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Home My WebLink About6636-zFOBM NO, 4 TOWN OF SOUTHOLD BUILI~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z.~.8~ ..... Date .............. ~pr.i.~... ~...., 19.~.~.. THIS CERTIFIES that the building located at . ~ass&u. Point. Ro~ ...... Street Map No. N.a.s.s. :..P.t..P.~e~k No ........... Lot No. ~ ..... .C~..t.e.h.o. gt~.....N...~.: ....... conforms substantially to the Application for Building Permit heretofore filed in thi.~ office dated ........... J..un..e .... ~.., 19 .?3. pursuant to which Building Permit No. dated ........... J.~.e... ~ ...., 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;I..~.a..t#..o.n..e..f.e~..~.ly...dw.e.l.]...~ug ....................................... The certificate is issued to .~F.8.~.3,~ ...... 01mci, .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval AprX,X .. 9...197~...by..R,¥Xlla ..... UNDERWRITERS CERTIFICATE No. 111.~92~....l~r..X~...1~7.15 .................. HOUSE NUMBER 10120 Street Nassau Pi~..t Road Building Inspecto~ FOII, M 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? 6636 Z Date .................... .~'.I~A~.~...... ~[. .................. , 19.~..,~... Permission is hereby granted to: ~.,...~.~.9~......~.c.......~.,.~.,..c..~ ............. ........... .9.~.~.h..?..~..?. ............................................... Build new one family dwelling pursuant to application dated ..................... ?.,,,l~,..e......,.~. ................. , 19~.~....., and approved by the Building Inspector. Fee $~..O.?..e.~..0. ......... Building Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS SW BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT ~ly the e~t~ ~uipment ~ ~scd~ ~ a~ int~ by t~ ~i~t ~m~ o~t~ a~ ~l~at~m~r~ t~e D~mlses of F~ank C~o~e11, ~Assapln~ ~d., 300" before End or L.I. in the following l~ation; ~ B~e~nt ~ lst FI. ~ 2nd FI. 0~ ~ ~ ~ ~ ~ ~ction Bilk Lot w~exami~don ~ ~ ~7~ andfoundtobeincompliancewiththerequlrementsofthisBoard, RXTURE LECEPTA LE J I IqXTURES OUTL.S I cEISw..S I,NCANDE E i L .¢, Ti 39 , / 37 }7 30 1 13, DRYERS__ FURNACE MOTORS ~TURE A~A~E ~E~RS I ~0 OTHER APPARATUS: COOKING DECKS OVENS DISH WASHERS TIME CLOCKS BELL UNIT flEATEBS MULTI-OUTLET i.. TRAN. .~ NSo,YSoTFEMH~T EXHAUST FANS 3 DIMMERS 1 ~o0 E NO. OF NEUTRALS A, W. G. OF NEUTRAL B.J. ~,lectrlc Co. Stlllwatez' Ave., Cutchog~ue, New York 11~;35 O~I[J, AL MANAG~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF SOUTHOLD Building Delmrtmeut 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 dispasal--(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 3. Copy of certificate of occupancy $1,00 $5.00 New Building....................~ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ........... ..~, .~...~...~......./~...~....~....~...~..D.;...~....~../J~.£~..~..?.. .... ~nerO.~ne,~O~rope~y ~H~S- ~,~, C~/~ Su~ivision ................................................................ Lot No...~.. Bilk No ............. House No ............. .......... ~ - ~- ~ · ..~/~.~.~.....~..Z~.~..~. Permit No. ~.~.~.~ ~ Date Of Permit .................... Apphcant ..,,h ................... ............ ............................. U,,,w,i,e,, ~,,,o~.~ ...~.L~.~..~.~.~ ............... ,~.nn,n, ,o.r, ~,,rov.~ ..... ~..: ............................ Request For Tempara~ Ce~ificate ........................................ Final Certificate Fee Submitted $ ....~ ........................... Construction on above describedAppbUildingcant a/~' '72'~meets~'x~x~"~'~-~ a(,U~ app~j~le _c~/~es ~and regulations. Sworn to before me this day Noto~ Public .................................... County (stamp or seal) ~ ~,~ ~ fl"he ~e,~'a~e disposal and ~,'a~ er Supply facilities fop [hi[; ~ ~ - have been Chief of General Engineering ~erv!ces. 0 ,~,// J SUFFOLK COUNTY DEPARTMENT OF NEALTH A.D. Reference No, A?PLICATION FOR APPRO~VAL A. 10. N TO CONSTRUCT A ?RIVATE SEWAGE DISPOSAL SYSTEM 692- Applicant FLOWER HILL B~ILDING CORp.~ PhQnc_~5 5. Subdtv. Address ~243 JERICHO TURNPIKE, WOODBQRY. N.Y. 6. Section -"7. Lot No. 84 Property locationWEST SIDE OF NASSAU POINT ROAD "8. Private well X NASSAU POINT ~iliaga ~UTCHOGUE Township SOUTHOLD 9. Public water · --Distance Lo main_ Public Water Company name Lot size: Width 100 .feet Length~_/O___feet (Enter on ceqter plot below) Sewage Disposal ~ystem: A. 900 gallon septic tank: PrecastX,.Equivalent~Block B, Leaching pools: Number_ Precast X Block Special If private well fill · ,oo/ in blanks below: Tank capacity~2 Gal~ Pump G.P.M. ~60 Total well depth 501. Depth to O.W. 5' Amount of water in well_ ~0' Test Mole Data Feet HUMUS 0 SAND g L~M 2 ~AND g GRAVEL -- 8 -PU~E SAND 12 .zed installations The undersigned CERT ' be in accordance with the Suffolk County Department o~ ~91th's current stand- ards thereto." ~ ' Date 1,/8/72 Signed -- 9un~'-or Bdtlder FOR NEALTH DEPARTMENT USE ONLY, Based o---~-the information presented herewith, is .the opinion of the Health Department, that an adequate and satisfactory Se Disposal System can be installed on this plot. Date_ Signed_ S-15 TOWN OF SOUTHOLD /~?.,~.