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Home My WebLink About6652-zFO~M NO. 4 TOWN OF SOUTHOLD BU~.nlNG DEPARTmeNT Town Clerk's O~iee $outhol~, N. Y. Certificate Of Occupancy No. Z~538 ...... Date .............~T13J~... 3 ..... ,19.7~. THIS CERTIFIES t~t the b~g l~t~ at .~. ~ ................ S~ ~p No..~673 ....... BI~ No ........... ~t No, .~ .... ~ol&..N,Z, .......... ~o~ sultrily ~ ~e AppHca~ for B~g P~t h~fo~ ~ ~ ~ht, ~ da~ .......... J~...1.1.., 19..~3 p~t ~ wM~ B~ing P~t No. ~.. da~ .............. ~... ~ ~ 19..7~ was ~, ~d co~o~ ~ ~ of ~e ~ men~ of ~e app~cable pm~o~ of ~e law. ~e ~p~ for w~ this ~ ~ ....................................... ~e c~ica~ ~ ~ ~ C~l. & .~ley. ~t~ .... ~s .................. of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) June.. ~...1.97~. · by. ~..Villa... UNDERWRITERS CERTIFICATE No.. X~.~612~ ..... ~J~2]~.~ ..................... HOUSE NUMBER .775. ......... Street ...tI;t~ .Road.. ~.~uthcld ................ Buildh~ ln~,ctor( NO. 2 ToWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N: Y. BUILDING PERMIT (THIS PERMIT MUST. BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF TIlE WORK AUTHORIZED) N°. 6652 Z Permission is hereby granted to: ......... O¢~:L..&..S~.le.y..B~,a. tte .................. ........... .1.0..:..B~n~:~l~..P. la~e ..................... .................. .1g.....B~b¥3. c¢~ .....:1..t .70~ .................. to .... ~.~i~d.. ~e.~ ..z~ne~..£amil¥...d~e 1.1 ,i~ g .................................................................................. at premises located at ..... ff~t..~ ....... C~LV.~..Nook. ..................: ..................................................... .................................. .~.e~l~..~].l..3~oacL ........... S~u~;ho.l~l.....E..l~.~ .............................................. pursuant to application dated .........................~.1~ ......1.'~ ........... , lCF/..~...., and approved by the Building Inspector. Fee ~ ~-h. ~-~ .......... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled .n typewriter OR ink, and submitted in duplicate to the Building Inspector with the following; for new buildings or new use: 1. Fmal survey of property with accurate location of all buildings, property hnes, streets, aha 'unusual natural or topographic features. 2. Fmal approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commercial buddings, 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 hnes, streets, buddings 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 inspechon of buddings 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 $I.00 $5.00 Date .,. ~.~..~.,~.:..~..~... ...................... New Building ...... ~ ........ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....... .~..~..~.. ..... .~../.~,~.......~t~.....~.0..~...T..I,{.~../~) .......................................................... Owner Or Owners Of Property ....~.~.~,~......~......c~.....~.~.);~,~.~ ..... ~;,z ...... ..~../~j~..~./~.~ ..................... Subdivision .~.~..?.......~.~.~.~ ..................................... Lot No...~ ........ Block No ............. House No...~.~.~.".../~ I/-/~ ~ Permit No ./a..(~.~.~....~... Date Of Permit ~.:./..I.?.~/..~. ..... Applicant .... ..C-~l~t~.....~. ..... .~'~.~..~..L,~ ............. Health Dept. Approval ...~.~..~...O...~.~..~ ..................... Labor Dept. Approval ............................................... Underwriters Approval ..~....~...~....Co.../...~....~. .................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permi~ r~e? a6applicable codes and regulations. Applicant ..........~....~...,J'~....