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Home My WebLink About7175-zTO~N OF SOUTHOLD BU~.BINC, DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ¥/~ .~l,.l~l..s...!~...: ...... Street conforms substantially to the Application for Building Permit.heretofore\~:l ia this office dated .........Al~ll ....8.., 19.~. pursuant to which Building Permit No...717~ dated ..........ApX'~J,..15.., 19.~.., was issued, and conforms to all of the require. ments of the applicable provisions-bi the law. The occupancy for which this certificate is (owner, lessee or tenant) of the aforesaid building. HOUSE NUMBER .... 1 l.h% ..... Street ..... Sl~.v.~., .I4~e.. ...................... FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT fl'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7175 Z Date ADril 12 19.~...~.... Permission is hereby granted to: .;~ ~a~.~..L~e.L ..Z.~.c ......................................... ..... .~..~.~A.~.~ .................................................... at premises located at Lot ~ eliJ~ Asses Est I ............................. M/~..E2L~ah..~..Laaa ............. ~f~ttituek ..................................................... pursuant to application dated ......................... ~,P~.~.....~ ........... , 1~......., and approved by the Building Inspector. ]110~1 ~SI~I. p:~.~l~ & ~e~ll~. res te f~l. ah eeeml~ f~oo~* Building Inspector e. This application must be ~mple~ely filled in by W~writer or in ink and submi~ in tripli~e to t~ Bui~ I~r, ~ 3 ~ts of ~, ~ plot ~an to scale. F~ ~di~ to sch~ule. =~ ' ~ b. Pl~ ~ ~W~g I~i~ qf ~j~* p~-~ldi~;~ P~m ~s,. r~t~ ~,~i¢ ~i~s or ~ ~ ~ m, ~ givi~ a ~il~ de~ription of layout of ~o~ must ~ drawn on ~ram ~' is' ~ of ~J~ a~i~tion. *'~*~= ~ c. ~ ~ ~ ~ this a~li~tion may not ~ ~m~n~ ~fore i,u~m of Buildi~ Permit. ~ d. U~n ~oval of this a~li~tion,.the Building In~or will issue a Building ~rmit to t~ a~li~nt. ~ ~rmit,~MI ~ ke~ ~ the pmmi~ available for ins~tion throu~out the work. e. No ~i~i~ s~ll ~ o~upi~ or u~ in w~le or in ~ for any pur~, whatever until a ~ifi~m of ~ ~.11 h~ ~n ~ ~ t~ ~ilding Im~or. ~ APPLICATION IS HEREBY MADE 'to th~.(~li~i~ding D~ipl~trMnt.for tl~ iwlmn~l'e'~ Buildin~ ~rmit pu~t m ~ ~lldi~ Zo~ Or~i~an~ of ~ of ~uthol~o~, New Y~, a~ ~*~'- . ' ~ - '; for t~ ~r~ion of bu?~i~,~i~i~s or ,l~rati~ns, o~ for rem~.~moliti~, ~6.~i~d.. ~ ,~i~t n~ to ~m~y wt~ .11 ~lJ~le I~ om~, ~.a.ng c~, housing co~, end regulatsofls, and t9 ~st a~t~or~zed ~ns~o. on ~im a~ in ~ildi~ f~ ~ in--ions. (Signature of applicant, or name, if a corporation) , i ~' ~ ~. -4 (Ad,ess of applicant) State ~er applicant is o~r, le~,'~nt, amhit~t, engin~r, ~ral con~tor, ~ician, plum~r or builder. ~sme o~'~wner of ~remi~ ~.~8,..~, ...................................... If ~lic~~~ure of duly authorized officer. .............. .... ........................... {~m~nd titl~ ~or~ram o~icer} Builder's License No ....................................................... ~.. Plumber's License No ....... ,,q;I,.~...-.~.'....;-....J..~....~...~.~i; ......... ~..~.."*' Electrician's License No...3~,~.-.~, ...................................... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ......'~ ................. Street and Number ....~l~St..~:[~a..o.l~..~_~h__!.S..~e...~&l;$;J.~;lil~..~L,3[, .......... ~ ................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy o,f proposed construction: a. Existing use and occupancy ..... ~I~P,~ ..................................................................................................................... b. Intended use and oc~.upancy ............. ~ ......................................................................................................... 