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Home My WebLink About7467-zTOWN OF SOUTHOLD B~u~.~ING DEPART~f~T Town Clerk's Offlce $outhold, N. Y. Certificate Of Occupancy ~o..~.~,,..?~, 0 Date ...............Sept.. ~-IIS CF~?ITIES ~at ~e b~d~g l~a~ at .. Jt!/~. ~.~Qr~..~ ........ Map No..x~ ........ Bilk No. ~ ....... ~t No.. ~ .... East. ~:ari~ ........... confo~ su~y ~ ~e AppHcaUon for B~ Pe~t hero,fore ~ ~ thl, o~ce dated ..............Au~. · 9., 19..~ p~u~t ~ w~& B~g Pe~t No..~67Z.. dat~ ............ ~Pg...9 .... , 19.7~., w~ ~u~, ~d ~o~ men~ of ~e applicable pm~io~ of ~e ~w. ~e ~u~ ~ .Fr$~a~e..~ne. ~.~mlZy..dveZ1~ng ....................................... ~e ce~ffica~ ~ ~u~ ~ . ~li~be~h .AI~ .6. ~ane. C~mbera ...... O~e~s .... (o~, 1~ or ~n~t) of ~e ~o~s~d b~ld~g. S~o~ Co~ty Dep~ment of He~ Ap~ov~ ~e. 2~. ~ 9~. bY..~ ,. Y~lla ........ U~ER~ERS CERT~ICA~ No..~ ~... ~. ~..~9~ ................... HOUSE ~ER ...... 39.55... S~t ...... St~r~. R~& .. E....~r~n. N.~ ...... ............ FORM 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? 7~67 Z Permission is hereby granted to: ffJA~ahe ~..,S~,.l,~..~..,T~,~L~b ~r. B ..... .............. ~.~Z.,,.....1.O02~. ...................................... at premises located at t~/.{~..~IJ;~,I~...TIQ~I~ .......................................................................................... .................................... , ................ ~.;..~.....~.r~.~. ................................................................................... pursuant to application dated ............................. Jkl~g ....... ~. ......... , 19.~..br..., and approved by the Building In~'tor. Fee $..15,.0.0 ........... ~ ~ Budd:ng Inspector Tow. o~ ~T.O~ "/~h~ C~4/~ -~/t0. ~ ...... ........ ................. ................ ~.:~.. .......... ~, ......... _~ ............ .~....~..- ~ , :....~--~ ~ ~ ~,~,~/ ,~ . ~ :~.~l ............ ~/ ....... : .......... ~ ~.~ ~,~ 7~ ~ INSTRU~IONS ~ ~. Thi~ oPplicotion mu~ be completely fill~ in by ~ewriter o~.in i~ end s~miff~ in triPlicote to ~e Buildi~ Inspirer, with 3 ~ of pl=ns, occumte pl~ plon ~ ~=le. F~ occo~ng to ~h~u)~. b. Plot pl=n showing I~otion of lot =nd of buildings on premises, relotionship to ~joining premiss or public str~ o~ orees, end giving o detoil~ d~cription of I~ ofpr~e~ must be drown on the di=grom which is ~ of this opplicotion. c. The work c~ered by this o~lic=tion moy n~ be comme~ before issuonce of Building Permit. d. Upon =pprovol of ~is =~licotion, ~e Building Inspirer will issue ~ Building Permit to the opplic=nt. Such permit shell ~ k~t on the premises o~il~ble for insp~ti~ ~gh~t the work. ~ e. No building shell be ~cupi~ or u~ in whole or in Pa~ for ony pu~e whoever until o Ce~ificote of ~cupo~y~ shell h=ve been granted by the Building Inspirer. APPLICATION IS HEREBY ~DE to the Building Department for ~e issuonce of o Buildi~ Pe~it pumu=nt ~ th~ Building Zone Ordinonce of the Town of ~thol~, Suffolk County, New York, end ~her oppli?ble ~s, ~rdinonces or~ Regulotions, for the constru~ion of buildings, =dd~ti~s or oltemtions, or for mm~ol or de~hti~, os hemm de~ri~.~ The opplicent =grees to comply with ~11 ~pplicoble I~s, ordinances, building c~e, h~i~ c~e, o~ ~ulotl~s, end ~ edmit =uthorized in~ecto~ on premiss ~d in ~lldl~ for n~esse~ ~tions. ~ ....... ~ ~G ~S ~ ~Srg~e of applicant, or ~e, if a~mtion~ ............. [ [ ~ ~ ~ ~ ~ (Ad--of appli~t) ~ State whether applicant is ~ner, lessee, agent, a~hitect, engineer, general c~troctor, electrician, plumber or builder, ~e~ Name of owner of premises ~Z~sbe~h AZZe= ~ ~a~e C~mbe~s If applicant is o corporate, signature of duly authorized officer. · (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Locotion of land on which proposed work will be done. Map No.: ........ ~ .............. 1 ......... Lot No. ~ ................. Street and Number ..... .11~/.~..~.~,%..~.~,fll,~..~a~l~..~a~'.~,~.....~.t.~.~ ............................................................... Municipality State existing use and occupancy of premises and intended use end occupancy of proposed construction: a. Exisiting use and occupancy ...a..c...c..e...s..s...o..~.