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HomeMy WebLinkAbout6617-zFO~ NO. 4 TOWN OF SOUTHOLD BUm.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . 7~. A ~. R ~ ~. ~ ~.E .... b.~; v ~'Street Map No ...... ~'~ 5~' x~mc~ ~o ...... .~...Lot No .................................. conforms substantially to the Application for BuiJdlng Pemit heretofore filed in this office dated ............... ~ ~.. h. 9/~,/19..7..~ pursuant to which Building Permit No.. (e- (,- 17. 7-- dated ........... ~ !../'.'l.q :,:., 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 ... A..t) ~. ~. ..... P. A ~,.~. ~. t_.¥ ..... D t,~./~. L.~..,. ~ ,~-- ..................... The certificate is issued to .. ~).bJ/~ L ~... ~.. ~. £ T~ 6=. ~ N ~ ~ .... -'~ f~.¥- ~-4f ~.~ ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...7...D. ?.-..~.../..9.7..~...-z.. ~../.~.L.,9 .... UNDERWRITERS CERTIFICATE No ....... .A.'.../. ?.?..~..3.5.--.. ...... /. ~.: .a..*....-7. ?. aousE NUMBER .... 7.8..~..... Street ...~..Z.~?..c. ¢.~. fi .... .~..m:.~..eT ............... ......................................... .~. ?~-r. ~..~...~.r. ............... : ..... ....,~:~,.~, .... .~. ~ .~..~ ......... Building Inspector FORI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6617 Z Permission is hereby granted to: ....... ..q~,x...a...~..~.~..t..a....~..x..,e..a.. .............. ............ ?.:..o......r..o...z.......~.~.y. ....................................... .............. ~i~la..Is~ ~n~ .......lq.,~.,~ ................ ..................................................................................... at premises located at ...... ..~..0...~.,.~..1. ..... ~..o,.u.,$..h..o...~..d.....S..h. 9.~.~.l~ .............................................................. ................................. ..A~...~.~.9..o.~.~...D..~.V.e .......... .Gr.~enpox~..~i~t...1.0.)...~.~o~th~l~..R,F.~D , ) pursuant to application dated ........................]~. ......... ~.Q .......... , 19~ .... and approved by the Building Inspector. Fee $~.~,.QO ............ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor w~th 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 installa- tions, a 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. C. Fees: 11. Certificate of occupancy $5.00 ~ 5'/ 2. Certificate of occupancy on pre-existing dwelling land use ~/ $5.00 3. Copy of certificate of occupancy $1.00 ..... ......... New Building ............. Old or Pre-existing Building ............ Vacant' Lan.d ...~ ...... ~ Location of Property .~;.. ~. ~ (.Q/cl. ~... ~ ~ ~ ......... ~/. ~ ~. 5.M. { ~ '~ HamNt ~ Hou~ No. Street / Ow,mr or Owners of ProperW ~.~>.. ~ ~~,. ~... ~ { ~.~, .~ ..... / County Tax Map No. 000S to ....... ~.. ..... Block .... /. ......... ~ot..~z..r..4 ..... Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planmng Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $. ~'.'..~'. ...................... Construction on above described building and permit meets all applicable codes and regqlations. _ Apphcant. t.~.~.~/..~.. ~~.....~c-..L~- ¢z'~~~~ Rev. 10-10-78 SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Re f erence Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~ Address 2. Property Ldc'at-i-on -- / ' ,tV, Vil lage~~'9~ - ' Township.~y~m~ 3. Publ i c W~ Cb'~n~'~me ~m~ - - 4. Lot size: Width //~ feet 'L6hgth /~ feet Sewage Disposal System: A.~gallon septic tank: Pr~~Equivalent Block B. L~ching pools: Nu~ber,~ of pools__~ Preca?s~_j~z~Block Special 10. If pr~v~te well, fill in the fol 1 o%~n~ g blanks: A. Tank capacity gallons C. Total wel~Septh / D. Depth to ground water E. Amount of water in well 11. 5. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main (For Health Dept. Use) 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 below and may be renewed if a current local Building Department Permit is in effect. 