The URL can be used to link to this page

Home My WebLink About6400-zNO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~. ~. ~.~. ~.~.~ ...... Sffeet Map No..~7.5.~ .... Block No ..... T ..... Lot No, I O confor~ substantially to the Application for Building Permit heretofore ffl~ in ~s office dated .......... ~ ~.~ .... ~.~., 19~.~. p~suant to which Bufld~g Pemit No. dated .......... ~.~ ~....~.~.., 19.~, was issued, ~d co~orms to ~ of the req~ ments of the applicable pro~sions of the law. The occup~cy for wMch tMs ce~ificate (owner, of the aforesaid b~lding. HOUSE NUMBER ~ ~ ~ Street D~P~ v ~ ~ ~T ~o.~ ~ ~oo~ ~EE N ~o Bffilding Inspector FOBM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT No. 6~100 Z PermissiOn is hereby granted to: · ....~.~..~.....~.~...k.?......-.....~.~. ...................... /0~7' ~.~.,~ ~/', ........ ~u....'...~..~.~....r..~..~...~.,... ~-,/, ~. ~~ ~- . ~£ .:' "iii~ .... ....... .(. ~.,.@,.~..~). ........................... ~t ~,~ ,~a~ at ~" ';'~) ' ~--~ jj~ ~ '~' ~"Z ....................................... p ............................................... ~ ................ ff~.~..~.......~....[ ...................................... Building Inspector. FO~ NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, hi. 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: I. 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 // ..... New B~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... .~....~...,~',. ........... .0...~....~...'~...,~..,¥. ........ .¥...~..~.T.......,,,T'~,.O...~....j~... ........ ..~...O..,0..,,~:~. ................... Owner Or Owners Of Property ...... ~.~..~...~. ........ ,~'..h.,,/-:-.,.L/....i~.....-~.....~... ............................................................. Subdivision ......................................... .~..'~ .................. Lot No ............. Block No ............. House No..~....~...~..... Permit No.....~....~...~..0..,..~-~. Date Of Permit .~./.!..2:l..7..~....Applicant ......... .?......./~.../~...../...?..../~.....~..._~... .................... Health Dept. Approval .'../:.'./.~.?.....~...~..~....!.~.O...~...Labor Dept. Approval ....... ;. Underwriters Approval ...~....{..~....&.~.~..~... .................... Planning Board Approval .4/: ~ Request For Temporary Certificate ........................................ Final Certificate ............ ~ ....................... Fee Submitted $ .................................... Construction on above described building ~t m~ a,L~. Ii:able codes and regulations. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seol) '/,,/7(o '~-- -,9~ Y ~--'~z -| BUILDING DEP*R?MENT ~//,,~G/C~ .~'~-~I ..... ....... . . ............... . ~ ~*'...~....;:..~; ........... ~.~ ............ ~ ~...~.. ~1 ~O...~ ................................. ~ ~ IC~. ~/ .......................... ............ ~.~.~,.~ ~(~ .............................. APPLICATI~ ~R BUILDING PE~T at, ............ ........... ..... o. ~is o~lic~i~ must be completely fill~ in by ~writer or in ink and s~mitt~ in ~li~te ~ t~ Bull Ins~or. b. PI~ plan ~ing I~ation of lot and of ~uildi~s ~ ~emi~s, reiations~ip to odjoinlng premiss or ~, ~ givi~ o d~oil~ deKripti~ of layout ofpr~ must ~ drown ~ the d~ wh ch is c. ~ wk c~er~ by ~ o~licati~ may ~ ~ c~meK~ before iSSuQKe Of Buildi~ d. U~ opp~ol of this application, ~e Building Ins~r will issue o Building Pe~ t ~ shall ~ ~t on ~e premis~ ~ilable ~r in~ti~ ~t the p~ of the work. ' ...... e. ~o ~ildi~ ~oll ~ ~cupi~ or ~ in whole or in pa~ for any pu~e ~mever until o ~if~e shall h~e ~ gmn~ by the Building In~Ktor. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building, Permit ~ to Building Zone Ordinance of the Town of Southold, Suffolk Cobnty, New York, and other appl cable Regulations, for the construction of buildings, additions or alterations, or for removal or demoliti°n. os The applicant agrees to comply with oll applicable lows, ordinances, building code, housing code, an~l ~u~, ....... ~atu;;';~"~'~¢ii~;;';~"~;;";~";"~;~;i~,'~ ..... . Z./ ~ ./~.,.,~.~.:.~'?~/~.~..,.,......j~ ........... )..~ ...... · ~ : ..... ~ ()~4::lresS Of oppllcont) State whether applicant is ~n~essee, ogeat, architect, engineer, general contractor, electrician, plumber or builder. .... ~.~..~..,~. ............................................. : ...... If applicant is o corporate,'signature of duly authorized officer. ..~/. ~) ~-- ~ ' .................. ......... '7- 1.Location of land on which I~roposed work will be done. Map No.: ...~....."~..~..~, ............... Lot No.../.C Sh'eet and Number ~.~r..~..~.~.....~.,.~..~.,...~.l~) .............. ,.~ ......... 