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Home My WebLink About6463-ZFORM NO. & TOWN OF SOUTHOLD BUrLI~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupancy THIS CERTIFIES that the building located at . ]i[1~..C1~7 ................. Street Map No. ~ .......... Block No... ~ ..... Lot No. ;I;~...(~$~lal0Q~'.t.,..~.: ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ &10~,~... ~, 19. ?~ pursuant to which Building Permit No..(~1~. dated ...........I~pr.~.. 6 .., 19. '7-3, 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 . ~..(Apar. t~$r~t~ }. No.t~13.. ~.t s. I~Nlllt:Lp3.e. rase. claris®) ................ The certificate is issued to .J&a~ .Y~.v.~U. ?..P.$bb3,e. ~e.aoh .~p.t.z ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .Fela .. 6...~97~...bl. So. ~.3,1& ..... UNDERWRITERS CERTIFICATE No..~Y. J., .lE~&ok~, .~p.~ .................... HOUSE NUMBER .... ~g.b~O~ .... Street ... ~ox'~c~h .Road.. i~P,,~27) ................. ..... Bufldi~'i~ ...... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. TEMPOBAR][ Certificnte Occupnncy Apts ~ 6~ & 63 No..Z~8.gt~ ..... Date .............. May. ..... 9"', 19..?~, THIS CERTIFIES that the building located at .. 'N/S 'Nox'th' Road- (01~.?-) Street Map No... ~ ....... Block No .... xx .... Lot No..xxx .... 0remnpor. t.. E.,¥. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. April..~ 19...7.3pursuant to which Building Permit No... 6~,63Z dated ......... Ma~,...$0 ...... , 19.-~.3, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...(.aompleted) · apa=tment. -./~otel. un:l.t~ ........................... The certificate is issued to .. Jack- Lev:l~t. · · Sound. Shol, e. Motel .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... Feb .. 6...197~'...by. ,~ ,. ~/illa. UNDERWRITERS CERTIFICATE No.. T.®mp. f.~om. Kubaek.$. · 6~..&. 6~ .apt~o .... HOUSE NUMBER .. ~;91~0~ ...... Street ...¢ounty~ Roc, d. 2g ...................... ............ ........... FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6463 Z Date ....................... /ij~ltiJ~.....(~ ............. , 19.~.,Tt.. Permission is hereby granted to: ,T~..~...~..e.~...~.......~/..C.......~.~.~... .... Kor~-..Ro~d .................................................... ............. ~i~'ee~pm-~' ............................................ to ]~b~L3.~..8..~n&t,.~tm~.. ........... Cs~ta..pZan..&~p~o~&l...a~..p~z..p3,,,,,~g..t~o~d...~.~l~l;~.~n~n,~s.) ................. at premises located at ..... ~J'/~q"~Oa"t~"JJ~AI~'""(4~'~')"~¢~S"~)'~J~Y"~]~"~ ........................... G:~e~ul~l't .......... li,,.]f,, ............................................................................................ pursuant to application doled ............................ AjlZ~sj.....J~ ........ , 1~,~ .....and approved by the Building Inspector. Fee ~l-~ .~-., ~.~. .......... SUFFOLK COUNTY DEPARTMENT OF HEALTH Riverhead, New York TYPE OR PRINT LEGIBLY IN INK Building Permit No. Health Department Plan No. ~--~__~ ~plication for Approval of Commercial Sewage Disposal System TO: The Suffolk County Department of Health Date ~~~ Application for approval of commercial sewage disposal system is hereby requested. (Name, side of street name~and distance to nearest intersecting street) . Hamlet Village I hereby certify that this commercial sewage disposal system has been constructed in. accordance with plans approved by the Suffolk County De- partment of Health on (date) and w~th all the requirements of the latest bulletins on sewage, disposal of the Suffolk County Department of Health. Applicant's Signature ~'.~,,-- ~.~_ ~ ~ ~ (Build~ - Owner) Address ~_~))~ ~ d/~-~~'--'~. ~ ~ Tele. No. 7Z~-~Z7 Ready fo~ inspection ¢ / / ~/~ / z FOR USE OF HE~,I~H DEPARTMENT ONLY ! f Inspected by C/.~ ~ Date ~'~ Installation satisfactory ; No Based on the information stated hereon by the applicant and other information made available, it is the option of this Department that this system with proper maintenance can be expected to function satis- .factorily and is not likely · . s~wage flow is not ~xceeded. Date · SCHD - S-13 6~58 to cause a nuisance, provided designed Structural features are not included~n CJlioi' Of OOllor~l ~::~iTleorillg Services TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK,S OFFICE ~/~ ~//~.~...T. ~..~,~. j SOUTHOLD, N. Y. Examined ~ ~ ...... 19.~ ................ , ..... ~pr~ .............. ~...~..., 19.~. Pemit No .................................... Di~pproved a/c ..~..~.~..~ ~ ~ ~. ~ ~ ~ ............................. .......................... ~~r~ ................. APPLICATION FOR BUILDING PERMIT Date .A.~ril ~ 19..?.~ ~ INSTRUCTIONS i~'-~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, w 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an~ giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit 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 part for any purpose whatever until a Cer. tificate of Occupancy shall have beer~[j granted by the Building Inspector. ~r APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises Ja.¢]c...Le.=;/z~ ............... ~ ........................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... ~ Plumber's License No .............