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Home My WebLink About6368-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerli[icate O[ Occupancy THIS CERTIFIES that the building located at W.~5.'. ~t.°.r.~P~q..L§~ue .......... Street Map No. xx Block No. ~x .Lot No. xx Southold N.Y, conforms substantially to the Application for Building Permit heretofore fried in this office dated ............... ~b. ~.~,~19 .~3. pursuant to which Building Permit No...636.8Z dated ........ F~.b .....~1~ ...., 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 ?r!.~a..t.e. .o.n. 9. ~m..i.l.y..d¥.e.~l..i~..g ....................................... The certificate is issued to . .L..o.u.i.q. i-?..a} .u?.~.i. ....... ~:~;9.r. ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval NQ¥..1.2. ~ ~1.73.. b.Y. :R....~:~.l.a ....... UNDERWRITERS CERTIFICATE No... ~:..t.99~?~ ...... g..u~..y... 2..~.9.7~ ............ HOUSE NUMBER ...~...2.~.~ ...... Street ...H.q.r~.o.n.. ~.'gP.? .......................... FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES ~JNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 6368 Z Permission is hereby granted to: ~..o...~...~..~l ..................................... : .............. ......... 459t .....t~t.t~hi-tma~..Rct .......... : ............. ............ ~.e. 1.v..i..z...z..e.. .................................. i ............. to ]~.u~.ld.. JGe~ ,..or~e... famzL1M...d,~e ~Z ~u~. ............................... ~ ..................................................... at premises located at ......~../..3....~.{..O.~..t..O.~l....~j~.e.. ................................................................................... Bouthold I~,Y · pursuont to application dated ........................?.,0..~.. .......... ~.~ ......... Building Inspector. 19..~.~..., and approved by the THE NEW YORK BOARD OF FIRE UNDERWRITERS 8[~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NEW YORK, NEW YORK 10038 ,,-.,,.,. 2..7 .pl,.th...,,o. on,,,. 6',7,..- N 100440 THIS CER'rlFIES THAT O~y the e~trJc~ equipment as described beJo~ and introduced by the applicant named on the abo~e application number in the premises of Lou~s ~amunnl, w/s~de Horton Lane, 2000' n/o Old North Rd. ,nth ' ' $°~thpldRc~I'.. ~., ~A2nd Fi. outside e$o~owmgmcat,on; yJ~asement T- 1st FI.' Section Block Lot ~o~ .~a.~i,~d o. Ju ne 2 R, 19 ? 3 and fo..d to be in compliance ~vith the requirements of this Board. RANGES SPECIAL REC'PT. i ERVICE DISCONNECT NO. O S E R V I METEI ~- ~- ~P~ E~UI[' NO. O~ .,-LEG ,~w ~:~w ~:~w 3~',~w .o o~.~c.c~,co,o. *.w.o. OF CC. COND. X 3 5 Omcm "Sorviee disconnect: 1-!OOamps., 1-200amps. CB ~]lee.~oom hcater: ~-2.0kw, 5-1.Ekw, 9-1.25kw, 3-1.Okw, 1- 10 amp, f'~r~pactor COOKING DECKS OVENS I DISH WASHERS K, W. I AMT. K.W, , MT. K.W. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTU~T ....,~. ,R..,.~ .So:So','JET ¢ A. W. G, NO. OF NEUTRALS OF HI-LEG 3-. 75kw EXHAUST FANS DIMMERS 250mom ..... Ruland, Mat;titu~k, L.i. Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO, 6 TOWN OF SOUTHOLD Building Depmtment Town CJerks Office Southold, N. Y, 11971 APFLICATION FOR CERTIFICATE OF OCCUPANCY ! nstruc~rlons A. This application must be filled in typewriter OR ink, and submitted in tripllcote to the Building inspector with the following; for new buildings or new use,: 1. Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. :2.. Final approval of Health Dept. of water supply and sewerage disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters, 4. Commercial buildings, Industrial buildings, Multiple ReJ~idenees 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 fines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, o~:cupancy and condition of buildings. 3. Dote of any housing code or safety inspection of buildln~s or premises, or other pertinent in- formation required to prepare o 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 : Dote ............................................. New Building......,.,.,.,.,.,,,,u// Old or Pre-existing Building ................ ~ ........... Vacant Land ............................ Location Of Property ......... ~...... ,~,,,...-,~./,..~.~.. ....... .~',.,~.,,~ ...... ~e. ....... ~ ........ ...~..,~.,~,.. Owner Or O ners Of ,,operty ' -- ........ '" .................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. ermit Dote Of ermi, ........ Health Dept. Approvo~ ........ .'~ ........................... labor Dept. ,~pprovol ................................................ Underwriters Approval ...... .~......'~'. ..................... Approval .~ ............................ Request For Temp,~C~-Oz//CertificateU ........................................ Final :!Certificate ......... ~: ......................... Fee Submitted $ .,~.,..