~....b...u:.~.l...cl:~..~.[ ................................................................................. b, . Intendeduse and occupancy ....~..q.~. bl.4.g ...m. oved to n.e.w location ~ conversion to one family dwelling 3. Nature of work (check which applicable): New Building.. ................. Addition .................. ation .~ ..... Repair .................. Removal .................. Demolition. .................... Other Work ~.~.~..O.g.l~.~...O~ ....................... . .... (Description) 4. Estimated Cost ............... -~.,.(~).~...~ ........................... Fee ...~.?...0~)... ........................................ i .................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... .~,lll .......... 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 t3/pe of use ............................ 7. Dimensions of existing structures, if any: Front ...........20 ............ Rear .~ .......................... Depth ...2.~. ............. 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 ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ......... ~,.t~ ........................................ Rear ........ ~.L~ ........................... Depth ....... .1.()~. ................. 10. Date of Purchase ............~.~.~ .................................. Name of Former Owner .....?..:....~.~.~1..~...~;~ ......................... 11. Zone or use district Jn which premises are situated ..~!.~."....~-.{~. ................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~¢l ............................................ 13. Will lot be regraded ..~r~.l ................... Will excess fill be removed from premises: ( ) Yes ( 30 No 1'4. Nome of Owner of premises .l~..A.~Ze~,..~,..~T.,...l~i;la~be~kddress ....~......~......C.... ............... Phone No. ...................... Name of Architect .............................................................. Address ................................ ,Phone No ....................... Nome of Contractor ~.~.~.~:.~....(..~..l;;..t,........]~..O...l~.~.....~..~).,Y...@:~'lJdress .....Y'-~....~.~..:]...~..~.~..~.. ....... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings whether existing or proposed, and indicate a set-bock dimensions f: p.rop.erty lines. Give street and block number or des~ ription according to deed, and show street names and nd ¢ wnether interior or corner mt. ~.~ J~l-'~ -- t ~ 'Z~>~ ~/E - I STATE OF NEW ~ORK, ! ¢ ~ COUNTY OF ..... 11.~;[':~ ],~; .......... ................ ,~..~'he.'~.~:L. JL~"le.~.'..,.~.[~ ............................... being duly sworn, deposes and says that he is the applicant (Name of individual signing centracf) above named. He is the .......................... ]~.~.~....q~3.e.3~ ............................................................................................................................... (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 ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this 19. ........ , ......... .?.... day of ................ ............. , ....... Notary Public, . ................................................... County~~~~' ................... .,. r ~ (Signature Of applicant) NO. 4 TOWN OF SOUTHOLD BI~.BING DEPARTMENT Town Clerk's Office Southold, N. Y. te~pora _fy Certificnte Of Occupnncy No. ~,6~.~.8 ...... Date .............. $'U,12.... 2. ...., 19.?~. THIS CERTIFIES that the building located at .~/~..Jt&r.~ .~toa6 .......... Street Map No. ~-.,. ~ ........ Block No... :~; ..... ~t No..xx .... u~s.~ .L~q~...~,~ ...... co~o~s subst~ti&ly to the Application for B~l~g Permit heretofore fried ~ t~ office dated ............. .A~...~., 19. ~ p~su~t to wMch B~ldMg Pe~t No. dated .......... ~ .... .~ ..., 19 7.~., was issued, ~d confoms to ~ of ~e r~e ments of ~e applicable pro~sio~ of the law. The occup~cy for which issued ~ . ~ri~e. o~e. ~.~ ~y..dwe ~.~n~ .~. k~ce ~.~ry. ~ ~.~ ............. The ce~ificate is issued ~ . E~ab.~th. ~en..~. J~e .~h~.~r ~ ........ ~er.~ ... (owner, lessee or ~n~t) of ~e ~ores&d b~dMg. S~o~ Co~ty Dep~ment of He~ Approv~ .... J~ .. 2~... 197.~ .. by..~,. Yllla UNDERWRITERS CERTIFICA~ No. H21223.~. ~r.. ~ · 29~.