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Home My WebLink About6756-zFOBa~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z56bJ+ Date NOW. 12 19.73 THIS CERTIFIES that the building located at . .P.~..~..~..rg.e...&..B%.1..1.a?.d...PA. Street Map No...xX.. ........ Block No. ~ ........ Lot No...XX .... qu..~.e.h.o.g~. 9 ..... N. ~Y: ...... conforms substantially to the Application for Building Permit heretofore fried in this office dated .......... J.u..ly.....2~., 19. ?~. pursuant to which Building Permit No. 67~6.Z... dated ........... J..~-. Y.... ~., 19..7.~., 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 .P.~.J..v.a..~.e..qU.e.f..a~..i.ly..d.y.~.::l. $.n.g ........................................ The certificate is issued to . .Ma. ~ga. ?.~.t..~.. F.r.~.n..k. .~.$..~.~.~.m.e.x'...J.p.....0fl~..$.r.$ ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .l~.°.v... ~2... 79.7.~....by.~:. Y$.l.la.... UNDERWRITERS CERTIFICATE No.. I~..1.2~7.1.~... ]/.~¥...~... ] 9.~.~ ............... HOUSE NUMBER .... ?.~. ....... Street . .B%..1.1.a.r.~..Rd. ............................ 89~ P:Lne Tree Road Building Inspector [ FOB, M NO. 2 TOWN OF SOUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TH.E PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6756 Z Permission is hereby granted to: at premises located at .j~..~3~ej..~lJl~.~lj~l.~lNJ,.jJ~j~J ............................................................ pursuant to application dated ............................... ~'Jl~. ...... ~J,~..., 19..~., and approved by the Building Inspector. Fee $1~e~j~ ............ H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant 1°~,,~,~ ,~ ~,~ Phone~,~. Address ~ ~~ ~ 5~7~ f~ ~ 6. 2.Property location~/~ Village r',~ .... ~ Township ~,~O~ 9. 3. Public Water Compan~ name ~ Distance to main 4. Lot size: Width /~ feet Length /f~ feet (Enter on center plot 10. Sewage Disposa~tem: A. ~00 ~allon septic tank: ent Block B. Le~_~hing pools: Number Special Subdiv. Section Lot No. Private well Public water below) The undersigned CERTIFIES: "Construction be in accordance with the Suffolk ards thereto." of authorized If private well fill in blanks below: Tank capacity~--Gals. Pump G.P.M. f Total well depth Depth to G.W. Amount of water in well Test Hole Dat~ ~" Feet 6 10 ~'~ ~ 16 18 installations will County Department of Health's current stand- Date" ~ J "~ q 5 Signed FOR HEALTH DEPARTMENT USE ONLY. Based o~ the information presented herewith, it is the opinion of the .Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date 7~ Signed~ __......_...__ .,..-- -- ~'~'----- ~. S-15 Revised 4/]/72 THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF BLBCTRICI'r~.~ * I~ 85 JOHN STREET. NEW YORK. NEW YORK 10038 ,~,..ove.~er ?. ~ ,,,,~.,~.~..~.~,. ~8]~8 N 1 25719 THIS C;;I;IE$ THAT o~y t~ e~t~ ~u~nt ~ ~ ~ ~ int~ by t~ ~t ~ on t~ =~ ~pi~t~ numar ~ t~ p~mi~s of in t~ f~[ow~ng ~ation; ~ B~ement ~ Ist F[. ~ 2~ Fl. O ~ ~ ~e ~tlon B~ ~t ~ exami~ on ~ OVe~ e~ ~ ~ ~ ~ ~ ~ a~ fou~ ~ ~ in complia~e with t~ requirements of th~ B~~. FIXTURE ~ECEPTA LESI WIT HE I RXTURES I OUTLETS I C rs c SI'N¢^'O=SCm]FLUO~E~CGNTI %'~I~ I / I I DRYERS ~RNAcE ~TORS ~TU~E A~A~E ~lS ~T. ' K.w. ~L ,.P. o~ ,.~. ~T. NO AW~ RANGES K.W. i i2.~ COOKING DECKS OVENS DISH WASHERS TiMECLOOCS BEU. UNITHE&T~S ~ULTI~T~T SERVICE DISCONNECT NO. OF S Water heate~: Z-~.5~ OF CC. COND. q/o I C NO. OF HI-LEG EXHAUST FANS DIMMERS A,~Ti WAI~{ 1 2/0 Charles ~. }[all, Box 417 Southold, L.I. 11971 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE M~T NOT BE ALTERED IH ANY MANNER. FOBS( NO. 6 TOWN OF SOUTHOLD 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 triplicate to the Building Inspector with the following; for new buildings or new use: I. 