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Home My WebLink About6628-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificale Of Occupancy No Z~661+ Date I]ov 26 19.73 THIS CERTIFIES that the building located at 5o.und¥1ew. &Xe..w~.s.t ...... Street Map No.]:.e..eg~.~.c.. ~l.~.SBlock No ........... Lot No. ~ ..... ?.~q .o.n.~.q... ~,'.~ ~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ,~.m~..e. .... 1 ....., 19 .~.. pursuant to which Building Permit No.6.6285... dated .......... .J..u_~.9 .... 1...., 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 .Y.'r. ~y.a.~e., .o?.e..f.~..1.y..c~f~.~.l.l..~§ .................. , ..................... The certificate is issued to . .ti ~.'.~. :..C.o.n.s..t.r.u.c.t. ~_.o.n..G..ox?p .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .l~.O¥..~. Ag?]...bY..R. ~..g.$.~ ....... UNDERWRITERS CERTIFICATE No...~. ~.2.2.~.~.I+. ....... 0.¢.~..2.~....1.9.?~ ........... HOUSE NUMBER ...3(~) ........ Street ~.o..m?.d..V.i.e..w..A.¥~. :~e.s..t .............. Building Inspector l~ON,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING P, ER~IT CI:HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF: THE WORK AUTHORIZED) N.° 66'28Z ~o~ .............................. Permission is hereby gronted to: ........ ~ .~.~.....C~n~o.~.. C ~ .......... ................. ~t~t~c~ ....................................... ~'o ..... ~l~..~...~...~.y..~i.~ ............................................................................... ~r ~remi~ I~at~ ~ ..... ~..~ ....... PW~"H~'~ .................................................................. ...................................... ~o~..~t~..i~...~.~ ............ ~~ ....... ~.~.~ .............................. pu~uoat tO app[ic~t~ofi ~at~ ...................... ~8 ..... ~ ................. , 1~.~.., ~n~ opprove~ 5y t~e Building Inspector. Fee $.~r~.QO ............ ,building inspector / FORM NO. $ 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. <3nd submitted in duplicate to the Building Inspector w~th the follow~ng; for new buildings or new use: ]. Fmel survey of property with accurate Iocahon of all buildings, property lines, streets, ane unusual noturel or topographic features. 2. F~nel approval of Health Dept. of water supply end sewerage d,sposel (S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings. Industrial buildings. Multiple Residences end s~miler buildings end installations, a cerhficete 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 ]957). Non-conforming uses. or buildings and "pre-existing" lend 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, occupency 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 dwelhng or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building .........~ .... Old or Pre-existing Budding ............................ Vacant Lend ............................ Location Of Property ..... .~...Q..?..~.~...~...~...~..~........~.~?..~..~.....?.~.?...~Z.~.~..~ ..... ..~ff...~.~..'. ............................................ Owner Or Owners Of Property ...... ..1~....$....'~..: ..... ~.~....~m4..~?~..!..~....~.. ........ ?....O~.....P.. ..................................... Subdivision ..?...~...C.~..~..~..C.'. ..... .~..~...~h....~'~..~. .................... Lot No.....~....Y.. Block No ............. House No ............ Permit No .....~...~.~.~....?... Date Of Permit ....~..!.!..!].!...Applicant ......l~....~....~.......~.~.?.....[~....~;..~.?..'~..!~..~... .......... Health Dept. Approval ....,~..?,...0,:~.,.~...~. ...................... Labor Dept. Approval .................. ,.~...'....~. .................. Underwriters Approval ...... ..~,....),~.,%..?...~..~. ................ Planning Board Approval ............ ...~...r...~... ................. Request For Temporary Ce.,rtificate ........................................ Final Certificate .......... ~ ........................ Fee Submitted $ ............................ Construction on above described building and permit meets all applicable codes and regulations. p ,cont ........ ..... ...... .................... (stamp or seal) Sworn to ,before me this ~- ....... ..... ...... .... Notary Public .................................... County ~ 'THE NEW YORK BOARD OF FmRE .UNDERWRmTERs ak BUREAU OF EL.ECTRICi~ ~ 85 ,JOHN STREET, NEW YORK, NEW'YORK 10038 THIS CE~IFIES TNAT ~ly t~ ~t~M ~u~t ~ ~ ~ a~ int~ ~ ~e~mi~ Oc~obe~ 18~ 1973 a~f°undt°beln~m~ia~ewiththe~quirementsofthisbe. FIXTURE LEPTA I WIT } fiXTURES I m 1 3 6 SERVICE DIS~ONNr:CT JNo. o~l s E I zoo c~ ~ ICOOKI~ DECKS } OVENS DISH WASHERS AMT. K.W. I AMT. K.W. kMT. K.W. TIMECLOCKSI ~U. rUNITMF. ATEIIS MULTI-OUTlET ~ SYSTF. MS NO. (~ HI-LEG OfF HI-LEG EXHAUST FANS DIMMERS NO. OF NEUTRALS A. W, G. OF NEUTRAL #Furnacest 0tl 1-l/Shp, 1-1/12hp 'Ronald R. Ennts, P.O.Box 20q Middle Island, L.I. 11953 ~ m~e~ 11 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. 3-~-~7 APP~ICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~5~' (~',~'(~v~'~$~.~ (~ Phone 5. Subdiv. Address ~ ~ ~~v~ ~ ~ 6. Section 2. Prooe~ty location ~ ~0~'~ ~ 7. Lot No. ~ ~ ~ ~%~ ~r ~~ %~, , 8. Private weil ~ -- Village. ~O~%~ Township ~~ ~ 9. Public water~ 3. Public Water Compa~name ~ Distance to main 4 Lot size: Width %~ feet Length ~3~-- feet (Enter on center plot below) 10. Sewage Disposa~ystem: A. ~0~gallon septic tank: Precast Equivalent Block__ If private well fil Street in blanks below: Tank capacity~"~al Pump G.P.M. ~ Total well depth Depth to G.W. Amount of water in well Test Hole Data I F~et ~ 0 I l0 I i4 I 16 I 18 The undersigned CERTIFIES: "Construction of authorized installations wil be in accordance with the Suffolk County Department of Health's current stand- ards thereto."/~ /< ~ L~/~/'~ /~,~ ~'~ ,j Date Signed ~ x~,~ ~ ~,,,~,~,~ / Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, i is the opinion of the Health Department, that an adequate and satisfactory Sew Disposal System can be installed on this plot. Date S-15 Revised 4/~/7E TOWN OF SOUTHOLD ,~.x~, ' L ~/',,..~._~ / ~ ~ ~ T~N C~K'S OFFI~~ '~, ~'~J ~/ ~/ /~ ~ /~,, ~.~ BUILDING DEffARTMENT-- ~ ~~ WUTH , Di~ppro~d ~[¢ ....~....~ ....... ~_..___~~t~l~~ ~ ~_-~ ~ ~~ INSTRU~IONS~ ~ ~- ~ ~ a. T~is o~lication m~e completely fill~ in by ~ewnter o~ n nk unisom ~ in tripllcote to ~e BuiJ~i~ Ink,tar, with 3 ~ of pl~ns, accu~te pl~ plan to Kale. Fee ucco~in~ to ~u~e. b. Plot plan s~owing l~ation of lot and of ~uildings on premises, mlalion~ip to ~jo n ng prem $es or areas, and giving a detail~ description of layout ofpr~ must b~ ~mwn~ t~e diagram w~ich is ~ of t~is opplication~ c. ~e work covered by t~is a~licotion may n~ ~ comme~ he, re issuance of Building Pe~it. · d. -U~ opp~val of ~is applicati~, ~e Build~n~ Insp~tor will ~ a Building Permit to t~e app cont. Such s~all ~ k~t on t~e p~emises available for in~hon t~r~g~t ~ work. . e;,. No ~uilding s~all be ~cupi~ or u~ in w~ole or in part f~any pu~ose w~atevet until ~ Ce~ificote snan nave ~en granted ~y the Building Inmector. APPLICATION IS HEREBY ~DE to t~e Building Dep~ment fo~ t~e issuance of a Build n~ Pe~it pu~uont Building Zone Ordinance of t~e Town of 5out~old, Sure--aunty, New York, and ot~er appl c~ e ~ws, O~i~ Regulotions, for the construction of ~uildings, a~itio~or alterations, or for ~m~a or ~emoliti~, os he.in ~ri~. ~e applicant agrees t~ c~mply with all o~licab~nonc~, ~uilding c~, ~s ~ c~e, admit aut~oriz~ inmectorS~ premises a~ i~ ~gs ~r n~saw in~ti~. / ~. ~ ~.0~---~.~ (Signature of applicant, or ~me, if o comomtion) (Address of applicant) State Whether applicant is °Wrier, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · " Owner - builder M.S.T. Construction Co ................................................ 'lqOme of owner of ~. .................................................................... .~.~. ................................. '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 ............................................... Location of land on which proposed work will be done· Map No.: ,....~..e..~...o..~._~..o....