2. State existing use and occupancy of pre '~ntended us~ and occupancy of proposed construct a. Exisiting use and occupancy ~.,~i~, b. Intended use and occupancy .. .~....~....~j~...~ ...................................................................................... 3. Nature of (check which applicable): ..... ........... '~:Jclition Alteration RePair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cnst ...... ~..~...~...;.'-- - .................... Fee ..;.~..~..'...~ ....................................................................... (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 ...........JV~....~/~..I'~.c~ ....................................... ~, .............................................................. 6. If business, commercial or mixed occupancy, specify nature and ~xtentlof 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 ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............. ~'4~. ......... Rear ..../.~.~.~ ............. ~.... Depth -~-/~'~ ~- 10. Date of Purchase .~g..~....:...~'...../.~....(?..~.. ................... Name of Former Owner ~...C,~..~...~/~.~'.T.~ ....... ~ ........ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does prOPosed construction violate any zoning law, ordinance or regulation? ............................................................ . 13. Name of Owner of premises'-/.~,...~Lg...~....,*r~... ......... Address4f..z......~:....Z.?~...-?J'.. .................... Phone NO.~.~r....,,~..'..~.~).7~ Name of Architect ........... ~ .......................................... Address ............................................ Phone No .................... '. Name of Contractor .................................................... Address ............................................ Phone No ..................... V.Z ,?, ~5'1 ec.- PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property li~ive street and block number or description according to deed, and show street names arid indicate whethe~ comer lot. \. ! STATE OF NEW~'OJ~,. ~ ~ ¢ ¢ COUNTY OF .~....'t:~......./:.~'"'~ · ....................... ~~....,~ ............................ (Name of individual signing app ication) 'a~ve nom~. He is the .................... ; ......... ~~ .................. ~ ................................................................. ; ........... (Contractor, agent, co~orote officer, mc.) of ~id ~ner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contoin~ in this application am true to the best of his knowledge and belief; and ~at, t~rk will ~ ~rformed in the manner ~t fo~h in the applicat~filed ther~Eh. Swam to ~fom me this ~ .................. ................... ..... ................. TERRI LEE ~ pUBLIB, S~n~e of ~w ~ilJlied in Su~10iR County ~sJ0n [xpires Mnrch ~, ~.~ THE NEW yORK BOARD OF FIRE UNDERWRITERS S'W' BUREAU OF ELECTRIC'iTY, ~. , ~ 85 JOHN STREET, NEW YORK, NEW yoRK 10038 ,,a,."7" N 46835 THI~ ~E~IFIE~ THAT only t~ e~t~ equi~ot ~ ~c~b~ ~ a~ ~t~uc~ ~y t~ ~i~ ~)~ th~ ~plica~ion ~um~r in t~ prem~s of Outnl~e lO i. the ~ollawln~ location; w~ examined orr FIXTURE OUTLETS ZECEPTACLES SWITCHES FIXTURES FLUORESCENT 26 28 r~ [] 2nd Fi. Section Block Lot and found to be in compliance tvith the requirements of this Board. RANGES ovENs DISH WASHERS EXHAUST FANS DRYERS TIME CLOCKS SYSTEMS NO, OF F~ET 0 APPARATUS: 1-1/Shp, 1-1/2hp E R V I C NO. OF CC. COND, A.W.G. NO. OF HI-LEG NO. OFNEU?RAL,S A.W.G. F~R ~' OF CC. COND. OF NEUTRAL ] 1/e 1 1/O ~.nthony Harris ¥,o~ey ;*,Vf', Calvertor~, Uew York l!q~3 GINERAL MANAGER Per_ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.DoReference ~o--~-/~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date 1-Applican~t~ ~ao~ ~AL~)~_~ Ph~e~ ~7~ 6-Sub divOT Address/o~ ~ ~ ~ ~#~f~ ~;~, A.~., .~J.~ 7-Section~ 2-Detailed property location /o O~* ~d~ ~'~ ~ 8-~t No. ~mlet ~ ~O nT~W~b Z.~. ~/~9-Private well? 3-~blic ~ter supply ~me~ ~./ Distance to nearest ~ino~ S-Lot Size: Width~ L~t~'~ft. (also enter on ~enter plot plan below:) ll-Septic ~ inside ~ions. Vol~co Gals.Length~ft. Width ~f~. Liquid depth ~ ft. 12-~ecast sections: ~Number~Squa~ Ft. Cess~ols: Block sizeL xncs.D ~s.H ins. Total blocks below inlet: ~1 ~2 Data ~eet 0 2 6 8 10 12 18 ~o~ ~ ~ ~ Indi e ~ ~ No'th The U~ersigned CE~S: "Const~ction of authorized installations ~11 be in acco~ance with the Suffolk Coun~ H~lth De~rtments' current Sta~a~s, ~lletins, a~ amendments thereto, covering Private Se~is~sal~Fstems". · - ' '.Owner - or ~ilder FOR ~A~H ~NT USE ON~. ~sed on ~e info~ation presented here~th, it is the opinion of the Health De~ment, that an adequate a~ satis~cto~ Se~ge Dis~sal System can be installed on this ~ot. (10/65 Revis.) S-15 <: ,/ ' I / / / / / <~rem~mrf, t4. Y. I977