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Home My WebLink About6654-zFORM NO, · TOWN OF $OUTHOLD BU-.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No ............. Date Dee ~0 19 THIS CERTIFIES that the building located at ...1~$],2,~ ..R~4 ............. Street Map No...XX. ......... Block No....~. ...... Lot No....X~.... ?.~.e...o~..~.....N. :.~.,. ........ conforms substantially to the Application for B. uilding Permit heretofore filed in this office dated ...........J.~e...12.., 19.~3. pursuant to which Building Permit No..~. dated ............. ~...~, 19.73., was issued, and confoTM to all of the require. ments of the applicable provisions of the law. The occupancy for which ~.hi.~ cergflcate is issued is . .~..I,.~.~..~....m~....f..~...:L~..~..w.e.]:.~..~. $ ....................................... The certificate Js issued to Paul Grobel 0~mer (owner, lessee or tenant) of the aforesaid building. S~o~ Co~ty Dep~ment o~ Helm Appro~ .~..*.e..S.S....~.?.~....~..r .a.,..?.S~ .~. ..... UNDERWRITERS CERTIFICATE No. ~...~.~J..~. ..... D..e.e....~.~...~.~.. .............. HOUSE NUMBER ..... ~?.0.~ .... Street .....~.e..~.~...R.o.a.d. ......................... TOWN OF SOUTHOLD BUIM)I~ ~,ml'~T,mm' TOWN CLIRIC'~ OFlqCE IOU'TI, IOLD, N. ¥. U Fr:RMrt (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6654 7 Permission is hereby granted to: ................. ~...~l~a .................................... ................... ~r~m~..l~eek .................................. to ....~I,;L 3,.c1... J2el,/... ozm....t:a.za:L27'.. ~,wal.Ltz~8 ................................................................................... at premises lacated ot ....~,~&..~& .................................................................................. - · · · .. · .... · ......................................................... ~O~e~ ........ ~o ................................................................... ~ursuant to application dated ..................... ~Gi~ ....... .~ ............ , 19~..., and approved by the Building Inspector, Fee $.66,X.9.~: ........... BUILDING SOUTHOI. D, Iq. Y. · ~.~~,~~ ~ · ..... ............. =. ............ -- APPLI~Tlffi F~ BUIL~NG ~[T ~ D~t~ ................................................ , I~ .... a. This a~licati~ m~t ~ c~pletely fill~ in ~ ~r~ in ink a~ s~mi~ in tripi~m ~ ~ Bui&di In~r, with 3 ~ ~ p~s, accuse ~ pl~ ~ ~. FM ~i~ ~ Kh~ule. b. P~t ~n ~inq I~ati~ o~tot ar~s, and g~v,~ a deto ~d d~r,pt,~ of la~ of~ m~t ~ drown on t~ diagram ~ich is ~ of ~is ~licati~ c. ~e Work c~ered by this a~lic~i~ ~y d. Up~ a~mval of ~is ~ati~, t~ BUildi~ ln~tor will i~ea Building Permit to the ~plicant. ~ch ~it~ shall ~ k~t on the premis~ ~ail~ for in~ ~h~ t~ wk. e. No building shall shall h~e ~n gmnt~ ~ the Buildi~ InCr. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulati..ons, for the~ga.~.*!_'~.. _~. ~",~ld~ngs, additions or alterations, o.r .for remOVal or demolition, as herein described. TI? ..appllc. ant ag. re~s.~l ~ob/-witb-al~al~cable laws, ordinances, budd, ng code, housing code, and regulafloas, and to aam,t authori,z~_d.~I ~' ~ses~l'l~ buildings for necessary inspections. '" t- ~ --~ ......... i~,-'~'~:;;'6';~'~:"~;';;~7'iF~';~i~i ........ ~ o / ............................................. ,.: ....... · .................... (Address of applicant) State whether apph'~is owner, lessee, agent, architect,, eng~ineer, general contractor, electrician, plumber or builder. :::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::: ..... · . ............. .... (lqame and title of corporate oliver5 ' '..~ ~:~_~ ~: ~'~ ~ Builder's License No ..................................................... ' , ..: I~, ~, ;>(Plumber's License No ................................................. ~Electrician's License No ............................................. Other Tmde's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: Street and Number .......................... ~ ......... .~.. .......... , el 3705 2. Municipality State existing use and occupancy of premises and intended use and occupancy of praposed construction: a. Exisiting use and occupancy b. Intended use and occupancy .......................................... ~. ............. ~ ............................................................... 3. '~lq~tl~e of work (check which applicable): New Building '/ Addition Alteration · Repair .................. Removal .................. Demolition .................... Other Work ...................................................... '~ ? & ~o ~ '~.