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Home My WebLink About7113-zNO, 4 TOWN OF $OUTHOLD BUILr~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. ?,~199~ ...... Date ................. .Jp,~y....8..., 19..~. THIS CERTIFIES that the building located at . R~0 ,~/.o..$/~..I~d$.&~. ~.e.k Street Map No. xx ..........Block No. ~.x ....... Lot No.. xxx.. P. eeo~ale... I~oY, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ 14al, .... 7' ', 19.7~+- pursuant to which Building Permit No.. dated ...........]~ar...8 .... , 197~..., 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&vate..olde..f-a~tZy. clvo~lLng...¢appr, ovod..by. M. ~,ppe&la~. 1. f~oo~ olx~y The certificate is issued to . .~una .~/®l*bel' ..... 0~F .............................. of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) · zu~....~ .... ~.~'p, ................ UNDERWRITERS CERTIFICATE No...pen~_~,g .................................. HOUSE NUMBER ..... ~0.90 .... Street .. Indt. ar~ 3l®ek .Lar~ .................... Building Inspector( FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7113 Z Date ...................... .~,~,~.~ h ....... J~ ............ , 19.~.~... Permission is hereby granted to: Feu~er e...~Le~es.....~/~ .. Z~me..:~'e~b.e~ ...... Southold ........ 9...~r~.L ~.~r...~Z). .......................................................................................................... at premises located at .R~0.~.,.....R/.~....II:~l.:~SJ:~..~eClr..T.al~e ..................................................... .......................................... ~.~c o.~:l..c ....... li.,,~.,. .................................................................................... pursuant to application dated ......................... 1-~'J ....... ~ ........ , 19..~.~.., and approved by the Building Inspector.~JOTJ~l need additLonal permit to fLu~,sb sec~ud fflool' Fee $..~..s~.O. .......... ............ .............. 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: ]. 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), 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 Building ...... Addition ................ Old or Pre-existing Building ................ Vocant Land .............. Location Of Property ..................... ~-.~.[~,.[~....~.. ........ 4=':/~.~.~,...'~-~.......,.4 .................... ..~.......~....~/....:./. ..... Owner Or Owners Of Property ........... .~..~,~,~,.~.-.-~ .................................................................................. Subdivision ../~.0..~.~.. ................................................ Lot No ............. Block No ............. House No ............. Permit No. 7...~/~..~-~... Date Of Permit/'-~//~.~.. plicant .~.~/~.~1.1~.~.-.~ . I~...P!.~.~..I/~-.~.~, ............ Health Dept. Approval ...~.~....~..~'......I.~..1.~..~._~ ........... Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate / Fee Submitted $ ...... .~.~..~..d. .................. Construction on above described building~permit me,ts a~?licable_c~, an~ regulations. Applicant ~/.'.:...../.~ ............................. Sworn to berate . .........~.... day of ...~:~ ...........~..L...~. .....(stamp or seal) .................................... Coun SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. ~'J~d~Y APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address I~ ~.~ $~m~ ~- ~'~ ~,~. 6. 2. Property locationlNI)~,~ N~RO ~o0'~ ~,~-~,;~. Village ~mo~l~ Township go~-~O ~.~f. 9. 3. Public Water Company ~ame ~o~ Distance to main 4. Lot size: Width ~ feet Length 7~7' feet (Enter on center plot below) 10. Sewage Dispos~ystem: A. ~ gallon septic tank: Precast /E~uivalent__Block B. ~eaching pools: Number / Precast~Block Special If private well fill be ards Subdiv. O~ac~,~o Section Lot No. Private well Public water in blanks below: Tank cap~city~-~Gals. Pump G.P~M. )~ ~-~Total well depth Depth tD G.W. Amount ~-f~ water in well ~Test Ho~'e Data Feet 0 4 6 8 10 12 ,,. 