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Home My WebLink About6567-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No~. ~..7.9.2. ....... Date ...... Feb .... 13.. , 19. ?.1+ THIS CERTIFIES that the building located at . ?.elm.ar .D.z-..~v.e. ........ Street Est. Map No. L.a..u~. e.1 CtYBlock No ........... Lot No. ~O .... .L.a.u. re..1...~! :.Y.. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... 2: aY . . .~.O...., 19 ?~. pursuant to which Building Permit No.. 6 ~6FZ dated ....... I,!a.y ....~.0. .... , 19 7~.., 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 .P.r. iy.a.Ce.. 9.n.c...~.a.m.J:~.7. ~w.e..:L.Z.$.ng. .................................. The certificate is issued to . Roya.~...~.el~.n .~.n.q .......C~..e.1-.~. ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~eb. ~ ~ 9.Tbr b~.. R, V~,~LXa .... UNDERWRITERS CERTIFICATE No..N...~.2.2~ ? ..... ?.eh. ~.~..~ 9.~.~. ............ HOUSE NUMBER 138~ . Street .. De]~u~ar .,~ri.v.e. ................... .. ....... ..... ]~il'~ing Inspect~ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT ti'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6567 Z Permission is hereby granted to: 4~gza~..~.ra..Yua~ ............................................. .............. .~,.o......~.~..o.~...~.~..,. .................. · Mattit~k ~o ~..x..a.....a, ?..V...~.°:~... ~.~.x.Y.....q..v..o.~.~:. .................................................................................. pursuant to application dated ........................... ..~..~. ....... .~..Q .......... , 19~..., and approved by the Building Inspector. THE NEW YORK BOARD OF FIRE UNDERWRITERS P,.k BUREAU OF ELECTRICITY [~ 85 JOHN STREET, NEW YORK, NEW YORK 1003S THIS CERTIFIES THAT Royal Tern Inc., 13~5 Delmar Drive, Laarat, L.i. inthefollowlnglocation; [] Basement [] lstFI. [] 2nd Fl. O~tEicle Section Block Lot WOS examined on Febru,--;ry 4, i .~ T II and found to be in comPliance wlth the requirements of this Board. RXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 2O DRYERS TIME CLOCKS MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: ,.~rnaees. Oil 1-1/Ehp, 1-t/12hp ~otor/s: 1-3/4bp E R V I C NO. OF CC. COt*lO. A.W. G, NO. Of HI-LEO A, W.G. NO. OF NEUTRALS A.W. G PER ,ff OF CC, COFtD. (~: HI.LEG OF NEUTRAL i 2 ]. 4 LJ. ndenhuPs b ;:"" ~ 83 Palm St., Lindenhurst, L.I. 11757 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FOB~I NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ~nk, and submitted ~n duplicate to the Budding Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of ail buildings, property lines, streets, aaa unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dlsposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buddings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. §. 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 inspecbon of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certihcate of occupancy $5.00 2. Certihcate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date New Build,ag ...../..~.~. ......... Old or Pre-existing Build,ag ....~./.~. ........ ~ ....... Vacant Land ..~.~..¢.'. ................ Location Of Prope%ty ........ ./Z.~....~...~~.~,.......~..~.~..'.~...,....~:~,......~..;¢. ............................... Perm,, No.~-~.~..~..7......~7... Date Of Perm,, ..~.~./..O...:..7..~.Applican, ;/~&..~.......~.~..~ ........................ Health Dept. Approval .~..:..~.:.~..~. ............... .~.~..~..~..~..~.Labor Dept. Approval ............................................... Underwriters Approval ..... /.~..../'.,.~...~,...c~..../..~... ............... Planning Board Approval ........................................ Request For Tem.~ry~ificate ........................................ Final Certificate ........ ~ ............................. Fee Submitted $ .................................... Construction on above described buildin~d~m?~e~l applicable codes and regulations. Sworn to before me this /~:~' /[ /'i ? Notary Public .................................... County (stamp or seal) /~ SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~)O~L T~6tA} .~y~ Phone)~'(~'F~ 5. Subdiv. Address ~'~~ ~o ~}~3 ~,~c ~;7~r~,:/~ 6. Section 2. Property Location ~m~A~ ~,d~ 7. Lot Number Lmo~ ~s=,~..,~,~,l 6 (+m 7~5 8. Private Well Village , ,..~ ~, ~ownsh~p ~OO~O( ~ 3. Public Wate~ Co~O8~y-Name 4. Lot size: Width)~ feet Length ~q~ feet 10. Sewa~,~sposal System: Ap~ec9asO~t.~llE~ii~in~ tanilock ! 9. Public Water Distance to main (For Health Dept. Use) B. Leaching pools: Number of pools / Precast~OBlock Special ll. If private well, fill in the following blanks: A. Tank capacity B. C. D. E. ~" gallons , Pump G.P.M. ~ Total well"~6pth Depth to ground water Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated bellow and may be renewed if a current local Building Department Permit is in effer_~. ~,/ ~ Date ~/~) ~ ~,~ Signed .~~~~?~~ 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 and Water Supply can be installed on this plot. APPROVAL DATE ~"~/? '~ SIGNED ~,- S-151 Rev. 4/1/73 LOt / 0O' ~. L.of 9 SUFPOLK dOUNT The se~a~e facilities for this ~nspeete~ by this to ~e satisfactory. Chief of Genp~! 04P THF, [OCATTON OF WELLS .~ND SHOWN HE3EIZI ARE F2OZ~ ¥~.~LD OBSE~V,~TJO]~S A/?'D / 0/] F'%~._~I~ .... ~,.~ .