOTED NOTIFY BUILDING DEPARTMENT Ar 1, BEFORE BACKFILLING ~OUNDA- _REVISIONS ?AVEMEA/T HA/Z- NASSAU FT: PLoT 40 RlCl'~Al~.b A, ~C~LUM?~/ ~.E, .i 2.44 ILO`' FOL/k'PX L/TTZ E 75" NON. c6~,37o01.., .... Io07-4-0' NAS U pOllY / ,ROAD ?ZOT /'lAN 3c.,4ZF 1% 3o;0" V ? ? RA,~woob " B: 0 I" j5 G EIVNt~A L NO TE $ 8! '[" ?ZAN t-1 ¢ V./ ?L UMBIN~,' EL,~C T. /VOTE £I£CT£/CAZ (.~p£ 7/tE coD~' OF ~'&Z~ W/,y 3~rAlY~' F/PE Z, tlV~£,el, vzl TEleX. ' :. '' FL 'tNO, l;~ ~ I .~; ~ , ~'FA ~- ~ffSF Z L F ?A F,/ ON 7'0' Ovd~ poo,~ ~ Louver II 4 SOUTH £LFVATION 4 I L L---..[ -- A<., plfl ALT NORTH E L. iE'YA T / O N par ~ BY NAsSAu pT, PLO'l, 40 ii¸ L[¸: WAI'Eg.?poo'FII~t 5~C7/0N'- A-A' Ia T/ON jO*' ~sc4z~- /'t"=1'o< TIO/V C-C NASSAU, PT. PLOT ~rO