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Home My WebLink About6735-zFOB~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMRNT Town Clerk's Office $outhold, N. Y. Certificete Of Occupancy No..2~?~.~.8. ..... Date ............ ~ept...$O ......, 19. THIS CERTIFIES that the building located at ...l~e~t · · L~e. k'~t .......Street Map No..X~ ........ Block No .... ~ .... Lot No.. ~1~. Gt*e~np~t- · ~,o¥~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Ju3~... 17., 19.73. pursuant to which Building Permit No.. dated .........', J~...l?..-, 19.73., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is issued is ... P~.~.v~.~e~. ona. em.~l~. &~elZtr, g ..................................... The certificate is issued to Ma~,~e~ethe .Clem~le~ .... 0w~e~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~;ep.t .. 1 ~ · · 19~6 .. b~ .~1 o. -7.$11&.. UNDERWRITERS CERTIFICATE No .... ~ ~ ~4~R~ ..... l~e~. 8. · '$9~ .............. HOUSE NUMBER ...... ~ [~0. - · Street .... .~-nle~- .-~ne .~xt- .... Gt'ee~po~-t ..... ..... I ...... FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6735 Z Permission is hereby granted to: ............... .C~t.c lxogue ....... ~tZL~ .......................... at premises located at ...~ ./~.....~I;O,~.t,..Jdt~J3.JL .~t~e, llt,:[OJO,.....~.~). ............................................ ......................................... ~:.~.n.~..o..r...t. .......... ~..:..x.,. .............................................................................. pursuant to application dated ................. .~.~Z ......... .1.~. .............. , 19.~..~.., and approved by the Building Inspector. Fee $..1.0~,.~13 ........ oudding ~nspector [ FORM NO. 6 TOWN OF $OUTHOLD , Building Depo~tment Town Clerks Office Sou~hold, N. ¥. 11971 APPLIGATION FOR CERTIFICATE OF OCGUPANCY 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 fram 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 land use $,5.00 3. Copy of certificate of occupancy $1.00 ~ Dote .................................. ~, ........... New Bt~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........... ........... ~..~...~...~.~L.~.....~....~....~.....~.. .......................................................... Owner Or Owners Of Property ...... ...~....~....~....~.`..~....~....~..~..~........~...'.......~.....~.....~-~...../~....~.....A~....~....~. ..................... Subdivision ................................................................ Lot No. -- Block No. House No ............. Permit No...~...?...~.....~...~... Date Of Permit .7..././..~l~..~....Applicant ...... ~.~...~....~....~..~..~.....~..~.../. .......... Health Dept. Approval ............................................ Labor Dept. Approval .................................. Underwriters Approval ~. j ~' 8 '~ ~ ~,.-- Planning Board Approval ~;' ~: Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ ...........~.~ ..................... Construction on above described building and permit meets all applicable codes and regulations. ...................... Sworn to~.. a f ~.~before matin(/~/.~. ..~.~.~ ~/~~ ........ ~ ..d yo ..... (stomp o~ /[~0 Nota~ Public ........... Coun~ THE NEW yORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICr'rY ' ~ 8B JOHN STREET. NEW YORK, NEW YORK 10038 ~'."' ~, '~ ~'~-'~-'.o-"' ~ N 158332 ~lS CB~IFIES THAT Ray. nd Clempner, e/side Inlet ~ne, ~end, 700' ~o Manhasset Ave., G~eenpo~t~ L. I RXTURE RXTURES RANGES =OOICINO OiCKS OVENS DISH WASHERS OUTLITS SWITCHES FL~C~E~ENT 37 ~o 29 37 DRYERS FURNACE MOTORS FUTURE: AREUANCE NEE)ElIS TIMICLCX3CS IULTI-OUTtIT DIMMERS SIRVICE EX~CONNEC[ S E R V I C E OTHER A~A~TU~ 1- 11 amp. 1 Oil 2-1/Shp, Vacuum Unit 3/0 1/0 1-1/~hp W.B. Ruland, Hattituek, L.I. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1 5. Subdiv. Address ~ ~.~ ~ .l'~ ~ t~. ~,~] ]/ C ~ -- 6. Section 2. Property 16c~ti~ .... ~,~7~.~,,.:-ik ~,~,~.~--~3~ 7. Lot No. ~-~ ~ 8. Private well Village3 ...... .~m , To~ship ~ ~ ~ ,~ 9. Public water 3. Public ffater Company name:~,_~ ~,-~,:,g~g~J~ Distance to main 4. Lo: size: ~idt~feet Le~sth ~0 feet (Enter on center plot below) 10. Sewase Dispos~ ~ys~em: A. /9~0/tallon septic tank: Precast~ Equivalent Block B. ~chint pools: Number~Precas~ock $pecial If private well fill in blanks below: Tot~w~ll depth De/th to G.W. Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date ~/ '~ ~a Signed ,-' %~ ',-%.~.%'~'~',,~'-~-~ ~ or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewag~ Disposal System can be installed on this plot. Date S-15 Revised 4/1/72 ~mJ~ .... ~ ........ ~...**(.~, 19....~ , ~ ~ ~ .~ .............. , ......................... , ~,.....~., ,o ................... :~ .................... ......... / .. .................. ~ ........ APPU~T~ ~ BUILDING ~IT ~, ...... g ............... . ~,Z~. .... · . Th~ ~i~lion mu~t ~ ~m~lat~l~ fill~d in ~ W~rit*r or n ink ~nd *u~mi~d in . ~. ~ ~ ~'1~ of ~t.