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Home My WebLink About7162-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property ..... l~'~/~ .W.e.~..~.~..R. 9.~.~' PeoOrlio, N.Y. House No. ' .... Street Ham/et County Tax Map No. 1000 Section .. ~.. ....... Block .... .~. ......... Lot .... . .0~.~. ......... dM Subdivision ............................... File ap No ......... Lot No .............. conforms substantially t° the Application for Building Permit heretofore f'ded in this office dated .... Apl'il, .8... ...... ,19~./~. pursuant to which Building Permit No.....~.6..~. ............. dated ../..AIYPJ,1.8 ............... 19 ."~ .~', was issued, and conforms to all of the requhements of the applicable provisions of the law. The occupancy for whiCh.this certif'mate is iSsued'is ......... ~iva~e ~ae ~)amil~, ~elll.~ of the aforasaid building. suttol~ Co~nt~, Dev~t o~ Heath ^~ro,~ ..... .e/.;.e .~.~...~.=..sq.=?~...~:..~.:. y~.t..~.. U),~RWRrrERS.CERVIFIC^~ SO ............. . .~..0.S~. ............................ IUILDING DIPAITMINT ~,~ f" ~'.~.~ ~FC- i~e~ ~ ~ ~, N. Y.~ ~amin~ ~.~....~ 19.~ AP~ICATIffi ............ ; ........... ~ ................ , ~9.Z~..... ~ ~NS~ONS ~. lhl~ a~lic~tion must ~ compl~t~l~ fill~ In~tor~ with 3 ~ o{ p!~m, c~ ~e work cover~ by this a~lication ~y n~ d. U~ a~mval of ~is applicati~, the Buildi~ In--tar will issue a Building Permit to the applicant. Such permit shall ~ k~t ~ the premis~ ~ail~le for in~ti~ ~t ~ ~rk. e. No building shall ~ ~cupi~ or u~ in whole or in pa rt for any pu~e whatever until a Ce~ifJca~ of ~cu~y shall have ~en gmnt~ ~ the Building Insp~or. .PLI~ATI~N .~S HERE~Y.~DE to the Buildi~ ~a~ment for ~e issua~e of a Building Pe~it pumuant~to u~za~n~ :on~ ~mance at ?e ~n of ~ld, ~ffolk Count, New York, and ~er applicable ~l~l~s, tar t~e co~truct[on of buildi~s, ~ti~ or al~emtions, or for m~l or ~moliti~, as heroin d~r~.'~ ~ppu.~an[ ~rees t~ comply with.all a~lifable I~ o~, bui!di~ C~, h~s[~ m,t auth~ri~ in~to~ ~ premises and m buil~S ~r~ ~e~ in~io~. ........................ , ...... ...... .......... Store.whether opplico~ i~ ~n~r, le~, ~nt, ~hit~c~, ~n~ine*r, ~eneml contmC~r, electric ~n, plumber or~uilder. Name of owner of~ / Jf ...... ~ ........... ~;"~"~i~¥'~F~¥;;~;'~;~';;'~ ......... ..,,.er. ........ Plum~r's Licen~ No .... ~.~ ........~ .............. · El~trician's License No ...... ~...~.~~~ Other Trade's License No ............................................... Location of land on which proposed.work will be done. Map No.: .: ...................................... Lot No ......................... Street and Number ........... ..~.....~.../../........~...o~...~.........~..?...~...!:..G..~......~..?....~/...~...~.....~ .... ..'~...~...~..?..~...~,~ .............. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed constructiOn: a. Exisiting use and occupancy / b. Intended use and occupancy ................................................................... ... ,... .~'. 3. Nature of work (check which applicable): New Building '~' Addition .................. Alteration Repair .................. Removal .................Demolition .................... Other Work .................................................... ,~ - O ' ' '~ ~ c) (Description) " 4. Estimated Cost ........................................................... Fee .,,.~.i...': ............................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...O....~....~.. ............... Number of dwelling units on each floor ............................ If garage, number of cars 7~'~'~° 6. If business, commercial or mixed occupancy, specify nature and extent of each b/pe 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 ..~..~..~ ............................. Rear ...('...~.~ .................... Depth ...... ..~....~..i .......... Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ... 10. Date of Purchas~ ...... ~?~.:.../....'~x.../..?....7....~. ............. Name of Former Owner ..../~...