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Home My WebLink About7569-zlrOuM' NO. 4 TOWN OF sOUrHOLD BUn.nlNG DEPARTm~T Town Clerk', Offiee Southold, N. Y. Certificate Of Occupancy No. ~6~32 ...... Date ............. Feb... 20 ..... ,19.7.~ THIS CERTIFIES that the buil~ling located et . Piae. ~ree. Itoa~. &. i~ ,0.*~*Street Map No.. ~ ...... Block No .......~ .... Lot No..xxx..Cutohol~e.. 1~o¥, ........ conforms substantiall~ to the Applica~0n for Building Permit heretofore filed in thl, office dated ...........8~t ....30, 10~l~. pm'~mm~ to which Butld~g P~mlat~ No. ?.~9~. - dated ..........Sepi. 30 .... , 1§.7~., was issued, and conforms to ~11 of the requir~ ment~ of the applicable provisiomt of the law. The oeeup~mc7 for which thl~ c~ifi~.te ~ issued is . P.~vate. a~e. f~ly. 4wel~lnl ...................................... The certificate is issued to . M~..&. !~1.. Lotht& .LIt(~ ....... 01~eFll. ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County 'Deps~'tment of Health Approval . F~b.. 20...1.97~...byl R~ .V~.3~a... UNDI~WRITE ~.I~S CERTIFICATE No. ]1208~Ct ..... F. eb...1¶...%97~.'~ ............. HOUSE NUi~ER ...... 160~ · · · Street..p~ .T~'ee 'Roar ....................... /~0~.~ NO. ~ TOWN OF $OUTHOLD BUILDIN~ DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Ns Y. BUILDING PERMIT (THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIl. FUll. COMPLETION OF THE WORK AUTHORIZED) 7569 Z Permission is hereby granted to: Oe.~...~J~l.~.r.~...~.u..~!~.e.~...~q...~.....~.....~. ~r~. ~tl~u~e Outcho .~..e pursuant to application dated Se~t ~0 19..~.~.., and approved by the Building Inspector. Fee $....q:.~...~ ......... Building Inspector ................ ........ :.!. ........ . ¢ APPLI~ ~ IUIL~NG KblT ~t~ ...~p~...~O~ ......................., 1~......7.~.. ~. ~is o~lic~i~ md b c~plet~l~ filial in b? ~rit~r ,~¢ in ink ~d ~mi~ in ~1~ ~ ~ bl~i~ I~, w~ ~ ~ ~ ~, ~u~ ~1~ ~ ~1~ F~ ~i~ to ~ule. b. I~fion of ~res, ~d iivi~ ~ ~il~ ~ripti~ of le~ of~r~ must b dm~n on th~ diaCmm whl~ i~ ~ ¢ ~ ~1~i~.~ ' ~11 b ~ ~ ~ pr~l~ e~il~le for in~i~ th~h~t ~ erk. e. No bildi~ ~11 b ~cupid ~ u~ in ~ole of in ~ ~r ~ny pu¢~ wh~ewr until ~ ~lf~ of i~ ~ ~__..,._~ ...... .,~, ..,~;. ~m~,,,o.,. ~urroIK .~ou.?, r~ew York, and ..m~r apCtcable Line, Ordinances or r~ugutur~ons, TOr Tne construction or DUilalngs, aClaltJOflS or alterations, or for removal or demoflt~n, aS herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, heus~ cede, and regulations, and to admit authorized inspectorS on premises and iD buildings for necessary impm:tions. GEOI~GE AIt~BI~ BUIL~. :iNC. (Address of applicant) State whether applicant is owner, lessee, agent· architect, engineer, general contractor, electrician, plumber or builder. Bu.i.l~,er Name of owner of premises ...~..T.,....~.....~..r..~A ..L..9..G..rande 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 ............................................. t · 0 her Trade s License No ............................................... X X Location of land on which proposed work will be done. /V~ap No.: ................. Street and Number ..~.;l.~.e...~.e.e...]~d...,...~..V. JlgJ~l~,V,, State existing use and occupancy of premises and intended use and occupancy of p?osed' construction: a. Exisiting. use and occupancy ................................................................................................................................. b. ' Intended use and occupancy ..d.~e.l~l.t~.g. ................................................ [[ ........................................................ 3. Nature of work (check which applicable): New Building ....Z.. ............ Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... . (D~:ripfion) 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 occupancy, specify nature and extent of each t~pe 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 ....................... Rear ...... ~2 ................. Depth ...... 21~ ............. Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front .... ].2,4o~6 ...................................... Rear ....... ~1~,.2~ .................... Depth ...... ~,6~r8~ ........... 10< Date of Purchase ~ ......... : ............................................. Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .............. ,~ ................................................................................... 12. Does prooosed construction violate any zoning law, orciinance or regulation: ...... ~c~ ............................................. 13. Will lot be regraded ..... ~ .................. Will excess fill be removed from premises: ( ) Yes (~c) No ] 4. Name of Owner of premises .~o..~..]~.eo...