~ .o..~..e...s. ..... Lot No. Street and Number SOU/ld View Ave West Peconic Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ... b. Intended use and occupancy ,9..n.e fa~iZy dwelZing , '3. Nature of work (check which applicable): New Building ,;..~... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .................................................... ~ (Description) 4. Estimated Cost .................... ~,0.~.~.Q..~+.....,...., ........ Fee ....,~.0Q .................................. ~,'i~ ................................... (to be paid on filing this opplic.otion) §. If dwelling, number of dwelling units ...... f),l~e ............... Number of dwelling units on eech floor ............................ If garage, number of cars ................................................. ~t ............................................... **' ......................................... 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 .........................3~. ..... Rear ....... 3~. ................ Depth ....~.~.../2,~ ...... Height Number of Stories 11~. ................ 9. Size of lot: Front ....... l.~.O .......................................... Rear ...... 1.~ ............................. Depth ....... .1~. ................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated "# ............. A....~:~st ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~3,~. .................................. 13. Wi~l lot be regroded ......~..O. ................... Will excess fill be removed from premises: ( ) Yes (Z) No 14. Name~fOwne-~f-r=-=--- ~.~*~, C,*ons'cl%tctlon ............................ ~ - ~ ~ ............................................................ (~ss .... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor S~me ............................................................ 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 shew street names and indicate whether Interior or comer lot. See filed plans STATE OF NEW Y, DPdC . ~cc COUNTY F I~%1/-1'0 J~: ~.~ ................................................................................................. being duly sworn, deposes and soys that he is the opplicom (Name of individual signing contracf) above named. O~ner bu~de~ He is the ................................................................................................................................................................................. (Contractor, agent, col~)orate officer, etc.) ~of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file th~s. 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 applicGJ~on filed therewith Sworn to before me this / ) ~ ~ . June -- 23 ' ' ~ ....................... aay at ............................................ ,,, ........ (~, ~ . ................................................... .......... ....................... DA~E H.D. ~,E~. $~i.t~ ,o ~ ~a~o~o~.,;. /~ ~ ~, ~ 0~ ~OAD . J~ Chief of General Engineer~~ ~$~ Services zrom field obse~atioB~ ~d/or f~om data obtained others. R,~V,~,O,~ YOUNG & YOUNG ~J,,,,,'l~/~75 400 OSTRANDER AVENUE',' R~HEAD,' NEW YORK OCT. 2~, 1973 A~EN W. YOUNG HOWARD W. YOUNG ' SU~EY F~: H~L~K ~ KWAS~ ,JR. . g ~0~ ~L~ AT PECONIC ~ ~DI~A~~~' I ~ srpitI~ ,J. bo) ...--- DIETZGEN 135 11846 MIL L L ,~ NE 0t~ ~O,~ D TO ADDITIONAL INSTITUTIONS OR SUBS, EQUF. I~F REVISIONS NO TE ~ ~UBDIVI$10 N MAP FILED IH THE OFF/CE OF THE CLERK OFSUFFOLK ~OUNTY ON NOF. gS~ 1957A$ FIL£ ttlO §001. AT PECONIC TOWN OF SOUTHOLD SCALE' I" YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, HEW YORK ALDEN W YOUNG HOWARD W. YOUNG SURVEY FOR: HALLOCK C. KWASNA,JR. LOT NO. 48 ," PECONIC HOME~ suFF0~_k co., .. y. "Y,,F~2. ~ ~.,-~--- 40' IDATE: MAY 15, 1973 No 73 -397 I · / -! APPROVED AS NOTED FEE:~f_~-~ BY /~T' NOTIFY BUILDING DEPARTMENT AT ?65-2660 9AM TO 47M FOR REQUIR- ED INSPECTIONS: 1. BEFOBE BACKFILLING FOUNDA- TION OR START FRAMING 2. BEFORE COVERING pIPELINE 3. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE EOR DESIGN Ol~ CGI'~- STRUCTION ERRORS 1 II f 1