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Home My WebLink About6776-zFORM NO. 4 TOWN OF SOUTHOLD BUHDING DEPARTME, NT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy No..Z~.~.~2. ...... Date ...........N..o.v.e.m.~ .e.l,..~.~.t..., 19. ?3. THIS CERTIFIES that the building located at ...L~..n. gy.~e.~....L~B..e' .......... Street Map No.~.e.r.~. ~a..t.er~lock No. ~ ....... Lot No...~. ...... ~.o..u.t.h.o.~..d .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......J..u.~.y..8., ....... , 197~. pursuant to which Building Permit No. dated .......A..ug,..,~j ........ , 19.7.3., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ...1~..~.v.a.t.~..O~e.. F~iF. ~ell~g ...................................... The certificate is issued to ...,~.V~;h.t~..]~,t,~tr ....................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...No..v:..7.~...1~7..~...-~.1}..,. ??1..1.a. ..... UNDERWRITERS CERTIFICATE No..~..1.2..~.0.~?.0~..~.~. 3.1.~..1~_~ ................. HOUSE NUMBER ....1.~..~0. ...... Street .... .L~..n.g~..i..6~...L~!..~' ...................... ..... : 8ou~holcl Building Inspe~or ~ FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6776 Z Permission is hereby granted to: pursuant to application dated .............................. ~T~4~ ....... ~....., 19..~.~., and approved by the Building Inspector. Fee -~,~) ............ TOWN OF SOUTHOLD Building Department 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: I. Final survey of property with accurate location of oil 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). ~. 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 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 $5.00 De,e ............ New Building;i~.~..ii~.~........~.....~..~/ '~ld or Pre-existing Bui,.~.lding/...-.. ~,.....~- ~,Vacant Land ............................ Owner Or Owners Of Property .../~...O..~..~. .......~"~ v ~.z~ .~ ........................................................... Subdivision (~ ~ Lot No ~ ~ Block No House No ~. Permit No..~...~..~..~ Date Of Permit ~/.~/2.~....Applicont ...... ~....~ ........... Health Dept. Approval ..~.~.....7..../~......~. .......... Lobar Dept. Approval ................................................ Underwriters Approval ..~.~L......~,~../.~..~,~ ........ Planning Board Approval ....... ..~...:...~...: ................... Request For Temporary Certificate ........................................ Final Certificate .......~¢~ .............................. Fee Submitted $ .~ ............................ Construction on above described building and per~ ~ts all,applicable codes and regulations. Apphcant Sworn to before me this //~ ........... ?... dayof ........ .... (s,amp o, sea, Pub,ic .................................... Coun THE NEW YORK BOARD OF FIRE UNDERWRITERS C~ BUREAU OF ELECTRICITM EE JOHN STREET, NEW YORK, NEW YORK 10038 D. te October 3~, Z973 4ppUeot,o. No. on/,te "' ...... N 124505 THIS CERTIFIES THAT inthefollowlnglocatlon; ~ Basement [] lstFI. [] 2nd FI. OU~,~d~ Section Block Lot ~ wo~ examined on October ~? · ~7~ and found to be in compliance with the requirements of this Board. FIXTURE /ECEPTACLES[ SWIT HES I FIXTURES I RANGES ICOOKINGDECKSI OVENS IDISHWASHERS EXHAUST FANS DRYERS I FURNACE MOTORS I FUTURE APPUANCE FEEDERS ;PECIALREC'PT TIMECLOCK$ I BEU ]UNITHEATERS MULTI-OUTLET DIMMERS "~ SYSTEMS R ~ .l 3~ ~'i SERVICE DISCONNECT NO. OF S E R V I C i METER N F N W W A.'V.T, A.V.p. TYPE EQUIP 1~'2W 1.e'3w 3.,e'3w 3~'4w O. OpERCC.~.CO D. OF'~C ~(~JqD NO. OF HI4EG oFA'H, iEG~ ~O. OFNEUTRAL$ OFA~"~OT~AL i lOq 0£~ * x i 2 ' ' ' I 4 OTHER APPARATUS: ~qotor,/$: i-lhp ".'Vurnace/s: l-1/Shp, 1-1/12bp *Future aSp';!an~e feeder/s: I-3#~, 1-P#12. Surdl !'.'.l..,~ct tic co. Uoltsvllle, L.I. 117h2 G~NBIAL MANAGIR COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. t SUFFOLK COUNTY DEPARTMENT OF HEALTH ~ H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTF. N 2. Pro~,erty i6ca~ion~ ~/~, . ~'~. .~/~',, ~V~', ~_ ~ '~ .... ~, '7 ,.v Lo~ No. --- ' ' '~-- - ~ '~' ' .... ' 8. Private we11~ ~ Villas~~' Township9. Public water~ 3. Public Wa~er Company name ~ Distance ~o main 4. Lot size: Width /~ feet Lensth. ~-h = feet (Enter on cen~er plo~ below) 10. Sewaie Dispo~stem: .~q A. allon septic ~ank: Precas~ ui~alen~ Block B. chili pooh: Number~Pre cas ~lock Special ~ J~ --*'~-' /~ h--a~*(~'e~' If private well fill in blanks below: Tank capacity~Gals. Pump C.P.M. Total well dep~h- Depth to C.W. Amount of water in well Test Hole Data Feet '0 2 6 8 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will in accordance with the Suffolk County Department of Health's current stand- -~ be thereto.," ~-- ' ~ : /,' / - Owner or ~i~ d~ ?