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Home My WebLink About6618-zFO~M NO. 4 TOWN OF $OUTHOLD BuILr~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .N.O.~ .~.....B~....?. ~...~.,...E~..~Street Map No ........ Block No .... ~ ..... Lot No. _:~nforms substantially to the Application for Building Permit heretofore filed in this office permit .~~~ ........ .... , i9 p~ant to ~h~ch dated ........ ~ .3~, ...... , m?3., ~as issue~, and co.fo.:es to aU of the re~ui~ ~ents of the applicable provisions of the ~. ?he occup~cy ~ssue~ ~ ... ~IT~ .¢~P..~. P~q~pl ..................................... ?he ce~cate ~ ~ssued to .... ~. ~.~ q~P~ ................. (o~e:, lessee o~ te~t) o~ the afo~es~ buffing. S~o~ ~o~t~ ~ep~t~e~t of ~e~th ~ov~ ... ~q. T~. ~3 ................. ~o~ ~ .... 78~ ...... s~ .. ~..~? ~..~ ........... 80 ~ ~1~ ~B~ Inspector ........ ................. FO~M NO. 2 TOWN OF SOUTHOLD BUILDIbiG DEPARTMENT TOWbi CLERK'S OFFICE SOUTHOLD, bl. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) -' N? 6618 Z Date ............................ Permission is hereby granted to: .... 2.:ad..J~e,c. kha~s ............................................ ....... 1.b.~......~lz~..&~ .............................................. ......... ~a~:~.~=te,....~.,:Z, ..... 1.1.7..8,9. .................... to. J3.uild..~a~z,~ .~ ~n~..~m&l.~.. d~e 5 .Z. &~a g. .................................................................................. at premises located at .... ~c~];...] ........ ~iF~W~O~.~&t ..................................................................... .............................. ~. :... ~.a.~..e.~...~.o...a.~...~...'.~. ~%~. 9...o..a.....s...a. ............ .s...o..u.~..h..o...z..4 ............................. pursuont to oppli¢otion dated ............................. ]/,a-y ....... .~$ ........ , 19...~Z~., ond opproved by the Building Inspector. Fee $.f).. ,~..'..~...~. ............ Building Inspector/ /' · THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ c~ ' eURE^U OF E'ECTR'C~ 'i: .' ' · [~ 85 JOHN STREET, NEW YORK, NE. VIi iY~)RK !110038 TNI~ CEEIFIES THAT F~e~ B~ckhat~s~ s/u/c No. ~eyVleW ~Q.~ HZ~WOOQ ~-s oOU~OIQ~ September 2q, 197~ andfoun~itob~i, compfiancewithther~quirementsofthisBoard. NXTUR~ L RXTURRS OUTLETS IECEPTACLE$ SWlTCNES INCANDESCENT ELU~ENT 1~ 32 19 16 DRYERS I FURNACE, MOTORS I FUTURE APPUANC! FB~OeRS AMT. K.W. OJL~, H.P. [ GAS H.P, A~T. NO. A.W.O. / SERVICE DISCONNL~T I NO. OF S 1 12~ Pan 1 Motor's: 1-1hp ~.~.ClAL RK'PT' R COOKING DECKS OVENS DiSH WASHERS TNC~OCKS I am {UNITHEATERS MULTI-OUTLET ~tf.' AA%,,S. TRANS. H.P. NO. OF mET V I. C NO. OF HI-LEG A. W, G. EXHAUST FANS DIMMERS Haymond Burdl No. Country Hd. Miller Place, L.I. 1176h m MANAO~ Per , t · I COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. I FORM NO. S TOWN OF SOUTHOLD Building Depa~tment 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 unusua~ 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 pldn 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 aH 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 premlses, or other pertinent in- formation required to prepare a certificate. 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 Dote New Building ....?.~ ..........Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..... ~/..~/..~...~'~.~Z?.~..e.~.?~...~..~...~...~...~..~?.~...~..~..~.~...~..~.~.~.~.~..~.~.~.~.t~.~r...~.~' Owner Or Owners Of Property ..~/~.~.,..&..~,~.~..~,~...P.,~.C.~]~,1~. .......................................................... Subdivision ................................................................ Lot No..~1, ........ Block No ............. House No ............. Per it 6618Z ~- - m No ..................... Date Of Permit .~;.2.~...~3...Applicant ,~.....~..~..~.~,D~]~a~,~ ......................... Health Dept. Approval ~0~ .................................... Labor Dept. Approval ...............~..:.(...~..'. ................... Underwriters Approval .../~....~... ................................... Planning Board Approval ...... .l..~...:./...~.d ................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted ~....~....~ ........ Construction on above described buildinv~/per,~,i~s a?