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Home My WebLink About7055-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z.6.0.~.7 ...... Date ........... J~l~y....~.~. ...... , 19~... THIS CERTIFIES that the building located at .P~..1'..°W...L~...&. ~ .~... Street Map N~ek0~. ~k No ........... Lot No.. } 7.... ~9~d.. ~.~ t ......... conforms subst~ti~ly to the Application for B~ld~g Permit heretofore ffl~ ~ this office dated ........ ~ .... 28. ...., 19 ~. p~su~t to which B~lding Pemit No. ~.. dated ........ J~..$6 ....... , 19.~., was issued, ~d conforms to E1 of ~e req~ ments of the applicable provisions of the law. The oecup~ey for which t~ ce~ffieate is issued is .~$~ge. O~e. f~llY..dve~X~ng ....................................... The certificate is issued to A~e0~le~. ....... ~ .............................. (owner, lessee or ten~t) of the aforesaid buildEg. S~olk County Department of He~ Approve J.~Y...~...~.~...bY. ~ .~8... UNDERWRITERS CERTIFICATE No...~. ~6~.1.3~ .... ~Y...22...19~. ............. HOUSE NUMBER ~.2~0 .......... Street .~i~. ~ ............................ .... ..... B~lding Inspector ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFfiCE SOUTHOLD, K. Y. BUILDING pERMIT ('THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 7055 7 Permission is hereby granted to: ~e g..~.a~....AZ~.. A ,T.,.OL%le= .......... .~;~L~ ........................................................... ~o .J~LLl~..~.~.L~..~a.~i~:...~::aiLi~ .................................................................................... at premises located at .~(~;...:~.....,~7,11~gl~,..~,.'(;D.~. ......... ~ ......................................................... .............................. Hlg~.a~..~.~m~..~d .............. ~.au, t,h.o.2d..... ~ ,~ A .............................................. pursuont to opplication dated ..................... ~).~...**~-~. ................. , 19..~., ond opproved by the Building Inspector, Fee $.~,~.Q0 .......... Building Inspector (j THE NEW YORK BOARD OF FIRE UNDERWRITERS SW BUREAU OF ELECTRICITY , ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 ;, ~,e ~;.:~ 22, :Zg?" A.,,..,,o.N..o.,,~ ?l"~5 N. 161131 THIS CERTIFIES THAT Mdy the e[~tri~a] equipment as described be[ow a~td introduced by the appllt~nt named on the above ap/di~at/~m ~umber/n the prem/ses oj' A.J. Gillen, Private Rd., w/of Minnehaha Blvd., Southold, L.I. in the following location; ~ Basement w.~e,.mi.~do. May 20, 197~ FIXTURE LECB'TACI~SI SWlT I RXTUR~ ~j~ lstFL [] ~nd FI. outside s~t~o. #~k and found to be in COmpliance tvith the requirements of this Board. ! 30 R SERVICE DISCONNECT [ NO. ~ I S 1 200 CB x COOKING DECKS [ OVENS DISH WASHERS 1 TIMFCU~ Uu lUNmabT~ 1 EXHAUST FANS DIMMERS E 2/0 OTHER APfARATUS: Motor/s: 1-1/2bp Water Heater: 1-~.SKW Elec. Room Heaters: 2-2.5KW, ~-2.0KW, 1-1.SKW, 2-.75KW, 1-.SKW SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department ~Z~ Reference Number 1. Applicant Address 2. Property Local)on Nu~ ~ ~-,~ ~ ~A/~¢~ Village J"Ou'[Th 3. Public Water.Company,,Name 4. Lot size: Width ~ feet Length./~ feet APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Sewage Disposal System: A. 9~o~-gallon septic tank: Precast P~[quivalent Block 10. B. Leaching pools: Number of pools Precast {~Block Special ll. If private well, fill in the 6. Section 7. Lot Number ~ 8. Private Well 9. Public Water Distance to ~ (For Health Dept. Use ~ gallons Pump G.P.M. ,~-0~~w4, Total well depth Depth to ground water Amount of water in well following blanks: A. Tank capacity B. C. E. 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~,~,v J /Y~ 7 Signed.,>]~ ~'~'~ FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfact6ry Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE S-15 Rev. 4/1/73 FOBM NO. Town OF Di~ppmved a/c .................. ~ ..................................... v b. Plot plon ShYing I~i~ of 10t andof buildings on premises, relat onsh ore~s, and givi~ ~ detod~ d~ription of I~o~ of~ must be drown on th~ d ag~m wh~c~ ts ~ ~ ~'~i'c~i'"~ c. The work c~er~ by this o~licoti~ ~y n~ be comme~ beige i~uonce of Building Pe~it. d. U~n appel of ~is opplic~ion~ ~e Buildi~ I~tor will issue shall ~ kept ~ the premises ~ailable ~r insp~ti~ ~h~t ~ work.. e. No buiJdi~ shall be ~cupi~ or u~ in ~ole or in pa~ for any pu~e wh~er until a C~fic~ of ~cu~y shall have ~g~ ~ t~ Building In--tar. APPLICATION IS HEREBY MADE to the Bu ding Department for the issuance of a Bui d ng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or .