HomeMy WebLinkAbout7398-zTOWN OF SOUTHOLD
BUn,nlNG DEPARTm~IT
Town Cl~k's O~iee
$outhold, N. Y.
Certificate Of Occupancy
No. Z~3~ ...... Date .............. &pi'J2.. · ·
THIS CERTIFIES that the buildin~ located at . B~l~t~- ~)~t~ ....... Street
Map No.liarbo~..Lt~ Block No ........... Lot No.. 72 ...... Sguthold. · .N,Y., ......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .............Ju~.... 1,$19..7~ pursuant to which Buildin~ Permit No...~398Z
dated ........Ju~....1.% ...., 19.7~., was issued, and conforms to all of the requlr~
ments of the applicable provisions of the law. The occupancy for which ~.M, certificate is
issued is l~.r~,vate, one. fa~t.l¥. &ve~Lln$ .......................................
The certificate is issued to . Rona~l .&. ~la~ga~.et. Butkov~h... l~ene~ ...........
(owne~, lessee or tenant)
of the aforesaid building.
Suffolk County Depa~-tment of Health Approval ~tpl~.l---23" '197{ · .by..tt,. ¥.lll&. ·
UNDERWRITERS CERTIFICATE No.. ~0~01~ ..... Jan..21.1~7~ ................
HOUSE NUMBER .. t1~6~ ....... Street ......B~i~mtin® .I)~ .....................
FOB~ NO. ~
TOWN OF ~OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7398 Z
Permission is hereby granted to:
.t premises located at .......... ..c......m~.... ........ .......................................................................
/-0 /-I/) ~ L~ ~T.~. ........ ...5'.(..Y.. ............................
....................... ~.. ...... .7..~, .................. ~.~..../~. ................................. ;Z.
)
/ ( ,.,/'/.)Z, 19'~..~....,
pursuant to application dated ................................................... ~.., and approved by the
Building Inspector.
Fee $..~...~... ............
The work covered by this application may not be commenced before issuance of Building Permit.
premises available for I~ian work. ~
e. No~ ~hall I~e,L~CCupJed.or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall hmmM~ I~he Building Inspector.
^PPLICATION IS HEREBY MADE to the Building~rtment for the issuance of a 13ui~di..ng.P.. it p _~.. t ~the~
~he~eulati..ons;'f~r ~construct.19n of buildings, eddttiam or alterations, or for removal' or demolition, a~ heroin described.
app.cont agrees to comply with all applicable laws, ordinances, building.code, housing code, and regulatlam, and to
admit authorized inspectors on premises and in buildings f~' neceslory Inspections.
~9~ ,/iW~' q>plic~nt, or name, if a ........
(Acklmss of applicant)
State whether applicant is:owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
. .......... ...............................................................................................
Name of owner of premises
If opplicont is a corporate, signature of duly authorized officer.
.... ~........~~.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~°~~~~~~~~~.~~~~~~~~~~~~.~Plumber's License No (Name and title of corporate officer)
Builder's License No...L~I~.....~..:~t ................. ...
..... ....................
Electrician's license No...,~.3,'~...--.-~ .......................
Other Tmde's Liceme No ...............................................
1. Location of land on which proposed work will be clone, Map No.: ..~J...~..7.. .................... Lot No...~.~ .............
Street and Number ........................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ...... ~l~,¢f~. ........ IO..~.. .....................................................................................
...... .....................................................
3. Nature of work (check which applicable): New Building....b~..... ....... Addition .................. Alteration ......... :.4
Repair .................. Removal .................. Demolition .................... Other Work .....................................................
(Description)
4. E~timated 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 ........................ 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 ...... .7....~.f. .................... Rear ......7.....~...~ ............ Depth ...~....~...~.~..~...~.../.
Height .................... Number of Stories ...O..r!..~. ........................................................................................................
Si;~e
9. of lot: Front ......... ~f~-O.:. .................................. Rear ........... .,~...~...~..:.....~ .......... Depth ~.~...~,.;.~..:..~'.~
10: Date of Purchase ..~I.~......~TJ..~.~..~.. .............. Name of 0 Former, OwnerF..fl~llt'..~...~....~'..~..~fJ~...~.....~...~....~..~
11. Zone or use district in which premises Ore situated ...... .~.~.~/.l~..~'J.l~..f.~.J ...............................................................
12. Does proposed construction violate any zoning taw, ordinance or regulation: ....... .~1.1~ ........................................
13. Will lot be regraded ..... y.~.. ............ Will excess fill be removed from premises: ~) Yes ( ) No
14. Name of Owner of prem,ses~ll~ ..~..~..~. ~clress i~..~..~.~..~....: No.~.~..5'...-..~./..~..~.
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor ............ .~...~J...~.. .................................. Address ................................ Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-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.
'71
Drive
STATE OF NL~V YORK, ~ c c
COUNTY OF ....... ../~.. ~..~/L~....... ~ ~
........................... /.~.~../~..~..~-.~. ........ ..................... /:.1. ........... being duly sworn, d~oses and says t~t he is the applicam
(Name of individual signing c~tmc~
above name.
He is the ......... ~.~ ..................................................................................................................................................
(Contractor, agent, co,rate officer, etc.)
of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file
this application; t~t all statements contain~ in this application are true to the best of his knowle~e and belief; and
that the work will ~ perform~ in the manner ~t fo~h in the application fil~ therewith.
Swam to before me this
........... day of ......... ...................... ,
Noton/ Public, .~ .......................
