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Home My WebLink About6367-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .....L~E..e.~.l..5.e...D~..l.?~..8~..u..gh.. Street Map No... 9.0. ....... Block No..~. ....... Lot No.. ~.].... s...$~. U..th.O..3..d. .............. conforms substantially to the Application for Building Permit heretofore filed in this office 'dated .......... .Feb,..~,~'1. -, 19 .?3. pursuant to which Building Permit No...~.3.6.?.Z. dated .......... ~.eb,..~1~t..., 19.73, was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... PE~.¥&t;e. O:Xl .~'alai],y. ~e~,J.$~ .................................... The certificate is issued to .... A~,bel'.~ .l~'~.ay .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .D.&.t..ed.. 0~..3'.~.1..~.~.~ ........... UNDERWRITERS CERTIFICATE No .... .D.a.~ .ed...0?.t:...~.,. ~.~.?.~ .... 1~...~...~..~. ..... HOUSE NUMBER .... 3~.~. ...... Street ....L~...O.a.~.d..e...D~.~.?? ...................... aouthold ...... .......... Building Inspector TO~N O~ SOUTSOLD 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) N? 6367 Z Date ........................ ~'~b......~ ~ ............... , 19...~.~. Permission is hereby granted to: ....... ]~eaa~.t..~d~terz..2ae..A/C.....A~bert ~ ................. · 1.~3~.-...W.~..I4e~I~..&~ ........................ ................. ~$~e~be~ ......................................... to ..... ~tt~.l~l .. ~e~.. ~ne · · ~'~,~ ~.:r · .dwe.~:~ ~J.~g ................................................................................ at premises located at "~aO'l~"6~ ....... 0~,b~lo.t~l-'4~'a'l~ ................................................................ ...................................... /,e.k®.-&$~.. D ~'.. 41., ............ ~u~h~t&....~v~v ........................................ pursuant to application dated ........................... ~'~91~ ....... ~1, ......... , 19.~.,~..., and approved by the Building Inspector. Fee $.~.¥~: ........... Building Inspecto~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ FL J: BUREAU OF ELECTRICITY ~ BE JOHN STREET, NEW YORK, NEW YORK 10038 N 119559 THIS CE~IFIESTHAT onl~ t~ el~t~al ~uipment ~ ~sc~b~ ~e~ a~ ;nt~uc~ ~y t~ ~pl~t ~ o~ the a~e application numar in t~ premises of Eomort ~!dr~., n/[~id~ Lakeside Dr.,South, Southold~ L.I. inthefollowingl~ation; ~ B~ement ~ lstFL ~ 2nd Fl, ~tslde ~.io. Bt~ ~t w~exami~don October 4, ~7'~ andfou~tobeincompliancewiththerequirementsofthlsBoard. FIXTURE [ECEPTACLE I WIT J RXTURES I DRYERS FURNACE MOTORS FuTURE APPLIANCE FEEDERS AMT. K,W. OIL H.P. GAS H.P. A.V,T. NO, A. W, G. SERVICE DISCONNECT NO. OF RANGES ~PE¢IAL EEC'PT COOKINGDICKSI OVENS ImSHWASHERS: AMT. K.W. At~T. K.W. OAT. K.W. TIMECLOCKS BELLi~UNIT HEATERS MULTkOUTi~TsYsTEMS ~?T. AH, PS. TRANS NO. OF FEET V I C NO. OF HI-LEG OF HI-LEG EXHAUST FANS AMT. H, P. DIMMERS AMT, WA~S E NO, OF NFUTRALS A. W, O. OF NEUTRAL ..!,,'.~ Pat t{ea~ey, 1~!2 East Montauk }{way, J!ampton ~ays, L.I. I19.4g ~NERAL MANAGIR Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~[~)~ 5 /' ~~'G~' ~ TOWN OF ~OUTHOLD 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 triplicate 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, 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, a certificate of Code compliance fram 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. Swam 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 3, Copy of certificate of occupancy $1.00 $5.00 Date .......~.. ~. ~ ~,,...~.,../,..~...~..~. ..... New Building ...... ~.'. ....... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~../~./`~/.~C.~./~.~..~..~.~L./~r~.~G~.~.~..~7/.~.~.~~~ ~ner Or ~nem Of Prope~ ~/J~4Z.~.~~. ............................................................................ s~o~ ~.~..~ ......................... ~ot No...&~... m~ N~~o.~. No ............. Per~ No.~.~.~..~. ~t~ Of Pe~t ~//~..Ap~n~..t ~..~a~ ........ ~ ~..~ ................. Health ~pt. ~ppr~l ....... ~./.~...~.~.~.