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Home My WebLink About7402-zNO. 4 TOWN OF $OUTHOLD BUTr.BINC. DEPARTMENT Town Clerk's Office Southold, N. Y. Certifi le Of Occupancy No.. S .62:~6 .. · Date ............ No.v... ~1 ...... , 19. THIS CERTIFIES that the building located at .. ~o~'el..Ck. l~a4. J~P~J~I.~.~ Street Map No. 3~x ......... Block No.. 31~ ...... Lot No, .~... 8outJac~e. I~oY, ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated ........... July .... jJ., 19..~1~ pursuant to which Building Permit No. dated ........... Jttly .... ¶~., 19..~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Pre,ate..~e. facially..d~eL~,~ng ...................................... The certificate is issued to. lio~ard .&. ~oFo~,~. I,ud®ekeF ........ 0~mer~ .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ]JOY. ~.~..1.~...by. Ro..¥~ .... UNDERWRITERS CERTIFICATE No.. ~.®nd4,~ .................................. HOUSE NUMBER ..... ~70 ...... Street ....C.o~#~r..C~.~$k..1~95~.... ~..l~. ~ .~..¶.~) FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7~02 Z Permission is hereby granted to: to ..~....~..z.~..~.e.~..~.~......t.~.$..~L.~..z.~ .................................................................................... at premises located at ....(~gl~...~'.e~l~..,,l~(3~[..(~..~,~..~.l~...[]L~..D.a~l. aA.~ ................... ............................ ~ ./.~.. ~.a,~J~;L~w...~LO.~.d, ........... ~a,t,~old .......................................................... : .... pursuant to application dated .........................~-..'~..?.. ....... .8. ............. , 19~?....., and approved by the Building Inspector. Fee $].~..t.~. ......... Building Inspector ~ ~ ~ __ APRLlCATION FOP, IUILDI~i PERMIT__ ....... IN~RU~ ~S a. This o~lic~im m~ ~ complexly fill~ in ~ ~writer o~ in i~ a~ s~ in tripli~te ~F~n ~ing 1~fi6~Y ~ buildings ~ ~ ~~ ~ning premiss ar~s, and givJ~ a detoJl~ d~ri~ion of I~ of~ must ~ drown ~ the diagram which is ~ of ~ ~plicati~. ~ ..~ c~er~ ~ th~.a~lic~onmay n~ ~me~befem i~_ ~g Permit. ~~al of ~is a~d~ ~uildi~ I~r ~a B~i~rmi~ ~e ~plicant. ~ch pe~it shall I , ~t ~ me prem,~ ~ailable ~r i~i~ ~h~ ~ ~rk. e. No buildi~ ~all ~ ~c~ or u~ In ~ole or in ~ for any pu~e whm~er until a ~ific~e shall have ~en gm~ ~ the Bulldi~ In~r. ~ignature of applicant, or name, tfa corporation) APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perm t pursuant to the ~ B. uild!n.g. Zon,e Ordinance of ~'.he T,o? of Southold, Suffolk Cou.n. ty, New York, and other applicable Laws, Ordlnanc..es or ~ ~egumt,,o. ns, ?or the c.onstruct~on or. ouJ!dlngs, odditlons or alteratmns, or for removal or. demolition, al herein descr bed i ne app.cant agrees to comply with m~ applicable laws, ordinances, buildln~ code, hous~r1~code, ~ reguh3tlans, and to/~ admit authorized inspectors on promises and In buildings for necessmydml~leem;~. - - (Address of applicon) ................... State whether applicant is owner, lessee, agent, architect, engineer, g~nercd..~contractor, electrician, i plumber or builder. .................................................... ......... . ,: .................... ........................ Name of owner of premises ..~J~.~.~'..~L~...~....~...~..~..~.I~..~......~.~...~.~..I~..I~..~....~..~ ................... i ............................ If applicant is a corporate, signature of duly authorized, officer. ~.~ / '"~ ! - D / ~ ...... X (Name and title of corporate officer) ~ Builder's License No ............................................... 'Z... ~4 ~ PI ber's N ~ ~ um License o ................................................. -' ' ; Electrician's License No ............................................. ~/~:~ --~?- ~'- ~_. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. /~ap No.: ..L....~.~, ....... ~..~..~-~ot i~ .......... ..;~. .... Street and Number~'.......~.~...~..~..L..~....~.~......m~m.~...~.~. ......................... ............................. M~Ii~ 2. State existing use and ~cupancy of premises and iD~ ,~ ~cu~~ c~ti~: a. ~isiting u~ a~ ~cupan~ ................................................................................................................................. b. Intend~ u~ and ~cu~nw ..... O.~..~....~.I.A~.....~.~/~.~ ................................................... property lines. Give street and block number or description whether interior or co~ ~er lot. 3. Nature of work (check which applicable): New Building .... ..~...... ..... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................ _ ~ (Description) 4. Estimated Cost .......... ']-4'~ ~ 6..?....,f..,.?....-....-~..:..0....% .................. Fee .L..tff../....r./'xl'7 ............................................................................. (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 ............................ Nurn~ber of Stories ................................ I 8. D,mens,ons of eDt,re new construct,on. Front .......... ~..0. ................... Rear ...... ~. ................... Depth ....