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Home My WebLink About6575-zFORa'VI NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at O?p,~eY l~.e.$~ .R.o.a~.. .. Street t¥[ap No. qlea~.es Po:i.~l~ck No.. Se~..~. Lot No. 6 G~eenpor~. N,Y. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ... ~Y . ~ , 19.~3 p~suant to which BuildMg Permit No. 6~ . dated ..... ~Y .. ~6.., 1~3. , was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which tMs certificate is issued is .P~vaSe..QD9 f~ly 4~.ll~g .......................... The certificate is issued to .~DtheF ~ ~ . Sto~y. . .~e~ (owner, lessee or tenant) of the afores~d building. Suffolk Co~ty Department of Health Approval Oat ~8..1~3 ~. B' V~a. UNDERWRITERS CERTIFICATE No. N. ~ ~ ~6 ..... ~t . ~.8.. ~ ........... HOUSE NUMBER ~ .... Street . C~gy .~'9~ 8o~. ................... i~OTE: Bedroom occupancy limited to 80 sq ft/~er person Building Inspector FORM NO. ~ TOWN O~ ~OUTHOt. D BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF,THE WORK AUTHORIZED) N? 6575 Z Permission is hereby granted to: .... l~.3.4,~a~.,.ge:a-t-z, aet.:~g...;~,l~ ..... ~-.C.-Guenthe:r & Jr~qr].a 8t, otaJ~ ................ ~ee~l~or.t .......................................... at premises located at ...~o.t;..£.....~3:ee.~.e&..P.t......aem..[ .............................................................. ................................... O.~r.e3~.~..~oa~ ................ Gte. an. por.~ .................................................. pursuant to application dated .............................. ~ ....... .%~'. ..... , 19..~.~., and approved by the Building Inspector. Fee $..,,~7.,.1.0 .......... REGR~xE~:4G LOT DRIVEWAY cdN, "~RuCTION,~i~I4 cESSPOOL coNS (RU~ ~ cELLA~ co~sTKUC~ION Budding Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRI¢i~TY'' [--tab September 18, 1~°HN STREET, NEW YORK, NEW YOFIK 10038 ~" ~'"'"~-~"' "" " 115316 THIS CE~IFIES THAT o~y t~ e~t~ ~tp~nt ~ Mc~ ~ ~ int~ by t~ ~uent~e~ 8totz~ Oeprey Nen~ ~d.. w/o ~ple in the following location; [] Basement [] 1st FI. ~.a=i.d~ Setpembe:r 13, 1973 FIXTURE [EPTA I IT I FIXTURES ~o , / ~9l ~41 ~o DRYERS FURNACE MOTORS RJTURE APPLIANCE FIB~BS ~.OF S ' Water Heaters: 1-4.SK'W 12'-0" Track Lighting Electric Room Heaters: 1-3.OKW 2-2.0KW [] $nd FL Outztle Section Block and found to be in compliance with the requirements of this RANSES ICOOKWO DECKS OVENS DISH WASHERS ,l~" l~.q i i iI"'w'l-,. { ,.w. m-. i ,.w. i ,,,. i ,.W.lt TIMECLOCK$ BELL UNIT HEATERS MULTI.QUTLIT GPECIAL RLIC'PT T,' . TBANS~ .. SYSTEMS 1 C ''~' 1 3/0 Lot EXHAUST FANS 1/0 3-1.SKW 6-1.0KW 3-.?5KW 2-.5KW T~wn Harbor Lane Southold, L.I.11971 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED, IN ANY MANNER, SUFF~0~.K~ ~-0UNTY DEPARTMENT OF HEALTH H.D. Reference No. 3~-~/~~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address ~gZ~ ~ ~ ~,~,z'T--- 6. Section 2. Property location F~,%% /~T' ~'~ ~ (D~f~g 7. Lot No. 8. Private well Village ~~ Township~k~%~ 9. Public water 3. Public Water Company name ~}~~ Distance to main. 10 Sewage Disposa~ystem: A. ~0~gallon septic tank: Precast~Equ~valent Block B. ~aching pools: Number ~recas~lock ~cial ' ~q If private well fil in blanks below: Tank capacity~ Gal D~bth ~o G.W. Amount of water in well Test Hole Data I Feet I k ~--~ 2 T I ~'~1 ~ 10 12 16 rsigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto. Date 0 ~.n.~-~r Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sew~ Disposal System can be installed on this plot. Date ~/Z ~ Signed ~ ~ S-15 Revised 4/1/72 WORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .................. Applicotion NO......