~..,....~.a..~.~..~. ........................ Electrician's License No ........]~v,~..z~. ................................. Other Trade's License No ................................................... 1· Location of land on which proposed work will be done· Map No ............... ~ .......................... Lot No....~Ir~ ............... Street and Number ......... ~./.~.....~.~;~.'C,~..]~[Qa~..~ ....... C~ee~_[g4~:D~, .............................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~.l~,~.~.,'~nnc]- ................................................................................................. ~ b. Intended use and occupancy ........ ~..J~D.~c~..13z-,c[,~,~ ................................ i .......................................................... 3. ~Jature of work (check which applicable): New Building ~ ......... ,l::~r..... Addition ..................... Alteration ...... : ........ Repair ......................... Removal ......................... Demolition ........................ Other Work ............................... : .... (Description) 4. Estimated Cost ............. 3,QO,.QO0....;I; .......... Fee ..':;.?,..~....~...~::...~.... ..................................................................... (to be paid on filing this application) 5. If dweiling,.?umber of dwelling units ...~ ............ Number of dwelling U.ni? on each floor .~ ................ ~.., ................. If garage, number of cars ............................................... ~ ........................................................... :.::...:~ ...................... 6. If business, commercial or mixed occupancy; q~ecify nature and extent 9fgach tyl:~, o,f use ~.,~[,~, ....... ~ ..................... 7. Dimensions of existing structures, if any:,Front ................. :.. Rear .~;......:.77.;..~..~?..~iD.epth-..~,~ ...................... ~ ..... Height ........................................................... Number of Stories ................ :..,..,, ........................ : ........................... Dimensions of same structure with ~it~a~[c;~ 9~ additions: Front ......................... ~-R'i~i~ '~:.:,..::~..'..~i~....~ ................. Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ............ ?. ....... :.'.. Rear ...:.....~:- ................. Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ...................................... Rear ................ : ......................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ,, ......................................................................... 11. Zone or use diat~i~t in which premises are situated ........ ."~..~ ....................................................................................... 12. *Does proPOSed constri~:fion violate any zoning law, ordinance or radiation: ........~ ............................................... 13. Will lot be regradad ....3~a. ........................ Will excasS fill beremoved from premises: [ ] Yes [ ] No 14. Name of Owner of premises ........ ~&~..;Lev.ta~ ....................................................................................................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ..... ~...a~..~..,.~.IR...~.e..~......e...~.~.l'.. ............................. : .................................................... (Address) (Phone No.) PLOT DIAGRAM ~ Locate clearly and distinctly ,11 bulid~, whether exlstir~ or proposed, and indicate all sat-back dimensions from property lines. Give street end ~ number or deecrlption according to deed, and ~hOW street names and indicate wheth- er interior or corner lot. See filed p]~s STATE OF NEW YORK, ) COUNTY OF ............. ~.l~...f..q..~... ..................... ) · ................. 3ack LevJ. n He is the ......................................... 0~1~.~ ................ ' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to Perform or hev~, I~e~formed the said work and to make and file this application; that ell statements contained in this application are true to the best of his knOWledge arid belief; 'and that the work will he performed in the manner set forth in the application filed therewith. ' /'~ ~t LEE ~ NeW York ~ · ..................................... ' ......................... }2 ' Notary Public, ~.~~::.~ County '. ........... ~~.......~~ ................ : ' "~ (Signature of~tppllcant) , ~ ../ . $1T~_ PL,,,qN Office Of Gordon K. Ahlers, P. E, '~AJfera~on of lhi~ Documen! Office Of Gordon K Ahlers, P. E. "Alterct~in of this Document excepl by a Licensed Profes- Sedion ~209, Subdivision 2, N, Y. tare Education Law. Office Of II · OHiee OJ Goi-~o~ K. Ahle:s. P. E. ~ "AHero~tan of this Docum~m alono] ~uglneer, ts Illegal". ~'.~.',w, po~T ~. Of{ice ~=~.~, Of !! Gordon K. Ah]ers, p..E. "AJferaflon of this Document ~".*" d~ -/,7;~'- e~cepl by ~, Licensed Profes- Office Of' Gordon K. Ahlers, P. E. "Alteration of this Document except by a Licensed Profes- sional EIglneer, is illegal'. N. Y. State Education L~w, L L P L 5~_.14 EMA-I-I C. I-LUM ~..), k.~G DIAGF-.A M b ./ / SlOT]ai Engir;eer, Is illegal". ~'echon 72_09, Subdivision 2, 5C1~ £MA'FI C.p:LUM~lkJ~ DIAGC~AM 1,3 F_$ t GI-.J 9