~ ...................... Construction on above described building and,perm, m.m.m.m.m.m.m.m~neets all/~/8~cable codes and regulations. Applicant ...................... ~.:~../L.~ ........ ..~..,,../c'.~/...~.,:.~/...~.:i.C........~..._~.....~.~: .......................... Sworn to before me this ................ day of ............................................ (stomp or seal) Notary Public .................................... County FORM NO. a TOWN OF $OUTHOLD Building Del~tment Town Clerkl 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 us~: 1. Final survey of property with accurate location of all bjuildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewedage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Re~sidences 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-existing" land uses: 1. Accurate survey of property showing all property lines, s~reets, 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 buildinc~s or premises, or other pertinent 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 ............................ Loco,,on of Property ....... Owner Or Owners Of Proper~y ..~..x ................. m .................i .............. ~"'""' ................ ~ .... Subdivision ................................................................ Lot No .......... :.. Block No ............. House No ............. Permit No...(....'~.....~....~...?Date Of Permit ....~..~../....~.Z.?.-}Applicant .~....~..?~.....~...~.....HJ....//.....~.....1,J.. j.'. ......... Health Dept. Approval ........ y(~..~..../././../..~../....~......Labor Dept. ,~pprova, ................................................ Underwriters Approval ...... ..~.....~.....&....?.Z.~...-..~../ ....... Planning Boald Approval ...... ~...~.. ..................... Request For Temporary.,Certificate ........................................ Final Certificate ......~../..; .......................... Fee Submitted $ ..~.. ............................. g and~m ts~ Construction on above described buildin it mee plicoble codes and regulations. App,,cant ........... ................................................... (stamp or seal) Sworn to before me this . ................ ooy aT ........................................ Notary Public .................................... County H!.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SiEWAGE DISPOSAL SYSTEM i. Applicant ~£~,f~ ~Ff7~'~/ Phone ~'~WF 5. Subdiv. Address ~f ' f~ &~/"~,[,~), ~-~ ,~. Section 2. Property' loc~tion &/~ ~.~ ~'~>~. ~ ..... ~7. Lot No, ~~ .......... , '~- '8. Private well w er] 3. Public Water~C'om~any name ~ Distance to main 4. Lot size: Width%~ feet Length ~ ~ feet ~(Enter on center plot below) 10. Sewage Dispos~y~tem: ~' ' ~u A. f~00/gallon septic tank: Precast~ ivalent Block B ~ching pools: Number ~ Precas~ ~3Block Special If private well fill in blanks below: Tank capacity~Gals. Pump G~.M. Total well de~th__ Depth to G.W./ Amount of water in Test H~o Data ~ ~eet ~r~ 0 2 4 6 8 Y2 14 16 The undersigned CERTIFIES: "Construction o~ authorized installations, will be in accordanc, e with the Suffolk County Department of Health's current stand- ards 'thereto." FOR HEALTH DEPARTMENT uSE ONLY. Based on th'e'inf~rmation~ presented herewith, it is the opinion of the Health Department, that aniadequate and satisfactory Sewage Disposal System can be i'ns,t~iled on this plot. Signed ~ ~,_ ~ ~ ~ Date 7~//~--/~ p _ .~ ~ .... .~. -~ S-15 Revised 4/]/7Z ~ TOWN OF ~OUTHOLD ~H~D, N. Y. ~ ~,~ ...... ~....L.~ .............. , ]OZ. ~,,c~.C .......... ' . ,, ,( ~, . ~ ~ ~ / ~¥'~" , D,~ ~ a c ' ' ~ " ................................ ~'~i~i~ ......... ~.,~'~ APPLIGATI~ FOR BUILDING ~IT ;, ' ................... · . Thi~ l~i~ti~ mu~ ~ ~m~l~ fill~ in b~ W~rit~r or in b. ~ot ~l~n ~ho~in~ Iomtion of lot ~nd of ~ildin~ on ~r~ml*~, r~l~tion~hi~ to ~. T~ ~k ~r~ ~ thi~ ~li~tion ~ not ~ communed ~fom i~*u~n~ of 8uildin~ ~rmit. d. H~ *~o~l of thi~ ~l~tion, t~ ~uildin~ In*~tor ~ill i~u~ ~ th~ ~mi~ ~il~ for in*~i~ throughout th~ ~o~. ' ~ ~. ~o ~i~ ~11 ~ ~u~i~ or u~d in ~hol~ or in ~ for ~n~ ~ur~ ~h~t~r until ~ ~Ll~TIOffi 18 Hfi~8~ ~D~ to th~ 8uildin~ ~nt for t~ - ~.~rln~ of t~ To~n o~ ~uthold, ~ ~unt~, ~ ~o~r ~1~, ora~n~n~l, budding ~, housing ~, ~nd regulations, and to ~m~t ~,~onzed ~m~ors on~* a~ in ~i~ for ~W in~i~ ................................................................ ~.~.~ .................................................................................................................... ~ ~ ~ o~ ~ ....... .~ ...... ~..~ ....... ~..~.~.~.i ................................................................................... If ~li~nt is, corporate, si~a~m of duly ~orized offi~r. Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ................................. ' ~,~1 ~ /-~,~c/~ "~'~',~ -;'5'_.