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Home My WebLink About6712-zFO~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z.~626 ...... Date ........... l~ove~ber. 2~ .... , 19. ?~ THIS CERTIFIES that the building located at .. East. (k~tle~;~;e. DrAve. · · S~eet Map No. ~2~3'~ ..... Block No.. ~ ...... Lot No..78 ...... ~zt. ~i~ .......... confo~ substantially to the Application for B~ldMg Permit heretofore filed ~ tMs ~ice dated ...j~5~ .g~ ........... , 19..73 p~su~t to wMch Buil~g Pemit No... ~ dat~ ...j~.y .~ ............ , 19. '7~ was issue, ~d confoms to ~1 of ~e r~, ments of ~e applicable pro~sions of ~e law. The occup~cy for whi~ ~ ce~fficate ~ issued is .... Pm~v~te .oRe..f~ft.y · Rwell.~ .................................... The ce~fficate is ~sued to ..... ~ohael. ~. ~es. ~pbe~. .... ~e~ ........... (owner, lessee or ten~t) of the afores~d b~dMg. S~olk Co~ty Department of He~ Approv~ . Oct,. -~2~. ~7~ .... R~. V~ ...... U~ERWRITERS CERTIFICATE No .... N. 1~9 ................................ HOUSE NUMBER ..... ~ .... Street ..... ~st..G~tte. Dray& ............. 1~,~-~ 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) 6712 Z Date ............................ ~T~I~.)' ....... b ........ , 19'73" Permission is hereby granted to: to ....JJl~J~1, ..J~v...o~e..-f~mt ;l.y..&v®~.~.~ ................................................................................. at premises located at ...... ~..~/~ ....... .,J~.-JJlMI~Z" ................................................................... ................................... g,..G~X~tt~..IX~ ......... ~ m.t,..ffe~',~ ....................................................... pursuant to application dated ............................... ~.~ ....... 6 ......19...~.~., and approved by the Building Inspector. TOWN Of ~UTIt~D BUILDING DEPARTMENT ................... . ...... ....... ~prov~d ................... , 19~ ........ P~rmit ~o.~...~ ...................... ~ ~ ~ ~... ..................... ....................... : ....... APPLICATI~ FOR ~LDING PEmlT Date .............~ ~. lhi~ O~lic~i~ mu~t be compl~t*l~ fill~ in b~ ~pawrit~r o~ in i~k ~nd b. Plot plan ~h~in~ I~tion of lot ond o{ buildinfl~ ~ pr~mise*, relation*hip to ad~oininfl premix* or pub c ~tr~ o~ area*, ond flivi~ ~ ~il~ d~ripfion o{ I~ o{pr~ mint be drown on the diagram which i~ ~ o{ thi* ~lic~ti~.~~ c~ ~ work c~r~ ~ thi~ ~lic~ti~ ~ n~ ~ cmme~d be{ore i~uonco d. ~p~ opp~l o{ thi~ ~pplic~ti~, th~ 8uildinfl In~or will issu~ ~ 8uitdino P~rmit to th~ ~pplic~nt Such p~rm ~h~ll be k~t ~ th~ pr~mi~ ~il~bl~ for in~fi~ th~ho~ th~ work. e. ~o buildi~ ~h~ll ~ ~cupi~ or u~ in whol~ or in part {or on~ pu~s~ whatever until *h~ll h~v~ ~n Omnt~d by th~ Buildin~ Ink,tot. A~LIC~TIO~ IS HfiR[BY ~fi to the Buildi~ ~pa~ment for ~ i~u~nco o{ 8uildinfl Zon~ Ordinanc~ of th~ To~ o{ ~ld, Suffolk Count, ~w York, ~nd other appl cob R~ul~tion~, {or th~ co~trucfion o{ building, ~ifi~ or ~lt~rati~s~ or {or mm~l or d~mol Th~ applicont ~r~ to comply with ~11 a~licobl~ I~, ordinam~, buildin~ c~, h~ admit auth°riz~ in~ecto~ on premise~ a~ in ~ildings ~r n~e~ i~tions. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether opplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~./~,~ ......... .~....../~.....~...,~..~.. ...... ...~..~...~...~...~ .................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... L Location of land on which proposed work will be done. Map No.: ....... .~.....D...~....~. ............... Lot No.....~.~. ............. Street and Number ..,A//.,,~.....~.'~......~r.Z~',~.~..~'~'...e![ .......... .~....~:..f..'.~..~,, ..................... .~.~x~/~X~..~, Municipality State existing use and occupancy of premises and intend~e~use and occupancy of proposed construction: a Ex s t ng use and occupancy ................... .~, .~..'~... ..................................................................... b. Intended use and occupancy ................................... :.~...~.~.~. ~; ........................................................... / 3. Nat_~'e of work (check which applicable): New Building ...i...~... ....... Addition Alteration ............... ~.. ~ R~pair .................. Removal .................. Demolition .................... Other Work ................................................ ~,.. (Description) 4. Estimated Cost ...........~-~D..]..~ ............................ 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 ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing Structures, Jf 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 ...... ;':~...'Z.. ......... Height ....../.~.../. ...... Number of Stories .................. ./.. .................................................. 9. Size of lot: Front ............. ~'......~....../'. ............................. 8-~ ! Rear ............. .~. .......................... Depth ..........~......