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Home My WebLink About6423-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~.5~+(f+ ...... Date .......... Auga~mt;. 27.r ..... , 1973.. THIS CERTIFIES that the building located at . gc~m~lv.i.aw./~v.e ........... Street Map No...XX ........ Block No ..... ~ .... Lot Nol(XX..l~c~lk~.h.e.!..6 .................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Y[a2eh. iL6,., 19.~.2. pursuant to which Building Permit No....6~..2..~.Z. dated ......... Ma=eh. 21,..., 19.79., 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 .. F'~i-¢~te ~me..f.a~.~il.y- ch~olling ...................................... The certificate is issued to ...A,N,. 3t;aillm*y. er ................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... Al~ttSi;..21fl. 1973 ............... UNDERWRITERS CERTIFICATE No..¥. 1.0.7.~.83...D..~.~d...A..U~..s.~..8.~..1.9.7.3 ....... HOUSE NUMBER .... l~L~0~ .... Street ...~O,J~.cl.v.~, .ay..A.V..e: ....................... ............................................ .......................... Building Inspector [ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEF.4RTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6423 Z Date ..................... ~t~¢~ ....... 2.$ ........... 19~.~... Permission is hereby granted to: ........ 8puf, hoJ.ct .................................................... to ~..~...~...~e.~....o. ~.....t.~. ~... ~ .-..e.~..z..~ ..................................................................................... at premises located ct 1~./8 .~.O..~...d..~..V.~e.~.~.~..A~.v..q~.&.~/~.~.~.E.~.~.~.~.~.~.e.~.~..D..~.~ ............... ................. ..S..o..u...t..h...o..l..d.. ......... ~,~... ....... pursuant to application dated ........................... ~,~L~. ............ .~...., 19.~/..~.., and approved by the Building Inspector. Fee $..!...0~)...t..2...O. ........ r Building Inspec~r ~O~M NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office SouthoJd, 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 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 tppographJc 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 $I.00 $5.00 Date .~..~...~,,..,, ,~.., .~.~...~. ~.~2~ .............. New Building ..... . ..~.... ....... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .~.....~..~.....~......~.e~.. ........'..~:./e../2../.~.......~/ ......... ~., .......................................... Owner Or Owners Of Property ....~I.,~...,,,~.T..e....~...L./~I~...~...~..t~ .................................................................... Subdivision ............... ~ ......................................... Lot No...' .~... ..... Block No. ~ ....... House No ............. Permit No. ~../3~,~..~... Dote Of Permit .~.....~...~...~..I, rr/.~'Applicant .~"q..~....~..f~.~..~,.-S....l~:Tl.~..~..t~..~'^ ............. Health Dept. Approval ~ ..................... ~. ....... Labor Dept. Approval .................~......~.. .................... Underwriters Approval .~.~.~;,....Sr..../-.~..~..,~ ........... Planning Board Approval ........ ..~..:....~... .................... Request For Temporary Certificate ........................................ Final Certificate .. ,~.. ................................... Fee Submitted $ ............ ¢..e. .................... Construction on above described building .and,permit meets all applicable codes and regulations. App,icant. ~..~..~....: ......................................... Sworn to before me this ~'~ ~,~ ....... .~...~. day of ...~......~ ....... L.~...'7...?~... (stamp or seal) ~-~7_,.,~'~0 Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS ~l: BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038, THIS CERTIFIES THAT only the eicetr~ equipment as described below and introduced by the applicant named on the above application number in the premises of A.,~. :~tollmeyer, Soundview Ave., 1/4 mi.w/o i,-'orton}s Lane, Southold,~.I. in thefollotving location; ~ Bosement ~ 1st FI. [] 2nd FI. OLit E id(~, Section Block Lot was examined on .~ ~[~ [~'~ t ~ ~ ! 9 ~ ~ andfound to be in compliance with the requirements of this Board. FIXTURE ilECEPTA LEI I FIXTURES DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS AMT. K.W. OIL H.P, GAS H.P. A~T. NO, A.W. G, RANGES iPECIAL REC'PT COOKING DECKS OVENS DISH WASHERS AMT. K.W. / A~T. K.W. U~AT. K, W, TiMECLOCKS BELLIUNIT HEATERSUNIT HEATERS MULTI'OUT~I:T SERVICE DISCONNECT NO. OF S ~' 20,0 C[~ MRTRR. X ~ ~". ~"~ mu,P ,~w ,.~w ~w ~..w .o.o, cc. co.~. PER ~ l OTHER APPARATUS: R V I C OF CC. COND. 750mom EXHAUST FANS DIMMERS A~T. WATTS NO* OF NEUTRAL~ A.W.G. OF NEUTRAL 1 5OOz~mm Water heater: 1-4. ~%tor/s: 1-1/2hp E[ec.room heaters: 1-2.Skw, 3-i .O~:w, 3- · 751~'~ Charles M. Ha!l, ~ox 417 Southold, L.!. 11971 / Per_ D ~ P~I. MANAOL~R COPY FOR BUILDING DEPARTMENT. THIS COPY OF ~;Ea. flCATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.p. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Applicant ~g~ ~)m~A ~;~ ~. hone~. Subdiv. Address ~ ~,~ ~. A.~7~O 6. Section Property location~f~ ~. ~,~,~ ,~ ~/~ C~,/~, z~.,f~ :~7. Lot No. 8. Private well /j~ Village ~ ~ ~,~) Township ~,~,~O 9. Public water ~ Public Water Company name ~ .~ ~. Distance to main Lot size: Width.i.' feet Length ~' feet (Enter on center' plot Sewage Disposal.' . / / A. ~0O/gallon septic tank: Precast-'- E~uivalent ~'Block B. ~aching po~ls: Number ~--~recast/~Block Special below) If private well fill in blanks below: Tank capacity'/~ Gale. Pump G.P.M. ~ Total well depth Depth to G.W. Amount of water in well Test Role Data Feet 6 12 ,~ ~ 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." ~' Owner or' Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Mealth Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date ~/~ Signed ~.