~...-~....Z.~.2 ........... _ ,, . .... .,_ ~pr~ ........................................ , lV.d rem, t~o .................................... ~ O ~ ~ z / ~ D~rov~ ~/~ ~ .... ~...~ ~ ~"~ - . ~/~.o ........................................................................................................................ -- pd~ ~. ', . ................. ...................... ......... .................. ~. Thi* a~i~tion mu*t ~ eom~l~t~l~ fill~d in b~ W~writ~r or in ink and ~ubmitt~d in tri~licat~ to th~ Bui~din~ In~or, 3 ~t~ of ~l~n~, ~ur~t~ plot ~l~n to *cal~. ~ ~ordin~ to ~eh~dul~. b. ~lot .~l~n. *howin~ location o~ lot ~n~ o~ buildin~ on ~r~[~ r[llt on,hip to ~ioininfl pr~mi~ or ~ublie ~tm~t~ or c. The work ~vered by this appli~tion may not ~ commen~d ~fore issuan~ of Building Permit. d. U~n approval of this application, the Building Ins~or will issue a Building Permit to the applicant. Such ~rmit.shall be ke~t the premiss available for ins~ction throughout the work. e. No building shall ~ ~cupied or u~d in whole or in pa~ for any pur~ whatever until a ~ifiate of O~u~nw shall have granted by the Building Ins~ctor. . ~klC~TIO~ I~ ~fi~fiS~ ~fi to th~ 8uildin~ D~nt for t~ issu~n~ of ~ 8uildin~ ~rmit ~u~u~nt to th~ 8uildin~ Ordin*n~ of th* Town of ~uthold, Su~ot~ ~unW, ~w ~ork, *nd other *~Hmbl~ ~*~*, Ordin*n~* or ~ul~tion*, for Ih~ building, *ddition~ or *l~r~Iion~, or for r~mo~l or d~mollfion, ~* h~r~in d~mri~d. Th~ ~licant ~r~ to ~om~l~ ~ith ~ll ordinance, buildin~ eod~, hou~in~ ~, ~nd r~ul~tion~, ~nd to ~dmit *ulhori~d in~etor~ on ~r~mi~ ~nd in buildin~ for ~ in~etion~. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, archite~.t, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~,a~~.....~..~.../~.~..~.---- -- -- ...... ::.,.~....'~...~f--' ............................................................... If applicant is a corporate, sign,ature of duly authorized officer. .... .............. {Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ..... ~..~...~.7.~.. ..................................... Ele~ri¢ian's License No...~..~..~..~.~.. .................................. Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. MapNo..-~..~-.~ [ C"'.~e~ue~ 2~'7~LotNo ~. ' Street and Number ........ . .~..-~:~J~'J~........~..~.......~.. ........................................................ ..~.O.~..~.aJ..~. ................... e / . MunicipaliW 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....................... ............. .....~ ......................................................................................... b. Intended use and occupancy ...... ]...~t~l..l~ ~ ......... ~r'~bU.~..///,~.~. ....................................................................... ~ ~ ~, 3. Nature of work (check which apolicable): New Building ..... ~'. .............. Addition ................... .~. Alteration ............... Repair ............ Removal ......................... Demolition ........................ Other Work ..,..;. ............................. ............. (Description) - Fee ............................................... 4.Estimated Cost ..... ..~ ....... ~ ....................... · · ............................... (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 occuoanc¥;specify nature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front ..................... Rear ........................... Deoth ................................... ~. Height .................................................. ;..., .... Number of Stories; ...................... , ..................................................... ~D|mensions of same structure with alterations or additions: Front .......................... Rear ......................................... ~lt3th ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...