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Home My WebLink About7245-zFO~'a~ NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. g/..0. Date ......... ?. T... ?/ THIS CERTIFIES that the building located at . ~. ~/~( ~.~/4.. ]. ~I~/4~-.. Street Map No. ~k~g.A .~A z~.fBlock No ........... Lot No.. ~. .... ~./~.'F..-f.I..~o,.C~.../.~/. conforms substantially to the Application for Building Permit heretofore fried in this office dated ......~I''' ~' ' '" 19..~/pursuant to which Building Pemit No. dated ......~.~/.../.O ..... , 19.7.~ was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...~ff. ,~ .7./~. ~ 7U./z'U...~./~ ~ ~ ~_ ~/....~.W~/-/-l. L/.~. ................ The certificate is issued to . .~,,~1~ ~/. i. O .... .~40 .7---~.D. ......... ~ .... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~"~.'~... ~..~ ?.7..~....~.~..~ .~! ~.~ UNDERWRITERS CERTIFICATE No../~/.~ .~. ~g)V .... /~ U. ~'~'../.~ ?.~. ........ ~OUSE NU~ER .../.?..~. ~.'W... S~reet..,~-~ .4 ~ ~.~.../,, A ~ ~.-.--. ............... · ~ Building Inspector BUILDING DEPARTMENT TOWN GLERK'$ OFFIGE ~'~-, .~.~L,~.. ~ ~UTHOLD, N.Y. ~/~ ~ ~' ~ ~,~' ~ ~ ~/~ .............. ~plicatmn No ................................. ........................................................................ ................. ....................... ,Building I~r~ /~2 ~~ ~ APF?~'ION FOR BUILDI"G ,E~IT ~ ~~ ~ ................................ ,19 ............ I NSTRU~I~S ~ a. This application m~t be completely fill~ in by ~pewriter o~ in i~ and s~mitt~ in triplicate to ~e Building~ Insp~tor, with 3 ~ts of pl~s, accurate pl~ plan ~ ~ale. F~ acco~i~ to ~h~ule. b. Plot plan showing I~ation of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and givi~ a detail~ de~ription of layout ofprope~ must be drawn on the diagram which is ~ of this application. c. The work covered by this a~l~ot~n may n~ be comme~ed before issuance of ~ilding Permit. d. Upon approval of thi~ a~pti~tion, f~ Building Insp~tor w~ll issue~a Building permit to the applicant. Such permit shall be kept on the premises available f~r inaction throughout the work. e. No building shall be ~cupied or u~ in whole or in pa~ for any pu~ose whatever until a Ce~ificate of ~cupancy~ shall have been gmnt~ by the Building In~ector. APPLICATION IS HEREBY ~DE to the Building Depa~ment for ~e i~uance of a Building Permit pu~uant to the ~uild~ng Zone Ordinance of the Town of ~hold, Suffolk Count~, New York, and other applicab · ~, O~inances or egulations, for the constru~ion of buildings, additi~s or a terat on~, or for mmova or demoliti~, as heroin de~rib~. ~e applicant agrees to comply with all a~lic~ble.la~s, ordlnanc~; bu Id ng c~, hous ~ c~e, a~ ~ulatims, a~ ~ admit authorized inspecto~ ~ promises a~ in buddings for ~essa~ i~tions. (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. .................. ....................................................................................................................................................... Name of owner of premises .... Li~Z:iJ3..C_~T~___~,.J;.I;.Q ................................................................................................................ I f ~ ~ul~, a~.horized officer. .... . _ - ........ Builder's Lic~se No ..................................................... ~ Plumber's License No .... ~,P. ................................ Electrician's License No...2~,~ .............................. ~her Tmde's Licen~ No ............................................... 1. L~ation of la~ on which pr~o~ work will be dane. Map No.: ....... ~ ........................ Lot No ..... ~ .................. Street and Number .... ~,.~.~..~..~~e..~,.~,...,.~.