14 16 18 The undersigned CERTIFIES: ' ~onstruction of authorized installations will in accordance with the Suffolk County Department of Health's current stand- thereto." Date Signedc~~ ~. ~ --- Owner or-Build~ ' 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 4/1/72 THE NEW YORK BOARD OF FIRE UNDERWRITERS aw BUREAU OF ELECTRICITY F--- 85 JOHN STREET, NEW YORK. NEW YORK ~'0038 * ,~,.A,~.t ~. 197~ A,.,~,c.,~.No.o.f,,. ~0,~ N 175544 THIS CE~IFIES T~T We~be~, Putn~ Rd., turn,Pole ~2, Pecon~c, SWITCHES iHc~HOEscE RXTUEES ~Ti ~N~L~w. RXTUI~ OUTLETS DRYERS I FURNACE MOTORS COOKIN~ DECKS OVENS ~ WA~HEP~ 1 200 CB a/o Water Heaters: 1-~.Sk~ 1-~.F.I. Mo~ora: 1-1/2bp v i i C EXHAUST FANS DIMMERS 21o ChaPles M. Hall Box Southold,L.I. 11971 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE M~ST NOT BE ALTERED IN ANY MANNER. 7..//J Application No ................................ Approved ................... :; ......... ;.'..:....., 19.?....~. Permit ................................ ~.~ Disapproved a/c ............................................ ~' ~'~-'~"'"~"~'~-'~ ~) ~Y:~ "fl INSTRUCTIONS o, This a~glicotion must be completely filled in by typewriter o~ in ink and submih~d in triplicote to the Buildin~,~ Inspector, wit~3 set~ of plans, accurate plot plan to scale. Fee according to schedule.. ~.i .~l~t[~n showing I~atlon ~f rot tm~6fbuildings on premises~, t~efaticln~ip t6iab~O~ning premises or public streets o~ >~ areas, and giving a detailecl~l~c, ription~f.layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this appU¢otion may not be commenced before issuance of Buil~ng Permit. d~. ~ (~o~at~c~praval of this~bl~plr~dafion, the Building Inspector ~9ill i~Sde a ~u' b~ng' Parm~-to the applicant. Such permit~ shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy ~' shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Bud nn Permit nursnnnt tn fha''~ ~uild!ng Zon.e O~inance of the Town of Southold, Suffolk County, New York, and other appli~=ab · Law~, O~l¥~n'c~s";;~ Kegumtions, for the construction of buildings, additions or alterations, or for removal or demolit on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ................................ ......... .................. (S gnature of app icant, or name, if a corporation) ................ ................ _.e. .............................................. . (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general Cohtractor, electrician, plumber or builder.~ Name of owner of premises ...... A...N. ~ ..1~. ~ i~..{~,,.~L . . - (Name and t~tle or corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No .....~ ................... Street and Number /~.~..I..~...~.......~....~.~..~.......~.~. ....................... ~.~.~.L~..i~..c:......,..~...¥., ............. i ...... : ................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy 6f proposed (~on~ruction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy .....~...~....E:.....~...~....*?..(../-..¥......~...~Z...~...L..L'..!..N....G. ............................................................ 3~( Nature of work (check which applicable): New Buil'ding ........... Addition .................. Alteration .............. /' Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... --~- ~ (Description) 4. Estimated Cost ....~.~..~.~.~ .................................... Fee ............................................. ........................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~. .............. Number of dwelling units on each flor ~ ......................... If garage, number of ~rs .....~.~.~.E .......................................................................................................................... 6. If business, commercial or mix~ ~cupancy, speci~ nature and e~ent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Nu~er of Stori~ ................................................................................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number~ of Stories ............. ? .................. 