~cabl~;Us and regulations. AOD cant ~..-..~..~~ Sworn to before me this ................ aat~or .................. ../. .......... ~ ............ mo ary umtc .................................... County - WTLLIAM ~. 9VILLIAM~O/q '~j:~ ~otm'y Public, State of New ¥0~ ~ Co,~m, ~l~e~ ~c~ aO, :lg"~t~' (stomp or seal)/ . 0 SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant X~r~~ Phone~ 5. Subdiv. ~e~ Address~6. Section 2. Property Location 7. Lot Number 8. Private Well Village a.=~,~.,~ Township o___~_~j 9. Public Water 3. Public Water C'dlit~ll~r'liame '~"--"'~ 4. Lot size: Width__)j~feet Length lll) 10. 11. Sewage Disposal System: A. O~_~gallon septic tank: Precast~Equivalent Block B. Leaching pools: Number of pools 1 Precast~b?Block Special If private well, fill in the following blanks: A. Tank capacity b~ gallons B. Pump G.P.M. ~ Total well depth. Depth to ground water Distance to main feet -~ (For Heal th Dept. U~--~ E. Amount of water in well~ The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date Signed~//. 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 and Water Supply can be installed on this plot. APPROVAL DATE ~'/x~)FF//~ SIGNED S-15 Rev. 4/1/73 YViF v Unauthorized alteration or addition to this ~urvey b a violation o~ ~ction 7209 of the New York State Education Law. Cop~ o[ this survey map not bearing the land sun, eyor'$ inked ~¢al or embossed seal shall not be considered to be a valid copy. ,r certifications indicated hereon shall run any to the ' :' -, ~hom the survey is prepared, and on his behalf to the , ~ 'n,,,~ny, governmental agency and lending institution listed ~;, and to the assignees of the lending institution. Guamntee~ ~:~ certifications ore not transferable to additional In~ilu~ms =r subsequent ewnar~. SURVEY FOR FRED BACKHAUS AT BAYVIEW TOWN OF SOUTHOI_D SUFFOLK COUNTY, N.Y. SCALE, 1",~.9~' / MAY 31, 1973 REFERENGE ~ HIGHWOOD AT BAYVIEW FILE NO. 5547, FILED NOV. 28~ 1970 eUARANTEED TO ~ LAND BURVEYOR tL¥& LIC. NO.~7~S RIVERH~ADs N.Y. 7'/./ OCT 1 ? 1973 ~,_, ~ Chief of Cenc~al Engineering Services Unauthorized alteration or addition to Ihis survey is a violation of section 7209 of the New Yo~k Stale Education Law. Copies of this sur~ey map not bearing the land surveyor"$ i~ed seal or embossed seal shah not be con.~idered to be a vaJld copy'. Guarcnlees or Cr;m ...... ~cated hereon shaft run only lo the person for whom the survey is prepared, and on his behalf to the title company, governmental agency and lending institution listed hereon, and to the assignees of the lending institution. Guarantees or certifications are not transferable to additional jltstJtulJolls ~ SURVEY FOR FRED BACKHAUS AT BAYVIEW TOWN OF SOUTHOLD SUFFOLK COUNTY~ N. Y, SCALE ~ I"~ 3~' / MAY 31~ 1973 SEP~ I0, 197~ ~.Z:OI h¥ it REFERENCE ' HIGHWOOD AT BAYVIEW FILE NO. 5547, FILED NOV. 28, 197'0 ~RANTEED TO: LAND lURYEYOR N.¥I. LIC. NO. ENT~B RIVERHEAD~ N.Y. : $ BUILDIt~ D~FARTM~rr~ ~ ~,~.~. ~ ~ .... ....... . . ........................ ....... ~prov~ ........................................ , I~.....,. yeti; ~.~..~..~ .............. Di r ' ' ~ ~pp ov~ a/c ........ ~ .................. ~ ....................................................... ~ ~ . .. ~ ( . ._ ~/~ ~ ......................................... ~ ...................... ~~=:...: ~ ~z.~ ....................... ........................... *PPU~ mR BUI~HG PE~IT ~. ~is o~licoti~ must ~ c~pletely fill~ in by ~ewriter ~ in i~ o~ s~mi~ in tripli~ ~ ~Bui~i~ In~r, wi~ 3 ~ of pl~s, ~cumte pl~ plan ~ ~. F~ ~1~ to ~h~le. b. Plot plan shying I~ation of lot and of buildi~ ~ premix, relati~ip to ~joini~ Dr~ ~ ~1~ ~ m O ar~s, ~d givi~ a ~ail~ ~rJpti~ of I~ ~ must ~ d~n ~ t~ diagram wh-~h c. ~e wo~ ~er~ ~ ~ a~li~ti~ ~ ~ ~ c~ bef~ i~ua~e ~ Buildi~ P~ff. d. U~ a~al of ~is ~li~i~ ~ Buildi~ I~tor will i~ a Building Permit to the ~l~t. ~ ~rmit shall be k~t ~ ~e pr~i~ ~ail~ ~r i~ ~ ~ ~. e. No ~ildi~ ~all be ~cupJ~ or ~ in ~ole or in pa ~ for any pu~e ~atever Until a ~i~ ~all h~e ~n gmnt~ by ~e Buildi~ In~or. APPLICATI~ IS HEREBY ~DE ~ ~e Buildi~ ~nt for ~e i,uance of a Bu di~~t ~uild~ Z~e Ordinate of ~e T~ of ~B, Surfak C~n~, N~ Yo~, and ~er~1~~ ~ulm.