~ ~- ~ (/~ ~ BUILDING DEPARTMENT- ~ ~ 0~ ~ ~ TOWN CLERK'S OFFICE SOUTHOLD, N.Y. L~,~ ~ V,~t- ~ ~% .... App,,cat, ............. Disapproved a/c ............................................................................................. INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in 'triplicate to the Building~ Inspector, with 3 sete of plans, accurate plat p an to scale. Fee according to schedule. b. Plot plan showing location of lot and hr'buildings on prem ses, relationship tO adjo n ng premises or pub ic streets of areas, and giving a detailed description of layout ofprpperb/must be drawn on the diagram which is part of this application. c~ The work covered by this application may not be commenced before issuance of Building Permit. d.. U.pon approval of this application, the Building Inspector will issue a Building Perm tto the applicant. Such per~it,.~ shall be Kept ~ the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy.~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk Counb/, New York, and other applicable Laws, Ordinances or~l/ 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 regulatiofls, and to admit authorized inspectors on premises and in buildings for necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electr c an, plumber or builder .................. Name of owner of premises . . . .............. · ................................................................... 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 wh ch prpposed work will be done MaDNo' ,...~......~.....~'..../~... j / ] ' ~ r '' '~'~ ................. ~ ............... LOT ~O ........... ~ ............ Street and Numar ...~~....~Z~.T ~.~ ' " Z~i~i~ii~ State existing use and ~cu~ncy of p~mises and intended use and ~cu~ncy of prod c~mction: a. Exisiting use and occupancy .................................................................. ....... ....... property lines. Give street and block number whether interior or corner lot. I~ure 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 ............................ f 2.. If garage, number o 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 Stories ................................ ./ 8. Dimensions of entire new construction: Front ...~..~.. ............... i ........ Rear ....~.....~.. .............. Depth .~..//./~..~. ....... Height ...J....~. ......... Number of Stories ....... ,/....~'...T.~.: ........................................................................................... -- 9. Size of lot: Front ........ ./..(~. .................................... / Rear ..... ./.../....'~'... .......................... Depth ...~...'~..~/....~..,~'.~. 10. Date of Purchase ........................................................ Name of Former Owner 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No Owner of remises .~.~ ~ ...~..! j~ (~1)~'1 [ A r J¥'aS~ 4 t~ j~l~l: ~1' 14. Name of p .... '~ .................................... dd ess ............... :~/...., ......... Phone No ....................... Name of Architect .............................................................. Address ................................ Phor~ No ....................... Name of Contractor ....~...~..//I..~......~x..J~....~..O.~ ....... Address P..~.~T.~..~.~..... Phone No..7....~...~...-....~...~../...,~' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from or description according to deed, and show street names and indicate STATE OF NEW,~O~/)~, ISS COUNTY OF ..~.~ ........ J' ~ .............. ~~ ............................................. being duly sworn, deposes and soys thru he is the applJcom '~'- -~u-~ame o~ individual signing contracf) He is the ....................... ~. .......................................................... ~.....]] ..................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and '~o rn~_ke and file this application; that all statements contained in this application are true to the best of his knowleclge crud be, lief; and that the work will be performe~,jn the manner set forth Jn the application filed therewith. ~: ~ Sworn to before me this ~, ~ ~ ~,) ,, i: Notary Public, ........................................ ~ ............ County ...... .~'., .~....~....~ .............~"~ -t~"- - ~- ../~.. ~ :..~...~.. ...................... · (Si~,~;~fU r~/applica nt ) t I t / / ,. '0 I [ I I I/- t