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Home My WebLink About6349-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~¶,O ...... Date ............. (~ .... ~ ....... , 1973. THIS CERTIFIES that the building located at l~.0,t/..8J8 · .lloet, h. Ro~I. Street Map No. 8~w~.oJrdl,... Block No... ~ .... Lot No. ~1~ .... 8ottt~o'ld...1~,1[o. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ,l~n. 2k ·., 197.3. · pursuant to which Building Permit No..631~9'~. dated ......... ,Titn .... 2.~. ...., 1973., 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 , l~lVa't,O. Olla .family. dl~lltltg ....................................... The certificate is issued to l~a~tk. 8aviakl, .,/l'. & .I/l£~t .... Ovll~s ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No.. ,.hi. 5...1973..bi'. a, .Villa ..... .lk,.. 1973 ................... ItOUSE NUMBER..5(;¢~0 ..... Street.. ~O~t,~l. l~,d. (g~) ........................... Building' ' Inspector TO~N OF SOUTHOLD BUILDING DEPARTMENT TO~N CLERK'S OFFICE SOUTH'OLD; N~ Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 63 t9 Z Date .................... ,l'~Z:~la,lrg ....... ~.~ ...... , 19.~.~.. Permission is hereby granted to: Joh~..~o~Lc.....~f~..F~nk..Sa~k$..J~.,& Wife to .~u3,1~,..mew...or, e..4:am$.t.y..&we~.t, img .................................................................................... ......................... ~App.ro.ve~..h~.. f~cl.. Al~pe~l~.) .............................................................................. at premises located at ..~v~.~..~,~'~.(.~'f).. ~or't;h'"Ro'~d' ..................................................... ........................................................ · e~thet~..., l~.r¥., ....................................................................... pursuant 'to oppiication dated ....................... j~ ....... [~, ............. , ]9.~.., end ~pprovecl by, the BUilding Inspector. Fee $,..R.~ .~ .......... TOWN OF SOUTHOLD Building Depo~tment Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR CERTIFIC:ATE OF O~GUPAHCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of alt 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 aoplicable. 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 Dote ...(~C~., ~......~.~.~...~....~. ....... New Building ....... ....v~... ...... Old,or Pre;existjag Building ............................ Vacant Land ............................ Location Of Property ..~..~.~.~-ww~.~.~..~:Z~%...~.cx~,-.St-.~..~.~.*..~..~C:)..r,~..~..~ ....................... Owner Or Owners Of Property .....~...~L%.~O..~,....~....~.~.~.....O'~.~.'~-3:~,..°--.~.~. ..................................... Subdivision ..~.~.~0~..~....~;~.~:~...~:~.~......~2.C~.LA~,....Lot No ...... .~..... Block No ............. House No..~..¢~..~-~ Permit No. ~9..~..~..~. ..... Dote Of Permit ....~.,.~.~.Applicant . .~...~-~.~.~....~.:..~.~,e,~.¢-.~.,'....)~-~. /'~ '~J' '~ Lab ~..~.. ~ ............... H~alth D~pt. Approval ........................................... or D~pt. Approval ............................... Underwr te Appravo ................ P onn ng Bo rd prova ........ ................... Request For Temporary Certificate ........................................ Final Certificate ............... ~ ..................... Fee Submitted $ ..,~..-..C~..L2 .................... Construction on above described building .an~ermit mee. ts~ll applicable codes and regulations. Sworn to before me this ........... , dayof ...... (stamp or seal) Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~;~ ~m~{i,k~ ~-~ Phone~. Subdiv. ~)~v3a Address ~o~ Q~ . ~ ~.