The URL can be used to link to this page

Home My WebLink About7510-z· O~,M NO. 4 TOWN OF SOUTHOLD BUII,I~INO DEPART~I~IT Town Clerk'~ Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .. KO~Oa .~0~ ............ Street Map No ....~X ......Block No~ ........ Lot No. lmx..1~ .8'~ff. Qlk .............. conforms substantially to the Application for Building Permit heretofore filed in thi~ office dated ..........~.. 29..., 19..~ pursuant to which Building Permit No. dated ............. &lag..29.., 19.. ~, was issued, and conforms to all of the requ/re- ments of the applicable provisions of the law. The occupancy for which t_hla certificate is issued is ... Privets..o~e. ~e~3~r.~tl~.~l~l ..................................... The cert~icete is issued to...M, tit .$et,~l~r. ll~lilg~ .... .O~e~, ..................... (owner, lessee or t~nan~) o! the a~oresaid building. Su~o~ ¢oun,y Depa~-h,~en~ of Health Approval . .IlOV...2~...¶9~...!~. ~e..V~I,~IS... T. Ti~TDER'Ar~iTE~S CERTIFICATE No...l~e~(L~nl .................................. HOUSE NtTM~ER ...~9~ ........ Stree~ .. l~on~o~. RO&~ .......................... .... ........ Building lnspoctor[ . 1~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7510 Z Permission is hereby granted to: ee.r.,...&l~.ez~..~J,~L~m~....~...~.g.....h.t~z ~ ~o ..~ ..~..~......~.e...~.~...~.~,u .................................................................................... at premises located at ....~./...~....~.~..~.~. .................................................................................... ~lev Suffolk pursuant to application dated .......................... ,~1~ ......... ~ ........ , 19e~...., end approved by the Building Inspector. INACTIONS a. This . .c~plicotion must be completely filled in by typewriter or, in ink and submitted in triplicate to the Bu Idjna inspector, with 3 sete of p~, accu~te plc~ plan to scale. Fee according to schedule,, r ' ''! b. Plot plan showing location, of lot and of buildings on premises, relationship to odjo n ng premises ar public streets or areas, a_~nd giving a detailed description of layout ofpraperty must be drawn an the diagram which ~Kt of this application c. ,ne work covered by this., ,application may not be.~commencad before issuanc~ of Building Ut . d; U.pan app .reval of this applicaflan~ the Building InspectOr Will iSSue a Build ng Perm t to t~licont Such permit snail 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 until a C~rtificote of Oocupancy~_~ shall have been granted by the Building Inspector. ~B .A,P,.PLI _CATIO~ .!S HEREB. Y.N~DE to the Building Department for the issuance of a Build ng~Perndt pursuant to the u,,aln~.' ~or? v.r.a,nance, o, ..me 'r.?n..o.f. Southold, Suffolk .Cour~ty, New York, and .~other applicable Laws, Ordinances or ~u ar?s, ?or me c.ans~ruc~l, on aT. ou~.~a~ng.s! .ac~. t!ans ~c ar. temtians, of for removal or demolition, as he~. in described. u · uuTnunzuo in=pocrars on premises Gna Ir) DUilalngs Tar necessary In~peotlon$. azLn m ZL , mc. (Signature of applicant, or name, if a corporation) 250 Cox Lane', C~utehol~ue (AddreSS of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... B.ui..1.d am ................................................... Name of owner of premises ex...lt E ,i .a ..................................................................................................... If app~rporate, sjgr~ure of duly authorized officer. ............... tT;, ......... Builder's License No ....................... ,~..~....-...~*.v ........... Electrician's License No ...... ~.....c~.~. ............... Other Tmde's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ......................... t No.- ........ , ............... Street and Number . liextl:o.e. ~¢ta~:le ~e.~..J~L,f,~.~,> ~ . .. ' ....................... MLmleipall~ State exi~i~ u~ and ~cu~ncy of pmmi~ a~ intend~ use and ~cu~ncy of p~dr ~mctl~: o ~stn u, a~ ~cu ~~ b. Intended use and occupancy ........ dzet~ug ..................................................................................................... 3. Nature of work (check which applicable): New Building. X Addition Alteration Repair .................. Removal .................. Demolition. .................... Other Work ..................................................... ~ (Description) 4. Estimated Cost ........................ ..~ ................................ Fee ....~.......o~.. ........................................................................... (to be paid on filing this application) .5. If dwelling, number of dwelling units ..... eae~ ............... 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 ..... ~(~ ........................... Rear ...~JJ). .................... Depth ........................ Height ...],.(~. ............ Number of Stories ...one ............................................................................................................ 9. Size of lot: Front ...9§o'0 ........................................... Rear ....9.,~.o.0 ............................. Depth ...1B.7..o.32 ............... 10[ Date of Purchqse ........................................................ Nome 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: ..