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 Beard of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Cede 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 19,57), Non-conforming uses, or buildings and "pro-existing" land uses: 1. ~ccurate 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 3. Copy of certificate of occupancy $1.00 New Building ...... . ..~.... ...... Old or Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of Property .J~.~.~.~..~...R.~.~....d......~.....F.J~4.(~'....~.....-~.~,'~..I..~. ~..~....~.~ ................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ~'.~...~...~..---~..... Date Of Permit~/..~9~.~.~.Applicont ~..e.~..~g.~.~...~....~?....~..~..~.....l..N....C..: ........... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval [r~.(~..~.,.~.~.~......l~...Ja~,~'.~./..~...Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .... ~ ............................... Fee Submitted $ ......~..~...-~.. ..................... Construction on above described building~oermit meets al~o. licable codes and regulations. Sworn to before me this · ~ .............................(stamp or seal) ~ ........ /. dayof / f Notary Public .................................... County TOWN OF SOUTHOLD /// ,~ ,/~.- TOWN CLERK'S OFFICE ¢ '~ ~ L~~' ' ~ ~ ~UTH~D, N.Y. ~~ ~ ~ ~/~ ~ ~ami~ ......... 19...~ Application N~.~. ..................... DiSproved a/c .......... ~....~ ........ ~ .......... ~ / ~ .......................................................................... , .......................... , .................... ................ (Suildi~tor ' APPLICATION F~ BUILDING PE~l~ ~, ..................... , qS... ................. 19 ......... I NST~U~IO~S I ~ ~. Thi~ a~¢i~tion mu~t ~ eom¢l~t~l~ filled in b~ W~writ*r or in ink and ~ubmi~d in tri~licat~ to t~ 8u~ldi~ m~{ o~ 3 sets of plans ~urate plot plan to scale. Fee according to schedule. ~1 b. PIo~ plan showing location of Io~ and of buildin~ on premiss, relationship ~o adj~inin~ premiss or ~bfic s~ or ~, ~ giving a de,ailed deKrip~ion of layou~ of pro~rW mus~ ~ drawn on diagram which is pa~ of this a~li~tion. * ~-- ~ c, T~ work ~vered by this application may not ~ commen~d ~fore ismanM of Building Permit: d. U~n approval of this appli~tion, the Building Ins~ctor will issue a Building Permit to ~he a~li~nt. Su~ ~rmit shaft b kept the p~mi~s available for ins~ction ~hroughout the work. .~ e. No building shall ~ oc~pied or u~d in whole or ~n part for any purpose whatever until a ComPlicate of O~n~ shall Bye ~an~ by the Building Ins~or. ~ APPLICATION iS HEREBY MAOE to the Budding Department for the i~uan~ of a Building ~rmit pu.u~ to ~ Buildi~ ZoM Ordinance of ~he Town of ~uthold, ~ffoik County, New York, and o~her appli~ble Laws, Ordinan~ or R~ulaflons, for ~ ~ buildings, ~difions or alterations, or for removal or demolition, as herei~ descried. T~ appli~n~ agr~s to ~mply wi~ ~11 ~li~le I~ ordinan~s, building ~de, housing code, and ~egulafions, and to admi~ authorized ~ns~c~ors on premiss and in ~ildin~ for ~ ink.iota. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. G~.~& .J. ! .~ .......... .................................................... ................................................................ Name of owner of premises ~.~.~.~..f&~.~...~..~...~..~ .~...~...~.....,J......T....E:...~..t...~....~?.~....~.