~ ~//~ ~rt ~ Other Trade's License No .................................................. ,~ ~,,_ ~ ~.~ !~ Location of and on wh ch proposed work will be done MaD No . Street and Number ...... ...,~....~ r- ..."~.....~......1~.. ......... ..~-..~:~ ~ .?-;.. .... ~ /- 4' State existing use and occupancy of premises and intended use and occupancy of proposed construction: ia. Existing use end occupancy .~...~..C,~4..~.~.......~L.~..~.~. b. Inte, lded use and occupancy ...... ...... ~..~..~.....~ ...... :~'~ .................... ............................................................................... ~ ................... , ............................................... /,-~..::.~ ~- .- . 3~ Nature of work (check which apl~licable): New Building ........... Addition ............ ; ........ Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) ;, 4, Estimamd Cost .............. Fee ........... ', ........................................................................ ................................. (to be paid on filing this application) ~ 5, If d~lling, number of d~lling uni~ ................. Numar of dwelling units on e~h floor ......................................... ~ If ~ra~, numar of cars .....~. ................................................................................................................................ ~ commercial mixed o~u~n~, sp~ify nature and extent of e~h Wpe of u~ ..................................... 6. If bus ne~. or g 7. Dimensions of exi~ing ~ruc~r~, if any: Front ..................... Rear ........................... Depth ................................... Height ........................................................... Numar of Stories ............................................................................. Dimensions of ~me structure with alterations or additions: Front .......................... Rear ......................................... Depth ......................................... He ght ......................................... Numar of Stories ........................................ 8. Dimensions of entire new con~ruction: Front ...~,~ ............. Rear ..... ~..~. .............. Depth ....~..~ ................... Rmaht ......................... --,..-~., ......... Numar of Stories ...~...~..~....[ ............................................................. ;~9. Size of lot: Front ...... ~ .................. Rear ........ 3'~"~ .................... Depth ..~ ............... ~ ............................ . . _ ~ . ~.~.~ ~ ......... of ,urch=, ...... .......... ,,m, of Forme, ...... ........ ..... 10. Date 11. Zone or u~ di~rict in which premiss am situat~ ................................................../ ~.~ .......................................... 12. ' D~s ~ropo~d con,ruction wolate any zomng law, ord~nan~ or m~lat~on: ...,.....~.~ .................. ~ ............... 13. Will lot ~ m~aded ............. ~.i_.....~.~.~ ~ill ~ fill ~ mmo~d from premiss..2..r[ ] Yes ~ No, .,me of O er of ........... ........ ....... ........ 14.Addre~) ~ ~ ~ ~ ~P~one No.) Name of Arch,t~t ...................................................................................................................... (Addre~) i~"~'~'~ Name of ~ntra~or ................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Lo~te clearly and di~inctly all building, whether exi~ing or propomd, and indicate all ~t-back dimensions fmm~... pro~rW lin~. Give ~met and b ~k number or. description ~cording to deed, and show ~r~t names and indicate wheedle. er interior or corner lot. STATE OF NEW YORj~ J,~ /J ~/ ) c~ ' COUNTY OF ~~ ........ ) '~' ................... ~..~.~ .~../.~.~ ....... (.p/.~,..../~../......~....,.,..~....~..~ ....... being duly sworn, deposes and says that he isthe applicant above named (Name o£ individu~ sig~ing 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 and to make and file this application; that all statements contained in this application are t[ue to the best of his knowledge and be ief; apd that the work will be performed in the manner set forth in the application filed therewith. TERRI LEE EtAK .~ ~ · ..... t ~"~ da of ..~...~ gGTARY pUBLIC, S,~T~ .ow York /./ "' ............ :...~ .......... ~ ,~e:e.~ ..................... ~ ...... v. .,... ~.~,,,,o~',. ?,:'~"~'~,- ~ "*,. ~' '~ (~ {"', '~J~emmiss,~n. Expires IVlarch 30~r~"r~,~.~ Notary Public, ~....'w%~.....~-...~..... County ~"~.....~....~......~:....;.. ..................................... (Signature of applicant}. U d .2~ ~- /cD" __ 0~¢. A" 0 L/ /,./ ,D A w / 0 ,~ A A/ -,.4 n /2"'°fa -I. 12 '-$// 8 :[ /q: P', LIF//jC. ~'OCDh4 '00,44 A APPROVED Ao ~'--- r I [2/.011 i~ ;/cD/'' _~_ l ~ lO "q S ~ C O ,aJ D m L O O IP M £.,4 tJ i! '1 '0" t t ,DZ./AM ! i, I' 5";C 7/O,'V F-F ,'2