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Home My WebLink About7420-zNO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .$~me$. ¥.&2 ............... Street Map No.~.d$~. ~h. ~ock No ........... Lot No.. ~16~ .... ~..ma.$h.o.14 .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. J.~l~...¶0, 19 .~.. pursuant to which Building Permit No....~ dated ...........l.~...¶?.., 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 . I~A'~.V~e..O~e. f~ll2..4~ll~g ...................................... The certificate is issued to ...~. ~ ...... .O~'. ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ]~.e,. ~...~.~.~....b.~...~.o..V..~..l~a.. .... UNDERWRITERS CERTIFICATE No.. ~ $~.~ ..... ~l~.t..¶ ~...~ ................ HOUSE NUMBER ..... ~0 ...... Street..~t. ~a~" ............................ Bmldmg Inspector · 0~w NO. ~ TOWN OF SOUTHOLD BUILDIN~ DEPARTM~r 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? 7420 Z Date ...................... ~ ......... ~J~ ......... , 19.J~,.. Permission is hereby granted to: ........... ~ ....... ]1.~, ................................ pursuant to application dated ............................ ~ ....... JJJ....., 19..~1~., and approved by the Building Inspector. FO~ NO. 6 TOWN OF SO~THOLD Building Department Town Clerks Office Southold, H. 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 ....... ./....~.....'T.~....7.~...'~.. ............. New Building .( ............ Old or _Pre-existing Building .... Vacant Land Owner Or Owners Of Property .......... .'...~....,~.....o...~.......~.......~../.~ ........................................................... su ,v,s,o. Pe tm it N o. ~...~...'~....O.. ~Date Of Permit .~...~'../'. ,~..'b' .' .~...~Applica nt ~..;~,.~....~ .,~....~..~.. ,,~.',~..' H~alth Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ................................... ~.Plonning Board Approval ........ ~ .................... Request For Temporary Certificate ........................................ Final Certificate ...... ~..' .......................... Fee Submitted $ ..'~'.. .............................. Construction on above described building and permit meets ali applicable codes and regulations. App,icant ~~ .... ........ ..~..... day of.--~ /.~ ~'"~"'cr~'"'"'"{"~'"'~ .......... (stamp or Notary Public .... .~/-~ ..... County // SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference !Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER~! SUPPLY 1. Applicant ~/m. Phone~/6~-~;z~Z~ 5. Subdiv. ~ddress ~z,'~.~f~ ~.~.~..~,.~ ~j~4',,/'..~//~.x/?~7/ 6. Section 2. roperty Location ~.~ ~~'/~,./~_ 7. Lot Number ~-;,~,,~ ~ ~. . 8. Private Well Village ~S~/~¢' Township~/~7'~ 9. Public Water Public Water Compa~y/~.Name Distance to main 3. Lot size: Width~feet ~/~.~v~-- , / 4. Length/~ feet / 10. Sewage Disposal System: (For Health Services Dept. Use) A. 900-gallon septic tank: Precast ~/'Equivalent Block B. Leaching pools: Number of pools Precast ~'/Block Special__ 11. If private well, fill in the fol- lowing blanks: A. Tank capacity ~z/'~-TM gallons B. Pump G.P.M. ~ C. Total well depth ~C) D. Depth to ground water E. Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be/~n accordance with the Suffolk County Department of Health Services' current standards thereto." T~/is application will be valid for one year from the date of approval indicated/below and/fnay be renewed if a current local Building Department Permi. jJ~is in effect. Date ~ Signed FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the ihformation 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 c~-~,' s~lled ~thii~~ S-15 Rev. 4/1/73 TOWN CLERK'S OFFICE ///?¥ ci~,.,,. ¢' 0~¢ '"~ SOUTHH~O~,,~D,. /_..~''' /-~ . examined ...~..~....~. ....... i...I....., 19..J.../ _.Application No...f...~,....~... . / / ., / , ~ '")~/ "7/--/D-O '7 ~- ,¢,~/,,~/~ ,'¢proved .~ ........ ::....~ ........ :.../......, ~..f../.. Pe,'m, No./.....:. ........... ~""' 7'4',,/~,. ,,,~-,",V ~,, "/,..;'~,'"% ... pp,oved o,c ............................. .......................... .5 I' . ............ ............ d. / This _ .a~ol?ation .rn.ust be completely ill!ed in by typewriter oe in ink and submitted in triplicate to the Building inspector, with 3 sete of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pub c streets o~ areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced befo, re issuance of Building Permit. d. Upon approval of this application, the Building Inspector'will issue a Building Permit to the applicant. Such permit~ shall be kept on 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 have been granted by the Building Inspector. _~ APPLICATION IS HEREBY MADE ,to, the Building Department for the issuance of a Building Permit pursuant to the B~uild!n.g. Zon,e Ordinance of...