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Home My WebLink About7174-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outbold, N. Y. Certificete Of Occupancy No. ~6~ ....... Date .............. JB... 6 ...... , 19.~. THIS CERTIFIES that the building located at ... B~$ts~dt. Court &...~e~t Map No....tt~0 ..... Block No ........... Lot No.. '13 ..... 8o~tho~ · · N.,Yo ....... conforms substantially to the Application for Building Permit' heretofore filed in thi~ office dated ............ AI~.i...l~ 19. ~. pursuant to which Building Permit No.. ?.~.~Z. dated .......... A.p~'.~.~..~.~...., 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 . P~.lv&.t* · o~ .fa~ly. d~e~ ...................................... The certificate is issued to . ~holal. Dape~e ........ 0~F ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Depsrtment of Heslth Approval . ;~a~.. 3 .¶97~..by. .E,..Villa ...... UNDERWRITERS CERTIFICATE No.. I~ .$~[.~.. Dee.. 2..1~, ................ HOUSE NUMBER ...... 1200 · - · Street. -Cunte~. Ave ............................ Bre~tst&dt C~ FOBM NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 717 Z Permission is hereby granted to: at premises located atLt~t,..~l.~....~a~l,J~JJ~e~..Jl~ll~ ..................................................................... ........................................ J~$1mt~lt,. ~l~..& ..Caete~.. ~ve ......... Ge~thet& ............................ pursuant to application dated ........................A~F~L3, ....... ~,~ ....... , 19~t .... end approved by the Building Inspector. Fee $&~ll...~ ........... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS q~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi ~n~ ~ Inspector, with 3 sets 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 public streetsr~or ~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. ~ ~ d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such perm~ ,-~ 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 ;~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or---./ Regulations, for the construction of buildings, 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 in buildings for necessary inspections. ~...4~Lot,~' AVe EXT. ~ o h aL (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... / Name of owner of premises ~/...C,~.../..~,,,.~.../-3 .5. ~..~ p..~ f C . If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... lumbers L~cense No ........................................ 1 ..7-E Electrician's L cense No .......................................... Other Trade's License No ............................................... 1. Location of ~and on which p~posed work wi, be done. Mop No.: .~.7....7..¢.. ........................ Lot No. .... ............I ~ ........ ~..~EI?..~.?...~.~..T Cou Fi1- .~.. Cu S~-~ AVe° 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 ................................... b. Intended use and occuponcy .~....~.. ( ~Z4j .,,~...1~. ~.C ~. I ~. ~' ~ .~. S 3. Natur~of~'~r-~ (check which applicable): New Builfling :,.;/~ .......... Addition .................. Alteration ..... Repair .................. Removal .................. Demolitiom..: ................ Other Work ...................................................... / ~ ~ ~ (D~cription) aa O / 4. Estimated Cost .......... ,....~. ..................................... L....Fee-..~ ................................................................................... (to be p~id on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of ~rs ~ ~ ................................................................................................. 6. If business, commercial or mixed occupancy, specify nature ~nd extent of each ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Nu~er o~ Stories ................................................................................................................. Dimensions of some structure with ~lteretions or additions: Front .................................... Rear ............................ Depth ................................ Height ........................... ;Number of Stories ................................ 8. Dimensions o~ entire new construction: Front ...5~ .......................... Rear ..~.-~ ................... D~th ..,.2.~.~f~ ...... Height ...L~.~ .......... Number of Stories O~[......~.,~.~.~ ................................................. 9. Size of lot: Front ................. ~.~.~ ............................ Rear ...... .~..~5 .......................... Depth ...L~..~ ..................... ]0. Dots of Purchase ...E.~..~L.../.~.~.~ ......................... Name of Former ~ner .......... ~ ........... ~.~.{.~ .............. 1 ]. Zone or use district in which premises ere situated ..................................................................................................... 12. Does proposed construction violets Qny zoning I~w, ordinance or regulation: ........................................................ 13. Will lot be regmded . ........................... Will excess fill be remov~ from premis~: ( ) Y~ ( ) No Nome of Architect ......................................... v ................... A~re~ ................................ Pho~ No ....................... .............. P o,, No. PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sotek dimensions from prope~ lines. Give street and block number or description according to de~, and show street names and indicate w~etHer interior or corner lot. \/ STATE OF NEW YORK, - ~'~' ~ ¢ c ......................... ~.~.~..~.~ ....... ~.~.~;~[:~. ................. being duly sworn, d~oses and says ,~, he is the applicant (Name of individual signi g ab°ve named~ 0 ~ & 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 ~ke and file this application; that all statements contained in this application are true to t~e best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the applicat~n ~led therewit~ Swam to before me this ~ , · t~ignature at app~ cant) ~DI~ T. BOKEN No. 52-0344963 Suffolk Count~( Commission ~pires March 80, 1~ THE NEW YORK BOARD OF FIRE UNDERWRITERS at; BUREAU OF ELECTRICITY ~--- December 2 i, lq7~8S JOHN STREET, NEW YORK. NEW YORK ~tOo38 ' THIS CE~IFIES THAT in t~ fol~ing ~at~n; ~ ~e~nt ~ lst FI. ~ 2nd FI. O~S i ~e ~tion Bl~k RXTU~E RXTU~S ~ ~1~ ~$ ~ O~N$ DI~W~H~S ~HAUST FANS I 1 200 CB x 1 ~/0 1 2/0 ~-~on ac uni~ ~o~ors: 1-1bp *~'urnaces: 1-1/~hp ,1-1/12bp Pe~e~ Bogovlc Main Rd. 5ou~hold,L. ~. 11971 COPY THIS COPY OF IN ANY MANNER. ' - - - FEE: BY 2, BEFORE COVERING PIP~LINE 3. FINAL WHEN JOB COMFLETED NOTIFY BUILDING DEPA .'rMENT 765-2660 9AM TO 4PM F~.', REQuilt. ED INSPECTIONS: , 1. BEFORE BACKFILLING FCUNDA. TION OR START FRAMING SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~Phone~5. Subdiv. Address 0 '' · u £ - , 6. Section 2. Property ~ocation ' ' ~T~ Coy ¢~J 7. Lot Number ~ ,~.~.,-T/"~I?~JF~L..d~ .,4~1¢ /'l~P~e~l~. ~o 8. Private Well ~.,',~$ V~llage o Township ~ 9. Public Water 3. Public Water Company-Name ¢ Distance to mein /.~l LC Width IO~.~afeet 4. Lot size: ' Length~O~.~feet 10. Sewa~isposal System: A. ~/Q~gallon septic tank: Precast~( Equivalent Block__ B. Leaching pools: Number of pools Precas~_~__Block Special ll. If private well, fill in the following blanks: A. Tank capacity JD~ gallons B. Pump G.P.M. C. Total well depth ~ D. Depth to ground water E, Amount of water in well (For Health Dept. Use) 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. Date ~'~/0-/~'7~ Signed~ ~ ...... Imgllliimim)glmmlMmlmii ..... Iii ...... Imlllm~ .... lm~l ....... mlliil ..... Illimimmim)iliI FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Depar~ent that an adequate and satisfacto~ Sewage Disposal System and Water Supply can be installed on this pl. ot. S-15 Rev. 4/1/73 k, k S~JFFOLK COUNTy HEALTH DEP~RT~,'ENT L~'E .-m~ 3 1975