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Home My WebLink About6395-zFOB~ NO. 4 TOWN OF SOUTHOLD BUIT.DING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.. '2563~ .... Date ......... l~ove~aber-.?! ...... , 19~.3 · THIS CERTIFIES that the building located at ...,Toc2.e~r. ~.eel~. ~.~:~y.e.... Street ~ No .... XX ......Block No .... X~, .... Lot No.. X~... ~ou.thc~l~1 ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........14~'ch. 3~ .... , 19.73. pursuant to which Building Permit No..6395~. dated ........P~ch..~/! ..... , 1973.., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ... P~.iva.te .one .family. dwelling .................................... The certificate is issued to .... Cheryl .Pagnozz£ ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~e;Pt,. 6.~.197~.. ~,..~1~ ...... UNDERWRITERS CERTIFICATE No..~..1.0.~.8..87. ................................. HOUSE NUMBER .... .1.~.0. ..... Street ...J. QC..k.ey..C..r.e.e.k...D.r.i.v..e .................. Southold ...... ......... FORM NO. I . . .~/.~.,~ ~ · ow. oF SO.T.OLO ~'n~/. ~~ ~ ~ ~ BUILDING ~PARTM~T~ ~ ~, _~~ TOWN C~RK'S OFFICE-- - ' ~. . ' ' ~ AppJicoti~ ~o ............~ .............. · Approved ~ 19 ........ Pemit No. Disapproved a/c ........................................................... ' / ,,~~ ~. //?~ P/~ o'/T ~,~--~-~ ............... /. ...... ~...~.....~......~...:~_.....~,,~ - · .... :..~. ....... .,...~...,~Z a. This ~i.tio. must ~ ~mpletely fille~ in by ~writer or in ink ~.k;.,;~.~ ;., b;~l;~l..u ~,~ ~uildi~ Im~or, wi~ 3 .ts of ~,ns, ~ur,~ plo~ plan to scale. Fee ~ording to sChedule. b. Plot ~ln s~ing I~tion ~ lot ~nd of ~ildin~ on premises, relationship to aUjoining p~mi.s or public lt~. or lre~s, ~ . giving ~ ~t~il~ ~rigtion of I~out of ~o~rty must k drawn on di~ram whiCh is pa~ of this .~i~ion. c. Tk wo~ ~r.d k this ~lic~tion ma~ not ~ com~n.~ kfore i.uan~ of Building Permit. ~ ~..U~n .~oval of this ~pli~tion. the 8uildkg Ins~tor will issue a Building ~ermit to tk appli~nt. ~ ~rmil ih~ll ~ k~t ~ the premi~ ~v~il~e for ins~ction throughout the work. e. ~o buildi~ ~11 ~ ~pi~ or u~ in whole or in p~rt for any put.se '~ ~ ~ ~ acc ~ whatever until ~ ~ifi~. of ~ ~,11 hiw ~ gr~n~ by tk 8uil~ing Ins~aor, APFLI~ATIO~ IS HERESY ~kDE to the ~uilding DePonent for tk issu~n~ of ~ Euilding Permit ~u~.~ ~ ~ ~uildi~ Z Or~m~ o~ tk Town of ~uthold. SuffOlk County, New Yo~, ~nd otkr a~li~ble L~ws, Or~in~n.s or ~1~, ~ ~ mnltru~i~ d . building, ~itiom or alterations, or for removal or demo~tion, as hereia de.rind. ~e appli~nt ~s to ~ ~ ~ ~li~e I~ ordinal, kil~ing ~, housing ~o~e, a~ regulations, ~n~ to admitauthorized ins~ctors on premi~ .n~ in ~ildi~ ~ in~ionl. ...... ................................................ ........... ...................... , .............................................................. ~. o~ ~., o~ ~,.~ ..... ~......~....~ ................................................................. If appli~~~~of ~th~iz, officer.~ ~ ~ . ..... ......... ..................... 1. Location of land on which~,..', ,~ ~ ~ -pr°p°sed work will b~dor~,. Map No.: ..................................................... Lot No ............. Street and Number ....~:~..~..~ ............ ~ ................................................ ~~. ........ MunicipiditR. 2. State existing use and occupancy of premises a~d intended use and occupancy Of proposed construction: ~/,~ a. Existing use and occupancy , ................ ~/.~ .............. . b. Intended use and occupancy ,,.[ ......... '; ............. ~~' ....................................................................... 3. N;ture of work (check which applicable): New Buildi .~ ........... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ..~ ................. Other Work .................................... : ~ ?' ee ~r /~ ..... (Description) 4. Estimated Cost ............................................... F ., ......................................................... (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 occupancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .?~.... Rear ' ~'.~ ~i 7, ........ Depth .~.....~:?...~,,?.~ ................ Height ....... ;. ..: ........ Number of Stories .....,..~-- ............................... Dimensions of same structure with alterations or additions: Front ......................... , Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ .~ · ' ........ ;.;~...., ........... Depth i~ ~;': 8. Dimensions of entire new construction' Front ~!...~ ................. Rear ....... r ............... Height ............ :~.~ .............................. Number of Stories ......... ~. ............................................................................. ~. Size of lot: Front .......... ~...~.'., ..................... Rear ......... ~;~...~. ....................... Depth .....,~.,.:~.,..~. .............................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ i 1. Zone or usa district in Which premises are situated ................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: '""l~"~ ................................................ 13.. Will lot be regraded ..... ~:_ ~., ........................ Will excess fill be removed frompremi.sa~: [ ] Yes~ .~[ ] No . ~ ~-~/ / ~<~ ' 14. Name of Owner of ' .......... ; · ........ premises ........................................................................ - ..................... o__*..*.*:..,., ..*~*,._' · (Address) Name of Architect ..................................................................................................................................................... ~' . ~. ; (Address) / Name of Contractor ........... , ....................................................................................................................................... (Address) ~ (Phone No.) PLOT DIAGRAM Eocate clearly and distinctly all 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 YORK, (~ / / ~ ~_ SS ...i ............ ;.....;.....; ................... :.i:......;; ............................................. being duly sworn, deposes and says that he is the applicant above named. (Name of ~ndividual signing contract) {Contractor, a~nt, corporate officer, etc.] of said owner or owners, end 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 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. FLAK JI(IT. MIY Pe~'t~-r~L~°~ NeNew Ymk ............. : .................. ..Y...de of ......... ............. .... Qualified in Sutf'~ik County -~C/ · " ~el~lissi0fl Expires [¥,a~ch .~u. 19 -' . ~,. ~ Notary Public ...................................................................... County ........................ TOWN OF SOUTHOLD BUILDING DEFARTMBHT 'TOWN CLERK'S OFFICE SOUTHOLD, N. Y. IUl~ ~IEMrT (THIS PERMIT MUST BE KEPT ON THE P~EMISES UNTIL FULl_ COMPLETION OF THE WORK AUTHORIZED) 6395 Z at pmmi~e$ located at ...~....,T.l~lr, e~..12zfee]g..Dl,&~/e~ ................................................................. ............................................ ~ ......... !.'~0 .............................................................................. pursuant: to application dated ....................'~.aZq3"tl ....... ~ ............. , lg.f~...., and approved by the Building In~ector. FORM NO, 6 TOWN OF SOUTHOLD Building Deportment Town Clerk~ Office $outhold, 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: 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ....~..~ ././...~.~. ......................... New Building ....... ~ ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..... "~"'~:..C....~..~.....~,.~/~4~..,~..'~"i?..~.~.!~.~4'.. ......... ,.~..~.?..~..;.~../...~../. ......................... Of Property ..//.4;.¢.~,).~.~....~.~.L?~.(......./..R.!.~,~..;~...~..~,Z. ........................................ Owner Or Owners Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ~..~.~.~.~... Date Of Perm't~Z.. .,2.~.Appl cant ............... ~ ........................................ Health Dept. Approval ...~..~....?../.~..Z.~. ................ Labor Dept. Approval ................................................ Underwriters Approval ..~..../.O~.~2~.,~. ................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......../... .............................. Fee Submitted $ .....~"....~....~.. .................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ............. ~.: ....................................... ..~.~..;..~...~.......~ ..:~. ~ ..~../~.. Sworn to before me this o, Notary Public .................................... County (stamp or seal) THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of ChePyl ?a~,nozz!R s/s Jockey Creek DP., 1000' w/o O~klawn Ave.R SoutholdR L.I. in the followlng location; [] Basement ~J~ 1st Ft. [] 2nd Fl. Section Block Lot was examined on A ll ~ US t ~ } ]~ ~ 7 ~ and found to be in eomptia,¢e with the requirements of this Board. FIXTURE RXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUC~E$CENT I? 15 DRYERS SYSTEMS OTHER APPARATUS: Water heater: t-~.Skw ~!otor/s: . 1-3/~hp },qlec.room heaters: 1-2.Skw, E R V I 3-2.0kw, 1-1.25k%~, 2-1.O~e#, C 1 1-. 75kw, 1-. 5kw W.Bo Ruland ~ !~tat t 1tuck, L.I. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATIO~ FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn const~ct said systems is requested, pertinent data herewith: Date H.D.Reference No ~-~ -/,~/~ 1-Applicant ~o~ /~//~-~ ~.-, /,,,~hone~-_Sub div Add,ss ~ ~ ~d ~ ? Section 2.~t1~~~ ~ ,.~, 8-~t No. ~et To~ ~ou~Mc~ 9-Private ~117 ~s~nce %o nearest ~in o 3-Public water supply name 4-Lot Size: Width t~°ft. L.e~n~th ~. (also enter on center plot plan below:) 5-Dwelling: Single Family~¢~Two Family? / /Cellar? ~._~Slab? / /Crawl Space? ~_~ lO-Proposed system: Septic tank / ~Prec~esspools ~ /Shallow pools ~_/Otber ~_/ Il-Septic tank inside d~ensions: Volume/;'~als. Length.__ft. Width' ft. Liquid. deptb__.ft. 12-Precast sections: ~Number~Squ~re~. Cesspools: Block sizeL__incs.D___ins. H ins. Total blocks below inlet: ~1 ~2 ~3 PLOT PLAN ~: ...:5- Ta~ Capacity Street The Undersigned CERTIF~S: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date /~F~ ~'- ~"-/ff~_. Signed -- ~-~/~' ~ ~, (/~ ~ .'~'::"~' ~ ..... /i ~. Owner -' or Builder FOR .HEALTH DEPART~NT 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_~~ ( o/65 a ,is.) Signed ?: 2he sewage disposal and ~zater supply facilities for this location have been inspected by this department and found Services DATE The Chieff oI AppP. OVED AS NOTED DATE:~ NOTIFY BUILDING DEPARTMENT 765-~-660 9AM TO 4PM FOR REQUI~- £D iNspECTIONS: ~ BEFORE BACKFILLING FouNDA- ~, i~ OR START FRAMING -¸i 4