3. Nature of work (check which applicable): New Building ......~... ............ Addition ..................... Alteration ............... Repair .......... Removal... ............. .... ... .. Demolition ........................ Other Work .................................... ............... (Description) Estimated Cost ....~.....3~...,,...O~...R..O~.~ .................. Fee ............ il;;'l~'~li;~'i~i;';'l~ii;atio;~i .......................... 4. 5. If dwelling, number of dwelling units ;;.~.'.-~1, ........ Number of dwelling units on each floor ......................................... cars .............. ~ ...... If garage, number of I .............................................. ; .............................................. ~ f 6. If business, commercial or mixed occuoanc~, specify nature~nd extent of eech type o use ...................... :...; .......... 7. D mens ons of existing structures, if any: Front .....~.~.~...e.~.u-- ...... Rear ........................... . Depth .......................... ~o~,ht ..... - ......... Number of Storms ............................. v ........... , ............... ~ .................. ~- .~ ....~ ~m~ {t,H~t,r~ w~th alterat one or-add tons ~ont ............. Rear ................................. ,.~. no~th .................... He ght ....................................... Number of Stones ........................................ 8. Dimensions of entire new construction: Front ........ ..~..8..? .......... Rear' ...~{~ .................. Depth"~-~-.. Number of Stories ....~.....~.~ ........................ · .......... ; ............................ ~. ...... Height ............ 9. Size of lot: Front .................................................................................... 150~00 ~ n=~, 1-50e00~ Depth ............ 36:7~52~; .......................... ;.~ ........ '~' 10. Date of Purchase .. · [.~..7..~. Name of Former Owner 11. Zone or use d str ct in which premises are situated ............................................................................... , ..................... 12. Does proposed constructiofi ~i~l~ife any zoning law. ordimal'~'~r regulation: ..:;!.I~.~. ....... ; ......................................... 13. Will lot be regraded ---.~:~& .............. Will excess f be removed from prem. ises: [ ]~,~ ~,-~.:-~a_Y'e;s. ~[ 3{ No . 14. Name of Owner of premises ~1~L~-~;~g~*T~-~-~`~R~r~-]~-~*"~P~h-~~'~ (Address} ' . ~,~qr~ . ~ . Name of Contractor ...;~R.l.s~w....~.q~fl-.~.,...,TAl~.e.~..~:~X..;l'~.. ,a;~...~'l~'~a"A~'~'a'""~'~§' ...... ~ {~.ddress) .._ {Phone PLOT DIAG~AM Locate clearly and diet ncr y all buildings, whether ex~st~ng or proposed, and ~nd~cate all ~imenst?j~ rom and block number or description according to d~.~ a~d show street n~ n nrtv..ro..e. ;, lines. Give street , . .,:,:~/_,~ ~ , . . er inter,or or corner lot. ' ' ~1'~/I*'//4/4~ - ' ' ,. /. ~11 ~ }~,O,~ ,~, /' ~l i~q;~ . 1 STATE OF NEW YORK, ) SS COUNTY OF ...................................................... ) being duly sworn, deposes and says that he is the applicant above named. ~- (Nartw ~)f individual signin ~ontract) ..... , · - 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 make and file thi~ application; that all statements contained in this application are true to the best of his knowledge and bel!ef; and that the work will be performed in the manner set forth in the application filed therewith. ...................................... dayo, .................................................. ............. Notary Public.. .................................................................... CounW ........ ~..'"