~.?. .................. Rear ...~.~.. ................... Depth ...~..~.....~.. ................... Height .................. ). ............................. Number of Stories ....~ .................................................................................... 9. Size of lot: Front ..... LL..ff.L.~.~.t. ................ Rear ...../.~.~,,..~...Z...t. .................... Depth ....... /..~. ................................... 10. Data of Purchase ........ I..~..~..~.. .................. Name of Former Owner ..... ~.:.....~..~i~.~..~.~/~ .~... ......................... 11. Zone or usa district in which premises are situated .......... ~...~...*~... .................jOt ........................................ , .... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... /:V.~ ............................................ 13. Will lot be regraded ....... .~...9., .................... Will excess fill be remove~l fron3 premises: [y~ Yes [ ] No 14. Name of Owner of pram,see I~.....~-~E......~ ...... ~[ ............... .t~......li~.. .............. ...~7....~.~.~.~ ....... ii;~'~;~;~"l{l'~;') ............. (Address) · Name of Architect .................... ..., .......................................................................... (Address) (Phone No.) Name of ContraCtor ..I~..1.]I~i' .~...~.~....~...e2>...~[.~..~.,..~..~r=.. ........ ~.(l~ddl.~.... ............................ .(~..~.~...-~....&....o~... ........ ~ ~ (Address) (Phone No.) ~.~2;!~ PLOT DIAGRAM Lo0.ate clearly and distinctly all buildings, whether existing, or proposed, and indicate all set-back dimensi0ns from ~'l~L~erty lines. Give street and block number or description according to deed, and ~[io~w street names and indicate wheth- er interiOr or corner lot. STATE OF NEW ~,_ORK~ - ~ ) J COUNTY OF ......~..~.....~...~....o..~....~.. ...................) ~ I .... ~..t:t~..e~:~....~..i......~..'.....~)...~..[.~).ll[~...~. .......... i .............................. being duly ,, deposes and says that he is the applicant above named. (Name of individual signin~ contract) ' . ~ .eisthe ............................ ......... ................. ........................................................................... (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly ~othorized to perform or have performed the said work and to make and file this application; that~all ~tatements contained in this ~pplication are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. / f' .... ~i'ERR LEE fLAK , ~/ ' d*v r~f NOTARrtfI~IJ~ State of New Yo/~ 1~ ?3 ................................ ;'.'"'-. ........... '~'~-;~ '~'.'~ L'~I~ ............................... Notary Public, .....',~..~~~.0,..1..9. [C~unty ..~_____-,~OJ~J~....~..~t.G'~-,¢~..... ................................................. (Si~,nature of applicant) TE~T // 5colc :4d,- I" MAP Of :.'.'.'.'.'.'.'.'.'~ I~ v Ii: Y1i: D ,J CiD "lr facilities for this location have been TIT~ COMPAre, cy[~MENTAL AGE~Y ¢ G mF-..£NDO~T Services E /~-L O O tE~ iZ~L A H APPRC~VED AS NOTED ~EE:_:.7,~ .~ , _~,~/ NOTIFY BUILDING DEPARTMENT JAT 765-2660 9AM TO 4PM FOR REQUIR. ED INSPECTIONS: 1. BEFORE BACKFILLING FOUNDA. TION OR START FRA~ING 2, BEEORE COVERING PIP,~LJNJ~ 3. FINAl. WHEN JOB COMELETED NOT RESPONSIBL~ FOR DESIGN OR CON- 5TRUCTION ERRORS ,] ''