% ................ HOUSE ~ER ...... 39~... S~eet...5~. ~.'o.~d.. ~ast.~ ~io~...~ ........ SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department ~/~ Reference Number --~0 APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant ~.t'-2. rtl~-l'W ~, ~ Phon~f~,~4~q~ 5. Subdiv. Address ~ .~CJ.~ ~ ~~q-~Q/ 6. Section Property Locat~oh ~ ~ ~ ' 7. Lot Number 8. Private Well 9. Public Water Village ~. ~A~r~,o~ 3. Public Water Company Name 4. Lot size: Width~j feet 10. Sewage Disposal System: Township Distance to main Length j~.~ feet (For Health Dept. Use) ll. A. 900-gallon septic tank: Precast_~quivalent Block B. Leaching pools: Number of pools / Precast /Block Special If private well, fill in the following blanks: A. Tank capacity_~allons B. Pump G.P.M. ~ C. Total well depth ~ D. Depth to ground water E. Amount of. water in well~. ~, ~ The undersigned CERTIFIES: "Constcuctionof-a~'horized installations will be in accordance with the Suffolk County Department:of Heal t~'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. 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 and Water Supply can be installed on this plot. APPROVAL DATE <:~ /?~ J/~/ SIGNED S-15 Rev. 4/1/73 FORM ~O. 6 TOWN O~ ~O~TNOLD 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: 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 ~ J · ~ Date ~ ,/~'~'"'""c~""~" ...... ./...?. s'~ew Building .....¥.........~:T~. dditic~n .............. Old or Pr-existing Building ....~.. V~c_ant Land, .............. .......... Subdivision ......... ~...., ,~,,,, ................................. Lot No. ~.Vlock No.~. ........... House No...~....~... .... Permit No..~/.~,Z...~.... Date Of Permit .....~"..~,~-..~Z~pplican, ..., ,~....~ Health Dept. Approval ............................................ Labor Dept. Approval .......... .......................... Sworn to before m 's ...... day of Nota Public County Fee Submitted $ .................................... Construction on above described buildin%g ~a~ets ?,~/~cab]e/~,/~ ~t ions. (stamp or seal)~r~ ,~-~.~'z/~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ nr 85 JOHN STREET. NEW YORK, NEW YORK 10038 .o,e March 6, 1975 ~..,i~.tio.,.o.o.f,e 763163 N 212231 J~e ~ambers, w/s Stars Rd. 1/2~. No. of Main Rd., East Marion, L.I ~s exa.tlt, ed on March 3, 1975 and found to be in compliance with the requiretnents of this Board. ~XTURE L~EPTACLES] SWITCHES FIXTURES ~ ~ [ RANGES COOKING DECKS OVENS ]DISH WASHERS ] EXHAUST FANS TIME CLOCKS ~ ~ELL I~UNiT HEAT~RS ] MULTI-OUTLET DIMMERS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SeEClALREC'PT~ I I : I j I ~k ~. Sgepnosk5 ' g2C Little Neck Rd. Cutchogue, L.I. 11935 SC}{D TO WHOM IT at SUFFOLK COUNTY MAY CONCERN: The sewage disposal facilities ~rner of Stars Road~ East Marion Southold Tow~ (Give deed location) DEPARTMENT OF HEALTH Date,, June 25~,1975 Bldg. Permit No. . Health BepartmentReference Number for a structure located have b~en inspected by this department and found to be satisfactory. TOWN OF SOUTHOLD 0 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 farm 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: 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 B~lilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~ .~'5--'">~' ..G, TAT?.5 1E'0,~.b ~ O'i'~ ~W'.5 CEJb~r~ ~b~ ~-'~? {"IA~0~ Owner Or Owners Of Property ....~.~.....~...~....L...~...!.~. ....... ..~..4..:.~..~...~...~....~....E;..~..~...~... ............................................. Subdivision ................................................................ Lot No ............. Block No ............. House No...~.........'5 _.~ /lu~ ~) ~)~,~Z /' /~L~F-~/- . Permit No. H~olt~ D~pt. Approval ~:...~....~... ~ ,C...~...Labo,-- ~pt. Approval ~...~.....%.....~.......: .............. P~onn~ng Bo*rd ~p~,a~ ......... ~.~ ................... Underwriters ApproYal Request For Temporory Certificote ........................................-- Final Certificote ~ee S~mit.d $ .......... ~..~ .......... Applicant ....... ~~~._,_;._~ ..................... Sworn to before me this ..... ~. ....... aay or ...~...,~ ...... .~.....~..../.. ....... (stamp or - Notar7 Public