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Home My WebLink About6764-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy THIS CERTIFIES that the building located at ...~.'~? .~.~ .~ ~..'r..E/.~,..~..I/.~., Street kN ~ tN Map No ............. Bloc o ........... Lo o .................................. conforms substantially to the Application for Building Permit heretofore filed ~ this office dated ......... ~. ~..~ ~.~., 19 .~3 p~su~t to which Building Permit No. ~.~.~.~ dated ......... ~ ~..~.qf.'f.., 197 ., was issued, and eonfoms to all of the req~e- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... ~... ~g ....... ~.4~J. ~.~( ...... ~W.~'.~.(~f.(T ................... The certificate is issued to E bWA K ~ (owne~, lessee or ten~t) of the afores~d building. Suffolk County Depa~ment of Health Approv~ UNDERWRITERS CERTIFICATE No. ~ / Z ~ ~ ~ ~ . . HOUSE NUMBER .... Z~ .... Street...~.'.~. ~. ~.f .~ .... ~ ~ .......... ...... ......... Buil~ng Inspector FOF, M NO. 2 TOWN OF SOUT~OL~ 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) N? 676~ Z Permission is hereby granted to: Bive~beaA ~ ...~...~....o.~.......~...~.~..!~1~ .................................................................................. at premises located at ....~..~.......~..~..~..¥.~..~..e..~.....~..?~... ........................................................................... .............................................. ~.~,,o...~... ......... .~:.~.:. .................. ~ ......................... ............................. pursuant to application dated .......................~'..11~.~. ....... ~O. ........... , 19..~..~.., and approved by the Building Inspector. JJO'~$ O~"~k &~ ~b~,O~l; ~ee $..~..'.).~. .......... Building Inspector( FORM NO. 6 TOWN OF $OUTHOLD Building Depo~tment Town Cierk~ 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-ex'st'ng 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 Date .. ~d~.... ~... Z.......~'... Z...;~,.~. New Building A/ Old or Pre-existing Building Vacant Land Location Of Property ..,~.~.~......~....,~.4..x/~....~....~.../._~.~..~. ...... ...~...~..v'~.-. ........... ..~...~.4..,./....~..~.......~....C...c~....f~. ....... Owner Or Owners Of Property . .~..~.~...ZT~..4~.~Z?........9~.....'~...~..../~.~...~../..~ ......... .r~./~..~...~..~......-:'/~...~......~f~..~'.../.r/ Subdivision ................................................................ Lot No ............. Block No ............. House No..:.?~..~'d.~ Permit No. Date Of Permit . ......... !1.2 Health Dept. Approval ............... Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final ~ertificote ,.~ ................................... Construction on above described building and pe?nit meets all,gpplicable codes and regulations. Sworn to before me this / ~) '¥ ~ ~'~2'?J~j~.~ , .... ~..~.... day of .,.~ ...................................... (stamp or seal) Notary Public .~.~.'.~..-i..~..:...i... County ANTHONY ALECI THE NEW yORK BOARD OF FmRE UNDERWRITERS BUREAU OF ELECTRICS' 8.5 ,JOHN STREET, NEW YORK, NEW YORK 10038 [~ October 25, 1973 683960 THIS CERTIFIES THAT on~y t~ e[ect u' t os d~scrl ' ' ~ on a ~a ' u r ~ th~ m' s o~ in the follo~ving locatlon; [] B~e,o~nt [] l. rl. [] 2.d FI. outlsde Section Block Lot October 1~, 1973 andfoundtobeincomplia~cewiththerequlrernentsofth~sBoard. RA~ SPECIAL REC'PT I ilOO[ I ' OTHER AFIiARATUS: CO(Y41NO ~KS [ OVENS [DISH WASSERS AMT. K. W, A,MT. ~.W. ~MT. K.W. rlMI~CLC)CKS] .LL ~ MULTI-O~JTLET 1 EXHAUST FANS H.P. DIMMERS NO. OF NEUTRALS A.W. G, OF NEUTRAL 1 11 Oeorge Zlmlin gh aus Park Place Pat chogue, L.I. 11772 m MAMA~ Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIfiCATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~ ~ Phone//i& 5. Subdiv. Address//~ ~,~ ~,~l~, ~ ~ ~,'~ ~ 6. Section 2. Property ]6cation'~/$ ,Pr,#~r~ ~' ?. Lot No. . Private well ~ Village 3. Public Water Company name ~/~ Distance to main 4. Lot size: Wid/~,~h~feet Length ~m~' feet (Enter on center plot 10. Sewage Dispos/~ S~stem: A. /~00/gallon septic tank: Precast /Equivalent Block B. ;L~,~ching pools: Number / Precasq~Block Special below) If private well in blanks below: fill Tank ca$~ ci ty &~Gals. Pump G.P~M. Total w~l depth Amount o well · , Test Holer Data Feet 0 ~c~,~ ~ 2 4 8 lO 12 k ~TY~-,.,'~ 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 7/,~/~.J Signed ,~,. ~ W~ · . or~-Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Mealth Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date ~/~, Signed(~ ~, ~-- ~ S-15 Revised 4/]/72 ~amin~ u~~~ ~ Date " -- I NSTRU~IONS a. This a~i~tion must completely filled in by ~writer or in ink and submitted in tripli~te to the Building Ins~ctor, wi 3 ~ts of ~s, ~urate plot ~an to sca~. Fee a~rdi~ ~ ~dule. b. Plot ~an s~wing location of lot and of ~ildi~ on premiss, relationship to adjoining premises or public struts or areas, an~ ' airing a ~tailed ~iption of I~out of ~o~ ~ ~ drawn on di~ram which is pa~ of this application. ~. The ~ ~red ~ this appli~tion may not ~ ~mmen~d ~fore i~uan~ of Building Permit. d. U~n a~roval of ~is a~l~tiOn, the Bui~Jng Ins~or will issue a Building Permit to ~he applicant. Such ~rmit shall be ~ ..... .