~ .;~ ~) ............................................... Sworn to before me ~l~s _ / ......... o, Notary Public ......... ~2:~ County SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number ' m ~ ~ ~ ~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant CRf~L ~, J~Ri~TI, F_. Phone 2. Property Location H~LL Village ~euTHek~ Township SouT~Ok~ 3. Public Water Company Name - ~ 4. Lot size: Width IOO feet Length l&¥ feet B. Sub4tv. Cnky~ 6. Section / 7. Let Number ~ 8. Private Well 9. Public Water--~- Distance to main 10. ll. Sewa~sposal System: A. ~O~allon septic tank: Precast [quivalent B. Leaching pools: Number of pools ~ Precast~ ~ OBlock Special Block If private well, fill in the following blanks:. B. Pu~VG~P.M. ~ C. Td~cal well depth D. Depth to ground water E. Amount of water in well (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accord with the Suffolk County Department of Health's current standards thereto. This applica will be valid for one year from the date of approval indicated below and may be renewed a current local Building Department Permit is in effect. Date Signed FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is thc oPinion of the Health Department that an adequate and satisfactory Sewage Disposal Syst and Water Supply can be installed on this pl, ot. S-15 Rev. 4/1/73 ~' ~ ~ ~1,,:A, , ,THE,,, , NEW YORK BOARD OF FIRE UNDERWRITERS "Tlr/"',~ d ,, BUREAU OF ELECTRICITY ,~ q d ,j I¢qh: i, ,, /,l~ ~ /, 85 JOHN STREET NEW YORK NEW YORK 10038 I ,, ',Da,e,May 217-1975 ,~:' .~pz,,,..,.,,,,'~o.o,,/,,e ?08602 , ' N 226122 'a.l~ thg ~l~trlcal e~ipment ~ d;sc;ib~d b;low and i~troduced by the applicant named on MXTU~E I [ ' c : J-~ [ ' : j I' ~ FIXTURES 'l~RANGES ..... J~QOKING DECKS ~ OVENS '~ ]DISH WASHER~ EXHAUST FAN~ DUrUm F~cvT~c~sI sw~zc,~s h~*~o~c~ml ~go~sc~m ~ ~F ~' ~Z ~ K w ~ ~ ss',."l,?',~ .... ~'", ,~,':~8~ ~, ~ ~z ~?.zl z ~,,~.6~ z ~z.s~ ~ ~ , DRYERS ' " FURNACE MO~O~'~ ' -~ FU~U~ APPLANC~ F~D~RS SP~CIALREC'P~I T~MEELOC~S ~ BELL {UNITHEA~E~S {MUL~I.OU~L~ DIMMerS ,,, , Ca'rI,G.;'Bratle/'-- ~ '!0 BarnTield, Pi., ". N. Babylon,' B.I.1!?03 Th~s cert,ficate must not be oltered ,n any manner, return to the off,ce of the Board if ~ncorrect Inspectors may be ,denhf,ed by thmr credentials TO TH~$ sURVEY IS A VIOLATION O~ '._j < - '0-:o - ~ _ iYIA~ 0,r PNOPZ",.q,7' 7'OWIV of' 5ouT/-/oz. lo. AL. y UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 720"? GE TEIE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY MAP NOT BEARING THE LA~D SUFVEYOR'S INK;.D SEAL OR EMEOSS.D SEAL SHALL NOT BE CONSIDERED zO RE A VALID TE, U~ CCPY GUARANTEES 1NDICAT~.D HEREON SHALL RUN ONLY TO THE 0E SO,,~ FOR WI,OM 1HE SURVEY IS EKE, AfLD, A,~D 0,~ HiS E~.HALF TO THE Disapproved a/c ........ ~ .................................... INSTRUCTIONS a. This application must be completely filled in by t~pewriter ~ in irg¢ and submitted n triplicate to the Building Inspector, with 3 sets of plans, acL'uratepIot plan to scale. J:ee acco,ding, to schedule. b. Plot plan showing location Of lot and of buildi,ngs on Premises, relatidnsh p tO affj0 ning premises or public streets o~ areas, and giving a detailed desoription of layo~t bfproperty must be drawn on the diagram whi,:h is part 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 apl) cant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building 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. 'BuiAIdPiPn~al~AonTelO~,N_JiS' HEREB, Y.,MA~DE to .thee B.,uil.d!ng. ,,I,,~,,,,rt_.ment.for. the .issuance of o Building Permit pursuant to the o~-.. -tgi_.._ z_-~a~-r~_nc~eL or ?e I.o,wn.,o,t. :x3~.l.a.,. ',urrolK .~.ou.n.~y, New ~rork, and other appli.c..able Laws, Ordinances or ~h~e~,~,=, ~ur me c.onsrrucT~,on o..t, ou~atng,s: ?,tmns or a!tera,ons, o.r for removal or demoht~on, as herein described = opp.cem agrees ~o comply w~tn.a, app.caom lows, ordmancqs, budding code, housing code, and regulations, and to~ admit authorized inspectors on premises and in buildings for necL'ssary inspections ? ,.... ................ ......................... (Signature of applicant, or name, if a corporation) ....... 0 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ............................................................. L ' ' · Name of owner of premises ...