~ ......... Labor ~t. ~pprawl ............. ~ ......................... Ap ra , ..... ..... ........................ Request For Tempom~ Ce~ificate ........................................ Final Ce~ifioate .........~ ........................... Fee Submitted $ .................................... Construction on above described building and p~rmit meets all applicable codes and regulations. Applicant ....'.~.. ~-~..... ,~.~.~/':/':/'.~. ~ ~ ..................................... Sworn to before me this Notary Public .~,--... County ANTttONY ALECI NOTARY pUBI,{C, State of New~ (stamp or seal) TOWN OF SOUTHOI. D Building Department Town Clerks Office Southold, Iq. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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, 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, 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. 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 dwelling or land use $5,00 3. Copy of certificate of occupancy $1.00 Date .......~.~...x~.....~...~ .../...~...~.~. ..... New Building ..... ~ ........... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...... ~/~.~..~//~.~./z~.~..~.z~)~..~..~..x~..~'~..~.~...~.~..~..~~`~/ Owner ~r Owners Of Propart¥ .......................................................................................... Subdivision ...~..~.~,.~.....~'-..~.~ ................. Lot No.....~'..../.... Block No....~'.... House No ............. Permit No. ~..~.~.~,~ Date Of Permit ...~.,<'.~..,~Z..Applicont ..... ,/',~.~../.4~E~.~.."~../~.../..~?..,/~..~.. ............... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......... ~ ........................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me ~is ..... ~..~.... day~of ............. ~...~ .... (stamp or seal) Notaw Public ~~,... Coun~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~ ~, ~u~W Phone ~? 5. Subdtv. Address qo-~o u~,,~ ~#~;(m ~ca~D~c~,,~ ~. ~7 6. Section 2. Property location C~R ~a14 P~ ~ss,o,= D~.7. Lot No. &l ~.~ ~o' ~ ~ ~,,¢r D~ ~$T ~8. Private well V~ Village .~s~r,~=D Township ~o~r~ o~ 9. Public water 3. Public Water Compan~ name Distance to main 4. Lot size: Width /~f.o= feet Length~feet (Enter on center plot below) 10. Sewage Disposal System: A. 900 gallon septic tank: Precast~ Equivalent Block B. Leaching pools: Number ~ Precast~ Block Special If private well fill in blanks below: Tank capacity ~LGals. Pump G.P.M. ~ Total well depth Depth to G.W. -/ Amount of wate~ in well ~ O~ Test Hole Data Feet 0 4 8 lO 12 16 18 installations will stand- The undersigned CERTIFIES: "Construction authorized be in accordance with the Suffolk County Department of Health's current ards thereto." Owner or B%ilder J Date i%-~ ~ 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 D isposalDate Systeml//&/7~can be installed on t hiSsigned,plog,~-~-~ %~,~(~,/z-~ //~ Sewage S-15 Revised 4/]/72 ' BUILDING DEPARTMENT ,,.'/~.. Y/7~ '~"~ ~'~-~'~ ~ · TOWNCLERK~OFFICE~,~ _I ,~ ~ / ~ ~ ~__~ ~ ~min~ ........... ~ ....... .? ................ , 19...{~. / / A~ll~ti~~ ............. ................................................. ....................... , {Building rote ..~~.~ ............................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and sub~n tted in duplicate to the BuildingS, Inspector. . b. Plot plan showing location of lot and of buildings on premises, relationship to adiolnine oremise~ or oub c streets or~ areas, and g ring a deeailed description of layout of property must be drawn on the diagram v~'"c~ s part of ~nle app Ication. 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 progreu of the work. e. No building 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 I-~REBY MADE to the Building Department for the issuance of a Building Perm t pumuant to the~, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app cab · Law° Ordinances or~'~ Regulations, for the construction of buildings, additions or alterations, or for removal or .demo t on, as herein described..