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Home My WebLink About6649-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...Z.~I.~ .... Date ............. 0~... ~ ..... , 19.73. THIS CERTIFIES that the building located at . ~/Lla. etge..l~n~ ............. Street Map No.V~..~lock No ........... Lot No.. ~ ..... ~gt~¢~...~., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. g~e.. 9., 19.~. pursuant to which Building Permit No.. ~. dated ............ ~..ll., 19.~., was issued, and conforms to all of the require- .-merits of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . .~. ~ .~l. ~ .B. ~ ..... ~eFl ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~...~.. ]~3.. ~.R~. ~ ..... UNDERWRITERS CERTIFICATE No... ~..!~ ~.~....~t. ~..].~?~ ...................... IIOUSI: NUMBER,. ~0 ....... Street ..... ~18~ .kS~ .............................. , .l .qZt. . . . Building Inspector BUILDING DEPARTMENT TOWN C, LERK-'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6649 Z Date ,1'tree 11 19.~... Permission is hem~ granted to: ~$ 9~...~.o.~.L~.~L..~Z~......If.ej~.,. ~.;;~.n..,.~...~e ........... J~:t,.t~...~ct. ............................................ .................... .1Lt.ctSe ....... ~.~......t.1961 .............. ~o ....~.~,~.~...~....~xl~...~l,~...~.~:LlJ4~ .................................................................................. at premises lacated at ..... ~D.~...~.J~ ....... .~.~,~I~I~..~.G3BO~. ................................................................. ..................................... Vll~,g,~..~,,~ ............ 14a&~$.~u~k ............................................................. purs~nt to application dated ......................... ~l~l~e.....~i ............. , 19..~.~., ami approved by Building Inspector. Fee ~0...60.: ........... Building In~-q~or { ' SOUTHOLD TOWN O~EpAaTMENT BUILDING TOWN CLERK'S OFFICE ~H~D, N. Y. ..... ........... , / ~pr~ed .... ~ .......... ~....~.~ ......... , ,I Pemit No ..... ~.~....~..~.. ~.......~ ~. is~pproved a/c ............ ~ ................................................................. ......................... , APPLICATION FOR BUILDING PIERMIT Date ........ *T:I~O...9. ......................... , 19..~.,~. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building inspector, w~h 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which is pert of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. . d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept the premises available for inspection throughout the work. e. No building shall be occupipd or used in whole or in part for any purpose whatever until a Certificate of Occupancy shell have granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Z( Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constructio~ buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable la, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; .................. G~n~..C~mt~u~t o~.~]~11~. ................................................................................................................ Name of owner of premises ....... .~.~`.~d~)[1::~.~.~.~`~[1i~1~.~2~~;~.~-1-~&~*..~'. ............. gd. wln G, J(oone ', Y' el. 1. Location of land on which proposed work will be done. Map No.:,~6~.¢~ ........... Lot No.....1.8 ..................................... Street and Number ...]i'.t].t~..Z~Zt~ .............................................................................. N~tJ~t,t~tl4~ .................... Municipality 2. Stat~ exiSting use and occupancy of premises and intended use and occupancy of proposed conStruction: a. ExiSting use and occupancy ......... Uz~d.~lr~.~pM~...~..z~t; .................................................................. b. Intended use and occupancy ....... ~l~l~..~.lll,~,~...;]~.l. ll.~J~,ll~,~ll. ........................................................................... 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building ...3[ ................. Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) Estimated Cost ~,,K.~Q0J),J).Q Fee ...,~....~f...~.~....~.. ................... .................... (to be paid on filing this application) If dwelling, number of dwelling units ~3..~... Number of dwelling units on each floor If garage, number of cars ....~3~ ................................................................................................................................ If business, commemial or mixed occupancy, specify nature and extent of each type of usa-...-..-..-...-..-..-. ...................... Dimensions of existing structures, if any: Front .....lat~l~e ....... Rear ........................... Depth ................................... 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 ...... ,~ ................. Depth .~J~ .......................... Height ..... ~ ....... ~,~ ........... i ............ Number of Stories .......... 13Zl~.. &.9~..~la.~ ............................................... Size of lot: Front ....,..~.~}~., ..................... Rear ..... 1~ ............................. Depth ....~..?~ ....................................... Height .................................................... Number of Stories ...................................................................................... Date of Purchase ..~,~.~....l 9.~.;} ........... Name of Former Owner ............................................................................ Zone or usa district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ..~1,~ ..................................................... Will lot be re{Faded ----~U ................. ~.... Will excess fill be removed from premises: ~ ] Yes [ ] No Name of Owner of premises .~iegl~.. K,,H~I. ............. ~,0..~[$.~,l~.{~fd~r~;;i~e,3tlt&~,..,~ ...... '~on~o.~; ............ Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ..~6tlt.Cllt.~l;la~tl.~..Z~.....~al~tt..~,ea~...Rl.d~e,..~l'Z, ............ 9Z~1~60. .......... i .......... (Address~ (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. GiOe stree~ and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. COUNTY OF ......... J~.~ ............. ............................. ~.....~...'~'...~..........~.'.......~.~..~.~. ................. being duly sworn, deposes and says that he is the applicant above named. {Name of indipiclua! 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 end 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 13e)rfl~-0aed in the manner set forth in the application filed therewith. ~ ',Y,/[LLIA~ J. MOONE' NOTARY PUBLIC, Stote oJ New Yor~ ............................. y o .............................................. ~,f~ -- ~. 5~-~755r575, Suffolk County FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, H. Y. 11971 APPLIGATION FOR GERTIFICATE OF OCCUPANC:Y 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 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 dwelHng or land use 3, Copy of certificate of occupancy $1.00 $5.00 Date ..... ~ ./.~.~. ,/?...~. .......................... New Building .....N...e..w. ......... Old or Pre-existing Building ............................ Vacant Land ............................ East Side Villa e Lane 8~.0' North Nain Road Nattitugk Location Of Property ....................................... ~;. ......................................................................................... Owner Or Owners Of Property ..... I~D_I~...&..,.T~a, ZL~e,..K.uhn ................................................................... Subdivision .... .¥.~.]:..]:..~.~.e...~..~....o..r.. ............................ Lot No....]:~ ...... Block No ............. House No.....~.?..O.... Permit No...~...-..~..... Date Of Permit ..(~/.~.~,/.~.]..Applicant .,~l,.~.O~q..~Q~fh.,s...~[~,~.~...,~./.~..~.~,lP,,K~...Kg]zm Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ............................ ; ................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Final Fee Submitted $ .................................... Construction on above described building a~J-.~l;~nit~et~' all applicable codes Sworn to before me this .... ..~.~7~/... day of ..... Z~C~C~,Z~.~... (stamp or ~ ........................... n ...... ~ ~ ~/It.1 IAM J. MooNEV ~//// · // //// ,,/~ No. 5~-~7S5575, Suffolk County SUFFOLK COUNTY DEPARTHENT OF HEALTH H.p. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Applicant N~. & M~*. N~? ~t~h~ Phone~a_5. Subdiv. wp,,___ Address _ ' ..... J'~" 6. Section---~-~- ~Z 2. Propert locatfon - - ' 7. Lot No. ,~ N Of Naim ~._ M~,,~_ Nv 8. Private w~l ___ Village___~~ ~n~'~ip__~ 9. Public water ~'__ 3. Public Water Company name mm~ Distance to main ~ 4. Lot size: Width~feet ~th 97~ feet (Enter on center~) 10. Sewage Dispo~ystem: A. (~0~ gallon septic tank: PrecastwEquivalent Block : Special If private well in blanks below: fill Tank capacity_~_Gals. Pump G.P.H. ~ Total well depth~ Depth to G.W. Amount of water in well 2 4 6 8 10 12 14 16 18 The undersigned ERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." r Z r rewl FOR HEALTH DEPARTMENT USE ONLY.' Based on the information pres e~ed he 'th, it H~-~al%-~ ~epartment, that an adequate and/satisfactory Sewage installed on this plot. is the opinion of the Disposal System can be D at e,, ,, Signed S-15 Revised 4/1/72 cs THE NEW YORK BOARD OF FIRE *UNDERWRITERS BUREAU OF ELECTRICITY i ' ~. ~,~,~.,~.~o.o.~,. N 118024 ·HlS CE~IFIE~ THAT o~y the e~t~ ~ulpment ~ ~scH~ ~ ~ ~ ~ t~ ~t ~ ~ t~ a~ ~pl~a~ num~ in t~ p~m~s of in the foll~ing ~ation; ~ Bme~nt ~ Ist FL ~ 2~ FI. O~t 5 ~e s~tion Bilk ~'"~i~°"Septe~Oer 27, 1973 ~df~tobein~mplia~ewiththerequi~n~ofth~B~. 11 - 22 SERVICE DISCONNECT NO. OF S Motor/B: 1-1/2~p *Special Receptacle/s: 1-50~p~., 1-30amps. Furnace/s: Oil, 1-1/Shp, l-1/12hp R "ME~.OC~S I B~LL ~ MU~TI.OUTUrr A,~T~t &MP& TRANS,. I .,~.~T. I ~.~. NO. of SYSTEMSFEET C OF CC. COND. Towle I ~on~, Inc. 33 Lincozn ave. Mastic Beach, L.I. 11951 Per EXHAUST FANS DIMMERS COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. N.'70'OO'E. -- 255.31 18 $.TO'O0' tV. - 270.0[, LOT t9 48' 20" =2' ;VD" 0 NOTE: LOT NU/AOEE5 SHOWN ,?.F-FEZ TO '//,AP OF VILLAGE /AANOiZ" F;LED [~ THE SUFFOLk. COUNTY CLE2t4'S OFF:TE AS /AAP N°- 366? .SCALE *'"' G=i~OH PIPE GUAEANTEED TO TI4E U.S. LIFE TITLE ;NSU2ANCE COLCPANY OF NEW 0 DU~VEYED. AP21't. 19. ~ODE~C~ VAN TUYL,RC. ~,CEN~EU L~,4D '/AAP OF P~OPE!ZTY /AATTI'T't~I4 NOTE LOT NLI~BEE$ $1.40'IVN IZ, EFEIL TO '/RAP OF VILLAGE /'AANO2'" FILED I,N TI..IE SUFFOLIC COUNTY CLE~I4'S OFFICE AS IAAP N~z 3669 LOT 17 N."/0' 00' E. - 230't "PO ND" 'TO'O0' W, - ~70.0~ LOT 19 SCALE ~ =i2ON PIPE GUAIZ,SHTEED T~ Tt~E $OLIT~OL[:) S&~qNG$ BANK f-ND TO T~E U.S. LIFE: JNSUEA~C~ COA~NY OF ~W ~ 5UEVEYED, SEPT. Z4, 1973 EODEEtCE. VAN TUYL, P.C. _ LAND GIZEENPOIZT, NE~V ..4 '1 APPRG~VED AS NOTED DATE:~'~ -- NOTI~:Y BUILDING DEPARTMENT I