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Home My WebLink About6810-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located a~n~et. La .&. 14anh~nset. Ay. Street Map No.....X~X.. ...... Block No .... ~ ...Lot No. X~;X...G~.e.e..np.o.r..t .... N. :.Y.: ....... conforms substantially to the Application for Building Permit heretofore filed in thi,~ office dated ............Aug...20.., 19..73 pursuant to which Building Permit No.6.~l 0~... dated ............. Au$..22., 19.73., 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.r.~.v.a..t.e....ope.. f .a.m.~.l.~,..d.w.e..1.1 .~.ng. .................................... The certificate is issued to l~oe:L .Lut, kovsk,t .~..V;l,rgl~..I~v.tk..or. sk~. ..... .of~...e.r.s.. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N.o.?.. ?.~... ? .9~..~... b.y...R:..V.i..1.1.a... UNDERWRITERS CERTIFICATE No. ~...~ 3.6.63 .~ .... ~'~.n... 71..~.~.. ................ HOUSE NUMBERm . . ~6~. ....... Street . ;[~ale~. ~. ' ~:~5~0 Manhanset Ave ....... FO~M NO. 2 TO~N OF $OUTHOLD BUILDING D~PARTM~NT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6810 Z Permission is hereby granted to: at premiseslocated at _T"/V L /.~ "T L/t/V./- ~ /~//~ItV H/tt'J$£7 AV .................................. ~--i~l~ E ~ '~ pursuant to application dated ............ ~ .................. ..~....~... ...... ..~...U...~.~.., 19~.....~....., and approved by the Building Inspector. Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No~_~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date~u~,~ust 1-Applicant Pho ne~$~__6- Sub dlv Address ~' W. ~we~A ~milder ?-Section 2-Detaile~~ ~%~a~Ao~reeeper~, N. ¥. 8-Lot No. Hamlet . N ~ ~ ~ ~., ~.v. ~ ~, ~ 9- Private well? n 3-Publi~u~ply name ..... y.~zt _~-~_'"'~D?tance to nearest main 60' ~-Lot S.ize: Width~ma~ft. ~e~K~_~. "~ai~'o' ~nter on center plot plan below:) %-Dwelhng: Sin~Family ~ ; Tw~'F~mily? ~ /Cellar? ~ /Slab? / /Crawl Space? lO-Proposed system: Septic a~nk ~Precast ~_~Cesspools ~ /Shallow pools ~ /Other / ii-Septic tank inside dimensions. Volum~ ~als. Length ft. Width ft. Liquid depth 12-Precast sections: ~$.~Number/ /SqualOrS. Cesspools: Block sizeL incs. D ins. H Total blocks below inlet: ~1 ~2 ~3 ft. ins. Seva~e ays%em %o eonst~ o'g one ?recrst Capacity Gals. T ~tJ~ The Undersigned CERTIFIES: "Construction accordance with the Suffolk County Health Depart rade Data Feet 2 w~%er 4 6 8 ~0 ]6 1¥ Indi ate No ~th authorized installations will be in nents' current Standards, Bulletins, and amendments theret~ Dat Signed ' 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 can be installed on this Plot. Date ~'~77 Signed < ~ --- __ (10/65 Revis. ) S-15 FORM NO. 6 TOWN OF $OUTHOLD 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 Jan. 14. 1974 New Building x,.x..x.. ............. Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property Corner ?,.~nh~use%~ Ave. 0. Iqe't L~ne Owner Or Owners Of Property Noel & ¥ir~inia Lu%ko~rs'~i Subdivision ................................................................ Lot No ............. Block No. ............ House No ............. 565 Permit No..6.,8.,1..0.....Z. ...... Date Of Permit ..8..,-.~.~,'T.?..8...Applicant N..,,.Lu..%.!~.°..?,.s.!~.i.....c..,/.,°....,C..;....?.:...,,P.,°.,w.e,.1.~' Health Dept. Approval .~..o.v........]:..~.%....]:..g...?.~ ............ Labor Dept. Approval ................................................ Underwriters Approval .....~.?.n..*.....?.!.....1.?..?.?. .............. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ...... .x..x...~. ............................. Fee Submitted $ ..~......0..0.. ......................... Construction on above described building and permit meets all applicable codes and regulations. Aoo cant N: Lu~ko~ski c/o C. ~. powell .............. ~ "~"~ ..................... .{. ........... (stamp or seal) ~/~_~.9'~ ~, .oto P ub,,c ........... ','. ........................ Co un,y THE NEW YORK BOARD OF FIRE UNDERWRITERS ;~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CERTIFIE='S THAT only the electrical equipment as d~scrlbed below and introduce~ by the applleant named on the abo~ application number in the premi~es of Noel Lutkowski, w/s~de Manha~3et Ave., car. of Inlet Drive, Greenport~ L.I. in the/allowing location; ~ B.se.~e.t ~X ~t FI. ~ ~nd ri. o ut s id e $~tion Block Lot was examined on J Fi nual'y ,~ p I f) 7 ~ and found to be in compliance with the requirements of this Board. DRYERs FURNACE MOTORS ~UTURE APPLIANCE F~EDERS RANGES ~PECIAL REC'PT 1 3o COOKING DECKS OVENS DISH WASHERS TIMECLOCKS BELL UNIT HEATE~ MULThOUT~T SERVICE DISCONNECT I NO. OF S 1 1 OTHER APPARATU$~ *~urnaces: Oil#1-1/Shp, i[2-1/12hp 1- 19 amp. ~rbage Conpaeto~ R V I C EXHAUST FANS H.P. ~ 1 DIMMERS A. W.G. NO, OF HI-LEG A, W.G. NO. OF NEUTRALS AW.G. OF CC. CC)ND. OF HI-LEG OF NEUTRAL 2/0 1 2/O 1200 Harbor Lane, Cut choF, ue, L.I. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. '. Disapproved o7c ..................... ................................................................. ....................................................................... ........... ........ (Building Inspector) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE~~ SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Aug~s~ 20, 197~ Date .............................................. , . , 19 ........... ~' - INSTRUCTIONS a. This application must be completely filled in by ~ypewriter or n ink and submitted in duplicate to the Bull b. Plot pk~n showing Iocat on of lot c qd of buildings on premises, relationship to adjoining, premises or public streetcar areas, and giv ~ ~ta ed description of ayout ofproper~ must be drawn on the d agra~ ~ ~ ~rt of this opplicat~n. )~ ~ ~e~dit~ ~rr~ ~~. Upon app~vbl ~. this application the Building I?pec ~c. ~e wor~ c°Vered by th s application may not be commenced before issuance of ~ild'ing P~it: ~ ~u~t~ss it tO the ~plic~t. Such per~,t shall ~ kept on the pr~ ses available for inspection throug p g · . ' ~ ~ No building ~tJ.be ~cupied or used in whole or in part for any purpose whatever until ~ ~?ificate of OccupanCy shall have been grant~;~ the Building Inspector. - -- APPLICAT ON IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant ~o the '"'~¢[djh Zone Ordinance of the Town of Southo d, Suffolk Count¢, New York, and other applicable ~ws, Ordinances or Regula~ons, for the construction of bu dings, additioKs or alterations, ?r ~or removal or de~2 a~ h~re)n descr.bed The applicant agrees to c6mply with all applicable laws, ordinances, buddmg code, nousmg c~ regumt.ons. ........ ~<~-,-~ ~.. .,. (Signature of applicant, or name, ~f.a corporation) Robinson 2o,%d, Greenpor{, :~. Y. (Address of applicant) Stot~,~j~r'applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plL~mber or builder. .: ....... :....~:~] ~ e~ - . .................................................................................................................................................... Name of owner ot premises .,.; ..........:;.,:...,; .......................................................................... \ If applicant is a corporate, signature of duly authorized officer. ~ .................. ......... : 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ....................... Sou%hold To~n Street and Number ..I~.~.q.$...L~.~.e...&..~.~k~m~.eLA.~.e ................................................................................... .~ ~& ~.~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .... .~uil~.~..q~..p..~.~.. ............... ' ......................................... b. Intended use and occupancy ..... .~.l~%~t~e.n.C-.i?~l-..]~.e-l*.L£P-~r ........................................................................... 3. Nature of work (check which applicable): New Building .:f...~..x. ........... Addition .................. Alteration .....: ............ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................ ~. ............... 4. Estimated Cost ....$.~.~.QQ.0. ........................................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~)~.e .................. Number of dwelling units on each floor ............................ If garage, number of cars '~mT° ¢~r o~:-q,ge 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 n,~.t 3" .... ~. ............................... Rear ............................ Depth ........................ Height ...~.~.t. ........... Number of Stories 9. Size of lot: Front 1§0 Rear 1§0 Depth 100 10. Date of Purchase ........................................................ Name of Former Owner .~..t,.~..~..q.s..~?.~.[ ............................... 11. Zone or use district in which premises are situated residen%i~l 12. Does proposed construction violate any zoning law, ordinance or regulation~ N P~I IO~S 13. Name of Owner of premises i~...L.g..%k.o..~59.%~,i .............. Address~.~%1%.%..~.h.~...I~.,,..,T,.~. ........... Phone .,o ............... ' ...... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .O.~....,~'.~....P..9.?...e..1.1. ....................... Address ...... Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail set-back dimensions from prope ty lines. Give street and block number or description according to deed, and show str ;et names and indicate whet? !r interior or comer lot. lk ........... ~x~'~.'F.~.'~"~-C4'.:~..-..~/~.C~,'~r- .¢~-.'~.. ............................ being duly sworn, deposes'and says that he is the applicant (Name of individual ~ning above named. He is the ........ ~./(k-.-.~...~z~-~ ................................................................ (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 ore 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. Sworn t~befc.~ e~d~e th~s ~'-~1 .~.~ ........ day o ...... ............ ............. ............................. .b q'o e/~V. 0.0, - ~ /'o,(,.- 5-0 7'or~t o~' 8our~,ox.o, ~¢o/£ : .fro '=1" ~ = ~Io~orn~of- ~0 U