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Home My WebLink About6796-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk'8 Office Southold, N. Y. Certificate Of Occupancy No. Z626~. ...... Date .............. Deo.. 30 ...... , 19.'~. Gillette & E. Gille; THIS CERTIFIES that the building located at . *Mid'isa4' Ptaee '~ ........ Street Map No. l~ax~to,,, t4ano~lock No ........... Lot No.. l~ .... Eas.t .gar&ola.. I~.Y, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Aug...ll+..., 19. ?.~ pursuant to which Building Permit No. dated ......... Aug...1% ..... , 197.~., 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 .. Pl'lva~e. ~ .~mll~g .pool-wi.th..f-circe .ere ........................... The certificate is issued to . .Kenneth .Wat~ot~ ..... 0w~e~ .......................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) · I~.R o .............................. UNDERWRITERS CERTIFICATE No.. ]~..1471+]9 .... 8el~t. · .2[~.. 49?3 ............ HOUSE NUMBER .... ?~ ....... Street ...Midte, nd. Ptaee ........................ ..... .5 ~ ,., .~ ~'~Yc-/..~ ~. ~? . ..... l~OB~ NO. ~ TOWN OF SOUTHOLD 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.° 6796 Z Dote ...../2,~/,~,~:~.~../.~.., Permission is hereby granted t~.... /~/ ~ -- Building Inspector. Fee $..~.~..Z--.~.~... ..... Ai~FROVED AS I~OTED gATE: FLE: BY NO,IFY BUILDING DEPARTMLNT AT 7~,5-256u 9AM 10 4PM FOR At.Q k~ ~NSt"kCTIONS: I BEFOFtE BACKFILLING F~UNDA TICN OP, SIAP, T FP, AMING 2_. B~. L)?,~: CUYEt'~ING 3. Fh~L WHEN JOB COMFLLTED NOT RESPONSIBLE FOR DESIGN OR CON- STRUCTION ERRORS FORM NO, 6 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: 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 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 ...~......~:....~..:....3..~....~..~....~....~.1.. New Building ...... ~' Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... !...~.. ~.~.~.~.%.~...~....~...y.~_.~. ~ .C.~..%..~ ~.s~..~\.~..~....,...~......~. .......................... Owner Or Owners Of Property \~ Subdivision ....~...~.~.%.\.¢~.~.....~.....~....\.....9~x ~ o ................. Lot No...~....~.. ...... Block No ............. House No ............. Permit No..~..~...~i.~....~... Date Of Permit .~ ................. Applicant ....~.~.m,..~..~.."~..~.....~...:....~......~.~. ~..~...r~. ........... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .......................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....~ ..................... Fee Submitted $ ...~,.~...C~. ..................... Construction on above described building and pe~nit meets all a~olicable codes and regulations. Sworn to before me this .....'~....~'. ...... day of ...~ .~..~..~..x..~....~..~>........~..~..~...~.\ (stamp or seal) Notary Public ~~~ounty TC~I [~C . ' NEW YORK BOARD OF FIRE UNDERWRITERS ~-- ak BUREAU OF ELECTRICr/;Y 85 JOHN STREET, NEW YORK. NEW YORK 10038 THI~ CE~IFIE~ THAT ~~ ~te~ev 2q, 1973 ~d/ou~beln~mpfiancewithther~uirementso~thbBo~rd. DRYERS FURNACE MOTORS UNIT HEATERS MULTI-QUTLET SYSTEMS HO. OF K DIMMERS SERVICE DISCONNECT S E R V I C E NO. O~ CC. CO~D, Al W.G. NO. O~ HI-I~O A.W. G, NO. OF NEUTRALS (Swi;~min~ Pool) This certificate covers cOmpliance at the date of InsDection only. Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. OF NEUTRAL Mi'ks Silrls, Main Road, East Marion, L.I. 11939 m~ 11 THIS COPY OF CERTIFICATE MUSTNOT BE ALTERED IN ANY MANNER. · THE NEW YORK BOARD OF FIRE UNDERWRITERS (~R BUREAU OF ELECTRICi'~fI ' ~ ' ' J~ 85 JOHN STREET, NEW YORK. NEW .YORK jO03E THIS CEI~'rlRIBB THAT only th~ M~c~rlcal ~quipm~nt ms d~crib~d b~ow and introduced by th~ ~Mlc~ nt na~ on th~ abo~ applicat~ pqmb~r in tb~ premises Kenneth Watson, Midland Place c£6 E. Gillette ur. ~ cJll~ette ur. East Marion, L.I. ==,=,mln~o- September 24, 1973 .nd found to be ln 6ompllance wlth the requirements of thls Board. RAN~L~ K.w. ]COOKING DECKS I OVENS i msH WASHERS T', c,.o,:~, ~..,,,.. ~ · 1 :' ' ' · NO. OF FEET SERVICE DISCONNECT J NO. OF J S ~T. .',/~. rn'E I~J~P. '~ ~v a~ a)'.(,w so, o~.~ coso. 1 100 CB X OTHER APPARATUS.' R V I C A* w.G. NO. OF HNLEG OF CC. COND. OF HI.LEG EXHAUST FANS DIMMERS NO. OF NEUTRALS OF NEUTRAL Mike Sillris t,~ain Rd. EAst Marion, L.I. 11939 Per. copy FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. Approved FOItM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. 