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Home My WebLink About6801-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certific;:,te Of Occupnncy No.~328 ....... Date ........... F~b ..... !~...;.., 19.?~, THIS CERTIFIES that the building located at I~/S. ~atphal~a .aa ....... Street Map No.. T.o.!~..o.o.d Block No ........... Lot No..1.~../.~ conforms substantially to the Application for Building Permit heretofore fried in this office dated ......... Aug .... 10..., 1973.. pursuant to which Building Permit No. 680.1.Z.. dated ....... At~....1.7. ...... , 1973.., was issued, and conforms to ali of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Pr~?.a..re..one..f.a~%~..y...dF.e.1..1.~n..g ........................................ The certificate is issued to .P.h~.!$p...]~..~..1~..o..r.e ........... 0~An.e.r ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . F.o.b....~.1....~ ~.7..~...by...R....V.~... UNDERWRITERS CERTIFICATE No.. ]~..208073 .... .F. eb...~.. !.~_f.~ .............. HOUSE NUMBER .... .~.~.~0 .....Street .... ~eatplla~,~. Ro.~ .................... 'B~lding Inspector~ FOBM 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? 6801 Z Permission is hereby granted to: ....~T~.....I~.olJ~r.t,t~.. ~m~ .................. ........ · oi, tr.~tel~ ....... .li,~. ................ ,o .~!~L.~..-.....°.~..*... ~..s.~z ..~.~.e ..................................................................................... at premises located at ..... ]J/R..l~&&t,~h~t 4L.J~&~,....JJJI,:~t,:[.f,t/P,~ .............................................. .................................. z~t~...t.~2. ....... ~n3.~oo4..sa~. ............................................................. pursuant to application dated .............................. ~l~J:.....lO. ........ , 19..~.3., and approved by the Building Inspector. Fee $...'J .~.9e2 .~. ....... SUFFOLK COUNTY DEPARTHENT OF HEALTH H.D. Reference No. ~ ~0~/~"~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address /~ ~'A~-~ ~.~9 ~,~.1~.~6~.~ /-'~'://~ 6. Section~ ~, Property-location ~F~/~ ~ 7. Lot No.~7~ f'61 ~ ~g~ ~ ~. / 8. Private well Village~Township~9. Public water Distance to main feet (Enter on center plot 3. Public Water Company name ~ 4. Lot size: Width /~.~'~fee't Length ~6,~ below) 10. Sewage Dispos~System: A. ~90~ gallon septic tank: Precast~ Equivalent Block__ B. %J,e'aching pools: Number / Precast~3Block Special ~ ~"~ If private well fill in blanks below: ~ank capacity ~-~als. Pump G.P.M. T Total well depth Depth to c.w. [C/ Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 The be in accordance with ards thereto." Date undersigned CERTIFIES: "Construction of authorized installations will the Suffolk County Department of Health's current stand- ~/~ Owner or Builder 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 c~ be installed on this plot. Date S-15 Revised 4/]/72 THE NEW YORK BOARD OF FIRE UNDERWRITERS i-- nl't BUREAU OF ELECTRICITY SS JOHN STREET, NEW YORK. NEW YORK 10038 THISb.t. FebZ'UarYcERTiFiES THAT 5_,19 75 ~m, tlc.tlo,,~'a.,,,,.m,. 760 760 N ?_ 0 8 ~'~J ". "~ o~v the el~trical equipment as &scrib~ bel~ and int~uc~ by the applicant nao~ed on the above application nu~r in the pret~i.~.,~ of ~llip Bella~, ~790 WeStphalia Rd., Mattituck, L.I. u.a.. exaudned on Feb ~ua~ 3, 19 75 at~d fou,ld to be in compliance with the re~ptire.,ents of this Bo,,rd. _.~RYERS _FURNACE ~OTORS FUTURE APPLIANCE ~EDERS ~PEC AL REC'PT t ME CLOCKS BELL U~I; H~TERS ~t;~t~; ~i~ME,~ Furnaces, Oil: 1-1/8, 1-1/12hp. Philip Bellamore 1600 E. Drive North Merrick, b.I. 11566 OfNFIIAtMANAOW! Per .This certificate must not be altered in any manner: return to the office of the ~ard if incorrect Inspectors may be ide~tlflgd ~y their · ~/~/~,~ TOWN OF SOUTHOLD ~11~/~ y TOWN CLERK'S OFFICE ...~ ...... ....... ....... ........... Di~ppr~e8 a/~ ............................................................................................ A~PMCATION FOR BUILD~NG ~E~MI~,.~ , ~,/~, ~ ~. ~...~.~..~e .............. , 8 ~t~ of pl~. ~r~ plot plan to ~le. Fe~ ~ording to ~hedule. b. ~l~t ~l~n [ho~i~g Io~tion of lot ~nd of building~ on premi~e~, relationship to ~djoining pr~i~ gi~ing ~ d~t~il~ de~ripfiOn of I~yout of pro~rty mu~t ~ dr~n on diagram whi~ i~ p~ of t~i~ ~ppli~tion. ~. T~ ~o~k ~r~d by t~i~ ~ppli~tio~ m~y not ~ oo~en~d before issu~n~ of Building Per,it. d. U~n ~ppr~ll of t~i~ ~ppli~tion. the Building In~tor ~ill issue ~ Building Per,it th~ pr~i~ ~il~bl~ for injection throughout t~e work. e. No building shall ~ occupied or u~d in whole or in part for any purpose whatever until a Certificate of O~u~ncy shall have ~en granmd by the Building Ins~ctor. APPLICATION IS HEREBY MADE ~ the Building Depa~ment for the issuan~ of a Building Permit pursuant to the Building Zo~- Ordinance of the Town of ~uthold, Suffo[k County, New York, and other applicable ~ws, Ordinances or R~ulations, for buildings additions or alterations or for removal or demolition, as herein de~ribed. The appli~nt agrees to comply with all applicable law~[ ~rdinan~bui~ding~de~h~usingc~de~andregu~ati~ns~andt~admitauth~rizedins~ct~rs~npremisesandinbu dngsfor~ary ns~ons.