~s, ~r ~ co~tr~ti~ ~f bui~i~ ~iti~ or a~i~s, ~r ~r m~l or de~liti~, ~ hewn ~. e apphcant ~r~s to co~ly wl~ all ~hc~le ~, mdt~, bu!ldl~ c~, h~i~ c~, admit au~fiz~ in~to~ ~ pr~i~S a~ in ~ildin~ ~r ~ I~ti~s. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................... ................................................................................................................................ Name of owner of premises ............. ...~......~.. ~. ...~....~..C~ J-~ ..~....~.....~... ............ . If applicant is a co.orate, signOture of duly authoriz~l officer. (Name and title of corporate officer) Builder's License No ..................................................... P~um~r's Ucense NO..L%..~.:..V........~.~,~:~.~ .... Electrician's License No..I...,l/..~.:....~. ......... ~her Tmde's Licen~ No ............................................... ~1~ / L~oti~ of Io~ on whic~ pr~d ~rk will ~ d~. Mop No.: ............................. ~t No ......................... Street and Numar Munici~li~ State existing u~ and ~cu~ncy of p~mises and intend~ use on~ ~cu~ncy of p~ c~st~cti~: a. ~isitino u~ a~ ~cu~ncy ~C~ ~0~ '9." N-dture of Work (check which applicable): New Building..................L/ Addition .................. Alteration .%.....~ ........ · Repai~' .................. Removal .................. Demolition ................. :.. Other Work .................................. ~. ............ · (Descriph0n) 4. Estimated Cost ..~...7., ~O0 r:~,, ~ ~" > ~ ' (to be paid on filing this application) / 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each f oar .'.. ~ .................... 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,~tories .............................. t 8. Dimensions ~of~ entire new construction: Front ............. .~....~....[...~....i~.... Rear ......~.....~...~...~... ....... Depth ..... ..~....~......0. ...... Height ..../...~.. ........ Number of Stories ........................................................................................ ~,..~../..~...; .............. 9. s'; ....................................... ........................ !.....! .................................................. 10. ~,;fo;;ur~a°~; ............. ~ ~ ...... :.~.'.'...~....... NRaema; of F ;r ..... 11. Zone or use district in which premises are situated ~..~'--~ ~.~...~..~..~...~../.*~ 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ,~..O.. ...................................... r r'' ~/'O ( )/'~No 13. Will lot be eg aaea ............................ Will excess fill be removed from premises: ( ) Yes 14. Name of Owner of nremises /~'~f'~ .~--'~f~r&/--~ .... /=.,7'~ Name of Architect .....~..~...'~...~...i ............................... Ad~re~OO ..... ...~.~;~.~.~...~.~.vnonemo.,.,.,.,.,.,.,.,.,~f~,R~ ........ Phone No. ....................... ~.Z:.,..-.0...7.!.!.. Name of Contractor ~j/~/v/~/~/Z:)O Address~;~.~.~..' ...~...1[./5~ ................................................................... Phone No ....................... PLOT DIAGRAMs- '~O E"/'f Locate clearly and distinctly all buildings, whether existing or [~op~a~in~/e~te (~lJ set-~Jns from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, .~1/ I. c c COUNTY OF ................................ ................................................................................................. being duly ~orn, d~oses and says t~t he is the applicam (Name of individual signing contrac~ above name. He is the .~.~ ................................... (Contractor, agar, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to ~rform or have performed the said work and to ~ke end fi~e this application; that all statements contained in this application are tree to the best of his knowledge and belief; and t~a~ t~ work will be performed in the manner ~t fo~h in the application filed therewith. Swam to before me this ................. o, ............................... ........ ...... ¢ N. .................................. ~oto~ ~ubhc ~, ~ARY PUBLIC, State · New York No. 52-~163~5 Qualified in Smfolk County ~mmi~ion Expires March 30. 19 L DATE FEE NOTIFY BUILDING 765 2660 9AM TO 4PM ED INSPECTIONS r l BEFORE BACKFILLING TION O"R 5TART FRAMING 2 BEFORE COVERING NOT I~SPONSlI~LE ~ AT AND r~