~ ................................................ 13. Will lot be regraded ....Ne. .................. Will excess fill be removed from premises: ( ) Yes (ac) No 14. Name of Owner of premises ~,d~e,~...~&~,l~[~.l~ .................. Addres~e,~..~,e~. ......... Phone No. ...................... Name of Architect .............................................................. Address ................................ =Phone No ....................... Name of Contractor .Oe.az'~e..AJl.~e~.e..JJlde~.t...~,l~et. Address .C~t~l~Jl. lt~,tle .......... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck 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 ATTACHED .......... STATE OF NEW YORK IS S COUNTY OF ...~.ls,;~.~e,l,k ...........~' · ............ ..~.~.~JL~....~.JJ.~.JJ~'.lle...~.~'.~[IJ.JtlJ~ .......................... being duly sworn, deposes and says float he is the applicant (Nome of individual signing ¢or~rl:l~ , , above named. He is the ....... J~e~l,t.~&~.t~ .................................................................................................................................................. (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 that the work will be performed in the manner set forth in the OPplicofi~n filed therewith. .S..w..°...m...t..°~ dmaey t: ;s ..~~....., 19....?.~. ............ .....~ .,~.~, .~...~ Notary Public, ............... [....~.~3'.-.-.-.-.-.-.-.-~'~.~.~ ........ County ...... ..'~...'d~5.....~... ~...~t ................................. ~ ~. ~ (SFghoture of applicant) ~'~--'- ~' --' JUDITH T. BOKEN Notary Public, State of New York/ No. 52-0344963 S~ffc{k Coun.~, Commission Expires March 30, 19J~ FORM NO. 6 TOWN OF SOUTHOLD Building Depoffment 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 disposol--(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), Nomconforming 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 formation required to prepare o 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 New Building ..... ~ ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property N~..~. S~folk~ Kouros Rd~ Owner Or Owners Of Property ..Es.t,h~r..~ax. kJ..tlZ .................................................................................... Subdivision ...................... .~ .................................... Lot No ........~..... Block No ............. I-louse No ............. Permit No..?...5..]:..0..Z. ........ Date Of Permit .8./..~.7.../..7...4....Applicant .G..e...o..r...g..e.....A..h..l.e...r..s.....B...l...d..e...r..;..I.~c.~ ......... Health Dept. Approval ~c~.0..-..~.2.Z...~./.2.~..,~].~. ........ Labor Dept. Approval ................f~....~...~..] ................... Underwriters Approval .... ../~....~.-...~...~..(..~'~.....~. ................... Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate X Fee Submitted $ ...~...... .......................... Construction on above described building and permit meets all applicable codes and regulati,~o.n~ ~ Applicant ...,....~.~IO~...~ ............ "'~'"'~~'r" Sworn to before me this Notary Public ........~.... County (stamp or seal) ,x~ _ .~, SUFFOLK COUNTY DEPARTMENT. OF HEALTH SERVICES HealthReferenceServiceSNumber APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicanll~m~',e AIm).emm Bl~ez. Phone?34-$010 Address 2 ex .~ lie e~e 2. Property Location #ew ~Bt~fel#LKeemem ~ Vi 11 age mew Be~=ell= Townsh i p ~e~i~eie 3. Public Water Company Name 4. Lot size: Width~,O feet Length~,$2feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: (For Health Services Dept. Use) A. 900-gallon septic tank: Precast X Equivalent Block B. Leaching pools: Number of pools Precast ~ Block Special 11. If private well, fill in the fol- lowing blanks: A. Tank capacity· B. Pump G.P.M. ~1311 .gallons C. Total well depth D. Depth to ground water E. Amount of water in well r 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. Date A~mmi 2~. 1~74 Signed 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 / /i.?/· ~? SIGNED ~ / ~ S-15 Rev. 4/1/73 ~. oyes ~_~.. ~. ~. ~ ¢ $o The sewage disposal and water supply facilities for this location have been lnsDoctcd by thls depa~tmen% and found, Lo be sat ~.n~ozy.__-, ~ __ ;Lz3~.e ( v~c~rr ) 9ta. O 4 'SG T. '~T TO THE NEW YORK BOARD OF FIRE ~UNDERWRITERS BUREAU OF ELECTRICITY. 8E JOHN STREET, NEW YORK, NEW YORK 10038 · o.,e~,ce=.r 5. 197~ ~,,.,,,c.,o,.No.o./,. 7603i?. N 197473 THIS CE~IFIES THAT ~s~e~ ~ ~o~o~ ~.~ ~0~ e/o ~wo~d ~.~ inthefollowingl~ation; ~ B~ement ~ lstFI. ~ 2nd Fl. 0~ S~tion Bl~k ~t w~ exami~ on D~ ~ ~D ~P ~ ~ ~ ~ ~ ~ a~ found to b~ in ~mplla~e with the requirements of this B~. FIXTURE ~XTURE$ ~ OVENS EXHAUST FANS OUTLETS SWITCHES 15 ~1 20 15 DRYERS FURNACE MOTORS TIME CLOCKS UNIT HEATERS MULTI-OUTI-IrT DIMMERS SYSTEMS NO, OF FEET SERVICE S E R V I C OTHER A(~ARATU~: OF CC. COND. Of HI-LEG OF NEUTRAL mPurnaees! O11 1-1/Shp, 1-1/12bp Motor/s: Panelboa~d/s: 1-12cir. 125amps. RRflR 227 East B~eakwate~ Rd. MattituekR L.I. 11952 Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MuST NOT BE ALTERED IN ANY MANNER. r APPI~¥ED 'AS ,.NOTED NOTIFY BUILDING DEPARTMENT AT 7es.2~eo ~^M TO 4~,MI ~OR REQUm. ~. BEFORE COVERING ~IPELIN~ 3. FINAL WHEN ~O~ COMPLETE~ NOT RESPONSIBLE FOR"~DES]~N OR CON- ,r j 4L ·