The URL can be used to link to this page

Home My WebLink About7560-zlrORM N~. 4 TOWN OF $OUTHOLD BUH~ING DEPARTMENT Town Clerk's Ot[ice Southold, N. Y. Certificate Of Occupancy No. ~. e?.e.? ...... Date ............Ji~U...9 ......... ,19.?~. THIS CERTIFIES that the building located at .l~o~.th. l~a .Drt,,m ......... Street Map No.O~.~,e~.t..b~'..~B~ock No ........... Lot No..8.~ ..... .0~..l.q.n.t...N. ,.~.:. ...... ... conforms substantially to the Application for Building Permit heretofore filed in thi.~ ~ffice dated ...........I~.e. IH;.. l~., 19~.. pursuant to which Building Permit No.. dated ............S.~p.t....~.~..., 19..~.., 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 .., .~'.i?.a.~;e..o.~, f.a~ty..4wL~ ..................................... The certificate is issued to . .~...e..ha..e.l, .g..O~p.# .......... .0~.eR .~ ...... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · 'C~' · · · '~' { .... /';'~' ?' · ''~' · .~.~'ff. t ~,.t,~,. UNDERWRt-T-EI~ CERTIFICATE No... ~.. ~..O.3..?.?,,1 .... .~-.../.C .lfZ~'.. .... HOUSE ~'-U~ER .1.~. ?~ ........ Street..~.o.~.t.h...~..~..~.r.i.~.. ...................... Buildlog Inspector FO~M NO. ~ 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 THE WORK AUTHORIZED) 7560 Z Permission is hereby granted to: at premises located at ~1~...~ ..~..~.~ ..~.~, ~ .[...~. Ilez, th Be~ Ot'l~e ..................... ~.~..~......~.. ............... , 1~......., and approved by the pursuant to application dated Building Inspector. Fee ~.,.?'..~... ............ BUILDING DE.P~RTMIENT . · row~ a.E:~K s OmC: ,,,/~ '~',~ ~/~ -.~ ~U~OLD, N.Y. ~ ~~ ............. ......... Disopproved ....................................................................................... a/c~ ............... o. Thi~ o~lic~tion mu~t be eompl~t~l~ fill~d in by ~p~writ~r or in i~k ond *~mi~ in triplie~t~ to ~h~ 8uildl b. ~lot plon ~h~in~ location of lot ~nd of buildino~'on premises, r~l~tion~hip to od~oinin~ pr~mi~ or publi~ ~tre*t~ o*~ or~o~, ~nd Oivi~ 0 d~t~il~ d~cripfion of I~ut ofpr~ mu~t be drown on the dio~m which i* ~ of thi~ opplic~ti~. ~. ~ work ~owr~ by ~is o~licotien m~y n~ be commo~ befor~,i~uonco of Bu~ldin~ ~rmit. d. Op~ app~l o{ thi~ ~pplicotion, ~ 8uildin~ In~p~tor will issu~ a Buildin~ ~rmit ~o th~ ~pplic~nt. Such P~rmit ~h~ll be k~pt on th~ pr~mise~ ovoilabl~ {or inspection ~rou~hout ~ work. e. ~o buildin~ ~h~ll be ~upi~ or u~ in ~hol~ or in p~ {or ~ny pu~o*~ ~h~ver until a ~holl h~ be~n omnt~d b~ ~h* 8uildin~ In~ctor. ~PLIC~TIO~ IS HfiRfiSY ~D~ to th~ 8uildin~ D~pa~ment ~o'r ih~ i~uenc~ of ~ Buildin~ 8uildi~ Zon~ O~i~-o{. th~ T~n of ~, ~{~lk~ Coun~ ~.Yo~k, ~nd ~h~r ~1~ ~ ~pplic~nt ~r~ to comply with ~ll ~pplicobl~ I~, ordinane*~, bulldinO c~, h~i~ ~, ................... ................................................... . (Add,ss of applicant) State whether aPPlicant is owner, levee, agent, a~hitect, engineer, general contractor, electrician, plum~ or builder. ..................... ............................................................... .............................................................................. Name of owner of pr~mi~ ....~..~...~ ............................................................................. 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....'.~...~ ................. Other Trade's License No ................................................ I. Location of land on which propose~J work will be dane. Mcp No.: .e~ ......... ~,..~Let No ....... ~ ............... Street and Number ......................... ...................................................................... ~....