~e~Fl~m,p.f. ~Southol.d, Suffolk County, New York, and other applicab · Laws, Ordinances or t~egu~armns, Tar the construction of buila,ngs, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. d ~ . " (S'g a re of applicant, or name, if a corporation) ......... ......... t~',aaress or opplicontJI ! ? 7 / State whether applicant is owner, Ieee, ~ent, a~hitect, engineer, general c~tractor, el~trician, plu~r or builder. ................................................................. ~ ................................................................................ L{~ ...................... Z ................ ~ ~-- __ ~. o, ~.~ o, ~re.,,es ....... ~.~~....~ .............................................................. ff app~cao~ ~ o =o~o~te, s~ure ~ du~y outhoriz~ o~ce~. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will b.e,dg~ne. Map No.: ..... ~,~=...~;f'~., ............. Let No../~ Street and Numar.......... ~a~..~~ ...............~~/~... ~un~=i~ii~ ........ 2. State existing use and ~cu~ncy of pm~ intended use and ~cu~ncy of prod c~tmction: o. ~isiting u~ o~ ~cu~n~ ......... ~~ .................................................. ~....~ .............. ~ ................. 3. Nat'~lloofwork(checkwhichapplicable):NewB~ilding'- .... ..~......... Ax~dJtion .................. Alteration .................. ~;,,~11~. Repa r .............. Rerrjoval .................. Demolition ............... :.... Other Work .................................................... ~r:~,e~ /__/~,. ~ (Descr pt on) " 4. Estimated Co~t ..~.~...~.~..~..'..~.~...~L![~: ...... '...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, spe~ci,~, in~,~e,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 ..... v.~....~;;>. ................. Rear ...~... ................ Depth .-~....(,,/ ............. .......---'/.../.......' Numbe, r_,of~_Stories .......... ./.. ............................. ~ ............................................ ~..:.v...../.. ............. Height 9. Size of lot: Front ............ ~..~.' .................................. : Rear ..../...~...~. .......................... Depth ..~./..~ff..~. 10. Date of Purchase ................. ~ ...................................... Name of Forrn~ Qwner .............................. /. ........................ 11. Zone or use district in which premises are situated ........ .~.~4/...~..0/~...: ............. ,v'"/' ........................................ 12. Does proposed construct~onyolate any zoning law, ordinance or regulation: ..... ../.~...0..~ 77 13. V~ill lot be regraded' ...../Y:~2;:~....~......,~ill,,~,, r--~*-x'a'T~ jexcess fill be removed__~a/~.,~ /.~ ~/'fr°J:I~a;~, ) Yes .(/,~ No 14. Name of Owner of premises ...... e...Y....~<.,z.~.v.. ............... Addre.~.~./.,rm~...,.~z...:....~./../...------ Phorm No ....................... Name of Architect ...................................... v ..................... Address ........................ :.... Phone No ....................... Name of Contractor ~. /~......~.....'~..~..~.~ Address ~/"~t~.~2~ ~ho~ No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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/~F~ YORK, COL~TY ~:_ ..::.... ~~ .................. ..... '.~.~~ ................ being duly sworn, deposes and says that he is the applicant· /'/ (Name of indivic~al ~ianing~'contracf) (Contractor, agent, corporate officer, etc.) / ] of said owner or owners, and is duly authorized to perform or have performed the said/work and t9~ make and file this application; that all statements contained in this application are true to the best 91this knowledge and belief; and that the work will be performed in the manner set forth in the appl~on filed therewith. Swam to before dayme thiSof ~ ,19 (////~/~'~//~/-~/~/~X Nato. ................. .............. Co n?,/ ................... , .............. · /':-7 '// THENEW YORKBOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICiTy --- &W 85 JOHN STREET. NEW YORK, NEW YORK 10038 · D.te September 19,197LI appl~.tion/~o, on'~lh51" ' ' N 183366 THIS CERTIFIES THAT only the electrical equipment as d~scribed below and introduced by the applicant named on the abo~e application number in tbe premises of Lawrence Simon,w/sSun,~et Way,5OO's/o e/end of Cedar Beach Rd.,Southol L.I. inthefollmvinglocation; E~ S.~e~.ent ~ ~,trl. [] ~nd Fl. outside s~tio. 8~o~k Lot was examined on Sept emb er 16,19 7 ~ and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DiSH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 14 20 DRYERS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF F~ST OTHER APPARATUS: !',.otors: 1-1/2bp ~lec. Room Heaters:l-.75kw E R V C NO. OF CC. COND. A.W.G. A, W, O. NO, OF NEUTRALS A.W. G~ P~R ,ff OF CC, COf4D. Of= HI.LEG OF NEUTRAL ! 3/0 1 1/0 W.B.Ruland Mattituck,L.I. Peg- 11 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. t 1 r_./ NOTIFY BUILDING DEPARTMENT A F 7&$.266~ ~AM TO ~PM FO~ KEQUIK- B~ INSPECTIONS: 'i ~OKE BACKFILLING FOUNDA- TiON OR S~ART FRA~,ING