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 pl. ot. A P OVAL DATE SIGNE ...... S-15 Rev. 4/1/73 FOBM NO. $ TOWN OF SOUTHOLD Building Department Town Clerks Office Southold0 bi. 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: 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-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwnters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and mnstollations, a certificate of Code comphance 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 on pre-existing dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .......... New Building .................... Old or Pre-ex,sting Building ............................ Vacant Land ........................... Location Of Property ...... ~.~..,,~...(:..o..~.~ ..... .?..~.,./..U...~.'....~ ....... ~.../~..~.~'./Y'..~,.~L~'.T.. ............................................ Owner Or Chvners Of Property ..... ..-~...~.~/'../l...Z. jg. ...... ~ ........ ..i(.~../~....~.../..A~'..4.,¢~ ....... ~.,~7....~...~...~...~.. ................................. Subdivision ...~.....Cj~'...~../~..~..L..~.......~./.~.O.~.~.~ .................. Lot No....~..~. ..... Block No ............. House No ............ Permit No. ,.~...~.../..?.....~.... Date Of Permit .~./~.~./.A.~......Applicant .."~.P..~..,F/,.z:.~.......~...d...~...~..c."-...~. ....................... Health Dept. Approval ./..~../.?../.?~ ............................. Labor Dept. Approval ............................................... Underwriters Approval ..I.~.LL?/.?.~. .............................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ ~- ~ Construction on above described building arfl~permit meets all applicable codes and regulations. · Apphcant ....................................... Sworn to before me this Notary Publi~'/.....~... /..~..~. ....... ~..c~..~.. ,~4ounty ~JUI~TH ~, BOK~N No 52-0344963 SufloJk Ccmm~ss ~ Expires March 30, 19~ (stomp or seal)~c' ~.~ (¢ ! Z_ TZO THE NEW YORK BOARD OF FIRE UNDERWRITERS (~fl BUREAU OF ELECTRICrrY : :, ' [-- SS JOHN STREET. NEW YORK, NEW YORK IO0Se · ~..eDeeembe. 20. ~73 ~.,,.,~.~o.o.,,,. ~270~ N 134035 THIS CE~IFIES THAT o~ly t~ ~t~ ~u~t ~ ~scH~ ~ ~ ~t~ by t~ ~l~t ~ o~ t~ ~ ~t~ n~m~r i~ t~m~s o/ Baylle, Albaeo~ Dr. Southold ~o~s, n/o Blue ~arlln, 8out~old,L.I. inthefollowlngloeation; [] Basement [] IstFL [] 2nd Fl. outside .,o~,,..,~ao. December 17, 3.973 and found to be in compliance with the requiremeats of thla Board. fiXTURE L___ ACLE$I SWITCNE I FIXTURES 3,, DRYERS FURNACE MOTORS FUTURE AFgLIANCE A/AT, ' K, W, OIL H. P, GA~ H P AMT NO. A. W, G, . RANGES ~T. K.w. 1 12. 5PECIAL AEC'PT. 1 30 COOKING D~CKS I OVENS 1DISH WASHERS TIMECLOCKs BF. LL UNITHEATRE$ MULTI-OUTLET ~:,11'. A~S. TRAN~S. H.P. SYSTrdMS 1 ~ HO.O~FEET SERVICE DISCONNECT NO. C~ S E 1 200 CB I~&'2W ~,~3w 3~3W 3,ff4w NO, C~RCC~,COND. A.W.O. 4/0 OTH R AI~'ARATLI~ ~-10~. R V I C E OF HI-LEG food blender, EXHAUST FANS DIMMERS A~T. WATTS 2/0 Charles M. Hall Box 417 southold, L.I. 119 ?1 m ~ANm Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. # T£~J T-' o.~ CE'S$.X'OOL3 e~/ ,4N'Y .LOT ALBACORE £Z ~.1 k ~,. D'0 .//..-5'. a~ , ~ 80 k TOWN OF IUILDIN~ DElmAR?MiNT 'rO. WN ~RK'S OFFICE SOUTHOLD, N. Y. ........................................ , 19 ........ Pemit No ................................... Disapproved a/c ............................................................................................ . ..................... .......... APPLICATION FOB, IUILDINe PEILMIT · Applicatio~ No .............. ~.. ................ a. This el~ication must be completely filled in by typewriter or in ink and submitted in triplicate to t~e Building Inspector, 3 sets of plans, accurate 'plot plan to scale. Fee according to schedule. b. Plot plan ~howing location of lot and of buildings on premises, relationship to adjoining, premises or public streets or areas, giving e detailed daserigtion of layout of property must be drawn on diagram which is pert of th~s ~Pplication. e. The w~dc eO~erad by this application may not be commenced before i~uanca of Building Permit. d. Upon el~amval of' this al~lication, the Building, Inspector will issue a Building Permit to the applicant. Such permit,shall be kept o, the premi~e available f~. inspection throughout the work. e. No bui~ shell be oeeupled or used in whole or in pert for any purpose whatever until a Ce.rtificate of Occupancy shall have been granted by the :~ng Inlpector. , APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zor~ Ordlnanm of the Toum of ~outhold, ~lffoJk County, New York, and other applicable Laws, Ordinances or Regulation,, for the coest~uetion building,, mlaqtiom Or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all apfllicable laws, ordjnaneee, building code, housing code, and regulations, and to admit authorized inepectors on premises and in buildings for neca~ary in~aectldm. ).) za~e. Jem la5 ............................ ~.e.....Z.,~..z..~.....X.....~.,. ....... (Address of applicant) State whether applicant is Owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................ el~ll~..~r~.. ~l[e331~ia..... ....... ~ ..................................................... : .................................................. Name of owner of premims ..... ~ .~..~..~...~....T.~,a,......,~...~.,e.~. ............................................................................ If applicant is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Builder's-License No ....................... '~7:-~ ......... ' "'"'"'~ Plumber's License No ...... ~....~.....,.~,,,~.,..i~ Electrician's License No ........ ~'~J, .................................. Other Trede's License No ......................... (~ 1. Location of land on which proposed work will be done. Map No ...... ~..8.~..~. ....... ....................... Lot No .....~..~......'. ....... ~"} Street and N.mher A3.1a&ee~e /)=/ye' , 8o..~.~}~o.~ ...... ~..~- ............................................................................................................................ ~'~i'~i~;~i~'~ .... ~- 2. State existing use and occupancy of premises end intended use and occupancy of proposed constnJction: ~J a. -Existin~ use end o~upan~ ......... ~.t.....Z.~ ................................................................................................ ....... ~....t.~..~...~.e., ,Z..Z.....~. ................................. i ........................... ~:, ............. ; 10. 11. 12. ,-' 13. ~':~ 14. 3. Nature of work ~[check which applicable): New Building ...... ~ ............ Addition ..................... Alteration...~.y Repair ......................... Removal ......................... Demolition ........................ Other Work ............................ .~LP~'...., ~ (Description) 4. Estimated Cost ....~..~,~I~Q~ ....................... Fee ....~...~I~II~J~L ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~ ........ Number of dwelling units on each floor ............. ~.~..v ...................... If garage, number of cars ................................................. ,. ......................................................................................... 6. If business, commemial or mixed occuoancy, 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.'-~FFo~n~... ........................ Rear ......................................... Depth ............................................. Height ...... ~...~..~..;.,' ......... ; ..... ., ..... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... .~.. ............. Rear ..... .~.~ ................ Depth ....... .~... ..................... Height 18 s Number of Stories ........... ..~. ........ ' .................... Size of lot: Front ..... ~,~.~. ....................... Rear .... ............ ,~1,~). .................. Depth Date of Purchase ....~...o..T.......~?...~....~.~.?...~.... Name of Former O~-r .....,:~....e,.~..;'..&..:E...a~...e.~.~:..~...e..e.I..e.. .................. Zone or Use district in which premises are situated ....... ...~..........,~.?...~.~.~'....¢~..'.~7.....'~. ............. ..._........ ................... ......... Does propoesd construction violate any zoning law, ordinance or regulation: ........... ~,~ ............................................ Will lot be re,reded ~el~. .......................... Will exce~ fill be removed from premises: [ ] Yes ri'] No Name of Ovmer of premises ..~h~lkl~...~l~.~,.P.l.$.....~.~l~.~....[..l[.~t~...~. ................... ~.;~...4~...~.q~;~ ............................ (Address) - (Phone No.) Name of AP=hNeee..~e~.....Jlezm3.~...~aT.~es ........................................................................................... (Address) (Phone No.) Name of Contractor .....~..~f}~. ............................................................................................................................ (Address) (Phone No.) PLOT DIAGRAM Locate clearly and c~lttncti¥ all buildings, whether existing or propomd, and indicate all est~ack dimensions from property lines. Give ,[,eet and block number or description according to deed, and show street nafl~mi and indicate wheth- er interior or comer lot. STATE OF NEW YORK, 6~.j~O~.lr ) COUNTY OF ...................................................... ) rJ, co .e ......... ~'~A- 'qll~'"~ '-~.,' ~..Inm?~e~ .......................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual ~tgning contract) He s the (Contractor, agent, corporate of ITcer, etc.) of said owner or owners, and is duly authorized to perform or have per!=ormed 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 belief; and' that the work will be performed in the manner set forth i~ the application filed therewith. - , ~,,~-~TARY PUBLIC. State ol ...................................... oay OT ......................... H~,. ~.~-~,~.~?/q:l --/,~.. ....ry ........................................ CA tVA I_ /10. O0 .=~ 3./ 0~ NO'7'~' : CA IgA 1_. mm FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, IN. Y. Certificate Of Occupancy No. ~ ~ 7 ~/~ Date ... 7 x/~ ~, 19.7c/ THIS CERTIFIES that the building located at . ?AMC. .Lt.. z~/, .,~ ) Street ~f/'71~t t 0 Block No ....... ~. Lot No. Map No ..... ~.E. ~.~ ......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... 3 C..~%~ 'i9.2~ p~suant to w~ch Building Permit No. (~ t~ t7.~. dated ........... ~ ~. ~Yq .~. , 19 7~, was issued, ~d co~orms to ~1 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...A. ~:~ .... ~A ~'~,., ~_',. !~t,..l- ~.t. t ,~/ ................. (owner, lessee or ten.t) of the Mores~d budding. Suffolk Co~ty Department of Health Approval 7. ~ t:- ....... ~ I q ~ ~/ ~ . . ~,/ /. / I. ~ UNDERWRITERS CERTIFICATE No ....... ~.'.../..~ ff.} ~ ....... ( ~. ] ~. ~.' .~( ~. HOUSE NUMBER w ~ ~ .... Street .. A ~ .~ ~ ('.~ ~ .... A.~.~ .ff ~ ............... .......................................... 5 f ¢a .................... ... j .... ?/,.. </X,..~ ..... Building ~specior LoT' 34~7~ ~/-I T E L ~ V,.d Tt ©/V APPROVED' AS NOTED NOIIFY BUILDING DEPARTN~I~ AT ?,~s.2660 eA~ TO 4PM FOR~UJRol E~ INsFECTK~/~t: 1. BEFORE -~ACKHLLING FOUNDA~ TION OR ~I'ART FRAMING 7.~ BEFORE COVERING IqPELINE 3. FINAL WHEN JOB COMFLETED~, NOT RESPONSIBLE POp. D;SIGN OR ~ STRUCTION REROI~ n~ '0 "' %~VAT£D' 144/. 4'" !~7W D \~- G USO- 7- I I D /2'-4-" 3-'-4" 6~0'' · CZ, F'£ o O,R T ir, Zo¢~veo Ar DONALD M. BAYLE..5 (CONSULTING ENGINEE~ ' ~ /973