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Home My WebLink About7591-zFO~t~ NO, 4 TOWN OF SOUTHOLD BU~.nlNG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No..Z..63,~. ..... Date .............. .F.e.b.....~.~. .... , 19.?~. THIS CERTIFIES that the building located at . .~..e. arv~L.e.w. &.~e .......... Street Map No.. ~$~;h~,e~l~/i~[o ........... Lot No... ~ .... So~th0~d, ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 0C.~.... 1 .~..., 19. ~. pursuant to which Building Permit No.. 7~.91Z. dated .......... 0e~ ... l~ ..., 19..7.h,, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P. riv&t$, on~. fa~,ly, tl~el~,~ ..................................... The certificate is issued to .. ~..&...14.r. lt..0.t.~O. {~l~'~ke~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...F.e.b....1.Q.. J.~.7.~ .................. UNDERWRITERS CERTIFICATE No.. p.e.r~d~,~$ .................................. HOUSE NUMBER ..... .l~0 .... Street .... ¢lear¥~Le.~. A~ra ...................... Building Inspector BUILDING PE~J~IT (THIS PERMIT MUST BE KEPT ON THE P~EMISESUNTIL FUll. COMPLETION OF THE WORK AUTHORIZED) No. 759~ Z Permi~ian is hereby gmntecl to: /v _ ~. at premises located at. . Building In~:~'or. Building Inspector BUILDING DIPAItT/~KI' /)///'~/"~ 0'O,~ '/~/1/ ~" ~,~/(' % TOWN CLmrS OFFKa a,/ Z' SOUTHOLD, N.Y. ' '/"- -- $ APPLICATION FOR BUILDING FERMIT ...--~,-.~.,-.,, ,,,.,,. ,, ,m,~-,m' l~m~,, accu.rme plm pmr~ m~ ~:am.. tee acceremg to senea~e. . .... ~: ___b__ _P/~la.n sh ,a~_'?l~., !~a, tiOn, o.f. lot %r~l, ef b. uil, dings .o9 prem. i.ses,,relation~ip t.o. ~acljoini .rig. premises o~ public siteets o~ ~ u,~u~, ~ne gJw .ng a~m~,!; .ma ~r~T~ .on m. Rlyo~-orpr .a?erty must oe arawn on the magram wl"/,ch: L~ prat of this applicaticn. ~i c. I ne worn coverecl Dy rnts appticabon may not be commenced before issuance of Building Permit. -" d. Upo~ approval of this. clipit, ,the Building ,Im~ector wi I' issue la Building Perr~it to the al~licam. Such permit ~ snail be kept on the premises available for inspect on throughout the work. e. bna building shall be o~cupied or ~sed in whole or in part for any purpose whatever until a Certificate of Occupancy shall ave been granted by th~.Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ssuance 6f a' Building Permit pur~nt to thei~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and ~... ~,.. 1AJm~ O~ or ~' Regulations, for the construction of buildings, additions or alterations, ~ f~.mmovial ar ~ ~ de~cribed..~ The applicant agree~ to comply wlth all applicable laws, ordinances, building code, housing ende, and 'mgulatlans, and to admit authorized inspectors on premises and in buildings for necessary inspections. · / , t...__ (Address Of ~,pli~'~nt)' State whether appl Cant is owner,'leSS~., agent, architect, engineer, general contractor, electrician, plumber or builcler.:.r'.i:ii I f applicant ~e, ~uly authorizecl officer. ......... Builder's License No. i, Plumber's License No ................................................. Electrician's License No ............................................. Other Tmde's License No ................. Location of land on Whi~:h proposed work will be done. Map No.: ........................................Lot .~.,: ...~ ................. Street and NUmber '~JJ~-JJlJ~-JJlllllll#J~ ............................... '. ................................................... Municll~llity State existing .use and eCca~pancy of premises and intended use and oocupancy,~f projx:~ con~'ruction: a. Exisiting use and ~..cupancy ................................................. . .........................../"---/ / I~'~'""T~' ........................ and acc n . . J "~ ' b. Intended use upa ~: ellllll~. · ~ ............................................................... ~ ......................... 3. Nature of work (check which applicable): New Building.. ................. A~Jdition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................... (Description) 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 type of use .......................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ................... Height ........................ Numbe[.of. Stories ................................................................................................................. Dimensions of same structure ~ith alterations or additions: Front .................................... Rear Depth ................................ Height ............................ Number~ of'Stories ................................ 8. Dimensions of,entire new construction: Front .................................... ear ............................ Depth Height~ .................... I~umber of Stories 9. Size of lot: Front ~ ~-~ ....................................................... Rear .......................................... Depth ......., ............ 