~a...G~'.a,,d~.. Address ..~t~&~ ............. Phone No. ...................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..O~er~;e..~.h. Ze~.s..]~.~te.~.v-[zte... Address ..C~t, eJl.o~ue. ........ Phone No. ...................... PLOT DIAGRAM · Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, end shaw street names and indicate whether interior or corner lot. STATE OF NE~ YORK, I c c COUNTY OF .~.~f.~l~. .............. ~'~'~ ............ .G...e..q..~.l~.~....~...]Jl,.],.~.~.e,..~.,~.e,l~,~l,~;. .......................... being duly~s,worn, deposes and soys that he is the opplican~ (Nome of inclividuol signing contracf) above named. He is the .............. ~a~t:~&e.t.o~. .......................................................................................................................................... (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 tr~ue.to ~the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. . Swam to b~fo~ me this ~. ,... _ · ,-~ .~ .~ o, .......... · Notarv Public ...................... ,,~r~-~,~'~....~,~ C~Jnty ................. ..~c...~.....'~,~......~.:~'~...~..~ ........................ -- ' ~ (~ //- (Si~l~ature of applicant) // 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 ~'.e ~P.u.~ ~:,~... 2.Q, ...~. 9.7.. 5 ....... New Building .......X ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~.~rt.~....?.~.¢..e.....~.t~...,....O..~...'c.P..h...o.~..u..e. ........................................................................... Owner Or Owners Of Property ~r.,..~...lt/[~.~,...Tb,...La..C,~zaz~d ................................................................. Subdivision ......... NGn~ ............................................. Lot No .....~ ..... Block No ............. House No ............. Permit No...7.5~9 .........Date Of Permitg,/.3~0.]..'~.~l.....Applicant O~.e.~.g~...~.J~.~.e.~.~....~..~[..[.~.e...m.,....[..~..g^.. Health Dept. Approval ....9./..~.:~/.7..~ ........................ Labor Dept. Approval ................................................ Underwriters Approval ....2./...6./...7..5.. ............................ Planning Board Approval ....................~ ................... Request For Temporary Certificate ........................................ Final Certificate ........Z. ................................. lee Submitted ..................... Notary Public ........... .~..~ County on lotions. Construction above described building and permit meets all~p/licoble codes~a,?~/~.,g~u Sworn to before me this \J ~'~/'O/~&~'~ (stamp or seal) ~ ~ ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicanliir, & I~s,L.l~(}r&,.de Phone Address R~.2 l~®tm~. N,Y, 2. Property Locationp~me TrN 1~,, Cmt~heI~ Village ~ie~om~ 3. Public Water Company Name 4. Lot size: Width1~4.~eet Township~m~el~ Lengt~&o~feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: A. 900-gallon septic tank: Precast X .Equivalent Block B. Leaching pools: Number of pools ~ Precast m Block Special If 11. ~, priv~J~e well, fill in the fol- lowing t~lanks: A. Tank~-capacity 4~ .gallons B. PumpinG. P.M. ~ C. Total well depth D. D~Pth to ground water E. A~6unt of water in well ~ Y (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installation~ will be in/a~6ordance with the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated,~elow and may be renewed if a current local Building Department Permi(~EO~AH~R~e~I~DENIN~. Date ~m~ ~, 1974 Signed ~ ~ =================================================================================== FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal Sy/~tem and Water Supply can be installed on this plot. APPROVAL DATE i-.,tt.//~'~ SIGNED ' ~ ~" , S-15 Rev. 4/1/73 THE NEW YORK BOARD OF FIRE UNDERWRITER THIS CERTIFIES THAT only the electrica! equipment as described belot~ and introduced by the applicant named on the above application number in the premises of M~. La, rand, P.ine Tree Rd., Bay Ave. & B±tter S~eet Rd., Cutehogue,L.Io Inthe.followtnglocation: ~ B~eme~t ~c l~tFI. ~ 2nd Fl. Section Block Lo, ~'~ ex. mh~ed on Feb ~u~vy ~, 19 7 5 and found to be ~n compliance with tM. re,tulre.~cnts of this B~rd. RX~u~ ~ ~ RXTURES ~ R~NGE~cooK[NG OECKS I OVENS IDISH WASHERS EXHAUST FAN§ t .... IENC&N~E~CENT ~LU~E~CENT [ vA~v~ ~ A~T' ~AMT ~ K'W~MT. KW ~KW ~ ~T J H.P *Furnaces: Oil 1-1/8bp, l-1/12hp Motor/s: 1- 1/2hp ' ! D -1.t!.6T I'IOL T~w~I oF eO~4Tl, qc~ur~. _ ~.¢. -,~.-- - BUiLDiNG DEPARTM,~NT AT /c, 5-266G 9AM ~O 4PM FOR REQUIR- ~NS~LCF~ONS: 5b~E BACKFILLING FOUNDA- gR S]AR~ FRA~ING ~gR~ CgVERiNG ~IPELINE H~AL WHEN JOB COMFLETED NESPONSIBLE FOR DESIGN O~ CON- Chief of ~eneral Englneortn& Service~ A~:~ED AS NO~-, j- t¸2 /? H P,C. ¢/ f