~ ~ (Signature of applicant, or name, if a corporation) .... ~:~c...~..~...-~.~z~..~.,......w..:.~..,...zt~ £..°.. (Address of applicant) State whether applicant is owner, lessee, .agent, architect, engineer, general contractor, electrician, plumber or builder. · .................... ~...~~.,...4.: ................................... : ................................................................... Name of owner of premises ..~.P...,~....~...~/...~~'..~.;..'~.....'. ........... .............. . ............................................... If ap, plicant is a corporate, signature of duly authorized officer. ...~..-...z..~...~.~:~ .w.z.:.~.-..e.~ ............... (Name and title of corporate officer) Builder's License No .......................................................... · Plumber's License No ......................................................... Electrician's License No ..................................................... Othi~i' Traders License No ................................................... ~. Lecation ~re~';~r, which propo~ wor, w~, be dona. Map No./'.~lZ~..~.~.~-!~Lot ~..Z~.~.~..:~ ....... Street and Number ........~.~.~..r.~.z~.&~./..~..;.~.?.~t~........~.../..~../...~..~.:....~.-..':~...~-~.~~.~-~.~2 ................ .- ~ Municipality 2. State existing use,.~d occupancy of premises and intended use and occupancy of proposed construction: b. i~c~tidela'~e and occupancy ..... ..~..~...~.....J~'..~..~./..~/..~.. ...................................................................... 3. Nature of work (check which applicable): New Building ........ ~ ........ Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 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 occuoanc~, 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 ~ntire new construction: Front .~...~..:../.~ ........... Rear ..~·..~,,..-../..o.. ............ Depth ...'~..~...L...{~.. ............... Hmnh ~ . Number of Stor es 9. Siz;of lot' Front ..... ../...t~..(.,..~..~.. ................ Rear ....... .~..~.~..~.~..~.. ................. Depth ..~....~...~.....o..~. ............................. 10. Dateof Pu~chase.,~l~.~,.~ :2,~-.'~,:~, Nameof FormerOwner.~t~',...~..~,¢,/...~.. ~,.,~,/,..~...,~,,,~ ,¢~..,,~,'.A~'/. 1 1. Zone or use district in which premises are situated -'- ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ,.,~/, ........................................ 13. Will lot be re~raded -~l~*....-./V/..0--...,~ ......... W),llex.cess, fill be removed~,frop3.pre, m, ise;~i~___Ye~ Dd No 14. Name of Owner of premises ~P~zE~ef~`~/~`~p~Z~/~/~~¢~~~.3~ . /) (Address) (Phoge eeo.! Name of Architect ....~.~..~.p....Z~....~.~.....~...~...~.¥~.,.. '.~..v..~.~...~...~.,~.~.~..E...~?....~...../~.:~.:. ................... ~.~..w.~:.~.e~.~... 4 ,t (Address) ~ ~ (Phone No.! Name of Contractor..~,,~,~,~.,~,. ,~.,~-~' ,a~'.,,..~, ........ ~,. ,~'~,, ......... (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 ...................................................... ) ....... be,n° du,y ,,orn, depose, and ,aye ,h,, he ,s the app,,cant above named. (Name of individual signing contract} Ha is the ............... .~....~.....~.....~....~.......~......~.....L(../...L:.....~.....~.....~ .................................................................................................................................... {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 n the application fj~E~l~r~ .~t~ ............... ...................... ,,?. .......... . , Notary Public ......... ~,,,,~,~v~....-'~'.~,~.t.~.. County ......... ~ ........ .c......,........~-........~ ......................................................... ~ ,//"' ' ' - ~ ($~rnature of applicant? rear of lot distance to corner ('~"feet if corner lot) frontage of lot I~J. 0 street name north arrow distance to corner ('b"feet if corner lot) A APPROVED RUDOLPH A, MATERN A. i. A. RE~iIEiTERED ARCHITECT 89 E, JERICHO TPKE,, MINEOLA~ N. Y. 11501 sheet no. number I~ ;I T U 14 '-4" DRAWN BY APPROVED sheet no. design number ~ MZ;~. iL RUDOLPH A. MATERN A. I. A. sheet design number 8 4 I 1 E L E-VAT I© ~,-I DRAWN BY APPROVED RUDOLPH A. MATERN A. I. A. design number hee'l no. DRAWN BY 12 IO~ .5 [') ET,Z',, tL RUDOLPH A. MATERN A. i. A. REGISTERED ARCHITECT B9 E. ,JERICHO mp;~lE. MINEOLA~ N. Y. 11501 sheet no, design number ~ X ~. L rE_ xJ b~ '~ [ ,r'_,~ ~ -~- h'q." = *'" '='" I rE; ~l F,Z E. pL,b,~ E. EL~-V, Ishe~ no.