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Home My WebLink About7263-zTO~/~q OF SOUTHOLD B'Un'.FtlNG DEPART~T Town Clerk's Office Southold, N. Y. Certificete Of Occupancy No. 2~666.6. ...... Date ...........S~tpt ..... ~ ...... ,19..7.~ THIS CERTIFIES that the budding located at ...S/& .Sotmcl .Aya ......... Street Map No .... ~ ...... Block No ....XX .... Lot No~X... ¥~at~;~.t.~Ck...~. ,.Y.o .......... conforms substantially to the Application for Building Permit heretofore fried in thi.~ office dated .............. I~iay .... , 11~97.~. pursuant to which Building Permit No... 72~3Z dated ...........~.8Y.... 5?..., 19.7.Lq., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thl, certificate is issued is ... ~.rl¥~te. one. $~a~lly..~e~L~r~ .................................... The certificate is issued to . R..o.b.e.r..t..~...L?..o.n.~..D.a.v.~..s ....... .~¥.m.e.r..s ................. (owner, lessee or tenant) of the aforesaid budding. Suffolk County Department of Health Approval ... F~ept...1~...35~ ................. D-NDERWRITERS CERTIFICATE No..~.~.~ .... Sep. t;.. ~9... 19~.~ .............. HOUSE NUMBER... 10.~2Q ..... SWeet ........ ~q~LU;~../~ve ..... ~,t~l~.uck ....... SOUTHOLD, N.Y.~/,~ ,~oJ~ ~ ~ ,~;~ ~ ~ --' .............. , ~phcation No..~ ........... ~ ............. ~pr~ tt ~t 19 ........ 't ~ ~ ~T~ ~ ~ ~ ~ ........................................ , pe~ ~o. ~..~ .......... ~.4..'/:~ Trio, ~ a Di~ppr~ed /c ............................................ ~ .................. ~ ................................................ ::::::::::::::::::::::::::::::: { ui ding n~tor) APPLICATION FOR BUILDING PERMIT M~7 17 Dote ................................................ INSTRUCTIONS a. This opplicatlon must be completely filled in by typewriter oe in ink and submitted in triplicate to the BuildingS- Inspector, with 3 sere of pla~s, accurate plat plan to scale. Fee according to schedule. b. Plot p~an showing location of lot and of buildings on premises relationship to adjoining premises or public streets 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 PermLt 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 unti~':i~Certificate of Occupancy~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursaant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other (~pplicable Laws, ;Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as hei;~ 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. (S'gnature o~F applicant, or name, if a corporation) P.O.~ox 690 Mattituc~ ~.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of ~rem secRObel?t If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .... ~]~'~.S. ............................... Electrician's License No....~.~.I~T..~& ............................ Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. /Vtop No.: ............ ~ ................... Lot No....3;~ ............. Street and Number .... ~./.~..~.9.~..~,.tr.~. ....... ~1.~.$.~.$.~,~3~..~.~.~., ..................................................................... Municipality 2. State existing use and occupancy of premises and in?ended use and occupancy of proposed construction: o. Exisiting use and occupancy ........ ..V.i&¢a~.~. ........................................................................................................ b. Intended use and occupancy ......... ~et..,,~&~,;l.~...d~e.~l~3~. ......................................................................... 3. Nature of work (check which applicable): New Building Addition Alteration .......... ........ Repair .................. Removal .................. Demolition M ................. Other Work ...................................................... (Description) 10 00 + ............................................................................ 4. Estimated Cost ....................... ~! .............................. 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 ........... 2~, .................... Rear ......... .1,2, .............. Depth ...... ~t.~. ............. Height .................... Number of Stories ....... O13~ ........................................................................................................ 9. Size of lot: Front ......... ~0. .......................................... Rear .......... ~Q ........................... Depth35D. ......................... 10. Date of Purchase .....1.9.~.~ .......................................... Name of Former Owner .J]~,~;['...Q'.~...~f),I~.Q~,asl~::L.~ ...... 11. Zone or use district in which premises are situated ...... !!~,~...C],;;i.,%t; ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .... t~Q ........................ 