8. Dimensions of,entire new construction: Front ..... ~ ......................... Rear...~ ................... D~th .~ ................ Height ...~ ........... Numb~r~ of Stories ...~ ..................................... ~ ~ ....................................................... ~ ............... 9. S~ze of lot: Front v...~ .......... ; ................................ Rear ....~..~. .............................. Depth ..~.~ ................... 10. Date of Purchase ........................................................ Name of Former ~ner ........................................................ 1 1. 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 ...... ~.~ ................ Will excess fill be removed from premises: ( ) Yes (~) No 14. Name of Owner of premises ~....~.~.~k~.~ ................ A r .~ ~-3G ~ e~ ~ ......................... Phone No ....................... Name of Architect .............................................................. A~ress~.?.~.~,.~...~ Ph~e No ....................... Nome of Contractor ~g.~.~.~....~.f.~....IN~ ......... A~ress ...~.~.~.~.~.~... Phone No~.~.~.~... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or pr~osed, and indicate all set-~ck dimensions from pr~e~ lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW%Y~I~,~ J c: ~: COUNTY C~ c~'~'~../~:'~ ............. ~'~"~ ~ff_~,-~.~ff _ . ........... ~.~..~....:..,..~ .................. beir3g ~luly sworn,, deposes ~nd, says that he is the applicant (Name of indiVidUal signin~ ~ntra'c~) 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 contained in ~this application are true't6 the best of his knowledge and belief; and that the work will be perf~)rmed in the manner set forth in the application filed therewith. Sworn to before me this '~"/~'" Public~,.~.~...)..x:~.~-~'ounty~"'s~aY o~f..:,.~~...~ ...... ,19 W' (Signature of applicdfnt) JUDITH T. BOKEN Notary public, State of New york No. 52-0344963 Suffolk Commission Expires March 30, CARPORT ;9 LI VII I~ G ENTRY ~_ I I FAMIL L6 DINING ~ I ~ L GROUND FLOOR SCALE I/4% ILO'' PLAN I MASTER ~DROOM - ,t, t ' , ~ .... ~_~ 4_~,,, ~ ~-,~'lt, l~ ,~'-~" ,,_ ~ ~1',1 I~,~ I I - BEDROOM ~ 17: BEDROOM E SECOND FLOOR SCALE I/4"= I'-0# PLAN ED INSPEC~(~S; TION OR START FRAMING A. ~EFOA[ g~VERING PIPELINE -® FRONT SCALE ELEVATION 114== I'= 0= SIDE ELEVATION SCALE 1/4"" I"- O" OTHER SIDE SIMILAR II BACK ELEVATION SCALE I/4% I'-0"' BETTER HOMES, FOR .~.T',T- A~ZC~ PLAI~ 'NO. 5505,- A, Better Hom~ & C-ard~ ," This plon I~os [- een prep~r~ to me~ top Ixo-' I~i. Io~1 wdotions may ~'equire SECOND I/4'~= I°. 0t FLOOR jr; ROOF ~ / 4,= ,~ I°.0 FRAMING PLA'NS BETTER HOMES FOR AIr.,I:-'A]~a.~,I[CA PLA_~ NO. 350~,- A This plan has been prepared to meet fessional standards and Z. ecal variations may recluim minor ~ Vmify dimensions on job. FOUNDATION SCALE I/4"- I'O" PLAN PLAN BETTER HOMES FOR AT,T, PI~klq NO. $50$- Be~e~ Homes-& Ve*iiy dimem~au aa KITCHEN CABINET ELEVATIONS SCALE I/~:"= 1%0" SECTION- KITCHEN SCALE I/~'"= 1%O'' CABINETS POWDER RM.ELEV. BATH ROOM ELEVATIONS DOOR SCHEDULE WINDOW SCHEDULE BETTER HOMES FOR ..&'f,f, AMERICA Better Homes & ~' oco variations may require minor changes. ~eri~y ~imensJons on job. GRO UN D 114 '' I'-0" FLOOR 2] T SECOND 1/4" - I;-0 FLOOR PLUMBING ELECTRICAL PLANS BETTER HOMES FOR .A]'x;"A~r~gICA PL~q NO. a5o~-~A ~, Be~ Hom~ & G~ " ! SJI~NO.' 6 lecQI ¥~rZ~Lions m~, require miner ~ ~DTAL ~ . 8 ~eri!y dimensiens on F SECTION HEAD JAMB MULUON SILL 5C~E $" - ILO" HEAD MULLION SILL SCALE $% ILo~ $ E'C--TI oN ~ F I.X_I~ D W I i'4 DC,'vV SECTION & DETAILS BETTER HOMES FOR AU. AMERICA PLAN I~O. 3503, - A Better Homes & Garde~ 2 Verify dimemla~s o~ .... 5~CT I 0 b..l -'77 P' L A._ k.l V .I E W - SEC 'lC)NJ ' £ E~Zk(/k.T t01',.l - _ @ 4) D ETKI L . BETTER HOMES. FOR ALT. PLAN I~0. 3503 Be~r Hom~ & Thi~,plan ~s been p ep~re~ to meet to~ lOCal varl.tlons may require ~ VeriFy dlme.sions on U /~,NN AT 40,C,C,C, xq,