~..._,-, ...... ~, FROM tVOFE: SU,~DIIII$10# MAP FIL£O IN TICE 5486. ALDEN W. YOUNG % ~ H~ ~/V. YO Ji~¢ SURVEY FOR: % ~¢, ~/ ROYAL TERN, INC. LO~ NO./0, "L~NEL COUNTRY ffS~ATES" AT L 4 UREL 6 UARANTESD TO: SOUTHOLD ~VINGS ~NK METRO~LITAN TI~E GUA~NTY SUFFOLK CO., N.Y. "Y SCAL[: I"=dO' ~DATE: flOKS, 1972 N0'72-897 I ..... ::::::!i....:: ........ : .. ' ........ DisapprovedAppr°ved ........ a/c ....~ APPLICATION FOR BUlL,DING PERMIT Date NSTRUCTIONS s. This application must be completely filled in by typewriter or in ink end submitted in triplicate to the Building Inspector, wit 3 sets of plans, ~gcurete plot plan to ~le. Fee m~ording to sebedule. b. Plot plen showing location of lot end of buildings on premisas, relationship to edioining premises or bubli¢ streets or sreas, ene~ giving e detailed de~ription of Iwout of properW must be dr~wn on diagrem which is pert of this epplic~tion. ¢. The work ~overed by this epplication me¥ not be commencad before issuanee of Building Permit. d. Ugon epprov~t of' this el~li¢~tion, the Building, Inspector will issue e Building Permit to the eppli~nt. Such permit.shall be kept on the promises eveileble for inspeefion throughout the work. e. No building shell be occupied or u~ed in whole or in pert for en¥ purpose wherever until e ~e.rtifi~te of Oe~upeney shall h~ve ~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of e Building Permit pursuant to the Building Zone Ordinenca of the Town of Southold, Suffolk County, New York, end other eppticable 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, ordinancee, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings fornecossar~ inspections. (Address of applicant) State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ............. Electrician's License No....~...~... Other Trade's License No ....................... : ........................... /., d t?~'-. ~"~.~/ 1. Location of land on which proposed work will be done. Map No.;~.,~.,.~:~...Lot No. ~,,.,.(~,.~ .............. Street and Number .....~...~.~...~...~..~ ....... ~...~, J,¥~. .............................................................. ~ ........................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ...... ~~ ........................................................................................ 3. · Na'cOre of work (check which applicable): New Building .......... ~ ...... Addition ..................... Alteration ...... :.~..,~ Repair ......................... Removal ......................... Demolition ...................... ,. Other Work ............................ Ti' ...... - (Description) (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 usa .............................. , ...... 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 o~f Stories ........................................ ~ aP' 8. Dimensions of entire new construction= Front ...... (ff,..~..'..A~. ..... Rear ......~....~....E. ........... Depth .....~:..~.../...q.."2'...'C..?.. ...... Height. ....................... .... ......... ............ Number of Stories ......... ~ ......................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Forrpe~r Owner ............................................................................ Zone or usa district in which premises are situated ~L~i~ q ........ .~..' ~; ...7~... ........................................... 12. Does proposed construction violate any zoning law, ordinance-- or regulation: ...... .~....~ ............................................ 13. Will lot be re,reded ~.~p,~.~.~........~. WiU.~l~e, ~.f!ll be ~re~L~d fromm premises: [ ] Yes *~,,No 14. Name of Owner of premises ...~.~,~=l,e~ ....... A.~..~:=......~c....-=..~ ................................................................ (Address) (Phone No.) Name of Architect ............. ~ (Address) {Phone No.) Name of Contractor ........ ~~%~' ............................................ ~ ........................................................... {Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly ell buildings, whether existing or proposed, and indicate all sat-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, ~ . o ) COUNTY OF ........... ..~..%~....~..~..~ .~% ............ ) SS ........... ~..~%..~...~O~.~...~.......~..'..~..~.~.~...~..~..~. .............. being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the .................................. ~ ................................... :i ..................................................................................................................... {Contractor, agent, corporate officer, etc.] of said owner or owners, and is duly authorized to perform or have performed the sa_i~G[~w0rk.:p~ to make and file this application; that all statements contained in this application are true to the best of ~his knowledge and bel~*an~ ti;t'~MP~l~lklk will be performed in the manner set forth in the application filed therewith. ......................_.... ........ .. o, ~ ' "d * uffotk C ~ ,.., ................................ APPROVED AS, NOTED ~ .~ ~ ,:~,, ,, /'~ ~ ~. : , ................................. ~ ...... ~ .-~-'-T--- .................... - ............... .~ ...................... '-T~_ :--, ........ . ~. f. r ~' '~ 2 ' ' ': ~ -~ ; - . :...~ ~ .........................~_..__~ . , / /,