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Home My WebLink About7600-z]FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupency No..a7150 ..... Date ...... July. 2.1.~ ............. , 19.76 THIS CERTIFIES that the building located at ]~/Sea. D.~o. &. areen.~ay. ~, Street Map No. 3~'~il ....... Block No. ~1[ ....... Lot No, 23.0l, ie.nt ~. N., .¥, .............. confor~ns substantially to the Application for Building Permit heretofore filed in this office dated .. 0e.tober..1 ......... , 19 .Tbs. pursuant to which Building Permit No. dated .. 0ctobe:~ .al, ........ ,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 .. Pl'zLvate..One. l~.am:Lly .Dleelling ..... . .....- ........................... The certificate is issued to . Mai.tar .& ito:~e..Camt~ .............................. (owner, of the aforesaid building. Suffolk County Department of Health Approval Aug. 2.1~. -t 9'~% ibY -R.. Vt. tla ....... UNDERWRITERS CERTIFICATE No. N21+81t-08. .................................... HOUSE NUMBER 2.~60 ......... Street .. Gre~nwa¥..l~a sS ........................ 306~ ~. Sea Drive FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7600 Z Permission is hereby granted to: ......... :/..~. ................ , ........ ~ ........................... ....... ~...:..:.o ..... ~::......2..~ ........................................... ~, ............................................... pursuant to application dated ..... ~ ........... . ............... ; ...... ; ........... ..~.~.~.. and. approved by the ' Building Inspector. Fee $ ......................... TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY ]......~.~..:... ~.~.~..'?/Z~...:~ .......... REGRADING LOT / ~ .Budding Inspector DRIVEWAY CONSTRUCTION ~ C~SSPOOL CONS t RUCTION / CELLAR CONSTAUCTION OTHER_ ~ FORM NO. 6 TOWN OF $OUTHOLD 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 installotions, 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 -~.~ L y' ~ ~)1 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .................... ; ....................................... '~.~... .......... ~. ........ ~..-. ........................................ Owner Or Owners Of Property ..... ./.r./.~.~..~(...~./.~..:~..~...~.~.~.~.~..~...~...~.L...(=...~...~?.?~.~..~.~.~.`~.. ........................... ................ Subdivision ........................................................... ;....Lot No, Block No ............. House No Permit No.../?.....~.,.~.~?.,.0..~'Date Of Permit../..,~../-.///~..~....AppJicant .... ,,,..~..~.~.g,..~.....c..~..../~,.,,/~..~?..~.~...../. ...... Health Dept. Approval ..... ~ .................. Labor Dept. Approval ....... .//.../....~ .......................... Underwriters Approval ./~.../.~.~...~....~..~...,~..i~ .............. lanning Board Approval ......... _/~...../~. ..................... Request For Temp y Certificate ........................................ Final Certificate Fee Submitted $ ,J, cO' ~) Construction on above described building and pe.~mit meets all appli a~;g.~Jbleicades and regulations. App,icant .......... ................................. rr Sworn to before me this . .~ I'"~;~'~ · ¢~ ' ................ dayof ............................................ (stamp or seal) ~L~'(/.u ~. 7 '/ ./j Notary Public .................................... County /" 6'-~/~¢Jl'~,O' j~jJ~ "/J/Nv FO~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TEMPORAllY Certificate Of Occupancy No. Z.66~.0. ...... Date ............ A. Bg...2~ ....... , 19.7.~. THIS CERTIFIES that the building located at I~,. S~ .Dr. &. Gr6enwa.y .E, Street Map No. 3~k.0 ....... Block No...XX ..... Lot No, 22 ..... 0right.. Ii,Y, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... QCt...1 ..... , 19.7.br. pursuant to which Building Permit No. 7.600a .. dated ........... 0. .e }. . . .~ .l .... , 19. ?.Ii., 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?.~ .v~.t.e.. 9.n.e..f..a.m.l.l.y..d.~.e..1.1.:~. g ..................................... The certificate is issued to . .Waltel'..~ .RO~ .¢ami®r ..... ~.~mer. s .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Allg...2~...197.~...by. Ii,. ViLla ..... UNDERWRITERS CERTIFICATE No... pg.n.d.l. 2g. ~ a-I ~ o~ HOUSE NUMBER ...2~6.0. ...... Street . .Gr. eenway .Eamt ......................... 306~ N. Sea Drive t Building Inspector FORM NO. $ TOWN OF $OUTHOI.D , Building Depoffment Town Clerks Office So.thold, hi. 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: I. 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 disposai--(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 pJori~ req~lrem~nts~ where applicable. B. For existing buildings (prior to April 1957), blah-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 formation required to prepare a certificate. C. Fees: l. 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 ZC' New BHilding '/"/~ Addition ................ Old or Pre-existing Building ................ Vacant Land Location Of Property .~...~.~.~...~....~.~.....~?]...~....~..~.c~....A/....~....~...~..~...~..~.?~......~.....~.../.~.~......~..~ ............ Owner Or Owners Of Property /]///~ ';y/~/~ ~S' /6/~9 ~-2'~/e /~, ~:~/~/'~7 / ~/~_ Subdivision ................................................................ Lot No...~....o~.... Block NO ............. House No?.'..:?.~..~. ' ....... Permit Nu....¢.,r,.,,.=...~.. Date Of P ....... ./..,.~... ....... ~,~, ~.. Hearth Dept. Approvol ..O~./~r~...'}~...Z.~ ....................... Lobor Dept, Approval ................. /~'..../~.. .................... Underwriters Approval .... .~. ................ Planning Board Approvpl Request For Temporary Certificate ............. ~ ..................... FinaJ Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meeJ~ all ai3~fceble ¢~regulotions. ~,pp ca ~ ..?ti .............................................................................,~..~/ . .............. 0 t ~I~ Ir~ I ~ ~J ,. ,THEi NEW, YORK I ]3OARD ,~ FIRE UNDERWRITERS ' ''~ ' "BUREAU OF'ELBCTR C TY ' q~ 85 JOhN STREET NEW YORK NEW YORK'lOO38 .onty the electrical equipment ~ described below and introduc~ b~ ~f appli~an~ named on the abo~ ~ppli~tloh ~u mber SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number Address Pr o p e r ty,~L9,c at ~ .o,~ ~. ,~- V.--" I~ I /..~ II/I ' wi w' : Village 3. Public Water Co~l~9~_~Name 4. Lot size: Widt/hSy'O feet Townshi p/~C- Length feet 6. Section z~ ?. Lot Nun~ber 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: A. ~;gallon septic tank: Precast c~.[quivalent Block B. Leaching pools: Number of pools Precas~ Block Special ll. If private well, fill in the following blanks: A. Tank capacity. B. Pump G.P.M. C. D. E. ~ 9allons Total well depth, Depth to ground water Amount of water in well (For Health Dept. Use) 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 ,~ndicated, below an&,~may be re~ewedJf a curreht. ~l°cal/ Building, ~D,epartment~,; Permit is in ef~C~. / ,~ //' . /,( Date 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 be installed on this plot· APPROVAL DATE ~/7~-~_ SIGNED (~ ~, S-15 Rev, 4/1/73 ........................................ , 19 ........ Permit No .............. Disapproved a/c ................................... :} .......... ;~L~ ....................................... ........... :. ....... ................................... ~ ........................................... . ¢¢ ~. ~i~ ~lic~i~ ~ b c~pl~ly fill~ in b ~ter ~.in ,~, w~ 3 ~ of p~ a~ ~ pl~ ~ ~. F~ ~ b. PM~ ~in~-I~ ~ ~a~ of buil~ m ar~s, a~ gwi~ a d~~~ I~ ~ m~t ~ d~ .~..U~ ~ol of ~,s ~11~i~, ~ ~,~ I~tor will ~ ~, ~ ~n g~ ~ me ~Ul~J~ I~o~. ~ ~.PLI~TI~ ~S HEREqY ~DE to the Buildi~ ~ment ~r ~u.aff~ ~~e at t~ T~n.of ~o~,. ~lk Co~, ~u~a~s, ~r me c~i~ ~ ~1~, ~t~ or al~mti~, ~ne app~icam ~r~s ~ c~ly wi~ all ~l~able ~, ordi~, admit au~Hz~ i~t~ ~ pmmi~ ~ J~ ~i~i~ ~ ~ti~ State wheeher appllcanf is miner, |e~, J~ "J ¢ I~ilder. "" ...... !..t ................................................. Name of owner of premises ............................. ~.~....~,...~ .~ ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Uc~se No ............ Plumber's Ucense No. LD' iL. ~ Electrician's License No. '! ;" ' Other Tmde's License No ............................................... Location of land on which prapaeed work will be done. Map No.: ....... ~.. ....................... Lot No....~.. ................. Street arid Number .......... -~-~..~;.l#ll~..JJJ~.~Jll~.~ ......................................................... State existing use and occupancy of premises and intended use and occupancy of propmed comtmctian: a. Extsiting use and occupancy ........... ~41~JeJll..~ ............................................................................................. b. Ii,tended use and occupancy ........ ~l~"~.~lJ*JiJlJll~- ...................................................................... 3. Nature of work (check which applicable): New Building. '...I ........... Addition ~ - ~ ~lteration ~ . , Repair .................. Removal Demolition .................... Othqr,.Work .................................................... 4. Estimated Cost ...................................... v ................... 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 ........................ Number of Stories ................................................................................................................. Dimensions of sam~e structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~. .................... ' ~ ' 10-. Date of Purchase ...... '~.~..~,~ .............................. Name of Former-Owner 12. Does proposed construction violate any zomng law, ordinance or regulation: ....... ,e~pc ........................................... 13. Will Iotbe regraded ......... ~ ............Will excess fill be removed from premises: (Z) Yes ( ) No Name of COntractor ............................................................ Address ................................ 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, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, l.S.S COUNTY OF: ................................. '~/~/~f /'5 & (~ ~ / ^/ /%" .,. I ~.. ,~ ~1 .... ~r- ....... : .................... ~.,~-, ........ ,.~,~....-~. ........ ~--...~ .-~,~ ---w ~., de~p~s~_ and says that he is the applicant (Name of individual signing conf~actO above named. If He is the ...................................................... : .................. ..~ ................................................................................................... (Contractor, agent, c?porqte offic~er, etc.) of said owner or owners, opel is duly authorized to perform or hove performed the said work and to make and file this opplication; that all statements contoin~l,~.:.~.:~Sr~qp~.li~q~i~op,~_m,.e t~.~. to the best of his knowledge and belief; and thor the work will be performed in the manner set torth in the. application fi ed thereWith. Sworn to before me this ................... ~..l. day of ....................................... ...... / // , Notary Public, . ................................................... '~U~I ~, ........................ :-n5~.;.~.,,~.....?,,~.,..:.,:......:.¢~.; ........ .~, ............... -'- (Signature of applicant) V~ L TE~ A'T :) EDUCATION 'I APPROVED AS NpTED -%¸ e, Y'7,ff '~ x/k 6O m .&- '2 ~k r 4¸,