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Home My WebLink About6692-zFOB.~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot[ice $outhold, N. Y. Certificate Of Occupancy No. Z568(~ ..... Date ............. Dee...~ ....... , 19..7.3 THIS CERTIFIES that the building located at ...Les.l. ie. Rd..&. lrsdia~ .Neg~t Map No..x.x~ ....... Block No..xx ....... Lot No.. xv... P. econic.. H.Yo .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... June...2~.., 19.?3. pursuant to which Building Permit No..669~z. dated ............ Jtuaee26..., 19.73, 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 . Priwate' 'o~' fami'~ y 'dwe'lling .... (approved 'by..Bal. Appeat~) ...... The certificate is issued to . .Thomas. & .Fel,~.ola. · .Ge~ge~ ....... .°wne~l ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... J)ec...%...1.973. · .by. ~, .ViLla UNDERWRITERS CERTIFICATE No... N..$30503 ....... Nowr. · 30 .. ~'9'7.3 ......... HOUSE NUMBER ...3~.~% ...... Street .... Lest.i-e. Roacl ......................... in c~r FOEM NO. ~ TOWN OF SOUTHOLD 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? 6692 Z Permission is hereby granted to: ....... P~v3&a~r,~..N,,~e~.....A~.....~o~..gei~e~, & WA£e .......... ~1~.....~, ..~v~..~-~, ........................ tO ..~: .~.~-._ ~-~...o~..,~...~e..,,,,.,~i~ ................................................................................... at premises located at ...... .W/~..Tru~ff o~ZL.~e~.k...L&,..&..~/.~..L~I~.~...P~ ................................... .............................. ?.~lm~. ......... ~.,;~., ............................................................................................. pursuant to application dated ............................... ~1;~,....~.~....., 19.....~.~ and approved by the Building Inspector. Fee $.. ~:1..~.~. ......... ! ~- Build~g Instpe~tor - ~L THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-- ~; 85 JOHN STREET, NEW YORK, NEW YORK 10038 THI~ CE~IFIES THAT only the e~t~l equipment ~ ~c~ be~ ~ int~uc~ ~y t~ ~plicmnt ~m~ on t~ a~ ~plicotion number in t~ premises of Geiger, n/w/cot. Leslies Hd., ~ Indian ~eck Lane, Peconic, L.I. in the followlng l~ation; ~ Basement ~ lst Fl. ~ 2nd FI. outside se~tlo, m~ ~t wasexamlnedon ~O~b~P ~ ~ andfoundtobelncomplla~ewiththerequlrementsofthisBoard. FIXTURE LE EPTA L I I EXTURES I DRYERs FURNACE MOTORS FUTURE APPLIANCE FEEDERS SERVICE DISCONNECT j NO. OF METER 1 ~ 00 CB S RANGES 1 12. ;PECiAL REC'PT 1 R r=j!.G ,w,I ,0VE"L IDTwAs ,f,S TIMECLOCKS BELLi~UNIT HEATERS MULTI-OUTLETsYsTEMS A~TI A~ps, TRANS NO. OF FEET V I C A. W.G. NO. OF HI-LEG A.W.O. 2 1 ~Furnaces: 011 1-1/~hp, 2-1/IJhp Motor/s: EXHAUST FANS DIMMERS OF NEUTRAL CarT-abus Llectrl,,, 112, Box 2~[2, Coram, L. ~.11727 GENERAL MANAGER COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN OF SOUTHOLD Building Inspector's Office Town Clerk Building Southold, N.Y. 765-2660 FOBM NO. 6 TOWN OF SOUTHOLD Building DepaJtment 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 duplicate 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 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 ~and use $5.00 3. Copy of certificate of occupancy $1.00 Date Dec. 5, 1973 New Building X Old or Pre-existing Building ............................ Vacant Land Location Of Property'/.W Corner Leslie Rd.and In.d..i.a...n..N..eck Lane, Peconic, N.Y. Owner Or Owners Of Property Thomas M. Geiger Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No, .,6..,6.~.~...~. ....... Date~j?~)~;~r~t .6.,./.~,0,,,/,~,,3....Applicant ,~,?,,r.,,1.~,&..m.e.~....~..°,.m,,,e,,?.!...~?..c..*. ............... Health Dept. Approval ..... .]:..?../.~,~.~ ....................... Labor Dept. Approvol ................................................ Underwriters Approval ...]'..~/...2.~/,7.~. ......................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate X Fee Submitted $ ~..,..0...0. .......................... Notary Public ....~Ne.t..se.~n~ ........ ; County s,o/l. ' Construction on above described building and permit meets all applica,.__,ble codes and regulations. Applicant THOMAS M,. GE!GER, ....~...:.. Sworn to~efore me this ~-~ ~'"/~ day of ~.c~7,~...~.~ .~. (stamp or seal) FOLK COUNTY DEPARTMENT OF, APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE ALTH SEWAGE DISPOSAL SYSTEM 1. Applicant ~--~' ~5 &~t'~-t Phone~X 5. Subdiv. Address L65f~ ~d ~-~J~'C- 6. Section ~ 2. Property location ~¢~M~)e&~ ~/~ ~6.~,~5~. 7. Lot No. ~ ~A)~'W~ ~gC~ L~6 8. Private well Village ~'e ~,'~ Township 5o~L ~ 9. Public water 3. Public Water Company name Distance to main 4. Lot size: Width ~7~ feet Length ~ feet (Enter on center plot 10. Sewage Dispos~ystem: A. ~0~ gallon septic tank: Precast ~ Equivalent Block B. ~aching pools: Number ~recast~Block Special below) be ards If private well fill in blanks below: Tank cap~acity ~als. Pump G.P.M. Total w~ll d~h Depth Amonnt of Test le == Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned :ERTIFIES: "Construction of authorized installations will in accordance with the Suffolk County Department of Health's current stand- thereto." Date//~/~ FOR HEALTH DEPARTMENT USE ONLY. is the opinion of the Health Department, that an adequate and Disposal System can be installed on this plot. Date ~/~-; Signed ~L ~ b~/r or Builder Based on the information presented herewith, it satisfactory Sewage S-15 Revised 4/l/72 TOWN ~ ~T~O~ l ba ~ ~ ~ _~ ~ ~ BUI~ING ~FARTM~ '~ : - ~ . .......... ._ .... . ........................................ . ............ ~ qo,00 ..~~....~..~ .......... , ~.Z~..~[ Dote ... ~. . INSTRU~IONS a. This 8Dpli~tio~ must ~ ~mpletely filled i~ by ~wriTer or in i~k a~d submi~ i~ tripli~te to the Building 3 ~s of plans. ~ureTe ~1o~ pla~ ~o ,scele. Fee ~rd~,~o s~dule. b. ~ot pl~ ,s~owi~g I~ti0~ of Io~ ~d of ~ildi~ o~ ~remi~s, rel~t~nship ~ ~joi~iqg~premi~s or publi~ stm~ or giving a de~iled des~iDfion of layou~ of or0~ must ~ dr~ afl diagram which is ~ 0~ ~is ~, The wo~ ~verad by ~his a~li~fio~ m~y not ~ com~ ~re i~uan~ of Building d. U~ approval of ~his ~ppli~tio~, the Building Ins~tor will i~ue ~ Building Permit ~o the a~plicen~. Such ~rmi~ ,shill ~ premiss nwilable for ins~ti~ throu~ou~ the work. e. No ~il~ing shell ~ o~oupiad or u~d in whole or in ~ for any purpo~ wherever u~fil n ~ifi~le of ~ ~11 ~nn~ by t~ Building Ins~or. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Buildin~ Zone Ordinance of the Town of Southold, Suffotk County, New York, and other applicable Laws, Ordinances or Regulations, for the con~o'~otlon of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all al~llca~le I~ ordinances, building code, housing code, and regulations, and to admit authorized insl~ctors on premises and in buildings for nece~aW in~pecflonL (Signature _of ~ppl[Gant, ~r nan]~,.if ~ corporation) ....... ....... State whether applicant is owner, lessee, agent; architect, engineer, general contractor, electrician, plumber or builder. '....~~.....C?~r~Y~....~...~.~ ..................................................... :..:. .................... , .................... Name of owner of~remises ~....~.,....~.~. · ......... .~..~.........~~ ..................................... If applicant or nature of~duly thorized officer. ~ lauilder'sX, ieense No .......................................................... '~ P~umber's Ucen~ No.....g..22.:...?... ................................. ~ ' Electrician', License No.....~.~'.~...7...~.. .............................. Other 'rrede'~ Licen.~ No ................................................... 1. t.o~tion of land on which propo~l wo[k will I~ done. Ma~ No ...................................... ....... .~_ot No ..... ~ ............ ~ ...... and Numar Municipality 2. State existing use and occupancy of premises an~ int~ occupancy Of proposed construction: a. Existing use and occu pancy ....~/./~.~. '~..~ ............................................. .~.~ ........................................................ b. Intended use and occupancy ....~..~x/~ ....... .~..~ ................... , .......... [. .............. ~ 3..~Natum of work (check which applicable): New Building ............. Addition ..................... Alteration ........ ; ..... Repair ......................... Removal ......................... Demolition ........................ Other Work (Description) x-.a ....................................................................................................... 4. Estimated Cost . t ....... ~ ........... Fee (to be paid on filing this application) 5. If dwelling, number of dwellin,~,[ts ........ ! ........ Number of dwelling units on each floor ................... [..; ...... ............ If garage, number of cars ............................................................................................................................................ 6. If business, commemial or mixed occuoancy, 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 .............. .~..~. ........ Depth .....~ ...... .~.~... ........... Height ...... ~.?.....~.. ...................... Number of Stor es ~:T~.T.. J~~: ....................... ........ ~ ~- ~ /~. , 9. Size of lot: Front ........ .~...~.,?. ................... Rear ............ ?......~.. ................ :.. Depth ..~. ......~..~. .......................... 10. Date of Purchase ..~.~ .......''!~,~.~ ........... Name of Former Owner .~.~......~'z~....~'~ .......... 11. Zone or use district in which premises are situated ..................................................................................................... 12. · Does proposed construction~ ~ .vi°late any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded .___ _~_......(~.~.-)..... Will excess fill be remo.,ved, from prem~,ses: [_] Yes . ~1~] No __ 14. Name of Owner of premises .~..~d~.,...~ ...... ~v.~....~.~.....~'.~r,~r~.....,.?~..'~..~..~' L/ (Address) t (Phone No.) Name of Architect ..................................................................................................................................................... /3 /~ ~ ~'! ~~-~'¥'~'d~'si)~'~-..D-/~J....~. (Phone No.) ,ame of ntr,ctor ....... ......... ................. ...... ...... (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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 NE~,~ .......................~~'/~~~ ................. being duly sworn, deposes and says that he is the applicant above named. (Name of indt~t'dual signing~ontra~) ~ I0 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 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 t~rewlth. \ \ '¢ \ N,6B~II'20 E. F~ND - I0 ,--: 4s7, 28 WELL AT PECONIC .:,,...ALE., 50, :~ 0~1~'2,3N PIPEL . ti '- c::," r ,f · OffiSh~ Of ICJ'- I,~': 5L4" ~'