=~OR HEALTH DEPARTMENT USg ONLY. B~ed on the information' presented herewith, i~ is the opinion of the Health Dep~tmeut, tha~ an~adequate and satisfactory Sewage ~;'~Disposal System~ be installed~ this plot. ~ ~ /~ ~K/ TOWN OF SOUTHOLD ~/~ ~ ~ ~ B~LDING ~EPART~.~ TOWN CLERK S OFFICE ~UTH~D, N. Y. Examined ~ 19~. ........ ............. ....................................................................... ....... ................... .................................. (Buildin~ Ink.tot) APPLICATION FOR BUILDING PERMIT [3ate INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building'Inspector, with~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~ · b. Plot plan showing location of tot and of buildings on premises, relationship to adjoining premises or public streets or areas, an~ g~wng a detailed description of layout of property must be d~rawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Buih~ng Inspector will issue a Building Permit to the applicant. Such perm t she be kept or~ 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 a Certificate of Occupancy shell have been ~rented by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the'issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regular ions, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general 'contractor, electrician, plumber or builder. Name of owner of premises .... ~....~.."~..'~.. ................................................................ ,, ...... , ......... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ............ ~ ................................. Lot No .......... Street and Number ....... ;~...c:~.~.~.~.~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed conStruction: a. Existing use and occupancy ................................ ;~ .......... ;_..: ................................. ~ ............................................. b. Intended useandoccuoancv.. ~ ~..c~..~ ...... · ......................................... .~'~* // · 3. N;ture of work'(check which applicable): New Building ...................... Addition ..................... Alteration ............... Repa r .................. ._...~ciemova! ............. ,.... Demo. lition ....~ ................... Other Work .................................... - '~d'~ ~_"t ~ {Descri~ion) · ~,,=-c~ . ' I~ e~~ . 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 ex-tent 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 .................. ._. ..................... Nu~b~_r of Stories .......... .~.,~ ......... .=...~ ....... 8. Dimensions of en~)~.~ew construction: I-ront ...................... ;.. I~ear ............................ uepzn ................................. Height ................................................. Number of Stories ............................................. ~:~-,,....~ ............................. 9. Size of lot: Front ...................................... Rear .......................................... Depth ........................................... ~ ...... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in Which premises are situated ............................................. 7' ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...................................................... ,3. w,,,ot be re-aded ............... p.m,.: Yes [] No 14. Name of Owner of premises ....................................................................................................................................... (Address) (Phone No.) Name of Architect .....e, ...... ~ ..... ~.,e$ ...... ,.~...~'d ....... , ....... ~t....~ ......... ;;i~ .............. ~'~'~]J~Fa'~"I~'~; ............. '- ,ame of Contractor ................................................. ~ ................. i~J~;~')' ...... ~'~'~'~ ............ PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail sat-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. cou.~¥ o~ ............. :~/~...~.~.. ........ i ............................ ~~ ...................... being duly sworn, deposes and ~ys that he is the appli~nt abo~ na~d. He is the ~'..~~ of sa d ow~r or owners and s du y authoriz~ to ~orm or ha~or~d t~ ~id ~rk and to ~ke and file this appli~tion; ~ .all s~n~ ~n~in~ in this ap~li~tion ~t fo~h in the ap$i~tion filed t~mwith. No. 52-0344963 Suffolk C~n~ $ ~ ', ....... ~ .................... ~.~ ............................................................................ 5CA~ ~: ~rY, ~" " ~$T NOLFL o N.5[ 5 7.¸ L SUFFOLK COUNTY I I [ I ri- I, ii -~--~ I- '/'7 ® 0 ® THOU^$ E. TULLY LiCLFI£E riO. 22914 IL Y, ST&TE APPROVt~U A,:> ~"' ,1 t r II I THOMAS E. TULLY ,igq,s D p,~DFER~IOHAL ENGIN[~R & LRND SUR¥~Y~ ..i%,;~,E i~O. 2~914 ~, Y, STATE I II '-0" 0 0 k .L 5:G" 7~.4,' %tl-~~' 5'- (2' ~ 5I, o" i'%llS E. TULt. Y dC...E hO. 22314 H. Y. ST,'JE iL~kqo.,lD,, N, ¥. t,40"T 'F_ F t G~ . o" I-' ._J 8"1" L g 8'- i" L. _,_j