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Home My WebLink About6578-zNO. 4 TOWI~ OF $OUTHOLD B[~.BING DEPAI~TMq2,NT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Date 14arch 2~ 19..~. THIS CERTIFIES that the building lOcated at*R.'.(~: .~:..'....1~....Rd....~..$. T.... Street Map No. xxX Block No..X~.. ....... Lot No. Xxx Southold 1~ oYo conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .F~a..y.... ??., 19 ?.3. pursuant to which Building Permit No..6..~?..8~.. dated I4ay 17 19.73, 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.~.v..a.t.e..o.n.e' .f..a~..~.l.y...d.~.e.Z..]..~?.1 ...................................... The certificate is issued to ,Totm Zech:Le]. ~rner (owner, lessee or tenant) of the aforesaid building. S~on~ Co=fy Dep~tment of Healm Approva .~..~. ~....~? .~... }~...~.'..V..~.~. ...... UNDERWRITERS CERTIFICATE No. N ll+~0 2/~ 2/7t~ HOUSE NUMBER ~80 Street Private Road # 2~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6578 Z Permission is hereby granted to: ~le ~.. ~tei~r~ ..~Z.C...,T~.~ ..7~eoh~.e~ ..... .... ~l.z'~v. ez~ ..................................................... ......... Jmaeepe~,. ................................................ at premises located at ....~/~.S..~..~.oal~.....o~'...8/~..~o~.t~..T~a~..~ .......................... ............................................................................................. .s..9.~.s;~.q.~.....~.. ,..~.~. ................................. pursuant to application dated ............................. [~.ay ......... .1.~......, 197.~..., and approved by the Building Inspector. Fee $ ...~.~...~ .~) ......... FORM 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 ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. 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, o certificate of Code compliance 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-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 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 an pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .............................. ~ ................. ~v Building ..... ~. ~ldition ................ Old or Pre-existing Building ................ Vacant land .............. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Request For Temporo~r)/~Certificote ........................................ Final Certificate ............. ~.... .............. Fee Submitted $ .................................... Sworn to before me this .... da of ..... Notary Public .................................... C?~ty i THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR!CI'~'y [~ ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~.te ~ ~ A...cation No. on /iie ~9~5~ only the e~t~al equipment ~ ~scH~ b~ ~ int~ by t~ ap~t ~ on the a~ ap~ication number in t~ p~mises of in the following location; ~ B~ement ~ 1st FI. ~ 2nd FI. ~ction Bilk ~t x x ~u~si~ w~ exami~d on Feb ruary 7, 19 7 4 and found to~e m com~iance with the requirements of this Board. FIXTURE OUTLETS q2 ]~ 19 DRYERSr FURNACE MOTORS [ FUTURE AM~tlANCE FEEDERS A~RT. K, W, Ott H.P. GAS H, P, AMT.,~ ~NO' A.(]W: G, RANGES SPECIAL REC'PT COOKING DECKS OVENS DISH WASHERS TIMECLOCKS BELLIUNITHEATERSUNITHEATERS MULTI-OUTLET , '. TRA . .~ SYSTEMS ~Jr ,~MPS NS H P NO. OF FEET SERVICE DISCONNECT ] NO. OF S R I C METER ~ 2 O 0 C5 1 OTHER APPARATUS: wl~c. Poom Heaters: !-2.5K;.I, Water ~eaters: 1-~.EKW EXHAUST FANS DIMMERS OF NEUTRAL ] ]. ~; 5 ~ Per ] ] . COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTHENT OF HEALTH H.D. Reference No. -~-~6)~-~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant~ ~.= (~,'um ~c~l~,L Phone 5. Subdiv. Address ~ ~'~ ~~o~ ~.~ 6. Section 2. Property loc~on~ ~o~T~ ~F ~ ~Av~. Lot No. ~9m--~/ ~,A~ ,~ ~,~h~"~' ' 8. Private well y~ Village~Town~ip~o~ok~ 9. Public water ~Q~ 3. Public Water Company name Distance to main 4. Lot size: Wid~feet Length~feet (Enter on center plot below) 10. Sewage Dispos~ ~ystem: A. (~0~a~o~ ~ ta~: ~r~a,~ ~~t ~oc~ If private well Street fill in blanks below: Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 Tank capacitive Gals. Pump G.P.M. Total well depth__ Depth to G.W. //~[~'-~ Amount of water in well The undersigned CERTIFIES: "Construction of authorized be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date~ Signed ~" -- O~ner or B~{la~ installations will 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 can be installed on this plot. Date ~,/~ ~ Signed ~~,,, __ __ S-15 Revised 4/]/72 Disapproved a/c ............................................................................................ ............... '('6~i ding InsPe~or) ................ - -! APPLICATION FOR BUILDING PIBMIT INSTRUCTIONS e. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 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, an~ 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 Building Inspector will issue a Building Permit to the applicant. Such permit ,shall be kept on~ the premises available for inspection throughout the work. e. No buildir~l shall 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 HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinenca of the Town of Southold~ Suffolk County, New York, and other applicable 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, ordinancal, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. '. ............................. ................................................................................. . ........... Name of owner of premises ...,~...