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Home My WebLink About7379-zNO. I TOWN OF SOUTHOLD BU~.BINC, DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of OcCupancy No. Z~$~O Date Oet 1 19. ~ ' RoO,W, !/_8 ~ l~ Map ~o..~ ....... Block ~o. ~ ...... Lot No; . ~ ....0~$~.. ~.q~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............J...1~.....~ 19..~.. pursuant to which Building Permit N°. dated ...........J..~.3r ..... 3.., 19.?.~., was issu~d~ 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~ivato ~e faai.l~, dwellia$ The certificate is issued to ...A~'..~..L~...C.h..~.~4 ..... .O~$~,. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~p~..~...19~.~...by. ~,. YAXla.. UNDERWRITERS CERTIFICATE No..~.~..833.2.~. ..... ~.qp.t..~..8..1.~..~. ................ HOUSE NUMBER ...1.0.~..0 ....... Street ...P.v.t..~. 9~.d..~. 7... ( .D;L.~4:I'~.~k .~) ........ Building Inspector TOWN OF SOUTHOLD BUILDING DEP~RTM~NT TOWN CLERK'S OFFICE SOUTHOLD, N; Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7379 Permi~ion is hereby granted to: tuck .............. ............................................. B,..u$...~.d ;~.qw one fa~Lly dw 1 ~n to ................................................ g ~. g. .............................................................. at premises located at ...l~...t......l~....~.~. N.~Z~O:~ Sg.13 ~ 70 ~Z~I~ain o~dl~ Orient ~ ¥. pursuant to application dated ~Tl~y ~ 19 ~' and approved by the Building Inspector. Fee $..{>.2.~.(~ ........... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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, end 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: ]. 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: I. 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 ~ Ii I~1 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~'~'~.-~vl~ ~.-~:) ,~ ~. %t-~t.~ ~,'Vli'~ ..~.~, .......................... ....... .............................. Owner Or Owners Of Property .~.....~:....'~..~..~..?Tr... ........ Subdivision ............................ ',.'~.. ............................... Lot No ............. Block No ............. House No ............. Permit No ........'~..~.~..~..~ate Of Permit ....J...j....~....Applicant .....1~....~...~......~.~..?~..~..%?~..~,.O.........~....1~Ic~ Health Dept. Approvalp...:.'~' ~.' al ~/i .~i~ .~.~ ................ ~1 Laborp ann ngDept'BoardAppr°valApproval ................................................ Underwriters Approva ............................................................................. Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ........ ~..~..~ ............................... Sworn to before me this f~,'~-/ ~ (stamp or seal)~/.7~.,~'° O MURIEL B~USH ~ NOTARY PUBLI~, State o~ New Yor~ ~ / ~ SUFFOLK COUNTY DEPARTMENT Oh HEALTH 1. Applicant Address 2. Property Location Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Village O l~--r-' 3. Public Water Company Name 4. Lot size: Width-&~ feet 6. Section ~m,r~,~ .... '-~=q~w~ ~.~ ~-~ ~..~,~,~_~ 7. Lot Number 8. Private Well Township ~-~w-~q~.~rZ~- 9. Public Water ~.~' Distance to main Length ~_~--~ feet 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 If private well, fill in the fo~wing blanks: A. T. jlnk capacity ~0 gallons B. -l~ump G.P.M. ~ C. ,i~tal well depth. (o[''~' D. ~th to ground water Z~.- E. A.~ount 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. FOR HEALTH DEPARTMENT USE ONLY. opinion of the Health Department that an adequate and satisfactory Sewage Disposal and Water Supply can be installed on this pl,ot. APPROVAL DATE ~/Z)~-- -- SIGNED Based on the information presented herewith, it is the System Builder's License No. ......................................................... Plumber's License No ..............~=....o'*%....~.......~..~.¥.~.L..I~..... Electrician's License No .......... {~:*~.t~l....~..~ ....... ~..~......~%~-- ~'~k,e, ~(~' '~ ~ 0 Other Trade's Li~n~ No ................................................... ~ ~Ot~ ~ 1. Lo~tion of land on which propo~ work will ~ done. Map No .................. ~ ................ ,.; ....... Lot NO ............ ~ ........ Strut and Numar .............................................................................. . .... :; ..p ...... · . .. Munici~liW 2. State exi~ing U~ and ~upancy of premiss and intend~ u~ and ~cupancy of p~ con~mction: a. Exi~ingu~ an~ ~upan~ ............... ~ .................................................................................................................... b. In~n~d u~ an~ ~upan~y .......... ...... .~.~.~.......~.L~.~.~.~ ........ ~ ................................................ APPLICATION FOR BUILDING FEI~MIT Date .............................. x ................ , ............ iNSTRUCTIONS ' i a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspecto~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~,~ b. P~o~ pla~ showin~ location of lot and of, buildings~on~ I~r~mises; relationship to adjoining premises or public streets or Bret giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall he~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanCe Of a Building Perml~IPUrsuent to me,Su,dlnd~.o',~r Ordinance of the Town of Southold, Suffotk County, NeW York, and other applicable Laws, Ordinances or R~gulations, for the eonstrm buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees tel comply with all ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in b~ildings for necal#rV insp~ i~ms. .... (Signature of apphcant6or name, ~f a corporation) State whether el:~licent is owner, I~e, e~nt, erchitt~t, engin~r, ~net~, oontr~tor, ~lectrician, ~luml~r or builder. eme o* owner o* premises .......... ...... ....................................................................... If el:~li~ln.~ i~ a corporate, si§nature of duly authorized offi~r. lN&me an~'~ [ corporete on'i~'~i "" 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ........................... [;' ....... ~ (Description) 4. Estimated Cost .................. I .......................... ~ee ................................................................................................. j (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. f business, commercial or mixed oocuoanc¥, specify nature and extent of each type of use ............. ...A~...L..~...~ ........ 7. Dimensions of existing structureS; iT any: Front ........ ..t~..,~..,. Rear ........................... Del3th ................................... Height Number. 6f Stories .............. Dimensions of same structure with alterations or addition~:.' Front ...................... ~... Rear ......................................... Depth ....................... Height ....................... ,.. Number of Stories . ~ ........ Rear ....... ..?....~... .......... Depth ...... ...'~....~ ................ 8. Dimensions of entire new construction: Front ..... ~ ..... Height .......... ~..~:~....~t'7. ........................ Number of Stories .................... [ ................................................................... 9. ' Size of lot: Front ......'~...~.. ......................... Rear ........ .'~c..~ ....................... Depth ...... ..~....~.... ................................ 10. Date of Purchase ...................... f ............. Name of Former Owner ...................................................... [... ................... 11. Zone or use district in which premises are situated ............... ~Z;~,~..v~....%.~IW.'t~w....J..~Ii~-~L...~.L ..~.... ........ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................ ...~...~,~. .................................. 13. Will lot be regraded ............................... Will excess fill be removed from premisas: [ ] Yes 14. Name of Owner of premises ............~...:....~...lr~....~i...17~¢..O ........................................................................ (Address) (Phone No.) Name of Architect .......................................................................... (Address) (Phone No.) Name of Contractor .............................................. ' ..k'~:~(...~.qJL'L.~ ......................... ;., ............................. ;~........~. ~..°JL ........ (Address) (Phone No.) ~ ~;~ PLOT D AGRAM *~i~ and distinctly all buildings, whether existing or proposed, and indicate alln:t-backn dlinm(enslOns from prop~rt~ ~ and block number or description eccord_io~ :o deed, and show street ames a d' dlcate wheth- er interiol~ or cor~ _ _ ~ STATE O~ NEW Y SS -~,~ COUNTY C being duly sworn, deposes and says that he is the applicant above named. ~igning 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 st~ements contained in this application are true to the best of h~"s'kn~t~ledge and belief; and that the work will be performed in the manner .set forth in the application filed themvj~lih.,,,~ ~, · -:::;..;:: :. :::::::::::::::::::::::::::::::::::::::::::::::::::::::::: .............. ,~urve~ted THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY- ES JONN STREET. NEW YORK, NEW. yORK I.OO38 i- ~,.sept.~.r 1% 197~ A..,~.,~.;o.o./% ~,~ '-[~ N 183325 THIS CE~IFIE$ THAT o~y t~ ~t~ ~u~t ~ ~d~ ~ ~ lnt~ ~ t~ ~l~t ~M ~ ~ ~ ~i~t~ numar in t~ p~mises of N. Chou~na~ P~. Rd. past Oas 3~at~on~ D2e~oks Rd. & Youn~ ~. Orient, N.Y. L,I. September 16, 197q NXTURE OUTI ISTS I3j FIXTURES 20 ll [] 2,,a n. outside s~tio, s~h Lot and.~ound to be in compliance with the r~luirements o/ thi~ Board. RAm 30 ICOOICING DICKS I OVENS I raSH WASHERS ?~E (3OCKs [ ~ELL ~ MUATLOU11~ SERVIC~ OISCONNECT I NO. M [ S 1 O0 CB x R "V I ¢ 11 DRYERS I FURNACE MOTORS I FUTURE APmANCl FEBERS ~T. '~.w* .c~t ..~- o^s ..,. fT. 3,o. ~w.o. EXHAUST FANS ~H' P. 01MMERS AMT. WATTS eeO. OF CC. COND. A.W.G. NO. C~: HI-LEO A.W.G, NO. OFNEUTRALS A.W.G. 1 tl/O 1 zl/O mFurnaces: Oil 1-1/Shp, 1-1/12hp Ronald R. Ennis, ?.O.Box 20~1 Middle Island, L.I. 11953 11 COpy FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.. ~f- 't APPI~(ED~S NOTED DATE:~MU-~- ':~''~/ ~/ NOTIFY BUILDING DEPARTMENT AT 7ES-2660 9AM TO 4PM FOR REQUIR. ED INSPECTIONS: 1, BEFORE BACKFILLING FOUNDA. TION OR START FRAMING 2. BEFORE COVERING PIPELINE 3, FINAL WHEN JOB COMPLETED ?r ,i