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Home My WebLink About7273-zNO. 4 TOWN OF $OUTHOLD BUFLDING DEPAR'DggNT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6220 Date ~ee.. 2 ..... ,19.~. THIS CERTIFIES that the buiMing located at a/.8. l~a~v:~a~ .Road ........Street ~p No..~ ........ Bl~k No...~ ..... ~t No.. ~ .... $~0~..~X, ....... co~o~ subs~y W ~e Application for B~di~g P~it h~fo~ da~ ......... ~...1.~ ...., 19.~. pm~t W w~ B~dlng P~t No...7~ da~ ........... ~...~ .... , 19~.., was ~u~, men~ of ~e applicable pro~o~ of ~e hw. ~u~ h . ~ivat~..~s. ~t~.d~a;'. Ii: g ....................................... ~e ~ica~ ~ ~u~ W..~Y. ~aggl~a~ ..... ~ ............................ (owner, le~ or ~t) of ~e ~o~s~d b~ding. S~o~ Co~ Dep~ent of He&~ Approv~ No~..~. 19~. · b~ .a,. Xlll~ ........ ~~I~ C~T~ICA~ No..~19~69 .... N~...~ 2..19~ ................. HOUSE ~ER ...... ~!~... S~t. ~$~g .~ .......................... FOBM NO. t TOWN OP SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7273 Z PermiSsion is hereby granted to: c~g~s, ane at premises ocated at ~ g ~f~ ,(K..~...~. OrD.. .... ~ .. ~..~e~eer. aeae ................................ A..} .......................... .................................................. .~.~l~t~.q~M ~..~.~., ..................... pursuant to application dated ........................~t~......~.~ .............. , 19~..., and approved by the Building In.~ztor. TOWN CLERK'S OFFICE '/~'~'/'~ Y ~ C~ SOUTHOLD, N. Y. ~/~. $/.~ ~, 7::'~,.,, ! '+ ~ ~ ,~' ~ ~ c~_. Examined .....~........~. ...... ..~...~....., 192~.. ~.Ap~p, lication No. E.~.~ ............. .~ ~praved ............. ~ ......................... , 19~.¢. Permb No. ¢....~..~..~...~....~ ~ ~ =pp,oved ......... ............. ......... .......... _ _ ._ - . ..................................................................................... ,. ...................... / ...................................... ~ .~ · ~ ~ , APPLICATION FOR BUILDING PERMIT ~ Date ..:~I~Z...;I,.~.~ ............................. , 19..'(.~ ...... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter oe in ird~ and submitted in triplicate to the Building~ Inspector, with 3 sat~ of plans, accurate, plot plan to scale. Fee according to schedule. b. Plot plan showing Ioc~tic~n 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 drawn on the diagram which is part of this application~ c. The work covered by the app i~btion may not be c~mmenced.before issuance o~ Building Permit. ~ d. Upon approval of th~ apl~hcot~on, the Budding Inspector wdl ~ssue a Budding Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. ~ e. No bui ding sba be OCCUpied or used in whole or in part for any purpose whatever until a Certificate of Ocouponcy~ 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 herei.n described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulat,ons, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) 250 Cox L~ne~ Cutohol~ue.: (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Bui ld er Nome of owner of premises ...R..~.d.]'....C...a.l~.t..e...n..9. .................................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .................. .?.~.?Z....~ ......... Electrician's License No .......................... : .................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .]~l~f.a...]~,~r~.~..~,e&d~...8~efrfl[e3.d~..~[ee..~a~.k ........................................................ 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 occupancy ........ .~E....e.~.~...t..a..~ .................................................................................................... · 3. ¢qa~ur~of work (check which applicable); New Building .... .X ........... Addition .................. Alteration .., ........ ~,.., Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (Description) 4. Estimated Cost ..~.~..5.~.~..~.~..,.~.5.. ........................... Fee .......................................................................................... (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 ..... ~0.: ........................ Rear ......... 50.: ............. Depth ..... 2,~.: ............ Height ....2.].: .......... Number of Stories ..2~ .................................................................................................................. 9. Size of lot: Front .... [I,~1.0.: ............................................ Rear ..... ~.0..,..l..'. .......................... Depth ....~2.~...6..1..'. ............ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .............. .A .................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~l.~ .................................................. 13. Will lot be regraded' ...~.