The URL can be used to link to this page

Home My WebLink About6730-zPOB3~ ~0. 4 TOWN OF SOUTHOLD BUH,BING DEPARTMENT Town Clerk'8 Office $outhold, N. Y. Certificnte Of Occupnncy No ............. Date ................................ THIS CERTIFIES that the building located at I J OD 'T~/~CI~ A u C Street MapNo. ~gLI BlockNo. ~LotNo. ~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ,J I/N f.- P_t) 7~.~ [~3~0~-~ ...................... , 19 .... pursuant to which Building Permit No ......... dated 19!.~. was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate issued is A ~1~ V/~-~ ~ ONE r~'~lk'~ The certificate is issued to ~/llkl~ ,~ Jx/f~-~lqL~E~4 (owner,'! ..... of the aforesaid building. NVV 17) IqT/, /~',d** 3-$0-7..,9 Suffolk County Department of Health Approval .................... .p .............. UNDERWRITERS CERTIFICATE No. bJ ~ q ~/ ~ (~ ~OOSE ~UMBER .............. Street .......................................... .... FOBM NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N~ Y. BUILDING PERMIT O'HIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6730 Z Permission is hereby granted to: l~,Ll,~,a~a..~,..gath~ee~ .... &~t, sl~ ................... ..... ~,9........~,rJ,,L..c.~.~.~.~t,..l~l ........................ ....... .Cmmaek ...... ~.,Z,,.....t~2.~ ..................... at premises located at '""~"6 ....... Peq~Mr'~elr''£~56'~"~ .................................................. ....................... i ....... t/Z~.....:~zae, k..~ ............ ~ga~ .............................................................. pursuant to application dated ..................... ~T~II~...,L~O .............. , 19.~3..., and approved by the Building Inspector. Fee ~Oe/a~ ............. PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRA['.ING L~i~:T DRIVEW^Y CON TRUCTION CE.~.POOL CONS~ RUCTh3N OTH[R Build 'In FORM NO. 6 TOWN OF ~OUTHOLD , Building Delm~tment 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 dispasal--(S-9 form at equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, AAultiple 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. 8. 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 unustml 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 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 $$.00 3. Copy of certificate of occupancy $1.00 Da,o ..... New B~ilding................~// Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ................................................ I ................... C~.~. ............... .~.:..J. LeJ..."4d..~. ........ Owner Or Owners Of Property ..................................................................... ............ .~.~. ........... Subdivision ...... ........... Lot ..... Block No ............. House No..).L.Q..O...-- Permit No.~..~..~...~...~-~... Date Of Permit .'7..(./..~./.7...~......Applicant ...~.t~l.~t~...~.....~..g.a4j~L¢..e.~...~.,...~,~.'~:: Health Dept. Approval ?.-S~?././~-abor Dept. Approv,~l Underwriters Approval ../~../...?...~....~...~.,~....~.. ................ Planning Board Approval ...... .¥......~.....~ .................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .................................... Construction on above described building~]/~an~ I:~ermit meets all a,~ble~,~.~r~. s and ragulotions. Applicant ...../..~.. ~......~.~..~ .................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS ~-~ ak BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 v.,,, September 8, 1975 '~'P"c"L'°"a'°'°"f"706938 N 244456 THIS CERTIFFES THAT t~'illiam A. Kotzky, 1100 Track Avenue, Cutchogue, L.I. in,hefollowlnglocation; [~ B~,ement ~ lstFI. [] 2nd FI. outside sec,~o, mock rot #6 .,..ex.,,,i.odo. September 4, 1975 andfo~ndtobeincompli,mcewiththerequlrementsofthisBoard. FIXTURE R EPTA FIXTURES OUTLETS EC CLES SWITCHES iNCAND~$CENTtFLUORESCENT k~v~ / 21 47 21 21 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SERVICE DISCONNECT 1 100 CB OTHER APPARATUS: RANGES O. Of --X S '1 E -- R,~ IETEE ~o. o~ cc coNo. x.w.O. QUIP. 1~'2w 1,e'3w 3~'3w 3,~4w PER,e' OF CC. COND. TIME CLOCKS / BELL UNIT HEATERS MULTI-OUTLET ~T A*4p$.I TRANS. ' ' NO. OF FEET V I C NO. OF Hi-LEG I A.W.G. OF HI-LEG EXHAUST FANS DIMMERS *Furnaces: Oil 1-1/Shp. 1-1/12hp Hotor/s: 1-1bp tqilliam A. Kotzky, 1100 Track Avenue, This certificate us o be altered in any manner; return to the office of the Board if incorrect. Inspectors mayo, SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Village C,,~ r u~(_~ 3. Public WaleTr Colm~fiy-~Fame 4. Lot size: Wid~%r~ feet 10. Sewage Disposa~t~ystem:~! Township Length feet (For Health Dept. Use) 5. Subdiv. ~E(~L~_Lt% 6. Section 7. Lot Number 8. PrivateWell 9. Public Water Distance to main ll. Ae Precast ~quivalent B.