- ........... ~ ............................ (Signature of applicant]~/ 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 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 ...... .A...q ~ .s...¢... ~..5.. ~....]:.~..7. ~, ...... New Building ......X. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~.~...~.9..~....~...~.~`~.~J.~..~.~...~.~.fi.9.~:~.~'.1;~`Q~.~F~.`~ ..................................... Owner Or Owners Of Property ....... .Z..n..[.~...~..d.....H.,o.,.~..e,~.....Z..~.c.... ..................................................................... Subdivision Elij~ ' s Estates Lot No 4~ Block No. House No....]:.]:..~.5. Permit No..7..~.7...D....~. ..... Date Of Permit .~./.~..~...~..7...~....Applicant ~.~%..~l[1.ql....][:[.O.~.~,R,~...%Rf;., ....................... Health Dept. Approval ....... .8../.%~/.7...~...J.~Q~..~2...Labor Dept. Approval ................................................ Underwriters Approval 7..../..~...5../.7..z.~..~.]:.7...~.7...~..C.) ........... Planning Board Approval ........................................ Request For Temporary Certificate ..... ~.o. .............................. Final Certificate .....)f.~.s. .............................. Fee Submitted $ .....5..:..0...0. ...................... Construction on above described building ~permit~lrs~all~ap~ble cod/~_and regulations. Applicant ........................... ..~'. ........................... Sworn to before me this .......... f..~. day of ................... :..~..?...~.~ ..... (stamp or seal) ~7,b/O 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 'rr,,'~m.,~ ~v,,~.,n,oo.. Yn~., Phone~9(~.~ Address 110S2 Township 3. Public Water Company Name 4. Lot size: Width ~I)0 feet Length ~? feet 10. Sewage Disposal System: A. ~'~-gallon septic tank: Precast :)OiEquivalent Block B. Leaching pools: Number of pools ~ Pr~cast'~Block Special If~rivate well, fill in the foX_Ii, wing blanks: A.~T~ank capacity ~ gallons B. :Pump G.P.M. C._~.Total well depth D. Depth to ground water E. Amount of water in well 5. Subdiv.~ 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main (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 ApI~ 4e 1~4 Signed ~ iI~mi~p ::~1~./~.~., ~ffill~ll'z :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 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 be installed on this p$ot. APPROVAL DATE SIGNED ~ -.._ S-15 Rev. 4/1/73 THE NEW YORK BOARD OF FIRE UNDERWRITERS [~ .5.%< BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 °~teau~Y ~S, 19'[~, Appi,.t,ouNo. o./,e 721~. N 172740 THIS CE~IFIES THAT only the e~t~al equipment ~ ~scd~ ~ a~ int~ by t~ ~i~nt M~ on t~ ab~ ~pl~ation number in t~ prem~es of Inland }!omes, EllJahs Le.., 1 e~' e/O ~.R track~ ',~att~tudk~ L.!. Job~l~ inthefoRo.inglocation; 9 B.e.ent ¢ lstFI. ~ 2~ FL outsfde s~t,o, at.~ ~t ~ e,.min~ o, July 1 ] ~). 19 7 ~ ondfo~ to be ~n compliance with the requirements of this Board. FIXTURE "XTU"~S RANGES C~KIN~DKKS OVENS DISHWASHERS EXHAUST FANS OUT.TS SWITCHES FLU~ESCENT DRYERS SYSTEMS NO* OF FEET OTHER APPARATUS= E R V I C NO. OF CC. COND. A,W.G. NO.OF HI-LEG .A.W.G NO. OF NEUTRALS A.W.G PER ~' OF CC. CC)ND. ~OF HI-LEG OF NEUTRAL Future Appliance Feeders: 2-3#~, 2-2#12, ]-2~1~ George Zimblinghaus ~ Park Place Patchogue, L.I. 11772 G~N~RAL MANAGER Per 11 " COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. '5 REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG PMO~'EJBSlONAL IENOINEIgR AND LAND ~URVEYOR LAND ~URVEYOR, N.Y,~, LI~, SURVEY FOR: TOW" OF ~he sewage disposal and ~a*er ~o be satisfactor~~°u*,u ' , General Engineering X ~; Servioes m: YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG INL~ND ~S, INC A~OWD AS ~o~rEo r I£