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Home My WebLink About7181-zTOWN OF SOUTIIOLD BUn.DING DEPARTM~ Town Clerk', Office Southold, N. Y. Certificate Of Occupancy Date ............ ~eP~...19 ....... ,lg.?~. THIS CERTIFIES that the building located at .Blmlml*d. J)z*lv~ ........... Street Map No.~/m.lt. C~.e~lt. Block No ........... Lot No..t~ .....8matholA.. !/.,,]/. ........ conforms substantially to the AppUcation for Building Permit heretofore flied in this office dated ........... ~p.r.~.]....1~, 19..~. pursuant to which Building Permit No. dated ..........&P~.~,~....~.~.., 19.7~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ued is Pr~,va.t~ .0~e..raat, l~,. d~l~ .&. ?=~vt.t.,..q~t~ ................... The certificate is issued to .fl.t...~.. y..P..o.~..~..¢~..~. ....... .~..e..~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 8.~p.t....~.6....~.~....b~...Ry..V.~..1.~.. .... UNDERWRITERS CERTIFICATE No...N.~..8~...~.. ~..~9~.t...~.....~..~. ................ HOUSE NUMBER ..... ~$~ ......Street ...~paX'd. Dtq. Ym ....................... Bugdlng In.peetor I~ORM NO. Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7181 Z Permission is hereby granted to: 8.t,e~l.e ~...l~l.t~s~ ........................................... ............... .a.~.o.~ .............................................. ~o lm.lJ.a ..n~v.. tm&.. ~Jw.t~...cl~e~L].~.z~ ..................................................................................... at premises located at ~.t......ltJ;I....~.~:l~t~.B .................................................... .......................... IggLl~.~..DzX.~ ....... ltcmtlm:L~ ....... 1~.~ ........................................................... ~.. pursuant to application dated ........................J~p~;l~, ....... .~.~ ........ 1~1~..~.., and approved by the Building Inspector. OWN OF SOU HOLD _¢ Z~ -.~ ~. ~ ~ ~.~.~ BUILDING DEPARTMENT ~t~ ~, ) ~ TOWN CLERK'S ~FICE .~'/ __ _ . ~-- ~ ~UTHOLD, N. Y. ~/~7/7~ ~~ ~ Examined ............. 19.~.~ Application No..~...:%..." .4. ................ 2r ¢( ...................... r ...... ..... .................... ~/.~¢~. APPLICATION FOR BUILDING PERMIT .~, t...],.~... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the BuJlding.~~. 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 streets or areas, and giving a detailed description of layout ofproperty must be drown 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 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 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, ordinancest building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for nece,S'sct~/nspections. ,Lo,:,: ........ ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................................................................................................................... Name of owner of premises ..~/~-- ...... .~...~/~.~).~.~... ...................................................................................... If applicant isa co~orate, signature of duly authorized officer. I~ P .. '/ / (Name and titl. of co~or~te officer) Builder's License No ..................................................... Plumber's License No..~.......~.....~.....~... ......................... Electrician's License No .... L~.....~./....-......~... ............. Other Trade's License No ............................................... 1. Location of and on which proposed work will be done. Map No.: ..~.~..?...~.. ....................... Lot No...~...~.. Street and Number ....~..~..~_.t~,~.....~,i~.,.~., .................................................................. i~,~~iiii i Munici~li~ 2. State existing use and occupancy of premises and intended use and ~cu~ncy of pr~ed construction: a. ~isiting use a~ ~cupancy ........... ~. .................................................................................................. b. Intended use and ~cupancy ........... ~.¢~... ~ ................................................................................. / 3. Nature of work (check which applicable): New Building v Addition Alteration Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (DescriPtion) (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, 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 .~...~...~'.~........~.....~:~....~.. ...... Rear~.~.~/~....~....~....~... Depth~r~....~...~..~. Height .................... Number of Stories ...."~.. ................................................................................................................ 9. Size of lot: Front ./..~.....~......~....~..~..~.. .......................... Rear ..../...~....~'........,~...~..-~.. ......... Depth ...../.~......~.~..~.~.. 10. Date of Purchase ....~.~.(~.~......~..~.../'~.~-- -J "~'~ ................... Name of Former Owner .~...I~'.~....?~.I'...~.~...~...~L~,~.~.~/ 11. Zone or use district in which premises are situated ................................................. ~ ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ..~V...~. 13. Will lot be regraded ..