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Home My WebLink About7178-zNO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy THIS CERTIFIES that the building located at l~lt.i~al~a &. ?lll~Ol.~ .&~treet conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... .A.p.~..t.1...~..., 19..~.. pursuant to which Building Permit No.7.~7~.. dated ............ Al~r;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 (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval A~...I~...197~'...by. i~,. ¥illa .... UNDERWRITERS CERTIFICATE No....J.'..Kti. b..~.~.k.~....~..~...~.. .................... HOUSE NUMBER ~..~..~ ......... Street ...... ~..e.~.~..ha..1.~.~...P&.. .................... Building Inspec~r TOWN OF ~OUTHOLD ~ ~. L~ ~_. TOWN CLERK'S OFFICE ~ '. T-~ - ~ //I/ / ~ ~ /~ ~Y ~...~...~....., ~ ~ ,. ~ Examined 19....~.. . ~pplication ........................................ ...... r" ...................................... Disapproved a/c ...... ~ ........................ ~ .......................... ~ .......................... . .................. ........... ............... APPLICATION FOR BUILDING PE~IT , ' ' .,,,e .......................... , : :, INST~U~IONS a. T~is a~lication must be completely fill~ in by ~pewriter o~ in ink and submitt~ in triplicate to the Build~ Insp~tor,_ with 3 ~ts of pl~s, accurate, plot plan to ~ale. F~e. according to sche~le. b. Plot plb~ showing Foc~tiOn~f lot ~nd of buildings o~ prdmlsesj Eel~tionShi~ to a~}oini~g premises or public streets~: areas, and giving a detailed description of layout ofproper~ must be drawn on the diagram which is ~ of this applicati~. c. The work covered by .this a~lication may not be commenced before issuance of B~ilding Permit. ~. U~on app~ga] of tHi~ ~ppii6dti0n, t~e Building Inspector ~ill iSsu~ ~ Buddm~Perm~t to the applicant. shall be k~t on the premises available for insp~tion ~roughout the work. e. No building shall be ~cupi~ or u~d in whole or in part for any purpose whatever until a Ce~ificate of ~cupancy~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY ~DE to the Buildi~ DePart~ent for the issUo~ of a Building Per~it pu~ant to the Building Zone Ordinance of the Town of ~uthold, Suffolk County, New york, and other applicable ~aws, O~inanc~s or Regulmions, for the comtruction of,buildings, additions or alterations, or for re~o~l or ~e~ion, es herein described. The applicant agrees to comply with all applicable laws, ordinances, building'c~, h~si~ c~e, anti, regulations, and to admit authoriz~ inspectors on premises and in buildings for n~essa~ in~ections. (S'gnature of appl'cant, or name, zf c~{corporation) (Address Of applicant)i ~ State whether applicant is owner, lessee, agent,, architect, engineer, general',contractor, electrician, plumber or builder. Name of owner of premises ....... ~.~__.~_,~,~.~Tq..~_~?~l~..~3~.~ ......................... i ....................................................................... If applic ' or te signature o~f duly ,authorized officer. (Name ar~d title ~f corporate officer) Builder's License No ............. ~ ....................................... Plumber's License No ....... 5:~...-.~. .............................. Electrician's License No ..... 3,'/..3~1~ ........................... Other Trnde's License No ............................................... I. Location of land on which proposed work will be done. Mop No.: ....~.2'.4.5 ....... ~.Z.?.5 ......... Lot No..~J~..&..P~,~ ...... Street and Number .... .~e~.~,tlal~;;J~L4m~'~O,13~,..b~.t,'l;~,l:1~nl~...~,¥.~....~Z.g52 ............... ,~a~l.t~lct .......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................ ~Q~G ...................................................................................................... b. Intended use and occupancy ................ .~...o....m~,. ........................................... .............,.... ....................................... Nature of work (check which applicable): New Building ..,~{~ .......... Addition .................. Alteration .....:....L....:. Repair .................. Removal .................. Demolition .................... Other Work .................................................... · '~C~ ~'~" (Description) 4. Estimated Cost ...~..3~eD.O~.~O.~ .............................. Fee .. (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ,,1. ............... 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 ~,~ ........................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... 69.! ..................... Rear ....... ~.9. ................ Depth ... 3.~ Height ....~,6.! ......... Number of Stories ..................................................................................................................... ' ............... 9. Size of lot: Front ......... 3. QO..~ ..................................... Rear ....... ~,¢~. ........................... Depth 10.; Date of Purchase ...... ~la'~C~..[r..19:7~ .................. Nome of Former Owner ..Geo.ll:ge,..l'~..~oo~l~,[ .......... 11. Zone or use district in which premises are situated ............. l~o~t~8 ..................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: Ye~s...8~e..G~.t,~,.~..~,e.1;.1;~ 13. Will lot be regraded' ......~,~ .............. Will excess fill be removed from premises: ( ) Yes 0C ) No 14. Name of Owner of premises ..~,~,3.3~,t~..~t~,1~..~7.~ ....... Address .....~.;I,.c~..~....~.~.Y..ePhone No..~..3....~.-..3...3..3....9.... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...T~t.3.G3~:tC[.~e.I~,,...[~G~ .............. Address .)~...x.....3:...3-.7..a....~...e:.t...t.~1~:No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exi,~ting 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 Iai. ~! II ~ ~. ~1 ~. /'$/d.a. d~ /d'a., d~ · I I STATE OF N E'~A/YORK, ~ 1. ¢ ~ COUNTY OF ............................. .~:~*'~ ................................................................................................. being duly sworn, deposes and says that he is the applicant ' (NOme of individdal signing, cootracf):- ' :z' ; ~ : - above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or ~ave performed the said work and to make and file this application; that all statements contained in this application a~'e true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this Notary Public, . ................................................... County ....................................................... (Sig ant) FOB~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN (:LERK'S OFFICE SOUTHOLD, N~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7178 Z Permission is hereby granted to: ...... ~,~.t ~.&~mk .................................................... ~:o ~.~.z..~.. ~.e.~...o...~..e....~.s..~.~'...~.~.~ ~l. ...................................................................................... at premises located at~O:~JL.~9~..&'..2~....~.O3~rvoo4..&ll~, .......................................................... ........................... 184 ~.~I)l~ ~t,&.. &.. ,l, ~.Z. id~e L~ · · A,ee ................... N~4~t; E.t,T~E .......... ' ...................... pursuant to application dated .................... ~:)~1, ......... .9 ........... , I~...., and approved by the Building Inspector. Fee'~,~95 ............... FOI~I NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southuld, 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 New Building ......~ ....... Addition ................ Old or Pre~existing Building ................ Vacant Land .............. Location Of Property ....~/.~.~.~..~,.~.~../~.v..~.~.~...][vJ.~.~,.1;.~,f;]~..~ ........~,]..~,~. ................................ Owner Or Owners Of Property .....~..~..]-.~'.~....n~......~..~...~....g.]~.~...~[.¢...~.'....~.~[.~..~.*...~.~;.' ................................. Subdivision ...~.9.~,1,5~77/.9.f~.~ ....................................... Lot No.~.4x..~¢~ Block No .............House No ............. Permit No.....7..]:..7..8.....Z.... Date Of Permit ~.z..]:.~...qZ...~....Applicant ...~........~.~...~..z..~...e.....-:....Z~..D.....~..O.~.~....~Xi'C. Health Dept. Approval ~,.0..z.~...~.-...5...~.7..~ ............. Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......X.. .................................. Fee Submitted $ ...5......0..0. ......................... Notary Public .................................... County Construction on above described building and. permit~l~ee.ts all applic,~lble cod~s and regulations. Applicant..,~~.~~ .............................. Sworn to before me this (stamp or seal)/~-~ SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number 1. Applicant Address ]amm~ 117 2, Property Location Village 3. Public Water Company Name 4. Lot size: WidthlOS,6~l~eet APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY ~,, H. _~ Jz. Phone~5. Subdiv.~ 6, Section 7. Lot Number ~ ~5 8. Private Well v~ Township ~tlm~l,d 9. Public Water Distance to main Length ~j~,~,) feet 10. Sewage Disposal System: A.~gallon septic tank: Precast_){~_Equivalent Block B. Leaching pools: Nun~ber of pools ) Prec~.q~f,_Block Special ll~. If p~ate well, fill in the follq)~j_ng blanks: A. Tq~ capacity. ~ ~allons B. BumP G.P.M. 5 C. Total well depth. ~ D. I~pth 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 _,~'tl 3_. 107~ Signed ZI3Z&lm~ ~13mm~m :b)4:,/l~,W. ~ ..................................................................... :Zm ..... 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 pl~ot. APPROVAL DATE (~f'/~//?,~ SIGNED ~ ~ - S-15 Rev. 4/1/73 5 T~N ~ ~uTblOLO, ~4, L:.~ 1o THE ASSLGNE~$ OF 'rile LENDING tNSlh TO ~,DmTIONAi INSTII'U'rloN$ OP. 5UB~Qi/EJ~'T THE NEW YORK BOARD OF FIRE UNDERWRITERS ~.W BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NEW YORK, NEW YORK 10038 D,~ September 10,197~ ~pp.~o~ion~o. on/i~ 7ZlZ1730 181564 THIS CE~IFIES THAT only th~ d~ctr~c~ ~q~pment~s d~sefibed ~ ~ ;n~ed b~t~ ~ppi~t ~lZ~q~ the ~bo~e.~ppli~zt~qn O#ntl~r in the p~m~es of in the following location; [] Basemen~ [] ~st Fl. was examined on September 6,197~ 16, I 37 19 16 DRYERS FURNACE MOTORS FUTURE AFl,lANCE I~IEDEIIS A.~AT, K.W. :L H.P. GAS H,P. :T. NO. A.W.G. SERVICE DISCONNECT I NO. OF I S IFu~'naoes: 1-1/Shp, 2-1/15hp EFutu~'e Appli&nce Feeders: 1-3#10,1-3#8 Mot ox-s: 1-1bp [] 2nd Fl. OtltS~Ld~ection Block and found to be in compliance with the requirements of this Board. RANGES COOKmNO DECKS OVENS DISH WASHERS R I C 2/0 EXHAUST FANS DIMMERS OF NEUTRAL 2/0 ~eorEe Zimilinghaus Park Pl. Patohogue,L.I. 11772 Per 11 '-, , f, COPY FOR BUILDING DEPARTMEHT. ' THIS COPY OF ,CERTIFICATE ~T NQT BE ALT~ED: IN ANY MANNER. MAP OF.." GEORGE T~RIJTt-tAHNE , .,V,/OOD?iU LL AT' ~TTfTU~ ~~ O~ ~w~b" F~'~S" //,,.Al" Of'- t&ATTi TL.JC',/~ 'SC. AL~' · 50'=" /Z · L~T N~/~,f'".~K'~ ~.t~,~¥N IK,~'~ JUL. Y 10);9 The sewage disposal and ~;ate~ Supply facilities for this location have been inspected by this dopaPtment and fOUnd Chief of General Engineerin~ Se~'vloes '1 -I