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Home My WebLink About7100-zNO. ~ TOWN OF SOUTHOLD. BUff.r)ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~--~15 ~ Date t~ /~? '7'/ THIS CF_~TIFIES that the bui]dlng located at ~0 $ _C~D'[ l~a,~'a 'Fo~j> Street Map No. t~ V/) ~ Block No. .Lot No. I conforms substantially to the Application for Building Permit heretofore filed in this office 7?' 7 dated ......................, ~a .... pursuant to which Building Permit No ......... dated 19./.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which i~ued i~ ,fl, O~,l t.- F ll ~ ~ L ¥ The certificate is i,~ued to ~o'I~G£ (owner, lessee or tenant) of the aforesaid building. S " .-. . , o /~/? , , unolk t;ounty Deparm~ent of Health Approval ....... ..) .............. ,, ........... UNDERWRITF&S CERTIFICATE No ............................................. HOUSE NLS/BER 3 t~ ~ Street -~ Building T~mpeetor TOWN O~ SOUTHO£D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT ('rillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7100 Z Permission is hereby granted to: at premises located at ....~.~..~...~J.~.....~t,~..~D~e.8 ................................................................... ...... '. K~.~..~.~ae.b... ~ad. ........... llraenp~+- ......... ~,.v..,, ........................................... pursuant to application dated ....................... ~.~.a..P.~.. ....... ~ .......... , 19...~..., and approved by the Building Inspector. .. Fee $ ...be,,?...,.~, ~. ......... .................... I~ii~Ji~"¥ ' spector / TOWN OF SOUTHOLD ~ ~ SF, L~ O-~- ~. ,~]a., ,, ~ -- ~ IUI~IN~ DEPARTMENT ~ ~ ~ ~ o~ ~ ~ ~ ................................. ~ph~ot~, No. Z..L%.% .............. ', ~ 2~ ?/0¢ ~ ~prov~ ............................. ~ ......... , l~...,..¢, ~ermit No ..................................... ............................... .......... 7 ~..z.....~ ........... ~ ~ ~ ~te ......... I..~.J.~ ........................ ]¢.~ ....... o. Thi~ a~lic~tion mint b~ compl~l~ fill~ in b~ ~*~rit~r o~ in i~ o~ ~mi~ in ~ripli~t~ ~ ~ Ink,tar, with 3 ~ o¢ pl~i ~cUm~ p~ plan ~ ~ale. F~ acco~i~ ~ ~h~ule7 b. Plot plan showing location of lot and of buildings on premises, relationship to ~joiniDg premiss or public streets or areas, and givi~ a detail~ de~ription of I~o~ ofpr~ must be drown on the dJag~m which is ~ of this applicati~. c,. ~e w~k c~ered by this a~l~ation may n~ be commenc~ before issuance of Build~ Permit. 8. Upon approval of this applieation, the Building Ins~tor will issue a Building Permit to the applicant. Such permit shall be kept on the premis~ ~ail~le for inaction thmugh~t t~ ~rk. e. No building shall ~ ~cupi~ or u~ in whole or in pa~ for any pu~ose whoever until a Ce~ificate of ~cupancy shall have been gmnt~ ~ the Building Ink,tar. APPLICATION IS HEREBY ~DE to the Building Depa~ment for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the T~n of ~uthold, Suffolk County, New York, and other applicable ~, Ordinances or Regulations, for the co~tm~ion of buildings, a~lti~s or altemti~s, or for m~al or demoliti~, as heroin de~ri~. ~e applicant agrees to comply with all applicable laws, ordinance, building c~e, ho~i~ c~e, a~ ~ulations, a~ to admit authoriz~ inspectom ~ promises a~ in bulldl~ ~r ~e~ i~ti~s_. ~,~,- .................... ~ e ~.=~.~....~ ............... ~,~ ~=~.~ .................... (Signature of ~pplicant, or ~me, if a co~mtion) (A~re~ of apphcant) ~ }~ ~ ~ State whether applicant is ~ner, les~e, agent, a~hitect, engineer, general contractor, electrician, plumber or builder. ....................................... ............................................................................................................................... ~ o, o~ o, ~ ......... G~.~x.a~.......~.~.L.~.~..~.