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HomeMy WebLinkAbout6741-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy N(~$36 ........ Date ............. Sep~b®l-.. THIS CERTIFIES that the building located at~. Ba~vi®~ .&. H.J..~a~ood. 1~ Street Map No~Lgh~ood ... Block No ........... Lot No..~... 8otttholcl. · E.][, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... J~t~y- - '9 ...... , 19. ~.~ pursuant to which Building Permit No. 67.~J.2~.. dated ........... J~'Y' · · '9", 19.~.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Pe-iva.t~ · oaa .rankly. d~ll:hlg ........................................ The certificate is issued to ' 14~3ZI~'0~--I '1~ ~' L'~' 'j~n~.'$, ....................... [ er, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approval . Sept...~0...~97.1~...by. R,. UNDERWRITERS CERTIFICATE No. 1~$1~O~9.~... Jan..~ .. ] ~ ................. HOUSE NUMBER ...... ~0. .... Street .. I~c~'.th. ~a~e~..R..o~d..$ .x.t .............. ........................ .... gh od. ................................. Building Inspector ~ ...... roBH No. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT 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? 6741 Z Permission is hereby granted to: ...... I~l,.l.~'~Qd...It.¢Je.L ,T, t,d, .............................. ...... :12g..... ~:Lem~..Z~me ................................. ........ ~ozJ.~J~). ...... ~i.,~., ........ 1.1.2.~3 .................. to JLt~t.~t ..~e~..c~tu~,..£m~l.lr..~ J~.~ ....................................................................................... at premises located at ...~,,t~,~-..JJ~J.j~ ................................................................................ ....................................... ~,...,tl~em/iJ/Je4.~ .*:..lt,.I, id~.~,~d...ll,~d, .............. ~ ............................... ......................................................... t~..~...~.:JA ........ .~.~,~ ................................................................... : pursuant to application dated .........................~U~J' .......... .1~ ...... , l~r/~...., and approved by the Building Inspector. Fee $..~o~{) .......... THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICIYY ~- 85 JOHN STREET, NEW YORK, NEW YORK 10031B ,a,e 1974App,,e.,,o. o.o.,,,e69"130 N 40991 THIS CERTIFIES THAT Millwood IlomesR s/e/cot. Highwooc~ Rd. & No.BayvilI~ Rd. Southold, !,.I. in the follotvin~ location; [] Basement [] 1st FI. .~ase~,ami.,~aO. January 28, 1971~ fiXTURE OUTLETS IECEETACLES 38 SWITCHES 19 FIXTURES FLUORESCENT [] 2nd Fl. outside Section Block Lot and found to be in compliance with the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET ~THER APPARATUS: "Future appliance feeder/s: ','later heater: 1- ~.Skw Motor/st l-3/;thp Elec.room heaters: E R V I C ND. OF CC. COND. A.W.G. ND. OF HI-LEG A.W.G* NO. OF I~EUTRA[$ A.W.G. PER .g OF CC. COND. OF HI-LEG OF NEUTRAL 1 ~/o 1 2/0 1-308, 1-2#12 4-1.5kw, 2-!.0kw, 1-,?Skw Joseph D. ,~,az,oni, 227 Waver!y Ave., ~edford, L.I. 11763 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF SOUTHOLD Building Depo~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 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 os 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: i. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existin~ dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ~ ~-~, '~ "/4-- New Building ....vT... ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ............................................................ ~ ................................................... .~. ........... Owner Or Owners Of Property ................................................ ~. ........... ~ ................................................ Subdivision ~...~..q..~....ut~.....~)'~...P~....-f.....~.....~.~.~..~.~...u~.. ...... Lot No...~... ........ Block No ............. House No ............. Perm,t No. Dote Of Permit Health Dept. Approval ............................................ Labor Dept. Approvol ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. A~licant ~'~, ~-~-~ ~o~ ~,o ~- c~ L~-~ ................ ................ ....... or Nota~ Public ~ ........... County 10. 11. SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant H ~ Phone~¥ ~'e"~ $. Subdiv.~l~.~1" Address ~.~ ~~ ~.~. ~1~ 6. Section ~ Pr°pert~~°ca~on ~ ' ' ' ' ' ~ 7. Lo~ Number~ . ~ ~~. Private Well~ village ' ..... ~wnship~ 9: pUblic Wate~ ~ Public ~ ~stance to ~n Lot size: Width~_~_~___feet Sewa?/~pos al System: A. ~allon septic tank: Precast~ Equivalent Block B. Leaching pools: Number of pools ~ Precast~lock Special If private well, fill in the following blanks: A. Tank capacity~ gallons B. Pump G.P.M..~ C. Total well depth~ D. Depth to ground water ~'l~, Lengthl ~V feet (For Health Dept. Use) E. Amount of water in well_~_~ ~ 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~ Si gn ~. ................................................................................ =::-__--__=__--__-- 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 pl~ot. APPROVAL DATE SIt,ED -- --_ S-15 Rev. 4/1/73 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. File No ................................................................... Date ........... f ~'Z";XL~ ............ ~'i"¢x .......... ~'k ...~....'..~.:..!:.;~ ...................................... ................................................................................. {or emtto n ' ~~ ~ ~ ~ peI co srruct ......... ~,,~ .................... [,,at the premises located at ........~ ....................... .... /.~~~.~.....~'.~ ....... ~kee, ~ ~ ~' ~, " returne<her~witb and disapproved on the fo ow nn nrounds ~ ~ '~ ~.---~..~ ~ ;~. ~ ~ ~2, ~ .... "'~fi'~"~ZL'""'~T .......... 'rO~VN OF SOUTH~~ BUILDING DEPARTM~d~~/~ '".~ r~ , ~. ~ TOWN ~K'S ~1~ ~/~ ~ ~///~_~. ~. ..... ~ ............ . 19.Z~. ~plication ~7~L. ' ' w / ............................ ~ra~ .......................... ~. ........... , ... ~ ~o....~..~ .......................... ~i~ppr~ ~/c _a._ .This .a..pp~cat. ion .mu. st be comp!etel.y ill!ed Jn by .typ~_writer o~, in ink and submitted in tr p icate to the Bulling :nspecror, wn'n ~ set~ o1' plans, accurme plot plan to scale. Fee accardin~ to schedule. ~' · glo. t .pta. n show~.n~.. I~a.t~on o:~ lot a.~.r~of.buildings on premises, relationship to adjoining premises or public streel~o~ areas, aha g~wng a de~a,ea aescription of layout ofpraperty must be drown on the diagram which is onrt of ~his ~nnli~ · The work covered by th~s apphcat~on may not be commenced before issuance of Bud ng Permit. '-~-" d. Upon approval of this appI cation, the Building Inspector will issue O Building Permi~ to the applicant. Such pe~it shall I~.l~p. t.,c~., the, pr.~n, ises ova. liable for I.nsl~r. Ion ~ the work. - (, e. r~o au,rang snarl ~e occupied or used ,n whole or ,n part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. t~ .A. PPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to~ ~ludi~ioZns,C~n~rO~ienca~Cr~trOu~f tlthoen oT~bui~d~ ~S~s.t~.l.d.,.Suffolk .Cou.n. ty, New York, and other applicable Laws, Ordinances oer The on~ cant a~ree t -,-,--~'-, ,,,;,~- -" __r~_,~.,_a~.a~_~ ,t?._s_ ~ a~!terat,ons! o.,r ~for re ,ma~?l or. demol, ltien, a~-hemin described. ~ u s o .~,~,7 .,,. u,, upF,,~uu,u ,3we, on3moncas, Dullalng cnae, housing ccx3e, c~d regulations, and to admit authorized inspectors on premises and iw buildings for necess~/inspections. ... ~..~....o.~.T.~.?.~..-...~ .~..e.~..o.......).~.~.~.. ]f,.~., ..2..T.~.~ State whether applicant is owner; lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· .................. . .~,.~.e.~..-..q~ ............................................ If~--~t~ ~c~t~re of duly outhoriz~ officer. · ~~~~ ............ ~ (No~ and title of co~rom officer) Builders Lic~ No ............................................. ;..~... cen. ......... .~-..-~...........r ........~....- ~her T~e's License No ............................................... ~ ~ ~oo~ ~. ~at~ of Io~ on wh~ ~ ~rk w~ ~ ~. ~op ~o.: .~..~.~. ~ ..... ~o~ 2. State exist~ u~ o~ ~cu~ncy of premiss and intended use oqd ~cu~ncy of p~ c~mction: o. ~isitJng u~ o~ ~cuponcy ...... ~..~ ................................................................... b. Intend~ u~ ond.~cu~ncy ...... ~..~..~~ .............................................................................. 3.~ Nature of work (check which applicable): New ~u~lding .:....~....._..... Addition .................. Alteration ...'. .......... '... Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~ (Description) 4. Estimated Cost .......... ,~4~O.~.0 ................................... Fee .~....~. ................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ~ ........... .~.Number of dwelling units oh each floor ............................ If garage, number of cars ............................ ~ ................................................................................................. : ....... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 6 .... 2e) -0" 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 af~ Stories ................................ 8. Dimensions of entire new construction: Front 6-~t -~# Rear ............................ Depth :~c)t _Om Height .....~.q.! ......... Number of Stories ....... ~....~./..~. .................................................................................................. 9. Size of lot: ,Frpnt_ .....~..,~1,.T.7._.~.7.~. ................................ Rear ........... ..~c~.~.e.~ ............... Depth .....~..~.~..8.~. ............. 10. Date of Pu~hase ..t...:,~.-.~..-.2-~. ................................ Name of Former Owner .~...c[.!f~...~.e...~..~..~...~.~ ........... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Wilt lot be regraded ....~.~ .............. :.. Will excess fill be removed froj~n~re~'_ls~s_.'_(__) ~_es__ . ~(~ ) No I'4. Name of Owner of premises ....~.....T~....~.~....~.?..I~...?......T~..?..'... Address ~Ta~:Le'b~e..~e~e.~: u]r-~eama zaaZ~Pho~ No. (~..~.~J~.O. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ~R~...JR~R...~.~.. ............................ 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 comer lot. STATE OF NEW YORK. .It COUNTY OF ~..~l~.~q.lr.;..; ....... · i ..... ~...,~[~..,Ii~..]~,~IR~..,~,, ............ , .................. being duly sworn, depose~~ and (Name of it~cll~;~dual signing contract0 above' named. He is the ........ L~,~...~....g3.CtX~O3P~,~.eL.~£f,:[{3~l[' .................. : ....... ;.....~.'...~ ............................................................................. (Contractor, agent, corporate 'officer~' etc.) of said owner o~..OWners, and is duly aUti~0rized tO' perform or have perfo~rmed the said work and to make and 'file this application; that all statements contained in;thiS-6p~tication-'a're true-to the best of his knowledge and .belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to before me this 19..-)...~.. .......... of ..... ..................... , Notary Public,~'~.....~e~~ County .... ~..~....~,~--,-.-~ .............. ~ ~ (Sig~ature of applicant) Tlallll LEE ~ · York NOTNIY 'PUBLIC, Slate et Nm No. 52-6t68295 ' alified'tn Suffolk Co~II~ ~1~'' Core'mission Expires Ma;ch ~0, says that he is the applicant TITL~- H~- r~EAP~ ~ ~vATIo~4 .~0 U TI-t O L D, ~-L rcVA¥1Ot'-,J s¢,,.L~ ~". 1=o" F-13-73~ APP~JDv. ED AS NOTED NOIIFY BUILDING DEP^RTMENT AT' /~5-2660 9AM TO 4PM FO& REQUIR-! J BEPORE BACKFILLING FOUNDA.I ' BEr©K~: COVERING PIPELINE : ~ HP~AL WHEN JOB COMPLETED z -k -F-- J,- ],¢L 4.~ L Z iTL Eo,, ,TYPICAL _,Cl~O 5 5 .S :C;,TIO~ '~C/~LB ', ~" - I'-~' ,AA, I L LWO 0 D HO~A E- ~ LTD. pa P,o× a'/.a