__ ~ -- S-15 .,:,, Revised 4/1/72 TOWN OF ~OUTHOLD BUILDING DEPARTMENT .... ~-~ TOWN CLERK'S OFFICE~../~'.~ ~_~~ F_~/~ ~ ~ Exomin~ ....... .~'.~. ...... , 19.~. ' Applicoti~ No....~..~.......~.....~ ........ ~ ~r~ed .................... ~. ................. , 19.~. .... Pemit No ..... ~...~..~..~...~... '~~~ ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which is part of this application. 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 one_ the premises available for inspection throughout 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 HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone~' Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction o(~ buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all Nl~licable laws. ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ~ ,~ ~ (Address of applicant) State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. .................................... , ......................... ..-. ................................................. .......................... Name of owner of premises .......................................................................................... If,app~cant is a corporate, signature of duly authorized officer. (Name~nd title of ~rporate officer) Location of land.on which p~opo~l.~, work will be done. Map No.: ~s~' ........................................... Lot No ............. Street and ~lumber ~/)~/`~(~2-¥~J~-e~?~-~`~-~?~&~/~~/£~~ ....... ~.~..~.~...~.. ....... .: ~ :/~* -7~ ..' .' Municipality State existing use ~a~d O~Ul~nc~f premises and intended use and occupancy of proposed construction: a. Existing use and oecuPanc~ .,.~ .............................................................................................................................. b. Intended use and c~cupaney .;.~.,~...~.....~'.~.~...'..~...~....~.~.~.~..L..t..~..G ....................................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration...~...,;~...., Repair ............. . ............ Removal ..........,...,,, ...... Deml;~tion ..,~ .................... Other Work .................................... o ~ ~;i;i';, Fee ..,...r~/.~.....:.,~ *~ ~ IDescription) 4. E~ima~d ~ ....~...~.~ ........................ ...... , ........................................................................ (to ~ Paid on filing this application) 5. If d~lling, numar of d~lling uni~ ....~ .......... Numar of d~lling uni~ on each flor ...~=,~.~.~.~..~.. If ~r~, numar of cars ...~ ......................... ~ ................................. '. . 6. If busine~, commercial or mix~ ~cupancy, s~ify nature and e~ent of e~h Wpe of um ..................................... 7. Dimensions of exi~ing ~ruc~r~, if any: Front ..................... Rear ........................... Depth ................................... Height ........................................................... Numar of Stories ............................................................................. Dimensions of ~me ~ruc~re with al~rations or additions: Front .......................... Rear ......................................... Depth ............................................. He ght ............................... ';. ........ Numar of Stories ........................................ 8. Dimensions of entire new con~ction: Fret ..... ~.~. .............. Rear ..... ~.~ ............... Depth ..~ ......................... H~iflht ....................... ~ .......................... ~um~r of Stori~ ...... ~ ................................................................................ 9. Size of lot: Front ...... ~.~. ................... Rear ..... ~ .......................... Depth ...~.~..~ ................................. 10. Date of Purcha~ ..., ........ , ......... : .............. Name of Former Owner ............................................................................ 11. Zone or u~ di~rict in Which premiss are situated ......................................................................................... : ........... 12. D~s propo~d con,ruction violate any zoning law, ordinance or m~lation: ....~.~.: ................................. : ............. 13. Willlot~re~aded .......... . ......................... Willex~fill~mmo~frompremi~s: [ ] Yes ~ No 14. Name of Owner of premiss ...~...~.,....~,.~.~.~ ...................................................................... ~ .............. (Address) (Phone No.) Name of Archi~t .............. ~.~.~Q~.....~v.~.~......I.~ ...... ~.~5.~.~..~v.~O......~.~..~=~.~.~ ....... --~ ~ ~ (Address) ~ ~ ~ ~ (Phone No.) Name of ~ntra~or ................................................................................................................................................... (Addre~) (Phone No.) PLOT DIAGRAM L~am clearly and di~inctly all building, whether exi~ing or propo~d, and indicate all ~t~k dimensions from pro~ IJn~. Give ~met and bilk numar or d~ription ~cording to d~d, and show ~reet names and indic~e whe~- er interior or corner lot. ~ ~h o, -- COUNTY OF ................. ~ ..................... , ............... ~~~~s~r~ de~s and ~ys th~ he is t~e appli~nt abo~ na~d, H ,,th ................................................... .......... .................................................................................................. - [~n~tor, ~t, co~mte offtcer, etc.) of said owner or owners, and is duly authorized to ~dorm or have ~or~d the ~id work a~ to ~ke and file this appli~fion; ~a~ all s~e~n~ contain~ in this a~pli~fion are tra· to ~ ~ of his knowl~ and ~l~f; a~ that the work will ~ ~dormed in the ~n~r ~t fo~h in the ap~i~tion filed therewith. JUDITH T. ~O~N ...................................... day OT ............................ . ................................ J APPROVED AS NOTED DATE: '~t~/~' ~L( l~' ?~ .. -- NOIIFY BUILDING DEPA~T~NT AT