~ ................................................................................... If applicant is a corporate, signature of duly authorized bfficer. D q~lame and title of corporate officer) Builder's License No...~ ................................................ Plumber's License No ........ .~....~....~.....~. ........................ Electrician's License No ..... ..~'....~,..O...,,~,~. ................ ....~....~ ~ 0'~ ~f/~"~ Other Trade's License No ........, ...................................... I~ I-/ 7 0? . ' 1. Location of land on which proposed work w be done. Map No.: .,..~.,~...~.~..~..~.'ItL(~...~..O....~o~ No ..... .( .~ Street and Number .... .~.~i~.~,.~.....~, ............. ..~.~.~.~..t~.~.Y..-~.......~r...~ .......................... i....i..;..ii..iiiiiii:;ii Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construc~on: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ......... ...~.. J¢~ L .....~.. ~ ~ ..~..~ .....~..~ .~.~.~. ~,.~. ................................................ 3. Nature of work (check which applicable): New Building .... ~ .........Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . ..... (Description) 4. Estimated Cost ..... ~/...~..,,~-T., ......................... Fee .....~.....~.~..~ .................................................................. (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 .........~.~.,A.~. ................................................................................................................. i ..... 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 af Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ......~ .................. Height ............................ Number of Stories ................................ 8. Dimensions of entire new conStruction: Front...........~1~'~'............. ....... ..... Rear .....C~....%...~. ............... Depth ....~-.~...'. ........... Height ....~,,..~.~ ....... Number of Stories'. ...... .~....~...~,~..~.'..~...~. ....................................................................................... 9. Size of lot: Front ......... .~]..~..,'. .................................... Rear ..... [.J.'~.~...~.~....~ .................. Depth ............ 10., Date of Purchase ....... ~'i...~,~.'1.~ ......................... Name of Former Owner ....~..'~...e,.¥...e..~.......~.9..~...~.~.~...~.~. ...... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ......~ .................... ~'> Wdl' excess fill be removed from premises:' (~-) Y_es_ ( ) No 14. Name of Owner of premises .....~.~-.~1..~.~.....~1~...~..~ ....... Address ~.~.~'~.~;.~..S..~...~..:..~.' ~lc~ No ....................... Name of Architect ....... ~,~)..~,~.~).~,.v~....~.~.....~..!....~.~.-- -- .......... Address ....1~.¢.~.~ !.ll.l~[.C. ...... Phone No ....................... Name of Contractor .~.~....u~..~..~..~.~.....-...~..~..'~.....~t..~x~,... Address ..~.~..~.¢.~! !.¢~%...~..~ ..... N o. Phone 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 comer lot. STATE OF NEW)~'OP-/(/',.,// I(t COUNTY Of ~....~~'~ ............................................................................................. i...being duly sworn, deposes and says that he is the opplicam (Name of individual signing controcf) above named. /,-~.~), ~ He is the ................................ ~....~,,~..~.=.... .............................................................................................................. (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 contoined in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swam ~,,~re me this - ........ ........ ............... ~'" - SUDTTH T. BOKEN ~ (Signature o applicant) N~tar/ Public, Stale of New Y~r~ Sulfotk C~un~ ~ No. 52-034496:3 March 30, lgr~_~, Commission Expires FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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 completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: l. 