PHILIP D. SMITH
l~otary l~ublic, State of New York
1%. 30-~741040
Qualified in Nassau County
Term Expires March30, 19
(Signature of applicant)
l/
NAP OF
,5U P,v'E' F ~.J [.;;
r~, -'~ !,~ -, '
Z05.63
AT
TOY,,' N
1
'8
.s.-
?r ,SOdTI- OL ;..)
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services //q~ ~--/~/
Reference Number
APPLICATION FOR APPROVAL TO CONSTRUCT
A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY
1. Applicanti~on~1.d~u~kov$ch Phone 765-21
Address P,O, ~x 571 $ou~hold~ N,Y, 11971
2. Property Location Hm~bo=
$outhold~ No¥, 11971
Vi 11 age Southo~d T0wnshi p Southo~d
3. Public Water Company Name
4. Lot size: WidthlO0 feet Length 205 feet
10. Sewage Disposal System:
A. ~0~- allon septic tank:
Precast)~]Ll( .Equivalent Block
11.
B. Leaching pools:
Number of pools ~0
Precast~~
i)k)(J[ Block Special__
If private well, fill in the fol-
A. Tank capacity ~/ gallons
B. Pump~ G.P.M.
C. Total well depth
D. Depth to ground water [~ (
E. Araot)nt of water in well
5. Subdiv.~ Imf.
6. Section ~3
7. Lot Number ~
8. Private Well ¥[$
9. Public Water N/~
Distance to main N/A
(For Health Services Dept. Use)
The undersigned CERTIFIES: "Construction of authorized installations will be in accordance
with the Suffolk County Departn~nt of Health Services' current standards thereto." This
application will be valid for one y~ar from the date of approval indicated below and may
be renewed if a current local Building Department Permit is in effect.
...................................................... ' ....
.................................................... .~ ........ ==========================
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 installed on this plot.
APPROVAL DATE ~/~//~ SIGNED ~ ~ ~
S-15
Rev. 4/1/73
THE NEW YORK BOARD OF FIRE UNDERWRITERS
ak
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
eat. January 21, 1975 Applic=tio.~Vo. onfUe7595B7 ..~ 204504
THIS CERTIFIES THAT
only the electrwal equipment as d~scribed b~low and introduced by the applicant named on th~ above application number in the premises of
Ronald Butkovich, Brigantine Drive, Southold, L.I.
in the following location; [] Basement ~ Ist Fl.
we~e.emir~don January lB, 1975
~2 ~8 29
[] 2nd FI. outside Section Block
and found to be in compliance with the requirernents of this Board.
RANGES
DRYERS [ FURNACE MOTORS FUTURE APPLIANCE FEEDERS
AMT. K.W. C~t "' Pl O^S .. P. Mr. .O. .~ W. O.
SERVIC~: DISCONNECT
1 200 CB
OTHER APPARATUS:
,o.o~x s I
;PE~IAL REC'PT
1 30
R
COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
i 7.4 1 9.3
TIME CLOCKS BE!.L UNIT HEATERS MULTI-OUTLET DIMMERS
2 600
SYSTEMS
~T. AMPS. TRANS. NO. OF FEET A~4T. WATTS
11 I
¥ I C E
OF CC. CONO.
2/O
Motor/s:l-~/hhp
~Furnaces: Oil 1-~8hp, 2-1/12hp
Pete~ Bogovic, ~~Na~~
Main Road,
Southold, L.I. 11971 GENERA~
This ce~ificate must not be altered in any manner~ return to the office of the ~crd if incorred. Inspectors may be identified by th
FORM NO. $
TOWN OF SOUTHOLD
, Building Deportment
Town Clerks Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Inetructions
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 ...& ~.=iZ..Z9. o...1.9.7.5 ............
XXXX
New B~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Location Of Prapertv ..................................
Owner Or Owners Of Property ..?..?..n. 9...Z..d.....a..n...d....M..~.~t.a...R.e..t.....B..u.~k~.v.i.~h ................................................
Subdivision ..H...a.~.b...°.~....L.~.9..h.}..s.....E..s.}..a.~.e...s. ............. Lot No....7...2. ..... Block No ............. House No....1.~]5.5.
Permit No...7...3.~.8...2. ....... Date Of Permit 7. Z'.!.!..T..7..a.....Applicant .... .R..o...n..a...1..d.....B..u...t;..k..o...v..i..c...h ........................
Health Dept. Approval ....Y..E..5. ................................... Labor Dept. Approval ................................................
Underwriters Approval .... .Y..~.s. ................................... Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Fin~ Certificate .....X..X...X..X. .............................
Fee Submitted $ .5..:..0..O. ...........................
Construction on above described building and.,l~'~nit meets,~applicable codes and regulations.
A
Sworn to before me this Ronaid Butkovich ......................... ~;;~ ,t'~ ......
· .~...~...~..'dayof .~....~..~..'/, /~.~/$- (stam or
t ..... "~ '~'"~'~': .................... /~m~ ~aI~L~ a~'~-°~)
No ary Public .....~ ....... '.z?~........~ ........ County ~ '~¢E P rt~rm
Clks. fla. 52 6365515
dl Commission Expires M.arch
~he sewage disposal and water supply
~acili%ies for this location have been
~nspected by this ~epar~and/ound
~Q ~esatisfactsrY ~:,~ ~. ~
Chief of General Engineerin~
Services
Z05.63
l/VI/V~ROOIM
CORN/CE D£T/]tL C-/ ~";1'-o'
?~ _ ?o I,V£ATIt£R
'-- 25"b'Yb
APPROVED AS NOTED
//
~,~i~' ~ ~ AT