~ching POOLS: Nun~ofpools Precast Block Special If private well, fill in the followi/l~blanks: A. Tank capacity gallons Be C. D. E. 900-gallon septic tank: B1 ock Pump G.P.M. Total well dep~h.~ Depth to groundwater Amount of water in well The undersigned CERTIFIES: "Construction of author~tions 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. 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 p)ot. APPROVAL DATE ~//~ 77 SIGNED (~ ~ .1~~ ~.. S-15 Rev. 4/1/73 £xamined 1 er 19.?..:i~ Permit No. r Disapproved a/c .......... TOW~ OF SOUTHOLD ~ TOW~ CL[P,~('$ OFF~CE ~ $OUTHOLD, N. Y~ INSTRUCTIONS inspector, with 3 sets of plans, accurate plot plan to sc0Je. Fee according to schedule. b. Plot' plan showing location of Jot and of buildings on premises; relationship to adjoining premises or public streets areas, and giving o detailed description of layout ofproperty mus~ be drown on the diagram which is port of this application. c. The Work covered by this application may not be comrnenced before issuance of Building Permit. d UP0~ approval of this application, the Buildk~g tospect0r will issue o Building Permit to the applicant, Such permit shall be kept on 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 o Certificate of Occupancy shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the Building Zone Ord nonce of the Town of SouthoJd, Suffolk ,County, New York, and other applicable Laws, Ordinances or Regulations; f0~ the construction of buildings, additions or a,terotions, or for removal or demolition, as h~rein described, The applicant agrees to comply with ~[I applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. 'x (Signature of appbcant, or namezj?~ a,~rporahon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generalcon"~ra~to- r, electrician, plumber or builder. Owner Name of owner of premises ,]~.~l;L.~.m~. _&,.._eztd.,~;~4~hl~z~_D~..R~o.tzk~F 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 ............................................... Location of land on which proposed work will be done. Map ,'qo .... ~.~9~ ........................... Lot No ........ ~. ............... Street and Number ............... ~.~.J~:_.A.V.~,¥~,~ ...................................................................................................... Municipality State existing use and occupancy of premises and b}tended use rand occupancy of proposed construction: a. Exisiting use and occupancy ................... l~t,~.~.l~l~.d .................................................................................. intended use and occupancy ................... 3. Nature of work (cheCk which applicable): New Building ...~. ........... Addition .................. Alteration .................. '" Repair .................. Removal .................. Demolition .................... Other Work ...................................................... ~:. (Description) 4. Estimated Cost .........~ .................................... 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, if any: Front ............................ Rear ................. · ............... Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimension~ of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front .......... ~ ............ Rear .....~ ........ Depth .~ ....... Height ;.~ ........... Numbee of Stories ~ ,~ .... ~ Size of lot: Front ..... ~ ........................................ Rear ......... ~.?. ....................... Depth ...... ~ ................. Date of Purchase. ..... .~1~...~...~.~ ................ Name of Former Owner ...~111!~..~1~.,11~1~..: ................ 11 Zone or use district in which premises are situated ...... ~ .................................................. _~,'.~....* ..... 