~-..~'J~ ~-.~....~...'~......~...~.../..~...~g.~.. 11. Zone or use district in which premises are situated ......-~....~.~.~..~...~..~...~...~...~.....~. ................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..../~....o. ............................................... 13. Will lot be regraded ....~. ..................... Wilt excess fill be removed from premises: (X) Yes ( ) No remses..~../ ..~ ..~., q.~. 14. Name of Owner of p .. ..~. ............... ..~....~....,.....~.. Address ..................................... '~o. ....~.~.?~ ............ ~.. Name of Architect .. .'.. )...m~..'-..~.-~i.~...~.9./.~...'~.....~....~....6~...... Address .............................. Phone No....'~...7..%.Z..~ Name of Contractor ~'~ ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propo~d, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot... ! 94.o COUNTY 0~~,~,,~. ~°'''~ .................................. ~ ................................................... ~ ...... :t,,heing ~1~ ~t~rn, de~ose, s ~nd sa~ ~W~ he i~ ~he ~pplic~nl (Name of individual ~ni'ng contrac~ above name. He is the ................................................................................................................................................................................. (Contractor, agent, corporo~ pfficer, etc.) of said owner or owners, and is duly authorized to perform or ha~e performed the said work and to ~ke and file this application; that all statemen~ cantoned in,t~s ap~l~m ~ ~ the best of his knowledge and belief; and that the wo~k will be performed in tSe manner ~t' fo~h in the applica~n filed therewith. Sworn to~me ............ ...... ................ .................. ' ............... ....... ' ................... JUDITH T. BOKEN ~ Public, Stale of New York No. 52-0344963 Suffolk Coun~ Commi~ion ~pJms ~o~h 30, FOBM NO. ~ TO~N 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) 7162 Z Date ....................... ~F.J~ .......$ ........... , I~Ri. .... Permission is hereby granted to: Ralph..~e~Ltt ................................................... ..~!.....A~..Ate .......................................... .... lio..~l;Le~ ......... Mo~Zo ................................ to ~...~...~ ...~, .a...~),;b~. ,~ ...................................................................................... at premises located at .~-/$....~.~.e..]~a& ...................................................................................... ......................................................... Pwemmtw ........ .N.,.~., .................................................................... pursuant to application dated ............................ ~..lll .......... , 19~. .... and approved by the Building Inspector. Fee t.~ 3 *.~. ............ Building Inspector / FOl~I 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, end 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 oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposel--(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, o 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 os to use, occupancy and condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o 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 $].00 New Building ....~.. ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....~'..?.~.~..'. ............. .~.../../.~ ........ .~....., ......... .c...o..~.!.c~........~....7..~...2.. ............... .~..:.~. ............. Owner Or Owners Of Property ..~.~....~./.~....~......~..:...[...yJ.o...~..?...../~...:...?....o..~...d..:'.~.~ --- --- .............................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. 7/~ :~ Z D t f Perm, .~'./...~./..7---- I n ~ / j~ ~ ~ ~ .................... ,ar~ O 't ............~.....App ica t ....... :.......~.. ................................................ 3 /v Health Dept. Approval ..a.. ................................... .~-~or Dept. Approvo~ ................................................ Underwr.ers Approval ......... ............P ann ng Bo rd Approval ............. ............... Request For Temporary Certificate ........... ~..,. ................. ........ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building a~d pe,~rmi~),~ets (eft) app(l~bJe code~ ,~gulations. App,cont ......... , ........ ............ ~..~ day of~.~.....~.~J.[. ..................... (stamp or seato~1 ~ ~ Nota~ P nty FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date New Building ............. Old or Pre-existing Building Vacant Land ............. Location of Property ~'74~-~--/'~///~ ~)~' O~;~,~ ..~.~.~,.. .............. ,ou,,~o. J srr,, dii- Owner or Owners of Property .... .~..~'..~;.. ~. ................. .~..~. .......................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No...~ ........ Lot No .... , .......... Permit No. 7./..~..2-...~.. Date of Permit 4/~./~.¢'7~.Applican,...~..~/~..~..~...~:~..~-..~.'..~.. ........ Health Dept. Approval .~./.~/Z ~ Jil~a-. .......... ~'..~.O..-./.~..E....Labor Dept. Approval ........................ Underwriters Approval ~ .~..°.1..Z. ?,~...,~. ......... Planning Board Approval ...................... Request for Temporary Certificate..~..~. '../.~../.~.?.4/. ..... Final Certificate...~. ................... Fee Submitted $ ............................. Construction on above described building and I~it meets all applicable codes and regulations. Applicant..Z~-~ .~..~-~. ~ ....... /,~l ......... SUFFOLK COUNTY DEPARTMENT OF HEALTHReference Health Department Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Village Peso m,'~ Township,~+k ~I~I 3. Public Water Company Name ~o~ 4. Lot size: Width /~& feet Length !q~ feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to n~in 10. Sewage Disposal System: (For Health Dept. Use) A. 900-gallon septic tank: Precast~*~ Equivalent Block B. Leaching pools: Number of pools Precast~' Block __~pecial 11. If private well, fill in the following blanks: A. Tank capacity, ~ gallons B. ,'-~ump G.P.M. C. ~otal well depth D. ~D~epth to ground water ~'~ E. Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the ~folk County Department of Health's current standards thereto. This application will be v~id for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in eff}~t. Date ~¢~~ ~'~1~?~ Signed ~ ~ ' ~--~ ~ 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 ~e installed on this pl~ot. /I -'-,4 s ' ' ' Rev. 4/1/73 THE NEW YORK BOARD OF FIRE 'UNDERWRITERS R.}~' BUREAU OF ELECTRICITY [~ 8~ JOHN STREET NEW YORK NEW YC)RI~ THIS CE~IFIES THAT ~ly the e~t~ ~uipment ~ ~db~ ~ a~ int~u~ by t~ ~t ~ on t~ ~ ~pl~at~ numar in the p~m~es of in the following location; [] Basement ~ 1st Fl. ~.~a~i.~ao. October' 2~, 197~ FIXTURE ~ RXTURES OUTLETS ECEPTACLES SWITCHES INCANDESCE~T FLUORESCENT 23,153 ~6 23 S~RV1CE DISCOHHEGT NO. OF S I ~0 ~}'~ METER A,~T. AMp. .PE EQUIP, I~W I.~3w 3~'3w 3.~4w NO. OF CCGOND. A~W~G, NO, OP Hb~EG ~*a~uve ~ppl/anee feede~/~z 2-3f6, 2-3f10 ~le¢..oom heater's: [] 2nd FI. outslde Section Block and found to be in compliance with the requirements of this Board. AMT. K.W.:' TIMECLocKS/ B~LL - uNiT HEATERS MULTI. OUTLET E R V I. C E A. W.G. NO. OF NEUTRALS OF HI-LEG Lot EXHAUST FANS 1 F DIMMERS OF NEUTRAL 3/0 1-1.0kw, 1-.?Skw , COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~k BuREAu OF' ELECTRICITY i_8_5~.JOHN S'I'R~ET, NEW YORK, NEW YORK 10038 THIS CE~IRE5 THAT N 2 5 ~exami~don Dece~e~ ~9 ~7~ a~f~tobeln~m~ththe~ut~n~ofth~ ~ FAI~ 1 600 2/0 Thomas R. Bedell, 10 Venetian Blvd., Linderhurst, L.I. 11757 This certificate must not be alt~'ed in any ~j re~rn to the their credentials 194-.o J2.ALPt-4 MIp oF C. ~; JOAN ~T Llldb * M. CONDIT ~F=iCOM Id OF' ~OUT.14OLI)., I,.1.',{. e= ~ou I1 AU~ ~ 6 '1974 DATE The sewage disposal and woter supply facilities for this location have been inspected by thim departmen% and found to be satlsfac~~ ~. ~ ' Chief ~f'General Engineering APP~)VED AS NOTED NOTfF¥ BUILDING DBPAP,~M~NT I-