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Home My WebLink About7065-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~.~.9..7.8 ....... Date ............... Jun~ . ~..., 19~. THIS CERTIFIES that the building located at fi~,~.:le.~te. Dx. .............. Street Map N .o~..r~.o.n.....!~..lBlock No ........... Lot No...!~. ..... E.a.s.t..O.a.~.~.o..n...N. :.Y.. .... conforms substantially to the Application for Building Permit heretofore fried in this office dated ........... J.a..n...~.0..., i9..~., pursuant to which Building Permit No.7..0~. ~.... dated ......... .J.a..n ..... 3.0. .., 19. ~.., was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P.r.ly.a..t.e...o~..e..~a.m~~ . .d.~.e.l.:..i~. g ....................................... The certificate is issued to l~rs, Carol Sa~o~ 0~ner (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... .J..m~..e...~..6..1.~..~....b.Y..R.:..V.J,..L~.a UNDERWRITERS CERTIFICATE No. N...~ .63.1.2..8 ....... .J..mi. 9.' .~. .... 1.~.~. ........... HOUSE NUMBER ...~..75.0. ...... Street ....~.~..1.1.e.t.t..e..D.r.$y.e ...................... .... ~'i ,spe~or t FO~M NO. ~ 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) N? 7065 Z Permission is hereby granted to: ............... ~ gM~..h.g..Z..~ .............................................. to ...l~l,~,~..xx~ ..~m ..~t,~:...~,w~,~,~, ................................................................................... at premises located at ....~1.9.~....~.~......"....~.;~..~.9.~..~;~A~'. .................................................................. ............................ ~.z...z..J..~..e...~..r.~..v..,. ............... ~ ~.t .;;~.~ ~..~..o..n.. ....... ~..-.Z;. ........................................ pursuant to application dated ...................... ~'~.~. ........ ,~.0.. ............... 19.~.~...., and approved by the Building Inspector. Fee $...~..0.~.?...(~... ...... FORM NO. 6 TOWN OF SOUTHOLD 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 inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: I. 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 .7......... Date ..... . .~.'.....~..'"~.....~......~...Z... New Building ..~.... Addition ................ Old or Pre-existing Building ................ ¥ooant Lend .............. Location Of Property ........ ~.~,~.~..T.~T.~'.:...~..Z~.Z/.~.,'~' .............. ~..~..,~'_,~.~,.~"~',~, .~.,.....~..,....~.'.. ............... Owner Or Owners Of Property ...... /~d~.. ......................................................... .....X~..:~.~..,,~.c,~./..~./~;~,~,~ .j~.. ....... Lot, No. ,¢..~r..... Block No ............. House No ............. /.4 Subdivision Permit No...~.'.¢~.~.~...,~..."~' Date Of Permit .., ,/...-,..~..~::~A/pplicant . ~,~..,~...~'.../~..~.~.~...~./...x.~.~'..~.:..~.~..' .ca,th Dept. Approve, ........... Labo. pt. Approve, Underwriters Approval~.~.... ............... Planning' "~ ' Board Approval ........................................ Request For Temporary Certificate ............ -~ ................ ~ .......... Final Certificate ..~:~.__ ......................... Fee Submitted $ ~..'~ c~) 0 / / Construction on above described bud ng and ~e,n,nit meets all applicabl/codes ~nd regulations .......... ~....~ day of ....~ ....... !..~....~....~. (stamp or seal) Notary Public .......... i ......................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS Ak BUREAU OF ELECTRICITY · * ~ 85 JOHN STREET. NEW YORK. NEW'YORK 10038 5. '.8'6 N 163128 THIS CERTIFIEB THAT only the electrical equipment = described below and introduced by the applicant named on the above application numlmr in the premises of Carol Sammon, w/s/de Gillette Drives 100' n/o Midland Plaaes East Mar/~nE L.I. ~nthe/~.~.,o.; L~ S~.~..t ~X~.tF~. [] ~d Fl. out~lde FIXTURE EXTURES OUTLETS SWlTCHlS 26 115 25 26 DRYERS FURNACE MOTORS FUTURE APPUANCE F~EOERS RANGES OVENS EXHAUST FANS UNIT HEATERS MU~'TS'OUTL~T SYSTEMS HO. OF FErr DIMMERS SERVICE DlSd~ONNECT S E R V I C E NO. OF CC, COl40. A,W*G, NO, OF HI-LEG qO. OFNEUTRAU A,W,G, OTHER A~ARATUS: Water heater: 1-q. Skw ~otor/e g Elee,room hea~e~s: 1-2,0~, 1 G.