~:I.~.L...~.,.~...~.{{.I.~.~.~;~..~,...~.~.~..~.~ ..................... 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,' ...... t, .................................... Other Traders License No ............................................... Location of land on which proposed work will be done. Map No.: ....~.~;.?.~ ....................... :'. 'L~t No ..... t~. ................. Street and Number ..~../.{.~,...~ ............................................................................................... .~{LU~J)./~ ....... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......~..{:{?.~..1~..~. .L.~.~.: .................... ~- b. Intended use and occupancy ................................................. Ak~ ........................... 3. Nature of~werk (check which applicable): New'Building ...~ ....... Addition .................. Alteration ................. Repair .................. Removal ............. ;..~ Demolitiom...~ ............... Other Work ..................................................... ~, . . .-"-'"" (Description) 4. Estimated Cost ..~.~a~.~.~ ............................................. Fee i.L~..~......~ .................................................................. (to be paid on filing this application) §. If dwelling, number of dwelling units ...~ ....................... Number of dwelling units on each floor ..../. ...................... 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 Stories ................................ 8. Dimensions of entire new construction: Front ...?.~.~.T.O.~i ...................Rear ...... ~.~.iL~).ii ........ Depth ...~.~).i~..~. ....... Height ..~.~.:.~.~ .....Number of Stories ....~ ............................................................................................................... 9. Size of lot: Front ...~.(~..~F....O..'.'. .................................... Rear ..... ~.~..~...'. ........................ Depth ../.~.~..'....~.~..'. ............ 10. Date of Purchase ..... /..0..~/..~.'.~.. ................................. 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. WiU lot be regraded ..... ....~.~ .............. Will excess fill be removed fromE~Q~: ( ) Yes ( ) No //t4. Name of Owner of premises .~.~.[.~...~...~..H.(~'/~...~.:..~..~.~.~.~.~..: Address ~'~'~e~J.~.".~[.~..~.:.'.. Phone N°. ~9:~0~.~.. .... Name of Architect I~Y/~J~..J~IL~/~P~/~.~.. ........................... Ad~lr~T~.~ .~.~J~)..~J~'~hone No.....~.. ............... Name of Contractor .....~.~,)..~.. ............................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, ,and indicgte oil set-back dimensions 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, .................. .'-,~,a~..'~..,-~.~...~,.,4 ............................. being duly sworn, deposes"and s~ys that he is the opplicom~'' (Name of individual signing controcf) above named. He is the ...... .. ~L~.~.~:~..~.~'~. ................................................................................................................................... (Controctor, og~t, corporate officer, etc.) of soid owner or owners, ond is duly outhorized to perform or h~ve perfqrmed the sold work ond to ~ke ~nd file this opplication; that oil statements contoin~ in this epplicati~ or& tree to the best of his knowledge end belief; ond thuT the work will ~ performed in the monner ~t fo~h in the opplication fil~ therewith. Sworn to ~fom me this . ........ of ...................... , Note~ Public, t~~~ ....... Coun~ ............................... ~..~....L~..~ ....... (Sig~ture of applic~t) TER~I ~E ~ ~ffik~ PUBLIC, ~ ~ ~ ~o. . ~lified in Sullolk ~ ~n Expires March ~, ' , ' ~ ' ' , I ' ! Ill I-Oil I ' ' i ',' I V Ill I~1 I ' m: /11I~ff )l r - IN~TIFy BUILDING DEPARTMENT TIONS ,< ¸4- i2/;0~,9,, ~ ~-~oo~4 ,,.[ I11 't II ® '© '®. 4 (3 hers,nO.," r ..<'/-/ Ed 7'/d l f, l & ~ · ~/'FULL TN.'C& Inc, NOTE,