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Home My WebLink About7618-zFOK~ NO. 4 TOWN OF $OUTHOLD BI~.nlNG DEPART~t~IT Town Clerk'e Office $outhold, N. Y. Certificate Of Occupancy No..~'..33 ...... Date .............AI~i .... 29.., 19.7.5 THIS CERTIFIES that the building located at . l~lue. 14a.~l~z~ -Drive ...... Street Map No.81d.. ~hs.. · Block No ...........Lot No....lO.. · ~een~ort...Ig,¥.o ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............Oat...7.., 19.7.1'. pursuant to which Building Permit No. dated .........liO.V....~. ..... , 19 .,/1~., was issued, and conforms to all of the requh'e- ments of the applicable provisions of the law. The occupancy for which *.h~, certificate is issued is . .l)r~.v. ate..o~e. ~lu~,l~..4¥~,~L~g ...................................... The certificate is issued to l~arren .lfathes®l~ .... .(~rner ........................... (owner, lessee or tenant ) of the aforesaid building. · Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No. 3l~067'~ · · · ~..~0.. 3.97~ ................ HOUSE NUMBER ...9.~0 ........ Street .Blua .Maz'l~n. 11~ ........................ ...... ....... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 7618 Z Permission is hereby granted to: ................ · Bex.....~.... J.~e s~.t ...................... to 1~.~.. x~...~e..,£e~1~y...~eLt ~ug .............................................. , ........................................ at premises located at ....~.~.~,...'t.O.....~,.'0,t~.:,]~/k~..~,~.L.~.3~J2~ ............................................................ ............................ ~.~.utk~.~...~]a~.~ a ~ .......... (~r.e~p.~r.t ....~, ~:, ................................................ pursuant to application dated ................... ~.C,~. ............ ~.. .............. , 19~.~...., and approved by the Building Inspector. Fee $91.,~0. ........... Building Inspecto[ FORM NO. $ TOWN OF SOGTHOLD , 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 New Building ................ Addition ...... ~,.. Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... ~:¥A~....~~....~ ................................................. Owner Or Owners Of Property ..... ....~...r C;~4t.j~ ....... ~ .............................. Subdivision ..~,~..~.~-~....~.~Lot No. ,.~,~,., Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Hea~th Dept. Approval ............................................ Labor 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. Applicant ~~w~,.....~, .......~.~ .~ ..~ .......... Sworn to before me this ....... day of .~..~-~ ........... (stomp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS ~l.k BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~. January 30, 1975 ,p, ficatlo. No.o. fl. 765574 N206732 only the electrical equlp,nent ~ described be~w a.d introduced by t~ appl~ant named o~ the above application nu tuber ~n t~e premises of 61cnn Hetdtmann, Albacore Dv~ve, BXue ~e~l~n Rd., 8outhold~ b.~. in the~ollowlnglocation; ~ ~.~o.t ~ ~., r~. ~ ~.d rL outside ~.~.~i,,odo. January ~7, 1975 and found to be in complianc~ wlth the requirements of this Board. ~YERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS iPECIAL REC PI TIME CLOCKs ~ BELL ~ MULTI-OU~ET DIMMERS RR #1, Box 15A, Main Rd., Mattituck, L.I. 11952 ~AOER ~ his certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified by their credentials. ~ I · DEPARTMENT OF HEALTH SERvicEs H~idtF, a~n '%' %n ?cb. ~8~' 1977 P. O. Box X .. A recent check of our files indicates that this office has never issued a final approval for the above referenced job, Please be advised that it is illegal to occupy the building until the f~l- }owing paperwork is submitted to this office and/or the following inspec- tion(s) are completed: i 1Well Drillers Certificate F_..~]Wa te r Analysis . F_~esspool Certification F~"'lFi na 1 Surveys ,. ter ..... . ....... Should you have any questions, please feel free to contact this office. '- cc: Town Building Department SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department , Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address~o.~ ~ , 2. Property Location~ ~j ~_~_ 3. Public Water Company Namek.),~c~. 4. Lot size: Width k~ feet ~_ength ~ "feet 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: (For Health Dept. Use) A. 900-gallon septic tank: Precast ~ Equivalent Block__ B. Leaching pools: Number of pools Precast Block Special ll. If private well, fill in the following blanks: A. Tank c~acity~l~lons C. Total well ~h_ D. Depth t~/g~ou~r_ The undersigned CERTIFIES: "Consti~,~tion of authorized installations will be in accordance with the Suffolk County Department of'i4ealth'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, 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 inst~lled/on this plot. ~// APPROVAL DATE /:/'/?/~'z/ SIGNE~'~~/~:~.~ / :/ ,I EX t Tiglt I P[CTiO iIEQUIRED S-15 Rev. 411/73 ........ , /ac 2._.... ..- Approved ............... .~.. ........ , Permit No. Disapproved ..... , ....................................... ,.._ AtPUCATIOH FO~ BUII.DIN~ PKRMIT ., ,'~)at, ..: ...~...~.. ............................ ,19.