~ ......... Municipality 2. State existing use and occupancy of premises and intended use a~d'occupanC~' of I~ri~oeded construction: o. Exisiting use and occupancy b. Intended use and occupancy ....~ .......................................................................................... ' .................. 3. Nature of work (check which applicable): ~ew ~..T ........... Addition .................. Alteration ................. ~epalr .................. Kemoval .................. L~em~qcm, ,: ............... Uther work .................................................... 4. d ~ (Description) Estimated Cost ...~. ........................... ,.~ ....................... Fee ...~......~.. ................................................................... ii~.~ /i~'i (to be paid on filing this application) 5. If dwelling, number of dwelling'~-'~u~b ........ ./.. ............... Number of dwelling units on each floor .../. ........................ If garage, number of cars .......................................................... 6. If busJoess, commercial or mixed occupancy, specify nature and extent of each ~pe of use ............................ 7. Dimensions of existing structures, if any: FrOnt ............................ Rear ................................ Depth .................... Height ~?;~.~' ......... NOmber or-Stories Dimensions~bT same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ / 8. Dimensions of entire new construction: Front ....... .~...~.. .................... R ~<~ / ear .....~.. ................... Depth .....~....?..../. ........ Height ....~...?..../. ...... Number of Stories ........ / ................................................................................. 9. Size of lot: Front ....... ./.....~...~'..~. ................................ Rear ...... ./...~...~.. ....................... Depth ..../....~.....~.....~ .............. i0. Date of Purchase ..... ~ .................................................. 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. Will lot be regraded ..... ~ ............ Will excess fill be removed from premises: (,)jO Yes ( ) No '14. Name of Owner of premises~/....'~....~...~ ..................... Address ................................ Phone No..~..~..~...T....'~....O.~ Name of Architect .............................................................. Address ............... v ............... Phone No ....................... Name of Contractor ..~ .~...~......~..~ ...... Address ......~...~ ........ Phone No.~....~...~...~.~..~/ PLOT DIAGRAM Locqte clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property liras. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, COUNTY .OF ....... ............. ;~...:. ......... ~.~......~~.~. ................. being duly sworn, d~oses ~ s~ys t~t he is the applic~m .:. (Na~ of i~ividua signing contrac~ above nem~. He is the ...................... ~~..~ ................................................................................................................... (Contractor, agar, corporate officer, etc.) of said owDer or ~ners, and is duly authorized to peHorm or have performed the said work and to ~ke and file this application; that all statements contoined in this applicetion'ore tree to the best of his knowledge and belief; and tha~ ~ork will ~ perfumed in the manner set fo~h in the applJca~ filed therewith. Swo~ to ~fore me this tab THE NEW YORK BOARD OF FIRE UNDERWRITERS ~_ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NI:yV YORK 10038 THIS UatVCERTiFiEsJ~uarYTHAT 1511975 ~.~,~.,~,,.,,./,,, 16~ ~73 N ,'). ~,~ 7 onl~ t~e el~tric~ ~quipmenJ as ~sc~ ~low ~ in~u~ by ~e ~uli~'an~q~ed~n the~h~, application .~ t~ther ~n the pr~,a~r~ ' Michael d. CoAAxns~ Norun ~ea ~ive, u~len~, ~.