10] Date of Purchase ........................................................ Name of [:ormer'Ownef':; .................. : ................................... 11. Zone or use district in'which premises are'situated ................................................................................................... ~ 12. Does proposed construction violate any zoning law, ordinance or regulation: .]~1~. ........................... 13. Will lot be regraded; ....?/..~;..-.~.. Will excess ~F!ll be removed fram~.prernises: (~) Yes . (II) No ]4. Name of Owner of prem,ses '...~..~..~..~ .............. Address ................................ Phone No. ...................... Name of Architect .................,.~=~.,] ..................................... Address ............... ~ ........ ;..,.... i~one'No. ...................... Name Of Phone No; ...................... PLOT DIAGRAM Locate Clearly and distinctly' all bU~ldings~ .... whether existing 'or proposed~ and' indicate all set-baCk dimensions ~>raperty lines. ,Give street and block number or descriptio~ according to deed, and show street names and indicate, whether interior or corner lot. STATE OF NEW~J;;;I~I~.,.. ! S S COUNTY OF ...~..~..~... .................... ~Jlllll~ ~,..~j!* ................. being, duly sworn, deposes and soys that he is the applicam: ' (Name of individual sign ng c°ntracf) above named. He is the ............. ~.~ .............. !(~nfractor, agent, corporate officer, etc.) of said owner or owners, and is duly~ authorized to perform or hove performed the said work and to make and file this application; that all statements contdit~ed'.in this application are true to the best of his knowledge and belief; and that the work will be'performed in the rnann,r set forth in the application filed therewith. Sworn to before me this ........................ o,o, ............................................ Notary Public, . ................... Cou ty : ~,,~...~ ......... ............................................. of app,conti' ........................ FORM NO. 6 TOWN OF $OUTHOLD Building Deportment Town Clerks Office Snuthold, 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 woter 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.~ ~q .~..T.,q.... J..8.. ,....?. ?..7. ~. ....... New Building ............... × . Addition ............ .... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property Cl~.arvtew Avenue, Smithfteld Park, Southold Owner Or Owners Of Property .~.~.~.,~...f~..,~.~.,....O..l:..t..9.....S.~.n..~.a..m..m. .............................................................. Subdivision ...S...m.~.~.h..f.;l.e.~.d.....~..a..~ .......................... Lot No..?..5. ....... Block No ............. House No ............. Permit No....?.,5.9.]L ........ Date Of Permit ~.0~..]..~./..~..4..Applicant ~G~e~[~e~A~h~e~z~u~]:~d~e~E~.~[~c~ ~.. .0. /. . .8. /. .'/. ~ ............................ Labor Dept. Approval Health Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ Construction on above described building and permit meets all applicable~codes and regulations. App cant ~ /~/,c,~,~ ~"~ Sworn to before me thi~.-, THE NEW YORK BOARD OF FIRE UNDERWRITE,RS BUREAU OR' ELECTRICITY ~- ak 85 JOHN STREET, NEW YORK, NEW YORK 10038 O~t o Slnra~, Clearview AVe., Bennett Lane ~ Brelstadt, in the fotlou'h,g tocatio.; !~[] Itose.awnl ~ t.~ Ft. w~.~.,,,i.~-- February 12, 1975 16 27 [ 20 16 Water heater: 1-4.5~ .room heater/s: 1-2.0~, 3-1.5~, Motor/s: 1- 1/2hp 1-10 amp. Garage ~or opener ' r,iflcate must not be al,ered in ony manner~ return SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number Address ~ ~-~ (.*~ Y.~ C~,~, aba ~ 6. Section 2. Property [6~ation C/~w~,/~_~m -4 ~oo' ~ ,~/~//~r~. Lot Number q~_~ 8. Private Well Village '_~ .... ~ld Township ~A./~ 9. Public Water 3. Public Water Company Name Distance to main 4. Lot size: Width yoo feet Length ~z feet 10. (For Health Services Dept. Use) 11. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY ApplicantJ~.,~ ~.1~s g~,/~,I~,. Phone 2Jr .s~/a 5. Subdiv. Sn~,~fi¢/d Sewage Disposal System: A. 900-gallon septic tank: Precast v//Equivalent Block__ B. Leaching pools: Number of pools ~ Precast v//Block Special If private well, fill in the fol- lowing blanks: A. Tank capacity ~Z gallons B. Pump G.P.M. C. Total well depth ~,a~ 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 Services' current standards thereto." This application will be valid for one year from the date of approval indicated b~!ow and may be renewed if a current local Building Department Permit is in effect. Date ~gned -~, 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 System and Water Supply can be_installeJ on this plot. APPROVAL DATE' /~/ '/'O/'~/c~/~'~ SIGNED-~////~j~'~-~-~'C S-15 Rev. 4/1/73 inspected ~Y tLJs dop¢,rtment and found Chief of Ceneva~ ServiCeS ED 2. BEFORE COVERING PIPELINE 3, FINkL WHEN JOB COMFLETED ¸,i