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. Certificote of occupancy on pre-existing dwelling or Iond use $5.00 3. Copy of certificate of occupancy $1.00 ...... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location O~ Property ............................................................................ ./. ...................................................... Owner Or Owners Of Property ~ E O 3~ G ~F M 0 I.-. E- 0 A ~.~ Subdivision ..~..?..~-..,'~'..L;.!.N....~.......!.4....6..~?..~:'~..~... .............. LotNo. ............ j/'~ BlockNo. --HouseNo'-~O'b~......... .... Permit No......-~.....J...~...0..... Date Of Permit ....J./..../..~...App ca t -/"/z'- ~ {> -~-~.T .~ cf 3 Ii n .................................................................. /0 ~ Health Dept. Approval~ ..~.~....../. ....... Y.~..'~.....:.~..~..Labor Dept. Approval .............. ...~'...~../.~......: .................. y / ?,3 // Underwriters Approval ..:....z.:.. ................................. Planning Board Approval ............. ~ ........................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ -~ ~ Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this )O/~Z~/ ................ day of ..... ~1 .~ ..~.~......~...~..~...~/ (stamp or seal)~ ~ ~/~-~ Not Public ..~..~~ County ~uv~ R.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 4. 10. 1. Applicant ~,~,r_~ .~[~,~% Phone 5. Subdiv. Address ~-l~] ~q~T. L~, ~1 ~ ~;W. 6. Section 2. Property location ~5 %~mc~% ~. Z~' ~/m ~ ~m~ ~%~ ~u~. 8. Private well Village ~m~,~m~,~{~ N.~,Township ~o~%~Ak 9. Public water Public w~ter C%mp~ny ~ame C~%w~o~. Distance to main Lot size: Width %~ feet Leng%h{~'~;~ feet (Enter on center plot below) Sewage Dispos~ystem: ~ A. /90~ gallon septic tank: Precastl,"Equivalent Block B. ~aching pools: Number~_Preca~-~Block Special__ Street B ~ ~,~.~ ~. If private well fill in blanks below: Tan~ap~ty Gals. Pum~"G ~ .M. Total w~depth Amount of water in well '~' Test Role Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned ]ERTIFIES: "Cons ruction of authorized be in accordance with the Suffolk County Department of Health's current ards thereto." Date Signed -~ ~ ~ ~ Ct~-t~0 ~- . ~ or Builder~ installations will stand- 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 ~/~ Signed ~ ~-- __ ~ S-15 Revised 4/1/72 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTFUC;ITY 8S JOHN STREET, NEW YORK, NEW YORK l, 197, 7231"r N 174323 THIS CERTIFIES THAT only t~e electrical equipment as deserlbed ~ ~nd ~ntrodueed by the aj~l_ '~e~ narn~ o~.~he ~ app~eatio~ number in the prem/se# o.f George HoleYae, e/side Beach Rd.,-225' a/o manhasaeC Ave., Oreenpor't ~ L. T. irt thefollot~inglocation; ]1 #o~,~,t [] Z,t F~. [] 2,d Fi. outslde s~tlo, e~h ~ot .,~ ..~,.i.~d o. July 29. 197 ~ o~d fo..d to be i. compliance with th~ requirern.ntz of this Board. DRY~RS FURNACE MOTORS SERVICE DISCONNECT [ HO. OF 1 150 CB OTHER APPARATUS: fiXTURES fUTURE AF~UAHCE FEEDERS $ S~ECIAL REC'PT R , ]GOOICIHO DECKS OVENS DI,~.I WASI~RS TIM~ CLOCKS I BElL ~UNiT HEATERS MULTI-OUTleT T"NS'I"'""I"'"' V I C EXHAUST FANS AMT. H.P. - 2/0 1 OF NEUTRAL 2/0 *Purnaces: 021 1-1/Shp, 2-1/15bp Cam~abus Electric, Route ll2,Box 2q2, Corem, L.Z. 11727 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. T/t'I¢ 14~. IZ#Z.t'7~' /Y/AP OF Pi~OP£1~TY ~E. OR. GE /-IAL, EVA,S ",5TEI~Lll4¢ N0111£5" SUI~OX~ O0UI~ HEALTH DEPARTN~I~ The sewage dlspesal and water supply ,f.~cilit~es for this location have een ~ ed by this department and~ Ch~~ En.ine Services 't APP~,OVED AS NO~ED FE~:/'/'7, ~Y ~, ' NOT FY BUILDING DEPARTt~NT 765-2660 9AM Tq.~,Pht FOR ',~QbJR- ED INSPECTION ;" ;,,' 3, HNAL WHEN q ERRORS -~:)-' A h'