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Home My WebLink About7561-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.7.,628~ ....... Date ............ ,Ian...9. ........ , 19..~.~ THIS CERTIFIES that the building located at . F~a&r~ .l~oad ............... Street Map No.. ~ ....... Block No .... = .... Lot No. ~...Or~e~t~. ~...~ ~ ............ conforms subst~ti~ly to ~e Application for Building Pemit heretofore filed ~ t~ office dated ........... Sep.t .. 26.., 19. ~. pursuit to which Building Pemit No..7~6.1.Z. dated ............. S~Dt.. ~6, 19. ~, was issued, and conforms to all of the req~re- ments of the applicable pro~sio~ of the law. The occupancy for which this ce~ificate issued is .. P=iva~. o~ .fa~ly. ~welltn¢ ..................................... The certificate is issued to .Ph~.l~. E .Sla~. · .Fi~ ..... ~ers ................ (owner, lessee or ten,t) of the afores~d building. Suffolk Co~ty Dep~tment of He~th Approval .. Now.. ~0 .. 19~-- by.~.,.- UNDERWRITERS CERTIFICATE No.. N..1.99137.. · De~.. 18... 19~ ............... HOUSE NUMBER ...2~2.3~ ..... Street ..... Ea. a. ~m.d .......................... .... ~ .)~ ..... ~ ...... ~ ............. B~l~g ~speeto~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION Of: THE WORK AUTHORIZED) N? 7561 Z Date kJJ~ ~ 19 ~ Permission is hereby gronted to: at premises located at .........JJL~.....J~.~.&~ ................................. ................................................................... 0Z, t,~t ...... .it...X... ...................................... ~.~ ........ pursuant to application dated ........................j~l~l.~.....~. ............ , 19~...., and approved by the Building In~tor. Fee $3,J~...1tO ........... TOWN OF SOUTHOLD IUIL~I~ DIFAI~rM~IT TOWg ~ OIIFI~! SOUTHOLD, N. Y. Disapproved a/c ............................................................. APPLICATION FOR BUILDING PERMIT 'NS RUCr ONS a. This app!ication must,be completely filled in by typewriter ,or in ink and sL~nLtted in tri~ to the Building~'~ Inspector, with 3 ~ of plans, accurate plat plan to ~¢ale. Fee according to schedule. b. Plot plen Shc~wll~g~location of Iot'and of buildings on premises, 'relationship to bdjc~ining premises or public streets or areas, and giving a ~!led description of layout ofprq~rty must be drawn on the diagram which Is Part of this application. c, The work cOVered by this application may not be commeqced before issuance of Building Permit. d. UPan appr6val of this ppplication~ the Building Inspector will issue a Building permit to the aPPlicant. Such permit~ shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of OocupancyJ shall have been granted by the Building InspectS.. ~:~ i~ .A, ,P. PLI ~CATIO~N ,IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant .to the u~aln.g' Lon,e ~ .m.!nance ot .~'.he Town o.f. Southold, Suffolk County, New York, and other applicable Laws, Ordinances or .~.l~U ml,.ons, .mr tl~e construc~on o.f buildings, ac~l.~lt. ~h;n$ o~' alterations, or for removal or demolition, as herein described · appacont agrees to comp,y with all applicable laws, 0~dinances; building code, housing earle, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signa~'re of applicant, or name, f a. corporation) ' (Address of applicant) State whether applicant is owner, lessee, Ogi,nt, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises....~..~ ..~..~...~.~' If applicant is a corporate, signature of duly authorized officer. Builder's License No ..................................................... P Plumber's 'License No. '.....~. ........................................ Electrician'~ License No. ~. 4~ .?..,..~ ................... Other Trade's License No ............................................... ~ ~' Locat on of land on wh ch propased work will be done. MapNo: -.../........~7. s ' .lotNo/~ \ · ~,~ ~ * ~ ,~ · ~_~.~-~.. '";"~.;~b~"-~'/-,,- .,:~ .................... Street and Number ...... .~..~...~.......~::IR~..( ........................... ~ ............... ~ ................. ~~ ................... Mani~ipallty State existing use and occupancy of premises and intended use .gnd eccup~n~, ~, \0f~Pr~Ol~sed cor-~truction: a. Exisiting use and occupancy ~ .............. b. Intended use and occupancy ................................................. 10. 11. 12. 14. Nature of work (check which applicable): New Budding .................. Addition .................. Alt mhon t ............. t.. Repair .................. Removal .................. Demo t on...'....~ .......... Other Work ....................... ~ ........................ . .... (Description) /xg. Fee Estimated Cost ....,<..... (to be paid on filing this app ication) If dwelling, number of dwelling units ............. /. .............. Number of dwelling units on each floo .... /. ........ ~ ........ If garage, number of cars .............................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of up Dimensions of existing structures, if any: Front ............................ Rear ................................ De Height ........................ Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front .................................... Rea Depth ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front .~..~.../. ........... Rear .....~. .................... Height ...J .............. Number of Stories ....... / ............................................................................. Size of lot: Front /.