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Home My WebLink About7074-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Towu Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z6..0~.2. ...... Date ............. AUg ...... 9 ...., 19.4. THIS CERTIFIES that the building located at .Nor. th. B&~.e~ .Roml ..... Street Map No. ~ ........ Block No. ~ ...... Lot No..:lg~... ~..o~.h.o.~4...~.e~., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~e.b... ~..., 19~... pursuant to which Building Permit No. ?0.~.. dated ...... F.e.b ......~ ......, 19.~.~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P.r.~?.a?.e...o.?e...f.?m.~.Z..y..d.~.e..1.~..~n.g. ...................................... The certificate is issued to . R.... $~;e.~O~;..(. $ o~t~o~.~ .Ha~e ~..I~)... 0~r~ ........ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval &~.. 8..tg~' .... by .Ii,..Vll]~ ...... UNDERWRITERS CERTIFICATE No. p.e.n.d..~, g ........ (. ~p.l..~'~t;k'%B~e~..~..oy. der.) HOUSE NUMBER .. 3.0~. ........ Street .... .NO~.l;h. ]~l~V$e.~ .~,4 ................ IvORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7074 Z Permission is hereby granted to: /~ ~nu.~o.l,m. ~.~'~ ..~,J~c ..................................... ....... ;:.:.::~yv.....~.e..v:...~.~. ............................................ ~o?thotd to ~.u..~.;L~...~.If....~e,...~Lt~..~j.w.e ;,~lr~g ...................................................................................... l~ $ North ~& tev ito~ ~&p~.rovea b~, ~ .A.~.P..t.~.~.~.). ot premises Iocoted at ....~ .......................... ~ ................................................................. ............................................. ,a~u.'l;.l::~10. ........... ~.,.~,, ............................................................................. pursuant to application doted ........................~.e..~ ........ ~ ................ 19~..~...., and approved by the Building Inspector. Feo ............ ' ' Building Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS aN BUREAU OF ECECTRICITY ~~u~us~ ~,~0,~. Es Jo.. ST,ET..Ew vo~. ~?~$~ ,oo~s THI~ CE~IFIE~ THAT was examined on [] ~d rt. outslde S~,on · ndfound to be in compliance with the requirements of this Board. Lot fiXTURE SWITCHES RXTURES OUT[-gTS i FLUORESCENT RANOES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS mTUU APPUANCE F~D~RS TIMECLOCXS UNIT HEATERS MULll-OUTLET SYS~IM$ DIMMERS SERVICE D~SCONNECT S E R V i C OTHER APPA~TUS: IFu~naoeBsl-1/Shp,l-1/15hp Moto~stl-3/~hp OF CC. COND. 2 F.W, BI'udi 119~ Wave~ly Ave. Holii~L11~pn.Z. FOR BUILDING DEPARTMENT. THIS COPY OF ~CERTIFICA~.~ MUST NOT BE ALTERED IN ANY MANNER. 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. §. Submit Planning Board approval of complel-ed site plan requirements where applicable. B. For existing buildings (prior to April 19.57), Non-conforming uses, or buildings and "pre-existing" land uses: I. 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: 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 Date ............ . .......... New Building................L//'~ Addition ............ .... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........... ..'~...0...~... ....... ~?...~..~.~........-~..~.'~....~..!.~..~.........-~....~..~...~.........EY`~..~.~j..~.!.~!~.......~.~?..?/e~k~ Owner Or Owners Of Property ...... ~ .......:~....Z...~...~.....L.~....N....0...-/.. ............................................................. Subdivision ...................................... --. ......................... Lot No. -- Block No.'~.. .......... House No...~....D-.~... Permit No...~....~...7...Y....~.. Date Of Permit ..~....F...L'.:...~..7..~..Applicant ....~..~.~T...R...~...L...~.. ...... ~.~....N..~..~.?.......~....A~.....~-.7.. Health Dept. Approval ......... , ........ ~.....~,~_~ ......... Lobar Dept. Approval .................... ..~....-...~..: ............. Underwriters Approval ........ ..~...~...N...~...~..~..C~:.. ............... Planning Board Approval ............ ./~...'....~....: ............. Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ......~ ......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ..~. ~ .~ ................................. ,. Sworn to before me this ........... day ........ o, ,y ........................ ~ ........... ~ou~y NOTARY PUBLIC, Stats of New York ~~~ Cemmisslo. Expires March 30, H.D. Reference No. -- APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant~u~4ouo ~o~$ Address ~,~.~0~.~. ~'%4~.o ~,~. 2. Phone Property location ~J5~OE Villag% ~ou~o~ Township ~ou~ Public Water Company name - Lot size: Width~%~ feet Lemgth~feet 5. Subdiv. 6. Section 7. Lot No. 8. Private well 5/~ 9. Public water ~q.~ Distance to main -- (Enter on center plot below) 10. Sewage Disposal System: A, ~gallon septic tank: Precast~ Equivalent Block B~. L~eaching pools: Number ~ Precast'~ Block Special__ If private well fill in blanks below: Tank capacity~ Gals. Pump G.P.M.