~ ......................................... Municipali~ 2. State existing use and occu~ncy of premises and intended use and ~cupancy of pried construction: a. ~isiting use a~ ~cupancy ................ ~ ...................................................................................................... b. Intended use and ~cupancy ~E ........... r3. Nature of work (check which applicable): New {3ui~lding' ,,.;.~, ....... Addition .................. Alteration ......~ ...... ' Repair .................. Removal .................. ~ Demolition ......... :...:...L. Other Work ...................................................... (Description) 4. Estimated Cost .e:,~l~.~l~.e.®. .............. i.....~. ........ i.r...Fee .Z..~.:.~. ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... 3. ................. Number of dwelling units on each floor ............................ If garage, number of cars ..i .............. 2 .......................................................................................................................... 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 ....2~,..;~.1; .................... Rear .....?..;I,...:~.~ ......... Depth .....3....3.....~.....~..,t.... Height ......3:.6.....~...t..... Number of Stories 9. Size of lot: Front ..15.~,~I ....................................... Rear ...... ~..5...~..t...O~)... ..................... Depth .......3..6..~........O~.. ............ 10. Date of Purchose ...~..~.~e..~......C~...t)...t.~ .a~... .................... Name of Former Owner ....~...]...~.~...a~...!..s...A.s..?..°...~..~...a'.?..e..?. ....... 11. Zone or use district in which premises ore situated ............ ~3~.~., ........................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ..................................... ; .................. 13. ~Mill lot be regraded .....¥a~ ............... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .,1;z~az~cl...T~O~l~es.~...T.~,, ............... Address .~...~.....~.3.,.Z,~ ....... Ph°ne No...3..~..8..'..9..6..9..6... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing Or proposed, and indicate all set-bock 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, I~ ¢ . cO .N OF ...... ...... ~le~3~.~...,.~ ........... being duly s.wom, .deposes and says t~t he is the applic~ / (Name of i~dividual :Signing'c~t~c~ ~ ::: : : t . above name. He is the .......... ~ ..................................................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or hav~ performed the said work and to ~ke 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 performed in the manner set fo~h in the application filed therewith. Sworn to ~e me this ............ ......... o, .................. , Nota~ Public, . ................ ~ ........... Coun~ ..~~.~.;....., ........................... (Signature of applicant) MERLE JOAN B~URGUIGON N 't~,y P~blic, S~te of New Ye~ No, 52.45137~ FOUM NO. · TOWN O~ SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEP~T ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7245 Z Date ........................... ,N&7 ....... .1~) ......... , 19.7~.. Permission is hereby granted to: ~rn] ,~ ..~[oae&.. ~ n~.....A/.C..~,5.1r:La.....~.t;t o ......... )~L~:Lttke3c ................................................. ~o Imll,~,..~w...o~,e..~m~;L~....~w.~ll~ ...................................................................................... at premises located at .,leO.~..~....~,~...J,d~e..,~,gAO,S..,,~e~...~ ........................................... ................................. W/.~...~lJ,,1 ~.b~...~.:~v..e. ,.....~,~ ~..t.~.t,.~.~.....~..,.~... .............................................. pursuant to application dated ..................... ~la~ ....... ~ .................. 197.t~ .... and approved by the Building Inspector. 