The URL can be used to link to this page

Home My WebLink About7564-zTOWN OF SOUTHOLD BUn.nlNG DEPARTU~NT Town Cl~rk', Office Somhold, N. Y. Certificste Of Occupancy THIS CERTIFIES that the building located at . .~.~}~'T{~ k D~l U ~' Street ~,p no. ~.~?..-r: f.,~t~o ........... ~ no..~..(,..0.~?.~) .... ~./~ conforms substantially to the Application for Building Permit heretofore ~ed i~ this office dated ...... ¥./...., 19 .,. t., was i~ued, and conforms to all of the require- mentz of the applicable provisions of the law. The occupancy for which this certificate iz ~e ce~'~cat~ ~ ~z~d ~o . .~., ~t,,S.a /~.n.$ ........ ~ ............ (owner, leasee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ 2}./. ~i~. ~.....~. ~; ~ '.~...~. HOUSE mr~ER .... t.~.~'.~... St~t .... ~e.,V.7...~./.{.c... 2~f~ .............. Buila,,~ll Inspector [ ~rO~ bO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN (:LERK'S OFF~¢E SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 756~ Z Date ........................ .~ept .......~. ......... , 19.~}+... Permission is hereby granted to: ~.~....L.......g.o..~..~.k...c..o. r~......~/..c....~..o.~.r..e....~.~o. ................ ~.~..~g.~k ......................................... at premises located at ...... .~.~,..~l.D.t,..~.....~Lp~..~.C~...{.___~...~13~..~. ....... ~ ............................... Summit ~ Central Dr ~ttituek pursuant to application dated ......................~.~.t. ........... 2~.. ....... , 19~..~...., and approved by the Building Inspector. Fee $.~.,.~.~. ............ /og _ i ...30. -- ~N '~K'S ~1~ ~ ~ ,. ~TH~D, N. Y.. .... L: ~.. ~ & , ~uildi~ In~tor) / ~ a, This a~ion ~st ~ mmpletely filled in by ty~wrJter or in ink and submi~ed in tripli~i to~ ~i~ ~, wi~ 3mrs of' ~ ~ur~ ~ot plan to scale. Fee a~rdi~ to ~dule. - b. ~o~~ ~a~ ~qw~ I~tion of lot and of buildin~ on premiss, rel~i~shJp m,~joinin~ pra~i~ ~i~ a ~tai~ ~tion of layout of ~o~rty must ~ orawn on di~ram ~i~ is ~ of this a~li~. c'. T~ ~ ~ ~ this a~i~tion may not ~ com~n~ ~fore i~u~ of Building P~mit. d. U~ a~o~l ~' ~is a~li~tion, the Building Ins~ctor will issue a Bulling Permit to t~ a~i~t. ~ ~ ~ k~ on the premi~ ~ ~ ins~i~ throu~out the work. e. No buiMi~ s~l ~ ~up~ or umd in whole or in ~ for~r~whatever until ~ifi~ ~ , ~PLICATION IS HEREBY MADE to the Building Depa~ment for t~,~ ~; · ~u.m~ [l~i ~i ~'J' ~ ~lldl~ Zo~ ~i~ of' ~ To~ 'of ~u~old~ff~ ~u~, N~ Yo~, and ot~r ~l~e L~, ~di~ or ~i~n~, ~s/~el~rati~s, or for removal or~ ~liti~fl, ~. ~m[n ~i~. ~ a~li~nt o~inen~, ~ildin~de, housing ~de, and regul~i~[, a~ ~ ~it authori~0n ~mi~s an~n State whether aj~icant is owner, lessee, agent, architect, (Signature of alN~licant, or name, if a corporation) (Address of applicant) engineer, general co~tra~ter, electrician, plumber or builder. owner ~ I~..~ ~ ............................ Name of of.premises ..... ...~~.~... ................................................................................... if applicant is a corporate,, si~l.il,ture of duly authorized officer. ' ~ - flName ~ title of corporate officer) Builder's License No ................. t ....................................... Plumber's License ~o.. ....................................................... Electrician*s License No ................................................... Other Trade's License No ................................................... Location of land on which proposed work will be done. Map No..~.'....~..~,.w.......~..~..Lot Street and Number .................. ~ · Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b/~ b. Intended use end occupancy ...................... ~[r~..~.~..~[!~.....~....~... ........... ~ .................... ~ ....................................... ~ ' ' Alteration .............. 3. Nature of work (check which applicable): New Building ....................... Addmon ..................... · Demolition Other Work Repair Removal ......................... " c:) ~--- (Description) 'ma-dCost F. .... .................. {'~ ................ (to be paid on filing this application) 4. Est~ 5. If dwelling, number of dwelling units ..; ......../. ..... Number of dwelling units on each floor ......................................... If garage, numoer pT cars ................................................................. , .... If bus ness, commercial or mixed occur)ancy, specify nature and extent*of each type of u~e ....... i.....~...~ .~... .............. D~mens~ons of extst~ng structures, If any. Front ....~ ..... Rear ....... ~ ........ Depth .....,'~... .................. Height .............. ~. ...................................... Number of Stories .................. ~ ................................................... Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Hei ht ...... ~...~' .......... Number of Stor es ... I ............... 10. Date of Purchase ..................................... Name of Former Owner .....~... ................................... ~ ....................... 11. Zone or use district in which premises are situated ................ ~..~..~.~.t.~ ............ ; ................................ 12. Does proposed construction violate any zoning law, ordinance or ragulation: ........... ...~......O... ...... ' ............ ; .................. 13. Willl0tbere~aded ....... ...~.t~,b ................ Will exc_ess fill be removed fro_m_j .remise_s: [ ] yesi ,~, " (Address) >hone No.) Architect ~ ' Name of .......... (Address) Phone No.) (Address) ~hone No.) ', PLOT DIAGRAM ack dimensions from ~ and indicate whath- Locate clearly and distinctly all buildings, whether existinG*or proposed, and indicate all set-~ ; pro. party lines. Give street and block number or description according to deed, and show street name ~' er tnter or or corner lot. ' STATE OF NEW YOR,,~,~ . J~. COUNTY OF .:...~~ ......... ) ..i ......... ..~..'~'~.~...~.;.......~..~...t~...~.~..~..!~ ...................... being duly sworn, deposes and says that he is the applicant above named. [Name of individual signing contract} 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 and to make 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 iperformed in the manner set forth in the application filed therew;th. ....................... ay of .... 19 .: . Notary Public ........................ .~.... ~......~:~..,~...~.......~_.~ u n ty ~ ......... ~: ................. FOI~M 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 ... ~..~..Y.. ~] ,....~.c~. 7...B. .................... New Building ....~ ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~.e.~.n..t.?~.~..].~..D.~¥.e.~..~...~..t.t..~.~f.~.~.k.'~..~..e.~.~.~ ....................................................... Owner Or Owners Of Property ..... ..G..e..o...z.l~.e.....~..~.9.~.9..~ .................................................................................... Subdivision ..C..~.~.~.~.~...~...~..~..d....~...?..~..t..¢..~. ..................... Lot No...~. ........ Block No ............. House No ............. Permit No...Z.5.~.~..~ ...... Date Of Permit .~/.~.7../.2.5....Applicant .....~...S.~...C..9..q~.t.~.~..c..t.~..o.g...C..9.~^ .............. Health Dept. Approval ..~.z.~.O...zk~ ........................ Labor Dept. Approval ................................................ Underwriters Approval .... ~..~.?~k~.~, ......................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......~ ................................. Fee Submitted $ ...B.~...0..0. ......................... Sworn to before me .. County (stamp or seo,) ~_~-~ '7 ~ , ',THE, NEW YORK BOARD OF FIRE UNDERWRITERS / ,'",,h~ !r-.h ~l III .IJI ,,85 JOHN STREET, NEW YORK NEW YORK 10038 : .George Nackos, Central Dr~ve, Zena ~ Summ~ Drive, Hart~tuck L.I. ~,~do,.' April 21,.-~975. , a~foundtobe~ncompl~ancewth~the.~qu~rement, ofthisBoard.~ · ,~ ~ '~uture ,appl ce , ~ ' ' P~elboard/s,: 1-Zcir. 125amps. 1-10 amp~ Compactor '.~-, ,r ,, bustav Bartra' ' ~;",~ ', ~ -~., zz/ ~ast Brea~ater Rd., ~s ce~ificate must ~t be a~ many mannerr return to'the office of ~he ~ord if incorrect. ~nsoectors may be identified by their 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 ~b~ C.~ ,. ~ ~:~'- Phone Address ~,~r~)~?~, F ~ ' 2. Property Location ~o~ i~-~ ,/~,. ~, ,~ ~.~ . ~ ~ ~ · ~ . ~ V~l lage ~~? Tow~ip ~?/' ~ ~ 3. Public Water~p~ny ~ame~' / ~Yt~,~.~C~, 4. Lot size: Width fee( Length. feet 10. Sewage Disposal System: 5. Subdiv. ~'- 6. Section 7. Lot Number ~ 8. Private Well 9. Public Water --'~' Distance to main (For Health Dept. Use) A. 900-gallon septic tank: Precast iEquivalent Block B. Leaching pools: Nunber of pools Precast Block Special ll. If private well, fill in the following blanks: A. Tank capacity, gallons B. Pump G.P.M. C. Total well depth D. Depth to ground water E. 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 Signed FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Heal th Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE SIGNED S-15 Rev. 4/1/73 DATA ORTA~;VED FROM OTH£P,~ Dt~I VE C£1V '[ 4g RBVISlONS YOUNG & YOUN, 400 OSTRANDER AVENUE, RIVERH ALDEN W. YOUNG SURVEY FOR: G£Ot?G~ NACKOS ~ TTITUCK TOWN o~ SOUTHOLD ~o. 45893 ' L4~/D G UARANTIEIL'D TO: SUFFOLK CO., N.Y. D IVE R"rVI~ilONS YOUNG & YOUNG 400 OSTRANDER AYEL~U~E, RIYERHEAD, NEW YORK AL.DEN W. YOUN~ HOW~ W. YOUNG SURVEY FOR: G£Ot~G~ NACKO$ AT ~ TT! TUCK S O U Thl OL. 0 A~'kkOV~D AS NOTED ',^'r~:4,.k-'~x ~7 ?y ' 49'-o /