~.I. 3/o 1 1/o 1-1.25kw, 2-1.0kw, 3-.75kw, 2-.SkW W,B, Ruland Elec., Nattitucks L.I. Pe~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERID IN; .ANY.. MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH ReferenceHealth DepartmentNu ber APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~)/~ ~,4~ -~,~yc Phone~-~-~/7 5. Subdiv. ~x~Y Address ~/ ~ ~-~ ~o ~ , 6. Section 2. Property Location ~o~ ~/~ ~/~/~/J~ ~/y/~7. Lot Nu~er ~ ~, ~ ~,~ ~ ~z~ ~,,~ 8. Private Well Village~~ / ~ownship '~,~ 9. Public Water 3. Public Water Company Na~ ?t/d~' Distance to ~in 4. Lot size: Width /d~ feet Length 10. SewagenDisposal System: /1~ A. /O~-gallon septic tank: Precast /Equivalent Block B. ,~L~aching pools; '~ ~umberofpools / ~ Precas~ Block Special ll. If~Pivate well, fill in the following blanks: A. ,Y~!.nk capacity ~ gallons B. Pump G.P.M. C. Total well depth ~//o D. Depth to ground water E. Amount of water in well feet (For Health Dept. Use) The undersigned CERTIFIES: "~nstructton of authorized installations will be in accordance with the Suffolk Coun~ Depart~nt of Health's current standards thereto. T~plicatton will be valid for one year from the date of approval indicated bel~ and ~ be r~newed if a currentlocal BuildingDepartment Permit is in~t. ~X .~ Date~ Signed-~~ ~/~Y H' . ase on th~ infor~tion pre~nted her~t~, ~t ~s the opinion of the Health De~aKtment that a~ adequate and satis~ctory S~age D~sposal System and Water Supply can be ~nstalled on th~s plot. ~ APPROVAL ~/~?/~ SIGNED ~ ~ ~ ~ ~_ DATE S-15 Rev, 4/1/73 · owH omc, i SOUTHOLD, N. Y. .... ...V.. ........ ~ ......... ;~ ......... , 19...: .... P,m, ~o ................................... APPLICATION FOR BUILDING PERMITDate /' ,~O i ,':4~...~ INSTRUCTIONS a. This application muir be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 3 sets of plans, ~caurm 'lf~t plen to stele. Fca ~ccording to ~hedule. b. Plot ~ ihowlllg location of lot mhd of buildings on pmmise~, rel~tiomhip to adjoining premim or public streets or areas, giving o detlikid Cll~on of tWout of property mutt be drewn on dllgram which 1~ part of this iPldlcotion. I1i ¢. The wod( oev~ld by this ipplieltlon mly not be commenced before iuuenca of Building Permit. d. Upon liN)roYal of' thtl Ipp41~ltlon,. the Bul~ing. Inlpe~tor will heue a Building Permit to the applicant. Such permJt,lholl be kept on~ the premim mm~lde for imp~tlon throughout the work. .-- e. No i~ng ahell be 6,~pted or umd in whole or in pert for any purpose whatever until a Cerdfi~ of Ocoubenw ~hall have been-~- granted by the ~utldlng Inlpector. APPLICATION IS HEREBY MADE to the Building Del~rtment for the iuuenca of a Building Permit ~ummnt to the Bui~lff;~o~ Obu~inanca of the Town of ~outhold, ~uff~k County, New York, and other aggllceble I.w4, Ot~llnlncal or R~ul~tiam, for the i;~ctlon I~ ~lnge, iddltlom or IIt~retlons, or for removal or d~molltion, el herein described. The I~ielnt egrem to. ~ ~ dt Jl~Ndlalble lew.~. oKI n,n., bulldtn, code, hou.lng cocle, and regulations, .nd to edmit .uthorlzed inspectors .on pteml..nd in bulldingl )n~ .7=~// (si0..ture of ,~..~/e .,~n?. ~, corBt~on! ~ ~ ther ~ owner, lemee, ~gent, architect, engineer, general contrector, electrician, plumber or builder. f / / If lelgl~nt ,, .~ ~~1:6~ .re of. duly ,~lh.oriz~ officer. Buil~Jd'r's Licenqy No .......................................................... P ~mber's License No ......................................................... Electrician's License No ..................................................... Other Trode's License No ................................................... 1. Location of land on which .... .' cnj~aose9 wor~4~ms-9~ao~ Map nl~ ................. ~..~..Lpt NO ......................... Street and Number .........~.../..~ te Municipality 2. State existing u~e and occupancy of nded u~e and occupancy of propmed construction: a. Existing use and occupancy ...... /,~..,c~......:...,. ........................... ~ ................................. ,, .......................... b. Intended use and occupancy .. ..