~....../. ....... 10. Date of Purchase ........................................................ Name of Former Owner ................................................... : .... 11. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ,.......~.....O. ................................ 13. Will lot be regraded ............. ,~...~. ....... Will excess fill be removed from premises: ( ) Yes (~No 14. Name of Owner of premises ~J.~..,....~..~.......~r~.~.~.-P.,~L. ...... Address ....e,~..'T'~/~.I9. ....... W' Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ~.f~..~.~L~J,d.~.rw~...;~-/3~...c-~......~ Address .~...(..l~....~.~...¢-Phone No..~.{e.~.~.!.~..~ PLOT DIAGRAM ~'~e L-~> 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 whether interior or comer lot. STATE OF NEW' ~e'O~ ............................. ~.~....~ ............. ~.1 .........be,ng duly ~orn, d~oses and says t~t he is the oppliconl (Nam~6f i~ividual signing contract) above nam~. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application am tree to the best of his knowledge and belief; and that the work will ~ perfor~ in the manner set forth in the application filed therewith. Swam., to bef~e .~ me day this of ~r~ ~ ~ ~~ (Signature of applicant) No. 52-0344963 Suffolk Co~ ~mmi~ion ~pires Ma~h 3~ I~ FOR~ NO. S TOWN OF $OUTHOLD Building Department 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 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: ]. 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 $5.00 3. Copy of certificate of occupancy $1.00 Date .......... I ....... '1''~'~' .................. " New Building ...... ~, ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~.~ ~--~L.~r[-~ '"i)~¢~..4~6;~....-~... YYll¢~I~'~ Owner Or Owners Of Property ..~J..?,,~.~..C:......~........~...~.~ ........... C..~..P..~ .................... Subdivision .t/~J.~/..?.....~.. ........ .~...~.~ .............. Lot No...'~..~..... Block No ............. House No ............. Permit No.~..']..!~..--.....7~:... Date Of Permit~..~..'7..~..~pplicont ...~..~.~.l~.~.t.~...~.....~7..(:~.....:~j~.~_. Health Dept. Approval ........ ........................... Labor Dept. Approval .......... ~,).)~. ............................ Approval ~.,T.~.I...~..~..~.~. ......................... Planning Board Approval ...... .~...)..~.. ....................... Underwriters Request For Temporary Certificate ........................................ Final Certificate ~ ~u~ t' ' ~ ~-~ ~ ID CD Fee ~ Dm tea ~ .................................... Construction on above described building a~/~p. ~.m. it meets oil applicable codes and regulations. Sworn to before me this ~- da,, of k~ ( -7 -~ ................ Notary ~/~1~. ~r~/OU nt y JUDITH T. Notary Public, State of New Yor[< No. 52-0344~763 Suffolk Countw[/' Commission Expires March 30, (stamp or seal) ' BUREAU OF ELECTRIC~ ~ , I'~ 85 JOHN STREET, NEW yORK, NEw YORK 10038 ..~ septB~ber ~7, ~9~ App,~.,,o.~o.o.,,,e ~"~ N. 11 711 9 THIS CE~IFIES THAT Michael Campbell, e/s E.. Gillette Dr. 6~0' n/o CIea~ Point Rd., East Marion, L.I. ~,m~o. Septe~er 2~, 1973 .~f~ndto~incom~anee~iththeroquirementso/th~B~. FIXTURE /EC~PTACLESI SWIT I fiXTURES IR, [ 31 16 18 2"'?w. I .., ,,,,,.,~=-,,,jo,..,. SERVICE D4SCOHNECT I NO'~l~lrl S OT R PPARA S: ~o~o~: ~-l/~.h~ ]~u~nsee/~: O~.l 1-1/Shp, 1-1/12bp RANGES COOKING DECKS OVENS D~SH WASHERS T'mC~°C~s-I .L~ ~ "UL.-OUTL,T R V I C OF CC. CC)ND. NO. OF Hr-LEG EXHAUST FANS DIMMERS '~. H. Ruland ~att ituck, ,~$. Y. I COPY FOR BUILDING 'D COPY OF CERTIFICATE MUST NOT BE ALTERED IN. ANY MAHNER, SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number S~-~--9/ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Property Location Village 3. Public Water Company Name 4. Lot size: Width i~-~> feet 1. Applicant ~;. ~ Address 10. Sewage Disposal System: ll. Township Length ~c-o feet A. 900-gallon septic tank: PrecastY<~ Equivalen~ Block B. Leaching pools; Number of pools Precast2c Block Special. I? private well. fill in the following blank~: A. Tank capacity ~--gallons B. Pump G.P.M. ~ C. Total well depth. D. Depth to ground water E. Amount of water in well 5. Subdiv. 6. Section~n~i~*_ 7. Lot Number 8. Private Well 9. Public Water Distance to main (For Health Dept. Use~ The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department permit is in effect. Date I ~ Signed ::::::::::::::::::::: FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE '~'~ "~ ~'~ SIGNED S-15 Rev. 4/1/73 ,o3 23 30 E. Jo~5 CLEAVES ~'O,N .'1'0 ~ ^ YALiD TRUE COPY. GUA~Ai~TEES INDICATED HEREON SHAtL ~UN CLEAVES ['>01N T Tg As~uo,4£f.9 ~L~V' ¢ --J lB' GUARANTEED 1~ "'H ~, ", r'v '~' .t 'F3~ LCO APPRO~VED AS NOTED NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM TO 4PM FOR REQUIR. ED INSPECTIONS: TION OR START FR~ING ' . 2, BEFORE CO~ERING PIPELINE "' 3. FINAL WHEN JoB COMFLETED NOT RESPONSIBLE FOR DESIGN OR CON~