~...0.A1 ................... Will excess fill be removed from premises: ( ) Yes ~ No 14. Name of Owner of premisee~-/'J~.~..~..'..~...~..~.l/~..~.~l;~....- ' -- n' Address ...~....~...~:...~.......~. ..... Phone No.--~..~...~....~.. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor~'..~./~.~....~...O...L.L~..~..~.~.. ...... Address r~.~....~.~...~..~.....~.. ..... Phone No.~.~..~..~..~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setd;ack 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 OF NEW..YORK. -- ! S S COUNTY OF ..~.~.J~..~..~.r,~ ........ )' · .... ~.,.,~...,....m.~...,.~.~ .................................. being duly sworn, d~oses and soys ,~t he is the applicant (Name of ir~ividual s~gning contrac~ above name. He is the ......... ~.~.~.~~ ................................................................................................ (C.~....--.ac or, 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 t~e to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Swam to bef~ me this . -- ..................... Nolo~ Pc I~c, State of New Y~ ~omml~ion Expires March 30, ]9~ FOruM NO. ~ TOWN OF SOUTHOLD , Building Deportment 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 disposol--(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 naturoi 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 $1.00 xx Date June 1 9 197~ New Bqilding .,T-,~, ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property She~&rd Drive Southold N.Y. Owner Or Owners Of Property .............................................................................. Subdivision C esw71 5/74 Lot 71 81Z ....... No....~Q.... Block No .............House No.....~.l.~.. Permit No..~.~8~>Z ....... Date Of Permit ....~/..1.$/.7)Applicant ...~.t~.r~e~. ~o~L'i14'o.c].a ......................... Health Dept. Approval ..~.../..?~.......,/,...~..~.... Labor Dept. Approval N21602k~ 3/31/75 .................................................... Underwriters Approval ..]~.1~LF~0(~.....9/.~,,/.7.~, ...... Planning Board Approval ..... .~.....R.... ......................... Request For Temporary Certificate ........................................ FinaJ Certificate ...~ ............................. Fee Submitted $ ~. :. .0. . .0. .......................... Construction on above described building gn~d per.mit meet& all app. cable codes and regulations. ............... ...................... Sworn to before me this .......... .1..~.. day of ........ ............ (stomp or Notary Public ..... ,9~l.f.f. ~.lk .............. County SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number ~/,i~ '/~/ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~J(-~z~-I ~.o~ttazk::$~phone~-~ 5. Subdiv.]~_ Address %~qt--M~t~.~\_7 '- 6. Section~~, 2. Property Location ~q~__,o~-~r_,~J~.~O(_~r~lr, l~,'~'~\/ 7. Lot Number '-- Y 8. Private Well Village ~m~-~qa~ml~ Township ~-~ctc~'t'~ole~ 9. Public Water~, 3. Public l~l~ter'~om[~m~:~me , , Distance to main 4. Lot size: Width I~ feet Length t~5> feet ~., 10. Sewage Disposal System: (For Health Services DEC%. Use) A. 900,§allon septic tank: Precas?_]~._Equivalent Block__ B. Leaching pools: Number of pools Precast__Block__~pecial 11. If privat~well, fill in the fol- lowing blanks: A. Tank capacity ~[ gallons B. Pump G.P.M. C. Total well depth D. Depth to ground water E. Amount of water in well ,,? The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. ........ FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE SIGNED S-15 Rev. 4/1/73 f! THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY*i~ '~" 26 R~="HN STREET, NEW YORK. NE~*I~O3S ~ THI~ CE~IFIES THAT FIXTURE fiXTURES OUTLETS SWITCHES FLUC~ESCENT DRYERS OTHER APPARATUS: outs~le [] 2nd FI. Section Block Aot and found to be in compliance with the requirements of this Board. RANGES ~)VENS DISH WASHERS EXHAUST FANS R 'v t c OF CC. COND. Falcon El,sc, 8e£v. COPY FO~ B~DING DEPARTMENT. THI$ COPY O$ ¢$RTIFICA~ MU$T NOT B$ ALTSRED IN ANY MANNER. THE March 31, NEW YORK BOARD OF FIRE UNDERWRITERS ~3U~EAU OF ELI=CTRICITY E~5 JOHN STF~E~T, NEW YORK. NEW YORK 10038 1975 '~PP~iC'ti°n 'v°' °'~ f~ 3U 483 N 218024 THIS CER"rlf=IES THAT only the electrical equipn~ent as described below and introduced by the applicant named on the above application number in the premises of Stanley Polywoda, Shepard Drive, Glen Rd. & Main Bayview, Southold,~. I. in the followlng Iocatlon; ~rcJ Basement ~ 1st FI. ,~a~ex..,i.edo. March 24, 1975 RXTURES RXTURE OUTLETS I~CEPTAC[E~ SWITCHES 12 23 17 DRYERS rt. outside Section Block Lot and found to be in compliance wi~h the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS OTHER APPARATUS: *Furnaces: O!! #1-1/Shp, *Special receptacles: Motor/s: l'lhp NO. OF CC. COND. PER ~' #2-1/12hp 1-30amps., 1-50amps. I i1 OF NEUTRAL 4 ~alcon EleQ.Service, UU Ostranmer Ave., Riverhead, L.I. 11901 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. STANLEy k'l' tV~ T e' 2 xF ,! · / rL, ,~' '~' '!; ~ APPJLOVED AS NOTED NOTIFY ~IkDING DEPAETMENT /',[ -~J~' C 7'/0 ~ 3. FINAL WHEN .lOB COMiaLETED