~ .................. Will excess fill be removed from premises: ( ) Yes (Z) No 206-10 26th Ave. ] 4. Name of Owner of premises .~ud,y...~.~,~;I,~,~. ................... Address B&~'.~ff~le.....~,¥.~. Phone No ....................... Name of Architect .............................................................. Address 25~f"~'~"~ii'~ ....... Phone No ....................... Name of Contractor G...~.9.~..q....A.~.~r..~.....~.~.8..~.~....!?.9. t. AddressC~ch~g~.e.,...N.,.Yghone No.?...8...4..-...5..0...~Q. .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. SEE ATTACBED PLANS STATE OF NEW_YORK, I c c COUNTY OF ..~.~.~.~.~..~. .............f °'~ .................. .~.~.~.~...~.$.~.~'.g.....[Z'.~.~.~.~.~ ..................... being duly sworn,, deposes and says that he is the applicam (Nome of individual signing contract) ~ above named. He is the .................... ~,,£.1.d,~. ........................................................................................................................................... (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 this application; that all statements contained in this application are true to the best of his knowledge and belief; and thru the work will be performed in the manner set forth in the application filed therewith· Swam to befo_re/)rne this . /~ ........... ............................. (~ig pp ' ) .I?DITH T. BOKEN Cr~m~on F.x~ires Mar'h ~ tY~ FORM NO. 6 TOWN OF $OUTHOLD 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 inspectior~ of buildings or premises, or other pertinent 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 M.&A.~ ..~.~'.~..f,e.~ .R..~,., ~.~.u~;hol~ Owner Or Owners Of Property ..M.~..,....~..~.~..,.....~..u.~.~.....C.~.l[l[.f...a..a...e. ............................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.7...2..7...3. ........... Date Of PermitS./...2..2.../..7...4.....Applicant G..e...e.~.~.?. Ah].ers~ Prelf.~e. nt ... Health Dept. Approval ].]~.4~.7.~..-....~.-..~...0..-...5..~ ....... Labor Dept. Approval ............... ../~......~. ....................... Underwriters Approval ...~...!~...~...~....~...~.....~.../~.Z..~...~...Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate Fee Subm tted $ ............................. Sworn to before me ............ · ~.. day of .....~~.....?...~ Notary Public ........ ~'~--~-u n t y Construction on above described building and permit ~e~s~all applic~,c~l~/~?~es and regulations. SUFFOLK COUNTY DEPARTMENT OF HEALTH Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~¢o~ ,~ /-~A/~ ~ ~]~,/~/~ ~.~Phone ~/ ~'oJ~ 5. Subd~v. Address ~ ~ ' , .~ - - ~. Section 2. Pro eft''~~ ~ ~'~'J ~~~. Lot Number up y LRcation ~ ' 8. Prj~te,,W~llr ~+~ ~ P~~ s~t ~c~eCt~a~ in .. bl ~ c Water Company Na~ ~ '~ ~ - - ' 3 Pu ,,~.~ .~ ~ Length ~ ~ ~ee~ 4 Lot size: .mu~. ........ 10. Sewa~isposal System: A. f9~q~gallon septic tank: Prea(C~st~Equivalent_____Bl°ck (For H~ B. Leaching pools: Number of pools_ / Precast~l~4)Block' Special ll. If private well, fill in the following blanks: A. Tank capacity_ ~/Z ._gallons B.J]Pump G.P.M. ~ S-15 Rev. 4/1/73 C. Total well depth_ ?m m D. Depth to ground water_~o E..Amount of water ~n well ~/~ _ TheunderSignedCERTIFIES: "C°nstructi~l~,~u~dsi~t~tt~:~!~q~i~na~~I~ w' he Suffolk County Dep~rtme~ of H ...... ~ ~.~.+~ h.lo nd'may be renewed if ~th t . r ?rom the date oT appruv:, .~- .......... w a _ will be v~l~d for one yea a current local Building Department Permit is in effect. .............. ~ . ~ ~ Signed ua~e . / ~_ ........... i ....... ::::::::::: ..... - ........ - . .................. :::::::: ............ ~ ....... FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the ~pinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this p~ot. A PROVAL DATE_ f /TF S NED__ THE NEW YORK BOARD OF FIRE UNDERWRITERS 8k BUREAU OF ELECTRICITY ~ . ~-- 85 JOHN STREET, NEW YORK. NEW'YORK 10038 ' THIS CE~IFIES THAT ~ly the e~ ~uip~nt ~ ~c~ ~ a~ i~ ~ J~ ~a~ ~ on t~ ~ ~pl~a~m~r in t~ p~s o/ ~aggxano, ~al~ ~aTvlew ~u,~ 1~ n/oAn~er, wx~ ~e~ar ~. Sou~hold, in the foll~ing location; ~ B~ement ~ 1st FI. ~ 2~ FI. O~ ~S i ~ ~ ~tion Bilk ~t ~ exami~d on ~ o w ~b ~ ~ ~ ~ 9 7 ~ and fou~ to be in compl~ahCe with the requirements of th~ ~rd. FIXTURE fiXTURES RANGES COOKING DE~KS OVENS FANS OUTLETS SWITCHES 19 36 DRYERS MULTI. OUTLET SYSTEMS OTHER APPARATUS: ElBe ,x'oom heaters E R V I C NO. Of CC. COND. A,W.G. NO.O~ HI-LEG A.W.G. NO. O~ N~UTRAL5 A.W,G. ~R ~' O~ CC. COND. OF HI-LEG OF NEUTRAt 1 4/0 1 2/0 2-2.5 k~, 3-1.5 k~, 3-1.25 kw, 3-.75 kw, 2-.5 kw RR ~1, 227 Hast Breakwater P~D., ~o~ I~1 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ' 7"0 e"; oO'T,S, OZ £~, /V: \ ',; ~4~. ~. ~. ~ Chief of General , APPROVED AS NO~ED FEE: Z/~ BY_ ~OTIFY BUILDING DEPAKTMENT /I ED INSPECTIONS: 3. FINAL WHEN JOB COMPLETED r r- ~' %,, ;r--r"r ]ii ,