~u__l_l_l_l~_il~caS~Oar ~rhe~esC~,nstruct!on o..f. b~!dir~,, a.dfl. It!ons or a.!terations~, or .for removal or. demolition, as herein descr bed. ~up g o comply w,rn a. app,maoie Jaws, ora,nonces, building code, housing code, a~ regulations, and to admit authorized 'insPectors on premises and in buildings for necessary inspections. (Signature of app icant, or name, if a corporation) fJeut, hold. ]i.~. (Address of applicant) · State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~'~il6e~ Name of owner of premises .A.~.*..~.~I,R~, ...... . .............. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No.....~..e...~.~l~..]..~ ........................ Electrician's License No .... ..~..~.~..1~....~..~. ........................ Other Trad6's License No ............................................... ~/~ ~r.~ / ~L /~ I. Location of land on which proposed work will be done. Map No.:~..I~.....~.~...W..~.~.,?,~.~. ..... Lot No....~.?. ................ Street and Number .~J~...~':L~lfit31L.~&~. ......... ~.~I.~IJL~[ ................................................. /t~Ff~'o Ld LRA~£ Municipality 2. State exmtmg use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....~..~..~....~1....~. .................................... b. Intended use and occupancy e~e fall'ly d. WO1 3. Nature of work (check which applicable): New Building ...~ ..... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ............... ~..$.~...0~......+ ...................... FeeA,,-~..~ _O ..... (to be paid on filing this application) 5. If dwelring~ 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 .L..: .............................. Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... ~.~ ..................... Rear ........... (~)& ............ Depth ...~.8./...3~ ...... Height .................... Number of Stories Om ............................... 9. Size of lot: Front .... t~.0. ............................................. Rear ......... .'L~I ......................... Depth ......... .1.~,~ ................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated hA" dt~..t,. ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... 3~1 ........................................ 13. ¥~ill lot be regraded ......~lll. II ............... Will excess fill be removed from premises: ( :~ Yes ( ) No .............. ....... No. 14. Name of Owner of premises ...A~.n~l.~,~.¢l~ ........................ Address l~ez ~ ~T ~ ...................... Name of Architect ...... ~R..~,~Cl~g.(Id ........................... Address ................................ Phone No ....................... Name of Contractor ..~t~.G..~W~,II~,~III~, ........................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil 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. STATE OF'NEW YORK, S.S COUNTY OF ........ ...... ' ............. T,i~Q..I~¥~iB~L ............................................. being duly sworn, deposes and says that he is the applicant ...... (Name of individual signing controct~ above named. . Bailde~ He is the .......................................................................................................................... (Contractor, agent, corporate officer, etc.) ~f"~bid owner or owners, and is duly authorized to perfofm or have performed the said work and to make and file' this app cqtion; that a statements contained !n tb.s ?pplication are true to the best of his knowledge and belief; and t~6f"th~.~Ork will be perf0fmed in the manner set fo/t~h m t~he applicat!on filed therewith. · Sworn, xt~ be. fore me this . ry Pub ' 'c ,,~ -~.~.'. ~ nty ...... ~"~/~ ........ ~ .............................. Note~ Public, $~ate of New York No. 52-0344963 Suffolk County ¢~ommission Expires March 30, The sewage fllsposal anti wate~ s~ppl¥ facilities for this l~cation have been Chief of genoral Engineering Sorviees BED R, APPROVED AS h!OTED NOilFY BUILDING DBPA0,1'M~.NT / 765-2660 9AM TO 4PM FOR REQ~ ,, 1 BEFORE BACKEI,LLING FOUNDA-