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 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 dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date September 6, 1974 New Building ...X .........Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~.~..~.~.5.~..i-~`j~..a~..~.s.~.L..a.~.n.'e.~.M~.M..a..~.~.~..i.~.~..u.~ .................................................... Owner Or Owners Of Property ....................................................................................................................... Subdivision F~i~j.c~h.:.f~...L~,ae...~.$.~.a..~.~..s. ............. Lot No ...... .8. ..... Block No ............. House No...1..1.~..5.. Permit No ......~..P-~5..Z. Date Of Permit 5/fl.0/.Z...~....Applicant I['P-,~%}..~O~.,....I~, ........................ Health Dept. Approval ..9./.~x/.ff.~ ............................ Labor Dept. Approval ................................................ Underwriters Approval ..N.....1..~?...O..O..O.. ......................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......Y..e...s. .............................. Fee Submitted $ .....5......0..0.. ...................... Construction on above described buildi~g~d per~~ app~ble codes and regulations. A~, cam~,.A~.~=_~''~ ~-,~F-,--, INLAND HO~, INC. Sworn to before me this ................. ........ /fl .... Notary Public .... .~.~..· County (stamp or sea]) SUFFOLK COUNTY DEPARTMENTOFHEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT ~,',.!, A~.p~IV~liE ~W~qEi~POSAL SYSTEM AND A WATER SUPPLY 1. Applicant I~t~m~cl ))um~m 7~. Phone298-~ Address ~mm~ 2. Property Location Village Township 3. Public Water Company Name 4. Lot size: WidthZ~ feet Length ~ feet 5. Subdiv. Bli.t4~*~s 6. Section~ 7. Lot Number 8 8. Private Well 9. Public Water Distance to main lO. {Fn~ H~lfh ll~,nf II~e) ._ 11. Sewage Disposal System: A. 9~gallon septic tank: Precast)D(~quivalent Block__ B. Leaching pools: Number of pools 1 Precas~j~> Block ~pecial If private well, fill in the following blanks: A. Tank capacity ~ 9allons B. Pump G.P.M. ~ C. Total well depth O0 D. Depth to ground water ~ E. Amount of water in well too L~. ! Ct The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date ~:L1 ~gm 1974 Signed 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 and Water Supply can be installed on this pl~ot. APPROVAL DATE ¢~/~/~'?~_ SIGNED ~~ S-15 Rev, 4/1/73 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ 8W ~UREAU OF ELECTRICITY / 85 JOHN STREET. NEW YOR~ NEW YORK 110038 THIfl CEEIFIES THAT ~ly t~ e~t~ ~u~ment ~ ~scdb~ ~ ~ int~ by t~ ~t M~ on t~ a~ ~pl~t~ num~r in t~ p~m~s of ~nthe/ollo~inSl~atlon~ ~ ~s~m~nt ~ lstFl. ~ ~ FL outside ~tio. ~l~ ~ exami~ on ~ugust %21,197~ and f°und t° b' in ~mpliance wlth the r~ui~m'nts W thls B'rd. FIXTURE I RPT fiXTURES OUTLETS EC ACLES SWITCHES iNCANDeSCENTI FLUC~E~CENT I ~ 2,Yt?w. I o~, I~JRHN.~CE TAsTORSH. p. [ FUT2T~EAP~J2o~E",'WE.~G. ' 1 3 6 SERVIC~ DISCONNECT ;0 CB IOTHER APPARATUS: · Furnaces: 1-1/8bp, 1-1/~hp S ~ANSES COOKING DECKS I OVENS DISH WASHERS TIME CLOCKS B~U. UNIT HEATERS MULTI-OUTLET TRANs ~ N SoYSToFEMHSET , ¥ 1 DIM~EES WATTS · 2/0 9 REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: / /~O ~ ~o~ INLAND HO~ES, INC. f~ {~o ~ -o~ , ~ TOWN OF SOUTHOLD ~ -%. SUFFoI~ ~CUiM .' facilities for ...... ~"- ~- - Engineering NO?E: ~orvices ~ = MONOMEN~ ~U~DIVI$10N MAP F/L~ IN FE~. 14,1974 &S MAP~. 60~5. RZVISaONS YOUNG & YOUNG JU/V~//~/g7~ 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK JULY 9, ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: /N/A/VD HOMES,/A/C, lOT A/O, 8, "EL/JAH'$ /A/V£ AT MATT/TUCK TOWN Or $OUT/-/O/D GUARANTEES JNDICATED HER[ON ,~HALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANy, GOVERNMENTAL AGENCy AND L£NOtNG INSTITUTION LI~TED ,21¸ 4'. o" ,0 'b