~..~*.~...~. ............ Rear ....../....~....~...:..-~..-'~,. .............. Depth Date of Purchase ....... ' ................................................. Nome of Former Owner ......................... Zone or use district in which premises are situated ...~.:. ................................................................................. Does proposed construction violate any zoning law, ordinance or regulation: ~ ........................................... Will lot be regraded ..... ~ .......... Will, excess fill be removed from pmmis~s~: (~) Yes Name of Owner of premises '~'""~".~....~.~ ........ i.... Address ...~...~ ...... Phor~ Name of Architect ............................................................. Address .............. =: .............. PhOn Name of Contractor ...~.~...~...~ ...... Address ....~,.~.. ...... ' Phon PLOT DIAGRAM Locate c early and distinctly all buildings, whether existing or proposed, and indicate all' set-ix property lines. Give street and block number or description accord ng to deed, and shaw street whether interior or comer lot. )th .................... ~th ........................ , ...... ( ) No :k dimensions from names and indicate ID.T, 93- . STATE OF NEW YORK, ' ~ fi S COUNTY OF ............. ,~,~I~,/~ ' .... ,., .......... : ..... '...;,~;~(.~... ...... ~..~.~'~.....~.?....~'.. ........... being duly.:sworn, deposes and says th~ (Name of ir~clividual signing contract) · above named. He is the ...................... .~.~ A('..~.t~.~..~..~.X~...'~ ............................................................................. (Contractor, agent, corporate officer,, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work a this application; that all statements contained in this application are true to the best of his kno~ that the WOrk will be performed in the manner set forth in the application filed therewith. MARY O. KLOS NOTARY PUBLIC, STATE OF NEW YORIJ =~52-7306925 SUFFOLK COUNTY Commissi0fl Exp~e~ March ~0. he is the applicant to make and file ledge and belief; and FORM NO. ~ 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, /v~ultiple 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-existiog dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ........ ~ ..................................... New Bqilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locat,on of Property .................. ....... ............... Owner Or Owners Of Property .~..,~...~.'~..,,~.~.....c~....~..~', .~.....~..~.~.:..~.~:...~...~/ ~ '~/*? ~'-- ~ .................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ?...~.~....~.../..~.... Date Of Permit .?.~.~..~../../..~Applican, ~.*:.~/......-..~/..:~'~.~;, ............... Health Dept. Approval ..~./.~....~......'TT..../...~...~. .............. Labor Dept. Approval ................................................ Underwriters Approval ..~..../.~...~../...~..~. ................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate F~ Submitted $ ~ ................................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ~(/" "//' (,~'-~G/~'~';? ~ day of ~* / '~ '~ (stamp or seal) '~/~' .... ................... D Notary Public ..........~..,~...~.. ...... ..~'.. ..... County MARY O. KLOS ~ ~,~ ~ NOTARY PUBLIC, STATE OF NEW YORK /~2. ~52-7306925 SUFFOLK COUNTY Commission Expires March 30, 19,,~ ! THE NEW YORK BOARD OF FIRE UNDERWRITERS ~P~ BUREAU OF ELECTRICITY ~t, ~,.,,,li,,~.o. ~,o. o. f,,.,- N 199137 THIS CERTIFIES THAT FIXTURE OUT[k'rS DRYERS and.found to be in compliance with the requirements of this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS S E R V 1/o /s:Oil, 1-1/8hp 1-1/l.2hp · Appli~nce Peeder/s~ i $#10 1-l#12 1-3~6 I 1/0 ~neodore Rohlo££ Orchard St, Orient, N,Y. 11957 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNiR. SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant/j~)y~x/,~/~,~/r Phone .l~ Address ""''-~' ' ~ ........ 2. Property Location )k/. ~ ~,~ Township ~{~/~ Village l'~,~ ~ 3. Public Water ~pany Na~ 4. Lot size: Width ./~ feet Length ~Vj feet 10. Sewage Disposal System: B. Subdiv. r 6~ Section ~ 7. Lot Number~ 8. Private Well 9. Public Water-~-~ Distance to main (For Health Dept. Use} ll. A. 900-gallon septic tank: Precast~Equivalen[ Block B. Leaching pools: Number of pools ~ Precast/~.-'Block Special in the gallons If private well, fill following blanks: A. Tank capacity ~ B. Pump G.P.M. C. Total well depth D. Depth to ground water Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date ~'y~O/7~F' Signed~ FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can~ /-,' ' / ,.db~ instal)ed on this plot.~-~,rXjG'/,r/,,~///~/ S-15 Rev. 4/1/73 80~16 ,' t l~O' . ..~ ~2~$~ b~ th~2 d~artment and fpund ral ~ngineering Service~ m , ~ 9 ~l Il ~ · ~/.k ' ~ :z~l , '. ,., -. , , ' , 7.: ', -,, ' - '3' - ~, ~ ~,/[ , '//" ' :1 ,'': " ' .,~ , , ':, ' ,,, ~ ' ii ' ~ . ',, ~/~/~, ~o~ -~ ~ , ~1 ~ ,,.. , ~., , ,, ,. BUILDING --. PLUMBING -- HEATING , I 765.2660 9AM TO 4PM FOR RJ~Q].'I, · r:D INSPECTIONS: 0RIE14T, 14 ¥. 11957 . 1 iBEFORE BACKFILLING FOUNDA TeE. 51~323,242i 5~-323L2634 "' ' z. B~FO~ COV[~,iN~ hi'tUNE I [ 'lIoN OP, START F .pu~!NG 7 ~ 19_t %. 77-/- r<. 0 BUILDING -- PLUMBING -- HEATING 0RIEl,IT, bi. Y. 11B57 Tek 516-323-2421 516-323-263.4 7 .............. Z~K TONy BUILDING _. PLUMBING -~ HEATJNG ORIENT, N. Y. 11957 '~els, 516 323 2421 263~ ' ' 51&323