~ kept ,t~ pmm~ ~vmlable ~r ms~on throu~t the work. e~ ~ ~ ~i ~ ~p~ or u~d in'whole or in pa~ for any pur~ whatever until a Qertificate of O~upancy shall have ~ ~ ~ ~ilding Ins~or. - ~PLI~ATION IS HEREBY MADE to the Building Depa~nt for t~ issuan~ of a Build~ng~mit pursuant to the Building Zone Ordma~ of ~e Te~ of ~d, ~ff~ County, New Yo~, and other ~li~e ~s, O~inan~ R~ulations, for ~ ~nstru~ion of ~ildin~, ~s or al~rations, or for removal or ~molition, ~ ~rein ~s~i~d. The appli~nt agrees'to ~mply with all a~plicable la~. ~in~, ~ing ~, housing ~, a~ regulations, and to admit authorized ins~ors on premiss and in buildings for ne~ary ins~ions. ................. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder, Name of owner of premises .~ ....... .~..~ ....... 1~~ ............... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. Street and NUmber ....~'../.J'.....~,/./../~....a~"~...~...~.......~.~.., ...................... .~...~...~....~..~...~..~....~..R~...~.....~..,~.. .... ' Municipali~ 2. Sta~ exi~ing um and ~u~ncy of premiss and inten~ u~ and ~cupa~y of propomd con~mction: a. Exi~i~ u~ and ~u~n~ ......... ~.~....~ .................................................................................................. b. In=~ u. and =u,~y ..Z.....~...=......~.,~[/~/~ .= ..................................... ' 3. Nature of work (check which applicable): New Building ...... .J~............. Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ......~f;...~,,.~..~..~. ....................... 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 .....~.~,~ .............. Depth ....,~-..:~. ..................... Height ............. ~.J~..../.. ........................ Number of Stories .............. ./.. ........................................................................ 9. Size of lot: Front ....../..~..~. ....................... Rear ........ ./.~..~... ....................... Depth ........ ~.,.~.. ................................ Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ...~...//..../.~-~ ............ Name of Former Owner 11. Zone or usa district in 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~.,~,~.~........~,~.~.,~..d..~..~.,~.~..'. ........ ..~/.~...~'.....~..~...~..~.,d~..C~. ...... ~ .............· · (Address) (Phone N6,) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ~.../...'~'.~...~...'~.......~...../..~..Z~..~. .............. ~.~;~/~..~Z",',',',',',',~.....,~.~.. ......... ~..~f...?..~.../.,~'..4..(~. .... (Address}' ~' (Phone r~o4 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 wheth- er interior or corner lot. STATE OF NEW YORK, ) ,~ ~o. COUNTY OF ...................................................... ) ~.lln~l ia suff~ co~=t7 · ~ ~,,.,~,,~ ................................................ ~in~ dulv ~r~ de~s 8nd s~ys thst be is the mppli~ni ~ i, tbe ....~~ .................................................. ; ........... , ................................................................................................. ~ (~ntmctor, ~nt, co.rate of~r, etc.} of said o~n~r or ownera, and ia duly authoriz*d to ~rform or ha~a ~rfo[~d tbe $,id work and to maka and fil~ this ap~H~tion; that all statement~ contained in this a~plication ara trua to t~ ~ of hi$ knowlad~ and ~li~f; and that tbe work will ~ ~dor~ in ~ ~nn~r aet forth in tha a~plication filed tber*with. .......... .................. ........ ........ ........................... ............... ..................................... 22.9 ~L~'~ __ - GLOVE L z 4',,/ 22.9 ® -CE$$SCOL SUFFoLR COb'~,T¥ ~I~AL2~t DEPARTMENT The ~e?,~o " d~Sposal and ~tep ~ have been fns~eC~ej ~;v ibis department and found ~o be . ~ Sepvl cesngineeptn~ ROM,4R T B UI L DER~c APPRC~E~ AS NO~:ED-d 7&S-2660 9AM 10 4PM FO& REQUt~ Klm'ON7- E/...½Z~/,4 T'/(.P/V _ Iii -/?£A :.-, £LE'~,;4 7-lob~ ROh4IRT BUILD~,E~ ,.~ ECI / o ~ J~ o ,g c A/ ~0 TE - / B UI L ££00R PLAN .3C,4t-~- V4"--/~O~ ._._~0 MA n T IlL PI,PS :-0 UMDA TI oN PLA M