~,~ ~lq~] 6. Section ' 2. Property locat~onv~-~ ~~E~D~P~61~ 7. Lot No. Village~o ~ -Township~ 9. Public water 3. Public Water Company name~~o~ Distance to maim 4. Lot size: Width/~ feet Length~,3~ feet (Enter on center plot below) 10. Sewage Disposal System: ~3 ~o A. 900 gallon septic tank: Precast ~quivalent Block B. Leaching pools: Number~ Precast Block Special -- If private well fill in blanks below: Tank capacity~/Z4~als. Pump G.P.M. Total well depth3~~ Depth to G.W. Amount of water in well ~O Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned ERTIFIES: "Construction of authorized be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Owner or-Builder "" installations will 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 I~l~~ ~ Signed/ ~~ ~- S-15 Revised 4/]/72 TOWN OF $OUTHOLD .. ~ "~' BUILDING DE.F,A. RTMENT '9~'/ ,'~"~__~ //"~ ~ ~ TOWN cLERK SOFFICE '~0-~- ?~ ~~~ ~ ~UTH~D, N.Y. ~ ~ .... ' .................................... Dim~r~ ~/e ........................................................................................... ......................... ......................... ........ ........... ..................... INST~J~S ~ ~. This ~pplicefion mus~ ~ ~mple~ely filled in by W~wri~er or in ink 8nd submitted in ~riplig~ ~o ~he Building Inspector, wil~ 3 g~ of ~l~ns, ~ur~te plo~ plan ~o scale. Fte ~rdi~ ~o schedule. ~ b. PIo~ plan showing Io~fion o~ Io~ ~nd of buildin~ on premiss, relationship ~o ~djoining p~i!es or public s~ree~s or ~s, en giving ~ del~il~ description of Iiyou~ of pro~r~ mus~ ~ dr~wn on di~r~m which is p~ oJ ~bis spplig~ion. ~. The wo~ ~verad by ~his ~ppli~fion m~y no~ ~ commen~d ~fore issu~n~ of Building Permit d. U~n ~pprov~l o~ ~bis ~pplicefion, ~he Building Ins~ctor will i~ue ~ Building Permi~ ~o lhe ~ppli~m. Such ~rmi~ ,shell ~ ke~l on~ ~he p~mi~s ~v~il~le for ins~ion ~hrougbou~ ~he work. e. No building shell ~ o~upi~ or u~d in whole or in pert for ~nY pur~ whe~ever uctil ~ ~iJic~e of ~cu~nw shell h~w ~ grin~ ~y ~he Building Ins~mor. 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. Ha m Road 5outhold (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises Fra~lk Sawlckt Jr 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 .......... ~ ............................. Lot No....~ .............. Street and Number ...~.....0......~,.......~./...~....~..,o.l'...t..~.....~..O..~.,~...-...C...~....2..~. ....... .~.,.o,l~..t...~..o..]:..~......~.....~....i ......................................... · Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,..V.~.~lg.l;...~,~J~,l;j. ......... ~.A~p. Dl".i;h~'.~.~l,..~)~..~.~l,..~,gj;).~ii.,,1Jl.) ...................................... b. Intended use and occupancy ..... .q~J..J~l:j~,~...~.Ji~J~g ................................................................................ 10. 11.. 12. 13. 14. Nature of work {check which apolicable): New Building ....................... Addition ..................... Alteration ............... Repair ................... Removal ........ Demolition ........................ Other Work ~....' (Description) 2t+, 000 + Fee ... ~...~ .~..,. ~'...0. ............................................................................. Estimated Cost ............................ .--.. ................ (to be paid on filing this application) If dwelling, number of dwelling units .....o.~.~ ....... Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ If business, commercial or mixed occuoancy, specify nature and extent of each type of use ..................................... Dimensions of existing structures, if any: Front .....................Rear ........................... Del3th ................................... Height ........................................................... Number of Stories ........................... ~ ................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth .......................................... Height Number of Stories ............... Dimensions of entire new construction: Front ..... .~..~....-..;~ ........ Rear ...... .tf~O.-.2. ............ Depth ....~.~.-.~. ................... Height ................................................. Number of Stories ...... .o..~..e. ............................................................................. Size of lot: Front ......!..2..0. .......................... Rear .......... .~2.Q ......................... Depth ...2,~.../...~ ......................... Date of Purchase ..................................... Name of Former Owner ............................................................................ Zone or use district in which premises are situated A i..s..t; .......................................................... Does proposed construction violate any zoning law, ordinance or regulation: ...... ~,Q ................................................. Will lot be regraded ..... ~t8 ....................... Will excess fill be removed from premises: [ ] Yes [ "]' No Name of Owner of premises ..... ,,'~3]r~..~. l"e/:t13s..,~a~;[~k;~ ............................................................................... .. (A~dress} (Phone No.) R. Nal;t, er~3 ................ damalca Name of Architect ..................................................................................................................................... (Address) (Phone No.I Name of Contractor ...d-...,...~.~..O..~...:~ ................. ~Q;~. ..........................; ........................................................... {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. See filed plans STATE OF NEW YORK,.___ . ) COUNTY OF ...................................................... ) ............................. ~o~.,,T~La[DQ//ID ............................................ being duly sworn, deposes and says that ha is the applicant above named. (Name of inc~vjdutll signing contract} . He is the ............................................... .,C...O.,~..~..~.~,,O.~ ...................................................................................................................................... {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. .......................... .................... .......... Notary Public ...................................................................... County /-~ ................................................... ~,~ ' {S~l(ature of applicant} , o.t. SeDtember 14, lP73 ~,,llc.tlo. No.o./i~ 6~2021 N in the following location; [] Basement [] /st Fi. ~ri,~do. September 10, 1973 FIXTURE I INCANDESCENT FIXTURES OUTLETS IECEPTACI~E SWITCHES FLUORESCENT / [] ~nd Fl. outside Section Block and found to be in compliance with the requirements of this Board. SPEOALRE4~'PT TIMECLOCK$ ] BELL tUNITHEATER$ MULTI-OUTLET ~WT. ~/~P. ' TRANE ~ SYSTEMS I 2 1 2O 34 24 2O DRYERS I FURNACE MOTORS I ~4TURE A~AHcE 'EDERS AMT. K.W. :L H,P* GAS H.P. A,V~T. NO. A.W.O. SERVICE DISCONNECT NO. OF S 1 100 CB OTHER APPARATUS: 'Furnaces:Oil 1-1/8hp, 1-1/12hp ~otor/s: 1-1/2hp Lot EXHAUST FANS DIMMERS NEUTRAL -1 Frank Stepnoski, 42C Little Neck Hd., Cutcho~ue,L.I. 11935 Per_ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. t I LOA~ Z SOUTHOLD 0 0 ZO.Z PAPSON 'SEAL OR ~ , · , ~e stage dtaposal ~8 ~te~ fac~llttes for this location ~ lnaaected by ~s de~rt~t to ~ Oat~o~cto~. I 2~a6o PAPSON '-'-'SHO'~/N AD-E BASED ON Ar,,, A5~,..., s.w. co-~-~[ ~ OF LOT: T'ITLE © ._~¢EL L ~qO. IZ79~'11 /,/ .S, ,C_AL,E, ,-40': [' / · .GyA~ANTEED TO THE TITLE G.U,qR, ANTE£ AND TO ,,50LITHOLD SA',/ING,5 ~.AN,~, / / - SILL. detail alwintite" aluminum double hung windows In, frame wall Io L Io ~ LIVIMO '~. ~..' ovm ~.. APPROVED AS NO~ED ,RAWN BY ~ROVED BY A. MATERN A. I. A. number CESSPOOL.' ~)ETA~IL . I I I I DRAWN R~ APPROVED BY I detail · ' "alw,intlte'.'aluminum horizontal sliding sash in, .,.... ~,.~-.. 2'~ 6" buck masonry veneer wall sheet no, RUDOLPH A. MATERN A.I, A. -~ ~ . _ I