~ (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 .'....,.~?....~.. ...... If garage, number of cars . . . 6. If business, commercial or mixed occulmmncy, speCify nature an~ extent of each type of use ............ : .............. 7. D mens onS of ex st ng structures, fany Front ..(?..~ ........ Rear ..... .~...~.. ...... Depth ~r.~..~ ....... 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 ......... ........................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........... ~..~.~) ................................... Rear ......................................... Depth .......... '. ..................... 10. Date of Purchase ........ ~TT.Z,.ki,.~: ~l~t .-~. Nome of~rmer O~/er ...... ~.: ..... 11. Zone or use d'strict 'n wh ch prem ~e~. are s tuated ~.~: =, ; ' ...;:~;. ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... 5.~t...~.~ .................................... 13; Will lot be regradec~ ......... .h....~....~ ........ WiJl excess fill be removed f~'~n p?e~!?~e.s;(~ /~Yes (~') No 14. NarneofOwnerofpremses .~..~..~.?.~ ~0¢~-~F-,O Address ~i....~.y.~.~..~... .................................................... Name ArchiteCt ......... Z~-./~,~'~.~,, ~ !.'" ............... Address ...C.,J[~..-~.~. ...... Phone No ....................... of r~a o ~.onrmcror ..................... ;.....;...,:.....' ..................... Address ..~Z~!;.L/~J. fn~.,m~. Phone No...7..[~...(.Z.7...~.i"-.../ PLOT DIAGRAM Locat.e clearly and distinctly al bud ngs, whether existing or proposed, and indicate all set-beck dimensions from property hnes. G,ve street and block number or description according tO deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, .~Cl-, ~j c c~'~''' . COUNTY OF ........................ ~/1.~'~? ~: i' ,r- i.' ~ ~J ................................................................................................. being duly sworn, d~oses and says t~t he is the applicom (Name of i~ividual signing contrac~ 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 ~d to ~ke and file this application; that all statements contained in t~s appl~ation are tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in th~application filed therewith. Sworn to befor~,~e this ,j(.'L~[ 7-> /~. /, ~ ........................ .................................. , Notaw Public,. .................. ~ ...............Coun~ ................................................................................................. ~y ~ ~ New York (Signature of applicant) ~mmissi0~ Explre~ March ~, ~9 ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY BE JOHN STREET, NEW YORK, NEW YORK 10038 ~ ~ D~'.,cember 12, 1971~ Jppllcatio. No. onfile 759116 · ,,.te · N 198106 THIS CERTIFIES THAT only the elee~l~l~ui~x~j~e~.c~lo~'~ ,ed,§y~i n~ ~n the abo~e appllc.tion number in the premises of .~1 outside in the following location; ~ Basen~.ent st Ft. [] 2nd FI. Section Block Lot · November t~, 1 w~ examt~d on and found to be in compliance with the requirements of this Board. F XTURE ? I I FIXTURES RANGES C~KING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS I mRNACE ~TORS I ~TURE A~ANCE FEEDERS SKOALRK'PT TiMECL~KS I BEU ~LUHITHEATERS MULTISET DIMMERS 1 200 CB x 1 ~/0 I 2/0 OTHER APPARATUS: Elee. room heaters: !iotor'/s: 1-1/2hp. 1-2.0, 2-1,75, 1-1.5, 4-1.25, 1-1.0, 1-.75 Marvin Lauramore 66 Chelsea Dr., Ut. Sinai ~4t. Sinai, L.I. 11766 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR AP~OVAL TO CONSTRUCT A PRIVATE 1. Applicant ~ ~'~,~ Phone Address 2. Property location 4. 10. Village Public W~ter Company Townshtp)"~O&~. Z~9. name SEWAGE DISPOSAL SYSTEM 5. Subdiv. 6. Section 7. Lot No. 8. Private well 9. Public water Distance to main Lot size: Wide. b.a.S__feet Length /Tn feet (Enter on center plot below) Sewage Dispos/~ S~stem: '' ~ A. [900/gallon septic tank: Precast ~ Equivalent Block Street If private well fill in blanks below: Tank capacity~--Gals. Pump G.P.M. )' Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet 0 8 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date C I ~ I~ Signed ~ ~ Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date ~/~/77 Signed ~- ~ ~,~___ -~.~ S-15 Revised 4/]/72 m Z WELL5 MAP OF PROPERTY PAUL Y. GROBEkI~ FI APPROVED AS NOTED DATE:~ ~, NOT/FY BUILDING DEPAR]'M~NT ~ BEFORE 8ACKFILMNG FOUNDA- 4:- J O, C'.oram, New York _.:11727 {46 3_:~ t.. ,u .... ,ir , // /