13. Will lot be regraded' ......~.~l& .............. Will excess fill be removed from premises: ( ~ Yes 14. Name of Owner of premises ..~Dht..~.. 13a.~'J.&..&..18:L~e ..... Add tess ......Y,.a.t,:I;,'L ~;~e,~ ..... Phone No; J Name of Architect .............................................................. Address ................................ Phone Name of Contractor ..... ~.~.e. .............................................. Address ................................ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock dimensions property lines. Give street and block number or description according to deed, and show street names and whether interior or corner lot. STATE OF NE~/~OP,.~ t ¢ c COUN .......... , ........................................... ~~ ....................... being duly sworn, deposes and says that (Name of individual signing c~tracf) ~bove name. 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 and file this application; that all statements contained in this application are t~e to the best of his ~owledge and belief; and t~a~ the work will be performed in the manner set fo~h in the application filed therewith. Swam to before me this .......... ....... ............ ....... · .................... (S gnature o app icant) JUDITH T. FoYer NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. ,~UILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP. EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7263 Z Permission is hereby granted to: ..~.b~...e.,~..~. ............................. pumu~nt to ~pplicafion &at~:l ......................... ..;~; .................. ¶~ , 19~ , ~nd opprov~l by the Building Inspector. Fee $ ........................ euilding Inspector SUFFOLK COUNTY. DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applican~]~o~r~ ~. ~'1~, v,'S Phone ~- ~r'~c~ 5. Subdiv. Address ~-'O,~OX- ~c),~,~o~ ~.~ ~ 6. Section 2. Property Location ~n~ ~v~e . ~4~7. Lot Number ~ ~rk //9>~- 8. Private Well Village ~A/~,&~ Township ~o~km~ 9. Public Water 3. Distance to ~in 4. Length~eet 10. 11. (For Health Services Dept. Use) Block Public Water Company Name Lot size: Width ~"Ofeet Sewage Disposal System: A. ~J~dO~gallon septic tank: Precast~Equivalent B. Leaching pools: Number of pools '~/ Precast{~d Block Special__ If private 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 C ~ S-15 Rev. 4/1/73 FORM I~O. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Soutkold, N. ¥. 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 praperty 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 dispasal--(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. F~s: 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 Bu ding ............... .~Vacant Land ...~L.. Location Of Property .~..~ ~-~..~ '~'j~ ~,~ ~ O ner Or O ners Prop, rty ...... .................. Subdivision ................................................................ Lot No. ' Block No........-'--..... House No./.~../.~..(D Permit No..~....~-.~.~....'~.... Date Of Permit~?-4....~./.~....~.~Applicant ...;~r4~..¢i~,' ............................................ Health Dept. Approval ............................................ Labor Dept. Approval ....¢~...~...~.......~.~.~.~..~...~..~....~... Underwriters Approval ............. .~..~. ............................ Planning Board Approval ..... ~...~. ......................... Request For Temporary Certificate ........ ~ ................. PinaJ Certificate ....... ~_...~ ......................... F. S.bm wed $ ................... Construction on above described building and permi~~_~plica ~l~c~odes an~egulat OhS Applicant ~~...~;~:..~~ ......................... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY [--- 85 JOHN BTREET, NEW YORK. NEW'YORK Id038 THIS CE~IFIES THAT O~y t~ e~t~ equ~nt ~ ~ ~ ~ Jnt~ ~y t~ ~t ~ on t~ a~ ~plicat~n ~um~r in t~ p~m~es o~ ~obe~ Dav~a~ 3o~d Ave.~ ~c~o~ Ave No~h ~.~ in the~ol~ing l~at~n; ~ B~e~nt ~ Ist FL ~ 2nd FI. outslde ~tlon ~...~i.~o. ~epte~e~ 1~, 197~ andfoundtobelncompl~e~ithther~uirementsofthisB~. fiXTURE fiXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 3 3 1 3 DRYERS FURNACE MOTORS TIME O. OCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS HO. Of FeET SERVICE INSCONNECT S E R V I C OTHER APPARATUS: ~otor/s: 1-3/~lhp 2 BobeI't A. Goodale, RR gl, Box 1SA, Main Rd., Mattituck, L.I. 119.52 Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MA~N.N~ ' S[~UN D AVENUE '""~.. " section 7209 of the New Yc~ ¢l~t~ Education Law. sec or embossed ~e : ~ ~-~ ~ ~'~ ~-~d o b~ a valid co~ n ~":~. cr c~ a~ .... ~ n hail ru~, on--the hereon, and to ,h~ ass,gnees of ,he lending ,nst,tul,om Guarantee, SURVEY FOR 4o