~.. .................. Height .....~ ........ Nu.n~er of Stories ...<~ ............................................................................................................ 9. Size of lot: Front ...~i~. .............................................. Rear ..../~. ............................. Depth ../.~.~ ....................... 10. ~ Date of Purchase ...i.:.~.~...~.~ ..................................... Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~...~. ............................................ 13. Will lot be regraded ...... J~'~"ll ._ ,-. _, / ~._~/4. ~..,.~ ~,~Will excess fill be removed.from premises: ( ) Yes (X')~ 3 '3~_3/N°. · 14. Name of Owner of premises I~t~.~...l~.~..~/~.l.~...3....~..~..."TAad'r'e~s-.,D/'~...~..~..t~.,~./..~..~ Phone No. ,!~....~.....~..:..~..~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor F~.?...~...l~J~../~.~......~a.~l~'-~...~.~'., Address ~...O.~.T'..~..~..L.~ ........ Phone No.~..'T.~......~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from cording to deed, and show street names and indicate STATE OF NEM~YO~ ' ' "'~~r;[~,~'~';~'/' ................. being dt~ly sworn, ~el?ses and says that he is the applicam above named. He is the ....................... ...~....~.~.~.1~..~..~' ........ .~...~..~..~.~.J~.iI~ ............................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized ta perform or have performed the said work and to make and file this application; that all statements, contaiqed in this application are trMe to the best of his knowledge and belief; and · thor the work will be performed in the m'anner set'forth'in the albplication filed therewith. Sworn to before/~_ me this <Z~ ~x~/ . ............ .......... . Pub I i~f~.....~...~.~..~ nty _ ¢~ignature of~applicant) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT ~ly t~ eEJ~ ~u}pmnt = ~cdb~ ~ a~ int~u~ by t~ ~l~at M~ on t~ a~ ~plicat~ numar in t~ premises of ~u ec~er, Koke D~., s/s B~view, Sout~old, L.I. in thefollowing l~ation; ~ B~ement ~ 1st FI. ~ 2nd Fl. O~si de S~ctlon st~ ~t w~ examined on ~,love~b ~ ~ ~ 1, 1 ~ 7 ~ and found to be in compliance with the requlrements of this Board. FIXTUKE FIXTURES OUTLETS25 ~T FLUORESCENT DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS AMT, K.W. ~OIL H.P, GAS H.P. A/~T. NO. A, W. G. SERVICE DISCONNECT RANGES SPECIAL REC'FI 1 3O S R EXHAUST FANS COOKING DECKS OVENS I DISH WASHERS ~v~!, ~PS. , · H.P. NO. OF FEET DIMMERS .C A.W.G. NO. OF HI.LEG A.W.O. NO. OF NEUTRALS A.W.G NO O COND, OF CC, COND. OF HI-LEG OF NEUTRAL 2/0 1 1/0 OTHER APPARATUS: # Furnaces: oil, 1-1/Shp, 2-1/12bp ~otor/s: 1-3/~hp ~ ]3ox ~z7 cmJ~L ~.~e - . Southold, L.I. 11971 P,r 11~ ~'"~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF SOUTHOLD 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 topagraphic features. 2. Final approval af 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 praperty lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection o¢ 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 .~..~.....~...~..(..N...~...~.?. ?..!..~.~`.~.?.?.~.~...~...-~...~'j.~/~.~.~.~.~...~..~.~..~....~.~..~..~.~..~.)' ............. Owner Or Owners Of Property g~M~~'~-~I~?~c~ .................................. Subdivision .~,...~.....~..t,~.......J~..S...-['..~..?...~.,,~ ................... Lot No ............. Block No ............. House No ............. Permit No..~...~...~.~..-.~-~ Date Of Permit4..~..Jt..~.~.lr'.~...~..Applicant ..~'..9..~....~..~...r~_....t~.......~:-L~...~...~.~....J...~...~..:,. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .~'.~.N..~!..N...~.. ........................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .....~..'...~.'~.~. .................. ................ day of ............................................ Notary Public .................................... County Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTHH.D. Reference No. L/'~O--~ APPLICATION FOR APPROVAL T~ Ci3NSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~O~ ~4~-~ I~, Phone~. Subdiv. ~"~{~ ~-~T~ Address ~0~$~.~ m~,~. ~T~,~ I~.~. 6. Section 2. Property location~ ~'~,~' a(~- ~1'~ 7. Lot No. ~r ~F ~ ~ ~/~ ~:o~ ~' ~'~ 8. Private well Village__~_~ ?-- Township ~'~,~.~ 9. Public water 3. Public Water Compan_y,name ~%~_ Distance to main 4. Lot size: Width ~ feet Length /q! feet (Enter on center plot below) 10. Sewage Disposal System: / A. 900 gallon septic tank: P~ecast~' ~ivalent__Block B. Leaching pools: Number ~ Precast Block Special If private well fill capacity~Gals. G.P.M.% in blanks below: Tank Pump Total well depth Depth to G.W. Amount of water in well ~' Test Hole Data Peet 0 2 4 6 8 10 12 14 16 18 The undersigned ERTIFIES: "Construction of authorized be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date ,~M~V ~ I ~ ~'~ Signed~ ~"' '' ' ~ .der installations will 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 can be installed on this plot~~ Date 7~~ ~ Signed S-15 Revised 4/]/7g SOt 95' / MAP OF PLOT - %. 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