12. Does proposed construction violate any zoning law, ordinance of regulation: ........... ~ .................................... ~3. VV~Jl lot be regraded ....,....~... ............... Will excess fill be removed from premises: (~) Ye~ ( ) No 14. Name of Ow0er of premises,~....~..;~ .......... ~ddres~.-..~l~.~.~one No. ~I...' Name of Architect ........ Addr~l~Jl~: Phone No. Name of Contractor ....~'. ,.~.- .~' ............. Addres,~ ~ ........... Phone 9. 10. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, 'and nd ca~ all set-back dimensions from property lines. Give street and block number or description according to deed, an~l sl~ow street names and indicate whether interior or corner lot. STATE OF NEW YORK, I. S S COUNTY OF ..~-~.~.s.~...~....,.,.,, ............... J' ' ~'~'~"<~ ' ~ ~'~ ~ ~i 'dui ................................. ;, .......................... ; ................................. .~g y sworn/ d~es end says thot he is the epplicen~ (Name of individual signing contrac~ ~ove name. He is the .................... :.~.~..'.;~.~. .......................................................................................................................................... (Contractor, agent, co~orate 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 th~ appl~cation~re tree to the best of his knowledge and belief; and tha~ the work will ~ performed in the manner ~t fo~ inthe applt~atlon fil~ therewith. Swam to before me this .............. ~.~ ..... d~y of ........... ;..;';:~.~ ......... : ............ , 19 ........ Nota~ Public, .....~-..:~..:~;..~.:'.~ Coun~ .................................. :. ........................................ (Signoture of ~pplicant) ' ~ TERR LEE Nu~BLIS,-State at ~tew ~o~, 3. Nature of work (check which applicable): New Building ...Z ............ Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... (Description) 4. Estimated Cast .........~,~,~ .................................... 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, 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 ..... ~..~1~. ........ Depth ....~...~..~. ...... Height .~..e.. ........... Number of Stories ............~. ................................................................................................. 9. Size of lot: Front ..... ~.~:~l~. ........................................ Rear ......... ~ .......................... Depth ......~,~ ................... 10. Date of Purchase ......~...~.,~....t~. ................ Name of Former Owner ...[,J~lll~...~...~"~eD.~ ................... 11. Zone or use district in which premises are situated l~ll~ll~ ~;~; - 12. Does proposed construction violate any zoning law, ordinance or regulation: ............... ~ .................................... 13. Will lot be regraded ........~..e~.~. ............... Will excess fill be removed from premises: (~') Yes ( ) No 14. Name of Owner of premises ..~...~...~.~....~....~ .......... Address .~....~.~....~l~e No. ,~4~'~.. Name of Architect .~.~r~.~.~...~...~?:.~.~.:~. .......................... .,, ~u,¢.> ~t. ~'~ ~t~, ^oaress ~6~..~%,~,~.~;i,,~ Phone No ....................... Name of Contractor ............................................. ~.~; ....... Address ~ ........... 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 whether interior or corner lot. STATE OF NEW YORK, I.c c COUNTY OF ................................ )' '"'~ ................. :2......~...,'. ................................................................ being duly sworn, deposes and says that he is the appHc~m (Name of individual signing contracD above named. 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 ~nd file this application; that all statements contained in this application are true to the best of his knowledge and belief; an~ tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this .............. ,Z::...Z of ......... LL..:LL ......... : ............ , ........ Nota~ Public, . .............................. ; ..................... County (Signature of applicant) [/V/L L/x4 v/ /~. 4/v~ KAT/-/L EZ/V L~, N /KO TZ K Y' FOUNDAT JO,~q ~" L':)LO:_ i,L VAL_ , \V& L. L FIiD, t;; HOm;$. 1100 RIDGE PIKE CONSHOHO~KEN, PA. 19428 , A RESIDENCE FOR ' APPROVED DATE · . DWG. NO.