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Home My WebLink About6642-zFORM NO. 4 TOWN OF SOUTHOLD BUITDING DEPARTMENT Town Clerk's Office $outhold, BI. Y. Certificnte Of Occupnncy No. · .~76 ..... Date ............ .D~..e. ..... 3 ...... , 19. ~.~ THIS CERTIFIES that the building located at Bm~ .Rae~.. & J~,ra~ .La~e. Street Map No.l~m~kal~. i~t~J~llk No ...........Lot No...%l~ ..... Sou~thold ........[ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........J. tme .... i,., 19.73. pursuant to which Building Permit No. 66~2Z. dated ..........J. ume. 4~ ..... , 19. ?5', was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .l~t.v&te. one. £~mil~ .~we3,1:Ln~ ....................................... The certificate is issued to . .Fraz~k .~. Ann.. ~Lc o. ...... .t~tuer~ .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .NOV... ] St .. 3973.. by. .B,..v. llla.. UNDERWRITERS CERTIFICATE No..Il..~7~6 ........ Nov..~.....~.97~ ............ HOUSE NUMBER . .60 .......... Street ..... Bout..Hob. ct ........................... Building Inspector l~O~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6642 Z Permission is hereby granted to: · .E:o~q~ .-Gen~t~ ~...~'~,1~ .-&..Am~ .. .......... ~;2.~O.....s~u~e.. ~ ............................. ................. ~a.yv.$t.[Le ............................................ to ~I.~L · ~e,~ .. oae...£aa;L~r. · ¢1¥e ifb;i,us ...................................................................................... at premises located at .~t..~...l~.....N~,tnel~oaw.~w~e~s .............................................................. ........................................ ~g~.~.~..~oa~t ................ ,So~t,~14 ....................................................... pursuant to application dated .......................~'~tt~e ....... ~ ............ , 19~.~,..., and approved by the Building Inspector. Fee $~.1..~.~..0. ............ Buildin~ Inspectol FORM NO. $ TOWN OF $OUTHOLD Building Delm~tmnnt 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 ar 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 New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Locot,on of Property ..... ....... Owner Or Owners Of Property..~'.../'~"'..~.?.s......~......~...~....~.........'~..../..~'.O.. ............................................................... Health Dept. Approval/x/.~.~..~'...' ............................... Labor Dept. Approval ................................................ Underwriters Approval ~....../..~"~...../..~...~... ................ Planning Board Approval ......... ...~;~ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ......... ..~...... .................... Construction on above described building and permit meets oil appl~able codes end regulations. Applicant ................ ~ ............ Ld ............. ..................... Sworn ]~efore me this ......~..'.~. day of ....,~ ~~.......~.~.,,~'--~' (stamp or seal)~ ~7~ ~aW PHblic ¢....,~ ~ ...... 'County THE NEW YORK BOARD OF FIRE ~UNDERWRITERS BUREAU OF ELECTRICI~'Y. ,' ' . 8S JOHN STREET. NEW yORK, NEW/Yo~K - N 125736 Rico, n/e Bow Rd. zn=ersec=lon or Ar~W in the following location; [] Basement [] Ist FI, ~=~i-~a-- November 1, 1973 FIXTUEE OUTLETS 22 DRYERS RXTURES [] 2nd rt. outside Section Block Lot and found to be in compllanee ~vith the requirements of this Board. RANGES COOKING DECKS ~)VEN$ DISH WASHERS EXHAUST FANS FURNA~ MOTORS FUTURE APPUANCE I~.EDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS SERVIC~ DISCONNECT S E R V I C 1 2/0 Electric room heater/s: 1-2.5kw, 5-2.0kw, Water heater/s: 1-11.Skw 2-1 .Skw, 2-1. lkw, 1-.gkw, 1-.75kw LET Electric Co. 56 Dunn Court Sayville, L.I. 11782 FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE. ALTERED IN ANY MANNER. · I ENI' Examined ........ ~ ......... ..~....., 19..~.~.. / Disapproved a/c ............ . APPLICATION IS HEREBY MADE to the Building Department for the issuence of e Building Permit pursuent to the Building Zone Ordinence of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or.Regulations, for the eonstrtmtion of buildings, 8dditions or elf]rations, or for removal or demolition, as herein described. The applicant agrees to comply with 811 aflfllicoble 1ow~, ordinences, building~, h. ousin! code, and regulation?, end to admit authorized inspa, ct, ors on premises end in buildings for neceisBry imgections. I ~ Ix,,-~ ,./..~..~...~ c-"°~..¢Z:....~..'t..~ f, .... State whether applicant is 9~vrmrj lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ........................................ ....................................................................................................... :...., .................... Name of owner of premises ...,~...~...~:.......~.....~....'~...~. ......... ..~./..~... ................................................................................... If applicant is a corporate, signature of duly authorized officer. Builder's License No .......................................................... Plumber's L cerise No ....................... ........................... Electrician's License No ............ .~ ...................................... . 1. Location of land on wh. ic.h~proposed_work will.be ~one. Map No .............................. .~.;; .......... Lot No ......... ./ ............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... ; .................. ...................................................................................................... Nature of work (check which apl~licable): New Building ....................... Addition ..................... Alteration.., ............ Repair .......... Removal .................. Demolition ........................ Other Work ................................ ~.. ...................... (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ..../. ........ Number of dwelling units on each floor ......................................... If garage, nUmber of cars .......................... Z .......................................... ~;. ......... i ...... ~i ........... :;%:.....~:,~ ...................... 6. if business, commercial or mixed occuoancy,$1~Cify nat,ure and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ...... ~ ...... Rear ............ ~ .........DeDth '. .................... "' of Stories -- ' Number Height ........................................................... · ............................................................................ Dimensions of same structure with alterations or addition.s: Front .......... ~ ...........Rear ..... ~ ............................ D -- ~ w,i,~t ...... ~ . Number (~f Stor es ............... ep~n ................................................ u, ....... ~'~1/'~ ~' : ...... ~ '//'-- 8. Dimensions of enti~new construction: Front ....... (~..~.....~...... Re.ar ....... ~z~.~eDepth ...... ..~...-:t ..................... Height ............... /.. ............................. Number of Storms .~=~....~... ...................................... ~.~..~,~., ........................... .3 · . . 9. Size of lot: Front ...... .~.....,,..~... ............. Rear .......... ~.. ...... ~.. .................. .Depth ......... '~'~'"'."v';' ...................... 10. ua~e of rurcnasa ......... ~ .......................................... ~ .......................... r'" 11. Zone or use district in which premises are situated ..., .......... (..~..'~...~.: .......................... ~7~ .......................................... 12. Does proposed construction wolate any zomng law, ordinance or regulation: ........... ~..~ .......................................... 13. Will lot be regraded y....~...._~ ............. ~J. ilJ excess fill be ¢emoved from .oremises: [ ] Yes ~ No . , .... ,_7:---,_ 14. · I~ame o~ uwner o~ pr~m~:,~-'~ ................................ iAd~r~ss) ................. (Phone No.) nf 6r~hitn~t ~ J' · ............... Name .............................. ~.//. ........................................................................................................ .,,.r-' __ ~- ,. ~ (Address) /~ (Phone ',,zO ...... Name of ContractoZ.. ,..~.~:- ...... ~ ~..~.~. ~ .L.~..~ .......... ..~... ~ ~ ........ ..~...--~..2 .... ....................... (Address) ............. (Phone I~.i PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck 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. OF NEW YO,~/ STATE .... COUNTY OF' ~~ ~ .............. being duly sworn, deposes and says ,thal~ he is the applicant above named. (Name of individual signing co~ct} ' ~- ' He is the ...................................... ~-., ~/r~ .............................................................................................................................................. of said owner or owners, and is duly authoriz. R~D~Hpltr~K~l~lN)r have performed the said work and to make and file this application; that all statements contained in this application araca~u~ut~ctl~abe~{ ~9~i~q~how~d;Ige and belief~ and that the work will be performed in the manner set forth in the application filed-therewit~e.. 52.0344963 Suffolk Counly~' C ....................................~ ~ day o.~f ............ ~ -, '-~-~ i~U~I~OUNTY DEPARTMENt OF HEALTH Approval to con~vu~8~Is~~ s~t~.i~Lrequeste~,pertinent data herewith: Date 1-Applicant Address ~_~ ~¢~ ~/ ~.~//~ ~y 7-Section 2-Detailed property l~.¢atien~,,~ ~ ~'~.j- ~I~,,~ ~.8-Lot No. ~T ~/~ ~ ....... 9-Private well? 3-Publtc~ wa~er sup~T~?e .,.~ Dist~uce to nearest m~in ~-Lot size~ Length~ ft. ~idth/~~ ft. (Also enterA~n center plot p!~n below:) 10-Proposed system. Septic tank/ ./Prec~,~_~Cesspools~Shallow- ~eols/ /other/ / Ii-Septic ~ank inside,.di~enslons ~V.~,u~~ls .Length Ft.Width ~t.Liqu~ depth ~ ~ ft. 12-Precast sections :~Number.~S~a~ft.Cesspool~ ~lock siz~n-~ ins .D~' ins.H~ins. PLOT PLAN NOTE Grade ~ I ~ Test Hole Ind~ ~,ate No ~th The Undersigned CERTIFT~: "Construction of authorized installations will be in accordance ~ith the Suffolk County Health Departments' current Standards,Bulletins, and amendments thereto,covering Private Sewage Disposal Syst~". Date~ Signed .~ ]2 ,~ / ',~ . ¥ F(~ HEALTH ~EPXRTMENT USE ONLY. Based on the information pre~fited herewith,it is the opinion of the Health Department,that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. (lO/6 ~OT ~- LOT NO'5. ~!F ~ '~ ~;~ TC, '~IAP OF NUNNAk~OMA '~ATE._D~_]~~ Ell[E) INTFt[ F. UFFC'LI4' COUN'~ YCLE:I~i4'~ OFf- ICF AS. I,,1AF-' t,~C. 512_6 ~ = CE$~FOOL EDUCATION LAW COPIES OE THIS SURVEY MAP NOT BEARING THE LAND SURYE¥OR'S INKED SEAL OR EMBOSSED SEAL SHALL N3T BE CONSIDEI~ED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL JUN ONLY TO THE PERSON [OR WHOM THE SURVEI' } f' LT 9-2030 TOMARK CONSTRUCTION INC. Building -- Con~tructlon 5250 SUNRISE HIGHWAY .~AYVILLE, NEW YORK I L~.I'I ,r..LEV~T lot1 I II II I II II I ~l__u_ ........ _~-- -- i APH:~)VED AS I~ TED 765.26eO~)e~M TO 4PM FOP ~QMtR- INSPECTIONS: ~ TION OR START FRAMING ~E¢O~E COVERING PIPELINE ~INAL WHEN JOB COMFLETED ~40] RESPONSIBLE FOR DESIGN OR ,tLT 9-2030 TOMARK CONSTRUCTION INC. Building -- Construetio~ 5250 SUNRISE HIGHWAY SAYVILLE, NEW YORK '1 /~s~ KIOIIT LLEVATIO~