~ ~ Total well depth~ Depth to G.W. Amount of water in well~o. Test Hole Data Feet %~ 2 6 ~"' 8 ~ ~ 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." d~ ~ ~ ~ Date %-%~ ~ Signe ~'%~ ~ \~ Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date S-15 Revised 4/]/72 o. This o~licoti~ ~e c~pl~ly flll~ in by ~ter PLI~TI~N .~S HERE~Y.~DE to the Buildi~ ~nt for ~e :i~uonce o~ o ~i~ P.~t ~nt to ~e ~ State whe~er o~licont is ~er, I~e, ~enf, ~hit~, ~gin~r, gene~l c~tmctoz, el~trician, plu~r or Name of ~ner of premiss ~ ~ - - Builder's License No ..................................................... Plumber's License No...~.....~.........~....~....~..~..~...~...~...~~(~ Electrician's License No. ~..~...:.~?..~.~. ................... Other Trade's License No ....... ? ....................................... / ., '~T Location of land on which proposed work will be done. Map No.: '-"- . Lot No. "..'~... .. Street and Number .~l~t.~,l.~.~/~,~..~.~.~.~C~ ....................... ~ ........................... .~.W.T.~Q.~,~s.I~.~.., ......... ......... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~v~,~.~..~,d~..T.....~<~,~l.O. ............................................................... ; ........................ b. Intended use and occupancy ...?...~....~.....~../~.t.~..~'.....C~,d.~.l~.t~J~ ................................................................. 3. Nature of work (check which applicable): New Building ~ ......... Addition .................. Alteration ........ ;...: ..... Repair .................. Removal .................Demolition .................... O'[,h~r Work .................................................... · /~ ~u~-- -- ~ (Description) 4. Estimated Cost ...'~..~,.°...°.~ ......................................... i....Fee ... ~..~ ............................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~ ....................... Number of dwelling units on each floor ....~e. ..................... If garage, number of cars ..... ~ ................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions ~f 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 .~...~..o...~ ............ Height ..!.-I...~. ........... Number of Stories ....1~.~..~-~. ...................................................................................................... 9. Size of 10t: Front J..~.~. ............................................... Rear ..I..'~.l..:.~.j ........................... Depth ~'..').9..~....~-...l~:.q.~. ...... 10. Date of Purchase ...~.....G~...~...l.~...C~h .......................... Name of Former Owner .~....IJ~..~..ri~.~.~:~.+..~..~,L.~. .......... 1 1. Zone or use district in which premises are situated ..~.~. ......... .~.. ............................................................................. 12. Does proposed construction viola~te any zoning law, ordinance or regulation: I~d.o ................................................... 13. V~ill lot be regraded ...~...~. ............ ....... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ~....u~.~..fr~d~c-~..~.~, ....... J ...... Address ~l:~ll~:l~. .............Phone No.~..~.~Z.~..'J..4.~... Name of Architect .............................................................. Address ................................ Phon~ No ....................... Name of Contractor ..~t..~.~.v.~. ................................... Address ................................ Phone No. ...................... 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. STATE OF NI-~V Y~K,//,, _~ lc COUN~ OF ...;.~~ ~'~ ....................... ~. ....................................................................... being duly sworn, d~oses and says that he is the applicam (Name of i~ividual signing c~trac~ above name. He is the .~.~[~,..:..~9~..~g.~.~..~ ................................................................... ~ .............................................. (Contractor, 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 ~atements contained in this application are tree t0 the best of his kQowledge and belief; and ~ar t~ work will ~ performed in the manner set fo~h in the aPplic~ion filed ther~ith. Swam to ~fqr~ me this ~_ ~ uo o. ........... : ..................................... ~ - (Signa~re of apphcant) JUDITH T. BOKEN Nota~ Public, State of New York No. 52-0344963 Suffolk Coun~ Commission ~pires March 30, TITLE NUMBER BUILDER'S No. k TITLE NUMBER BUII.DER'S NO. k ~ ~IS ~ I~ A WO~TION OF ONLY TO THE PERSON F~OM THE ~U~I LENDI"G INSTI~TION LlUED HEREON. AND COPIES OF THIS SU~EY MAP NOT B~RING TO THE ASSIGNEES OF ~E LENDING INSTI- ENGINEERS--SURVEYORS ($1e} see.aeSa LOCATED IN '.~A Y"~"/~'C-",/" ,7"C:;..~.,,:,t/ o..~ ~/~-,~-O~H ~"0.. /t~ / ~ I IN. - Chief of Or~oral E~glneeri~$ LUMBER SPANS TO COMPLY WITH STATE .AND LOCAL CODE. ,