~,~ The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations. , ..// /-- ~"L~ '~ , (Signature of applicantv,6r name, if a corporation) .......... z./..~..~....~...~...~:...~...~z:=..: ................... ~,-~_~_. ~ ~ ~ ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~.....~¢/'.~ .~ ............................................................................... .............. i~:;'~:~'~;~:;;'::;;"~::~;:;;~;:'~;;i:;;';i ................... 1. Locotlon of land on wh cb.proposed work w II be done. Map No ..... ~._.. ~. ....... Lot No.: ..~.../.. ............... f/ Mun,c,nalltv 2. State existing use a.nd occupancy of"~'rem/is~'s and intended use and occuPanCY of~L~d conltructlon. a. ~sting .. ond occuponc~ ................. :~_ ......................... ~-~~)2~ ................. : ........ ' ............................................... b. ! '~ ...... ~ .... ~7 ................................................ , 3, Nature of work (check which applicable): New Building . '" Addition Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ...... ~..a~/....~....~...~. .......................... Fee ~, ~--~' (to be paid on fi!lng this application) §. If dwelling, number of dwelling units ........ ~ ................ Number of dwelling units on each floor ............................ If garage, number of c~rs ........................ ./.. ................................................................................................................. 6. If business, commercial or mixed occupancy, 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: Front ....................................Rear ............................ Depth ................................ Height ...................... ;.....Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~...~.~..~...:. ........ Rear ....~..-~..'.T..~..Z... Depth ~...~..~.~....~..... Height ...../...~..~./. .... Number of Stories ................ /. .............................................. 9. Size of lot: Frant ..... .~.....~...~ .......... Rear .o. ~ ........ · ~.. .................... Depth ..~..~..~.. ................... 10. Date of Purchase ............./....~...,~./.. ........................... Nome of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ................................................... ,/..' ............................................... 12. Does proposed construction vlo~at.,e,any~ zoning law, ordinance or regulation? ..... .~x~..~ ......................................... 13. Name of Owner of premises~/,,~....~.~=.Address,z~ . ,~,~7,~..~,~,.....~..:.~... Phone No Name of Architect ....... ,~,~- ~,~"~"~ ............................................ ~7 Address ...................................... ~ z,,~ ,'~.~ ~/~[ ..... Phone No ..................... Name of Contractor .jx6~x...~.~~ ........ Address ,,./..../..~,~.~'..../'...'...~')~X/.4~..~..~'-lShon, No..~......~T...~ ......... PLOT DIAGRAM /'~~ ~J~ / '~ ~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indical-e whether interior or corner lot. STATE OF NEW YORK, COUNTY QF .............................. ~ ' .......... ~.,~..;... ,.,,~., ,~~ ................. being duly sworn, deposes and says that he is the applicant above named. He is the ...... : ......... ~ .............................................. ~; ....................................................... (~ntmctor, agar, co~omte officer, ~c.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~e ~d file this application; that oil statements contained in this o~licotion ore tree to the ~ of his ~l~ge and ~lief; and tha~ the work will be performed in the manner ~t fo~h in the opplicoti~ fil~ ~ith. Swam to ~fore me ~is day of 19 Nota~ Public, . ........................................................... Coun~ ~ (Signa~re of appli~nt) SU/L DEnS L£FT- ,~/L/E ELEY/770/V ELEFXTIOh' 7l .S/DE EL E?A T/O/V ,S £C,T/O N ~R ~t PORC~ /PORCH 1 / FLOOR GcAL~ - PLA M -} t?O M/ R F IIL DERS UNEXC,~ V,4 ERRTAt ,c'/zL /~ FO UA/DA TI ON' PLA N