19..~ .... Pemit No. Disapproved o/c ............................................................................................ (Bu-ilding mspecror~ APPLICATION FOR BUILDING PERMIT Dote ........ Au~uo$...l-Je~ ................ , 19...7.~..*: INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witl 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn 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 Building Inspector will issue a Building Permit to the applicant. Such permit.shall be kept on- 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 shall have been granted 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 regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (S~ature of applicant, or name, if a cO~oration) .......... 3.~ ~O....¥m %Item m ..)lwno ~.~m2...ib~.~ ..... (Address of applicant) BobomJ.&, Now York State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................................................... · bu.l.z~e~'. ....................................................................................... Name of owner of premises If applicant is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No....M~rJ~o~..N~r .............. Lot No .......~8. ............. Street and Number .......... ~[;I,.[I.~,.~.g.~...,l~,l, Rl~.~l .................................................. ~llL.~;r[~l~ ................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed constnJction: a. Existing use and occupancy ................. IIJ.~,l~1.o..J:aa13,)gxtvelJJ.~ ............................................................ b. Intended use and occupancy ............... ~.I...a~.~.~....~R~X...~I.~,IJRIL~I~&..~.~IO~, ................................................ 3. Nature of work (check which applicable): New Building ......... ~. ........... Addition ..................... AIteratio.rt ....... ~..,.. · Repair ............... Removal ......................... Demolition ........................ Other Work.~'/~'~ ,~_~P.,,,~,. ,~,~;(~;.... ~, ..e~.~..l~..., ~ uescription~ 4. Estimated Cost .........~.~z..9..O...O. ....................... Fe (~ ;~'/~'~,C~" ' ~ (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 .~.O....;~...tA.O. .......Rear ............................ Depth .....~.-..7.~ ................... Height Number of Stories ........................................................... 9. Size of lot: Front ............... ..1..O.,~. ............... Rear ........... ..k.~j..k......[,~.~. ........... Depth ........ .7..5 ..................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ....... ~,~. ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ..n..e. ............................................ 13. Will lot be regraded ....-~.g~.: ....................... Will excess fill be removed from premises: ix] Yes [ ] No ....... ~®nn®tb ¥&taon. Htdl&nd PI&o®, F~at Hirton ....... 14. marne or uwner oT premises ............................................................................................................................... (Address) (Phone No~[..~ ~.~.~ Name of Architect .....~t~e,.tlLtx~¢..£e=l...gexl~.~...5~5.Q...V. el~,~..~a~.~..~e~a~&,...d~6~3~6 ............ (Address) (Phone No.) Name of Contractor .~.~...~..e...~.~..~:~.e..[~..~.~.?~.].~.~..?..~.~.x~.~...5..~..~.v..?.~.~.~t~.~.~.~.~.~.~.~ ............ (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 wheth- er interior or corner lot. STATE OF NEW YORK, ) COUNTY OF ..................... R~tf~[k ............. ) PLEASE HOLD FOR PICK UP SESAME CONSTRUCTION SERVICES INC. .............. .~JL[LJ.a~II...~....J~.~.&I~II ........................................ ~ ..... being duly sworn, deposes and says that he is the applicant above named, (Name of individual signing contract) He is the ....................................................................... .~g~L~,l;l~g ...................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ' '"' /f~ CAROL CARROLL .~.....~.....,.~...... ......... ~Z'.,.~ .................... day o ~'.'.'./..~0[r~,R¥. p0~l~,. 5,t~e ~)f I~ y~l t~ Notary Public ........................................ 9.9.~.~i!i.~.i ~. ~ ull~l & £ou~l~o u n t y ................................................... Cernmi~ofl Expires March 30,.19 7~' ~t~'~ nt} ?.,~h'l. .,