~. ~-~,-,-~,,~,z-,, Janu~y 13, 1975 FIXTURE- [ I J' RXTURES -' ~*%GES ~COOKING'DE~KS~ - OVEh{- TOISH WASHEIS~ EXH*US~ FANS OUTLET ECEPTACLES SWTCHES ...... ~ecue~ ~ ~- ' T ~ ' DRYERS ~ FURNACE MOTORS - ~TURE A~A~E ~EDER~SPECIAL REC'PI] TIME CL~KS [ BElL I UNIt HEATERS ; MULTLOUT[ET DIMMERS · ' - V C aY~ece/s= 0[[~ [-[/Shp [-[/[2hp ~, Motor/s: 1-1/2hp Mschael J. Collins 20-lq 150th St. GENERA[ MANAGER Whttesonte, N.Y. 11357 I~,~__ D This certificate must ~ot be altered in uny manner; return to the office of the J~ard iJ ;ncorrect. inspectors may be ident?f~ed by their {reden,,ol~ FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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 $$.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Is 23- Date New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owner~ Of Property ...~.....~ .............................................. ........... ............. Permit No...~.....,~.....~...~.....~..~--¢ZDate Of Permit .?./~..?....~.Z~..~'.Applicant . .~....~.....~....~ // Health Dept. Approval ............................................ Labor Dept. Apprd~al ................................................ Underwriters Approval ..~'...~....~..3..2..~....~.. ................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ .................................... Construction on above described building and permit meets oil applicable,.codes and regulations. Applicant ......;.....~..~....z~z..~.. ......... ~..~....¢~.~.~ ~' ............................. Sworn to before me this ~ t~,~-~ day o f ~~.~-/./..~.. ~..2.~''~ Notary Public ..~../bT'..~T..~.~ .4~... ....... County SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~/~?~c~/~,~ / ~'//z,~s Phone --~ 5. Subdiv.';L ~, ?- Address ~'_,~.~, £ _. ~,,( ) ~. Section 2. Property Location ~ ~/~, ~Z,_ S~ ~ ~ v'~ 7. Lot Number-- - ' '~ ~. Private We~ ,, ....... Village (,,,r~ - mwnsnlp., ,~,~/c~ ~. Public WateF 3. Public Water Company Name ~- Distance to ~in .... 4. Lot size: Width /J2,~_feet Length /'~.~ ~ feet 10. Sewage Disposal System: For Health Dept. Use) 11. A. 900-gallon septic tanK: Precast /~/Equivalent Block 8. Leaching pools: ~ Number of pools '/ Precast~q~lock_ Special If private well, following blanks: A. Tank capacity. B. C. D. E. fill in tI~e ~),2-- _gallons Pump G.P.M. Total well depth ~~- 9~ . Depth to ground waser W ~- t_.~.__.. Amount of water ~n well x/~ __ ._ t? . _l The undersigned CERTIFIES: "Construction of authorized installations will be ~ 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 afld Inay be renewed if a current local Building Department Permit is in effect. FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented hei~ewith, ~t is the opinion of the Health Department that an adequate and satisfactory Sewage DisDosai System and Water Supply can be installed en this plet. APPROVAL DATE Rev. 4/1/73 G 1,4'74 ¢. '50"~. Ir-ST tl C',' L ',-~ I4' l/kl CIIAI.=_ L COLLI 0 t2..~ To,,,.,~ o~' S¢._,'r.o~=,.. MY. 5L 1 i~,V I~y Ct f) · I~c'} D ~-FkIC l<. UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION /AARION fac_~.~i~ for this location have been in2~e~d bT this departmont ~d fo~d '- Chig~ O~ General ~ginoori~ Services r'l /~-z o TONY NOEKL[W BUILDING ~ PLUMBING -- H.E, ATING ORIENT, N. Y. 11957 Tels, 516..323-2421 516-323.-263~ = / APPROVED AS NOT, ED NOTIFY BUILDING DEPARTMENT 765-2660 9AM TO 4PM FOR REQ'JH, ED INSPECTIONS: 1 BEFORE BACKFILLING 'FC, UN~/', TION OR 2. BEFORE CQ~I,~,PIPELIN~ 3. FINAL wHEN ~OB C~MPLETED :1 J~ 3¸1 TONY I~UII. DING ~ PLUMBING -- HI~^TING ORIENI, l~, Y. 11957 TeIs. 51~323-2421' 51~32~2~4 , ' OI~I,EHT,' I,L ¥:4! Tek 516-3'23,2 1 5,16:3~3-2~3~ ~