~.A.~i.....,~,.C../~..L.'~..J,, .............................................................................................. If applica_n~,[s_a corporate, sign_at)jre o,f duly authorized officer. Builder's License No ................. .. ........................................ Plumber's License No ....... .~.e,,~.~.~...~..~ ............................ *' Electrician's License No....Ce.,e~.~..~.~R......~,,..Ld~":T..~..~, Other Trade's License No ................................................... 1. Location of land on~whi h proposed w?k_ will be done. Map No .. ..~.. .Lot No ~ .... . ,.. Street .nd N_...he..;~..~. ......... ,. ................. ~.....~ ........................ l ..................................... ".'"-'"-".":"'"'."t:" , , /' iv -- MunlclpallW 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... ...~.~J:~......~;~.~.[:~ ................................................................................. b. Intended use and occupancy ....... .....C~L,~,a,......?.EL.~.~.~,~c......~Q.~k.'~,. .............................................................. e Se ~Ja'ture of work (check which applicable): New Building ........ .~. ........... Addition ..................... Alteration ....... Repair ....... .............. Removal.... .............. . .. .... Demolition ........................ Other Work ................................... : .... (Description) Estimated Cost ...~.....~....,...~..~..~. .............Fee .................................................. ,~ ............................................. (to be paid on filing this application) If dwelling, number of dwelling units ..~:~..':'n,q., Number of dwelling units on each floor ................ , ........................ If gara~qe, number of cars ............................................................................................................................................ If business, commercial or mixed occuDanc.y,.specify nature and extent of each type of use ..................................... Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stor_Jes ............................... ~ ............................................ Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ..................... ... ..... ....... ....... .. Height ......................................... Number of Stories ................................... . ... . Dimensions of entire new construction: Front .r,~...,~.. ..............Rear ....~.,~.... .................. Depth .....~,.~..~ ................ ' Height .............. .~. .............................. ' Number of Storms ..../ .................................................................................... 9. Size of lot: Front ..... .~.;~..~.,.~. .................. Rear ..... ..~....~.~ .......................... Depth ...~..~...~..:. ................................. 10. Date of Purchase ..................................... Name of Former Owner ......... ~ .................................................................. 11. Zone or use district in which premises are situated ....... g~:Zl~,a~....~.~xm,.,~.'~.....~u~.~.~...S. ................................. 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 14. Name of Owner of premises .~/3.~A...;Z~.c~.~.~. ...................... .~..~J~..~.~.~.~ .................................................... (Address) (Phone No.) Name of Architect ........................................................................................... (Address) ' (Phone Ne;) Name of Contractor .~..eg..~....~...J~.{~...~....e~......~...~ **~3...-~.w. F~r ....... ~1';~''W'~' '~''~' ~L%/' ~' '~3-ssl .......... ~'~n'~t'~'' '*'' '~' 'x' ~'~oeNo .... PLOT DIAGRAM \k at ~'1 Locate clearly and distinctly al! buildings, whether existing or proposed, and indicate all set-beck 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,~'.OR.K.~ / _~'~ ) SS COUNTY OF~,~....~//~. ...................... ; .......... ) ...................... ~ ................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name o£ individual signing contract) He is the ................................................................................................................................................................................................................. ~' {Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform or have performed the said work arid to make and file this application; that all statements contained in this application are true to the best of his knowledge andj~.~;l~.~O[J~ the work will be performed in the manner set forth in the application filed therewith. Notary Public, State of New Yo~ ./'~ '~ (")~.v ~,~v J ~.~ No. 52-0344963 Suffolk Count.~,. ~ .................... /.../. ........... day of ................ .~....~.~ .............. lg~..... ....... J~ommission Expires Match 30, 19~) ~- Notary Pu .l ounW ..... ~ ......... 6/ . {Signature of applicant} SU~'~OI,K COUNTy H~ALTH DEPAR2M~N2 dispesa! and water suppl}, for %his looation have beem / ' ;',5)z_ z:.' '" T, r3 7 Ft R S T .FL O0 t~ NOTifY' BUiLDiNG D£PARTN~ENT _~j~, i~,; -- ~r, '~ 'BEFOBE ~BACKFIELiNG :. 2,, BEFORE COVERING FRONT E-LEVATI ON ,t