~. .......................................... If app~ is~,a corporate, signature ~of duly authorized officer. ........ ..... (marne and tltl{of corporam O~T~eer; 1. Location of land on which proposed work will be done. Map No.: .................... Lot No. - - !~......~.~..~ ..z~ .. ~. J~.~ Cc;~ .~. . . St~t and Numar ~...~.~.~a~....~.t~.~&~.~..~L~ ............. .................... Munici~liW 2. State exi~ing u~ and ~u~ncy of premiss and in~n~ u~ and ~upancy of pro~ con~mction: a. Exi~ing u~ and ~cupancy .................................. b, Inten~du~and~upancy O~ ~Gm ,C~ ~GLLim ~.: . ................................... .... Removal .................... Demolition ............. Other Work .... ,~..., .. .. ~:~.~,. ~ .P.. ................ F~ .....~...~....~ ........................................... ~/~,,.....~.., ~ '"~'~ (to be paid on filing this application) ~.~-~. _ units ..... ~.....,:. Number of dwelling units on each floor ........ ~-~i.Y...~...~..~'~'~ of dwelling cars ................................................................................................................... *-.- ................. commercial or mixed occupancy, specify nature and extent of each type of use ures, if any: Front ..................... Rear Height Dimensions of alterations or adc Number of Stories ................................ 8. Dimensions of entire new construction: Front ...~':~.~..~. ......... Rear ..... ~. .................... Depth ................................. ...... ./. ........ ~ ............. Number of Stories 10,- Date of Purchase ~..../..~..,2~. .................. Name of Former Owner .......... :':. ............................................................... 11. Zone or u~ di~rict in which premiss are situate~ ..................................................................................................... 12. D~s propo~d con,ruction violate any zoning law, ordinance or m~lation: ..... .~.~ ............................................... 13. Wililotbere~aded ................................... Willex~fill~mmo~dfrompremi~s: [ ] Yes ~ No ~ ~ ~ / (Address) (Phone No.) - (Ad ess) ( h ne o) (Address ~e~CO, -~' (Phone No.) PLOT DIAGRAM L~te clearly and di~inctly all building, wheth~ ~i;ing or propo~, and indica~ all ~t-back dimensions from prope~ lines. Give ~t and bilk numar or d~ription ~cording to d~d, and show street names and indi~te whe~- ~ inmrior or corner lot. STATE OF NEW ~ing duly sworn,, de~ says he is the appli~nt abo~ na~d. ~' ~, ~. ..~. ............................. : ...... Ce~ ~.~..~ ......... :.~ ................................... , ...................................... of said owner or owners, and is duly authorized to ~Horm or have ~Hor~d the said ~rk and to make and file this appli~tion; ~ all ~tements ~ntained in this appli~tion am true to t~ ~st of his knowl~ and ~lief; and ~at ~ work will ~ ~Horm~ in t~ ~n~r ~t forth in t~ ap~i~tion filed the~wi~ ...................... o, ........ ........... (~ ol ~p~t/ i .,.. SO' 5C4L~: -co' = I" / ..~CAL£: SO' = TO THIS SUKYE¥ iS A VIOLATION OF ~ ' ' ' S~ZS} -- ~o'--- ,o~~ PINE I10,0, T' ~ ~ E x%°16g o ~ o b44~6A%£ T J. AT' I~ECOMIC ,SUFI~OL~ Co.~ .~ CODES ,M,L FEDERAl., STATE AND LOCAL CO~ES, ORDINANCES REGULATIONS ETC. SHALL BE CON~d~RED AS PAPoT OF SPECIFICAT OHS FC~ THIS BUILD- lNG AND SHALL TAKE PREFERENCE ~[R ANYTHING SHOV~N, I:)~CI~IIED IMPI-IED WHERE SAME ARE AT VARIANCE. BUILDING PERMIT IN N. J. UNLESS: THE ARCHITECT'S IMPRESSION SEAL AND SIGNATURE ~ HEREON, HOT[ CoNTRAcTOR TO VERILY ALI: DIMENSIONS AND CONDITIONS · · i f ",4.