~ of ~il~n~ on ~remi~, ~lation~i~ to ~o~i~ · . ~ ~ ~md ~ thi~ ~li~tion m*~ not ~ ~m~ ~fi)re i~ d. H~ ~1 of thi~ ~fimtion, the ~uildin~ I~or ~ill i~ ~ 8uildin~ ~ ~ ~l~l~ ~r im~i~ throu~out the ~ork. L ~ ~t~i~ ~1 ~ ~m~ or u~ in ~hol~ or in ~ fi)r ~n~ ~r~ ~he~*r until ~ ~ ~ ~ildin~ In*~emr. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Building Permit pUrsuant'fi) t~iButlding Zone Ordinance of the Town of Southold, ~uffolk County, New York, and other apGflicable Law~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descri,be~. The applicant agrees to comply with alt aDPlieable law~ Ordinancea, buildin code. housing code. and regulations, and to admit authorized ine,.coctor$ on premises and in building~ fi)r neceeeary i~ions. (__~- (Signatumof alxolieant, or name, if a corporation) ·. · .......... : ............... ........................... ~: ~ ~pplica,t is owner, I~I~, ~liq"t, a~llt~% e~.r, I~1 c~tr~tor, el~'icie,, plumier or builder. '<: ......... ........... ' ...................... :~,~...~.., ...................... i ........ '. ........................................................ · · ~' ............. ,.,.~..,~..~...~......~..,,...,..~.,...,.., ~. .............................................................. If ~ffi~,' n} ~s a corporate, si~natura of duly ~Jthoriz~l officer. ~' Buiider's License No ......................................................... Plumber $ License No....~..~../~... Electrician's License No: ~.~ ................ Other T~'s Limn~ No ................................................... 1. ~ of I~ ~ ~h ~o~ work will ~ d~. M~ No ~, Lot ~.~ ~..~ ~ ~ Nu~r ..P~..~;;.~....~~..~=.~:~.:~' ' ~~ ~ ~d ~u~y of premi~ ~mn~ ~. a~ ~ of ~ ~n~: '~a. ~= ~ ~u.n~ ..... ~....~..~. .................................................. . ........................................ . ~ . :: .. _~ ..~.~.~..~.?-~~.~...= .............. ~ ~~ u~y ..... ~...~ .............. ~.~.~.~.~ ....... ;..~ ...... . .... 3. Nature of work (check which applicable): New Building ...... ~ ...........Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~, (Description) ......... ................................................................... Estimated Cost ....... ~--~...~./. ........................... Fee (to be paid on filing this application) If dwelling, number of dwelling units ........ ~ ....... Number of dwelling units on each floor ......... ~ ................. If garage, number of cars ............ ~ ............................................................................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use ,.....,-7.. ............................ 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 ................... ..-7. ....................... Height ........ ~ ............................ Number of Stories ....... ~ ............................. c ( 8. Dimensions of entire new construction: Front .....~....~.. ............Rear ...~...o.. ................. Dep{h ...~..G. ....................... Hei-ht .......... .~..~. ......................... Number of Storms ............ :. ................ ;.~ ...... =....:...:..?. .............................. · ~ ~ · · · ~[0 9. Size of lot: Front ..... ~,..~..,.I. ................... Rear ~;~,,~..~J...~..~'. ................. Depth .......... . ........................................ 10. Date of Purchase .~....~/..~..7..,~... Name of Former O,wner ............................................................................ .~. .. ! . . . rp *n ~ /~ , . ........ 11. Zone or use d~stnct n winch premises are s~tuatea ...l~, ........................................................... 12. Does proposed constraction violate any zoning law, ordinance or regulation: ....~ ............................................... 13. Will lot be regraded ~ .................. Will excess fill,J~e, removed from premises: [ ] Yes · ~ No 14. Name of Owner of prem,ses ..... ~c~...,.,~..~.~..~;~;F...-=,.~...~w.?.-,~-,,~l~-,e~l;i;.~,* ...... Name of Architect ..... ._....~.~ ........... ..~....¥, .................. ~ ....... ?'~'.i~J~'~i ................ ',"~ ............. ~i~'~l'~ ............... Name ~f Contractor ........................ ~-.,.. (Phone ~o.) ........ PLOT DIAGRAM Lecate clearly and distinctly all buildings, whether existing or proposed, and indicate all set,beck dimensions from prop~'~y lines. Give street and block number or description according to deed, and show street n~imes and indicate wheth- er interior or corner lot. STATE OF NEW YORK, COUNTY .................................... .... ,~~.....~~ ..................... ~ing duly sworn, depots and says that he is the applicant above na~d. ............ ....................... ' ...................................................................... ~ Con~ctor. agent, coyote officer, etc.} of ~aid owner or own~r~, and i~ dul~ ~uthori*~d to ~orm or h~ ~rfor~d th~ ~aid work ~nd to m*k~ ~nd fil~ thi* a~licafion: that - ~tat~ment~ contained in thi* *~lication mt ~orth in th~ a~lication fil~d t~[*~ith. ............ ............. o, ,~ot~ry rumlC....~.. ~ ............. OU y ....... (.~..~....~.-.~; ......................... 0 X 0 ps t/O~,8 p~ iao&B oxo C-Is- £ p ~t..¢' c-/..f CP35-