~...~._..~.~...~ --~:"--~ .......... ../f,~./.¢C..~..~...~..'~/~..,~ .......................... ,'~ 3. Nature of work'~(check~ which apohcable).' · New Budding' · ..... ...~.............~ Add,t,on' ' ..................... Alterat~on'~ ............... '~ Repair Removal ........................ [ Demolition ........................ Other Work .................................. ......................... (Description) 0o / ................................................................................................. 4. Estimated .......... ~ ................................... (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 ........ ~ ............................................................................................................................ nature,.Jl3d extent of each' o~ use '"'7' ............. ' ......... 6. .If business, commercial or mixed occuoency, specify ~ 7. Dimensions of existing structu~j~'a~nY: Front .........~ ..... Rear ......... ~'""7---- - epth ................................... Height ......................................... Number of Stories ..... ;.....~a~C.....,~: ...... ~:.L..-7 ........ ~ ...................... Dimensions of same ~r~teture with alter, ations or eddy'Front .......................... Rear ...... 7 ...................... no~,k ~ ................ He,aht ..... ~, ................ NU~ml:~e~ef Stor es ...~:......:....../.~...:./. .......... 8. ~i'~n;'~i~;'~'~'~'~i~'~'~c~truction:-Front ...~....~LC~.....~/· ....... ,. Rea~ ....~:~.~.......~ ~'~' · ......... Depth ..~...~?~.....~...~..~... ........... · .... ~. ...........Number of Stories ...... ~...~. ..................................................................... Height ................. ~-= ! ,...^ ~ ~ ....... 9. Size of lot: Front ........./~/"~:~'"/' ................ Rear .......... /.~..~. .......... 7' Depth ~.....~.. ......................................... 10. Date of Purchase .................................. Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated .......................................... ~/~ ............................................ 12. Does proposed construction ~io~late any zoning..law, ordinance or regulation: .~.~..=; .......................... .~ ................ Will lot be regraded ........ · .~'.~..~. .............. WilLexcess fJJLbe removedL.~_~_~__ _, _ ~/~,~.from premises> [ ] Ye~,~ ~J~.o _ 13. Name of Owner of premises ..........~.~:.~.4~.q .~..~.~.., ...... ~.dl~.~.4~..X~-.'~.~.~./..i~;~.~..~.../.~"~"' '~'" 14. (Address) Name of Architect ............................... ~ ............ : ......................... .......... ....... Name of Contractor ........... ~d~(.d~2..~....,~l~... ~Z'~xc~ _~·,~/~',~/~//~, ~'~'-a'&~// ........ ,. ,C;;...,';: ............ · (Address)'~m'~'/4~'~'~'~'/""~r"~'; ......... .~..a__?~...-i~:i..-..,.lp, none o.~ 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 wheth- er interior or corner lot. STATE OF NEW~..R~.Z~/~ ' /// ) ...~./~ .~.......: ............................................ ~ing duly s~rn, ~ and says that he is the appli~nt above named. H, i, ............................... ; ............................................................. : .................................. .................. (~nt~tor, ~t, ~mte o~, etc. ) . of said owner or owners, and is duly authorized to ~rform or have ~rfor~ t~ ~id work and to make and ~ thi~ppH~tion; ~at all sta~ments contained in this ap~i~tion are true to t~ best of his kno~ a~ ~lief; ~ that the wOrk wil~ ~dorm~,in the ~n~r · ~ . · · JUDITH set forth m the apphcat~on filed t~rRw,th. Not~ g.~ ~. .......... ........................... Z 0 (w~; .T~ST ,.,o-~. >r SCALE-- ~0'- I" /&AF oF- V~,oFF--;'~T¥' ,'-o' ~.ITUA.Tr- ~T F---~ T TO\VN O!~- '~OUTI.IOL. I"~, GLIA, I"~AI,,,IT~E.b 'rid TI4~ LJ.$. L,l~'~r TITL~' IN'S UI~.~,I.4CI~ CO./kNl'~ 'i'0 'ri.Il ~0 b ~- F~ lC. k' VAN TUYL, t'ff. C. LICL-N G~.I~ LAN DATE-~S~ THe sewage disposal and water supply £~ci~ies for this loo~tion have beem Chief of G~ne~al Engineering ~orvicCS API~¥ED AS NOTED ~O~/:Y BUILglNG DEpAP, TMENT AT /,,2 ? ,~ 7 v7" .:/; /