~.,~....: NST. UCT,O, S · · ;, a. This..a~al. icat,on,m,ust be completely f,l!ed ~ by .t14~.wnter ac. ,n ink .~1 submitted in triplicate to the Buildingn inspector, Wen ~ set~ or pram, accurate plot plan to mme. Pea ~i.ng ~le,~ b. Plc~plan showing location of lot and of buildings on premises; '~dl~tianshlp to odjoini .rig. premises or publ c streets areas, and ~iging a detailed descrtRtion of layout ofprpperty must be d~wn or~ the dlagrc~ whmh is part of this applicatlon. C c. The work covered by this application may naa be c .~mence~ I~efpre i~Suanc?qf_Bui!ding Permit. d. , U.pon app .reval of ~ls appl.lc, at. !on,. th.e Buiid!ng I~to~ will 'l~sue a Building Permit to the applicant. Such permit shall oe Kept on the premises ava,ama tar mspeatmn ~h~ the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occup~ncy,~. shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bu Id ng Permit ~umuant to the ,Buildlr~.' Zan,e Ordinance of t. he Town of Southold, Suffolk County, New York, and other applicable La~ O!dinana~ or~ .~gu arl..ons, jar the construch, on of buildings, additions or alterations, or for removal' or demol tio~, as ~desoribed.~ e appiicam agrees to comply with all apPlicable laws, ordinances, building code, housing code, and rngulatlam, and to ~ admit authorized inspectors on promises and In buildings for necrasary inspections. /~ (Signature of applicant, or name, if a corporation) : ............................... ..................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ' .......... .................................................................................................................................................................. Name of owner of premises ......~......~...~...~....~....t~.......~.....~..~....~....~'...~...~.. t~ . If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. ~L.~,, ~:t,~,~"~'~.~. Electrician's License No ........................ % Other Tmde's License No ............................................... Location of land an which proposed work will be done. Map, No.:...~...~....~'....'~.. ..................... Lot No..X.~. .................. Street and Number .~. J.~....~.j.~..~,.~.~,L~t~,3 ........... ~:)~to~. - ' Municipality State existing use and occupancy of premises and intended use and occupancy of pmpased construction: b. Intended r,se and occupancy . ..~.L.~.....~.~. ..................................................................................... 3. Nature of work (check which applicable): New Building......~,. .......... Addition .................. Alteration ......... Repair .................. Removal .................. Demolitior, .................... Other Work ................................................. (Description) 4. Estimated Cost ..~ ................ ~ ................................... ee ..F..,....~/ .................................................................... (to be paid on filing this application) 5. If dwelHng, 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 same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensians of entire new construction: Front ....... ~.~. .................... R~ ~O~ Depth ~ Height ....).~ .......... Number of Stories ....... ~ ............................................................................................................. 9. Size of lot: Front ...... J.~.~. .......................................... Rear .....~.~.~.~ ............................ Depth ...~.~.~ ................. ~0. Date of Purchase ........................................................ Name of Former O~ner ....~.~.~.~.~,~..~.~.~. .......... 11. Zone or use district Jn which premises are situated ..~.J,~.~.~...~.~.~.~.b~....~.~.~.~ ................................. 12, Does proposed construction violate any zoning law, ordinance or regulation: ~3. Wil~ lot be regraded .....~...~ ............ WHI excess fill be removed from premises: ( ) Yes (~) No 14. Name of Owner of premises .~.~.~..,~.~.~.~.~.~ Address ~.~.~.~..~,~.~... Phon~ No ....................... Name of Architect ....~.~.~ .......................................... Address ~ ~ ~t~ ~t~ Phone Name of Contractor .~.~.t~.~.~.~..~.~.~.~.~.~. Address ...~.~,~ ............. Pho~e No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from prope~y lines. Give street and Nock number or descripHon according to ~eed, and show street names and indicate ~hether interior or corner lot. ........................... .,.~.~..~64~....~//./~4 ...................................... being duly sworn, deposes and says that he is the applicam (Name/~ individual "digning contract9 above named. /v ~ ~ (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 thor the work will be performed in the manner set forth in the application filed therewith, Sworn to before me this ~ ~ C ................... ...... ............... , . % ......... ........... ........ / ' JUDITH T. BOKEN Not~ pubJJc, Slate of New york APPROVED AS 'NOTED ~:~:~:" ~FEE,. ~ NOT~I~Y ~l~ ~RT~T 765-2~9~ TO 4~ FOR REQUIR. 1, ~RE B~FILLING ~UNDA- TION OR START F~NG 2. ~RE COVERING PIPELINE 3. FINAL WHEN JOB COMFLETED NOT RES~~N OR ~ STRUCT~N ~~/~-. t I I ql FI Fl