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Home My WebLink About8358-zNO. · TOWN OF SOUTHOL~ BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. Z7128 Date July 19 19 76 THIS CERTIFIES that the building located at ...... S./.S...R: 0.,.~:.~..R.e.e.v.$. ~lrStreet Map No.X.x ........ Block No .... ~ .... Lot No, .. ~....F:a.t..~.~.t.u.e..k., .I! :.~., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .~a.n..1.6 , 19 ~.~.. pursuant to which Building Permit No...83.~.8..Z. dated . Jan 16 1976 , ............. , ,.. 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 . . . v. a t. e. .o.ne. . .f a.m . l. .................................. The certificate is issued to . .~..h.~..s..Hom.?.e.1. ........0.w.n.e~. ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ?u.~.y...]..9...1.9.76 ............. UNDERWRITERS CERTIFICATE No.. ~.2.9.27.07.... ?..~..?..7.. ??.?6. .............. HOUSE NUMBER .3.2.1+~. ....... Street . .C.a..rap..M.~..n.eql. a...R.4. ...................... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDIHG DEFARTN~ENT 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? 8358 Z Permission is hereby granted to: ~...~...z5.../~.~....C_.5'2~.~. ..... ~. .............. .............. ...'~........~.~.~L~....~ .... ~.o..~.~',e L_ Building Inspector. approved by the ,'-, ~,' I~uildirig Inspector, FORM NO. 6 TOWN OF SOUTNOLD 0 Building Department Town Glerk~ 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 New Building .... ~. Addition ................ Old or Pre-existing Building ......... .. ...... Vacant Land .............. Location Of Property ...~.4~....~.~...,~../.../~._~.,..Q,..~...~,..._~,..4~,.: ......... ,../~......~...~.~...7~....~,...~..~:..,,.,.~..~...-. ............. Owner Or Owners Of Property .....(~..j.,....~....O...../~......./~......~.....~. ....................................................................... Subdivision ................................................................ Lot No ............. B~ock No ............. Hause No ............ Permit No ~...~.....~....~...~.. Dote Of Permit .//..../..~./...~..~..Applicant ..~.../....~.....~.../...~....4'...~.....~Z....~...°.~?...~.. ..... ../....~. C.. Health Dept. Approval .... 7../...(.~'..../..~..~. ................ Labor Dept. Approval ................................................ Underwriters Approva~ ...~77~.."~./,~.~:" -- ...................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate .......................................... Fee Submitted $ ...... ~..:..~...~ ................ Construction on above described building and permit meets all applicable codes and regulations. Sworn to before m~. ~) ~/ ........ · L.~... day of/~7~;~; ............... (stamp or~s~/~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number 3. 4. 10. 11. Applicant Address Property Locotion Village Public Water Compapy Name Lot size: Width/~° feet Length/~'-~ feet APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 6. Section 7. Lot Number 8. Private Well ~v 9. Public Water Distance to main Sewage Disposal System: Ae Precast / Equivalent 900-gallon septic tank: Block B. Leaching pools: Number of pools ~- ~ Precasl~' ~B1 ock Speci al If pr~L~t~e well, fill in the fol- lowing blanks: A. Ta~il~ capacity ~& gallons B. Pump G.P.M. C. Total well depth D. De~th to ground water E. Amount of water in well (For Health Services Dept. Use) / The undersigned CERTIFIES: "Construction of authorized installations will be in accordanc~ 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 h/7' 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 //L/~/2_(~ . SIGNED S-15 Rev. 4/1/73 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY d I " " 85 JOHN STREET, NEW YORK. NEW YORK 10038 ' ' 292108 na~ July -/, 1976 ..~pr~,c,-,tlonr.'o o,,f,l~ 851125' ~, ~ ~Ii~N TH S CERT F ES THAT ' ~, '{~ ' , Only the electrical equipment as described below and introduced by the applicant named on the allove applteat~O~ nt~mber tn the pretn~see of Charles J, Hommel,se/cor. Camp Mineota Road, &.Private,i'ROad, '~, Mattituck. L. I. ~nthefollou,~nSIocation;'[~ Bo,ement [~ z,trl. [~ ~nd rl. out~ide Saetia. ~u moe~ rot wan exnrninod on J u I y I , 1 9 ? 6 and found to be in compliance with the requlremen~e oJf this Board. F XTURE I I F XTURES RANGES COOKING DECKS J ' OVENS ',,, I DISH WAS~ERS EXHAUST FAN~ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ;PEC AL REC'PT T MECLOCKS BELL UNIT HEATERS UL -au DIMMERS SERVICE DISCONNECT I NO OF I S E R - V ~ 150 Cl3 -x I 2/0 I OTHER APPARATUS , Motor/s: I-I/2hp I GFI Joseph D. Mazzonl , ITh 227 Waverly Ave.17 OENERALMANAGER Medford, L.. I 63 Lic 482 , D is certificate must not be altered in on, manner, return ,o ,he offsce of the Board if incorrect 1291782 ,6JI dittanc# to wells aflJ cmslx~ols are by location {'mm house ovmer* and ob~mvation~. ~lnce most weJJs and pools are not visible these dimemions faciliti~ ~or t~!s !ocation have been tnspecte~ b? Chief of General Engineerin~ Services ~ert ~'~ Unaulhorized altemhon or add,hen to this su~ey ts a wolation ~tion ~09 of ~e N~ York State Educohon Low, Cop~ ~ this IU~ map ~I ~ing tho land suw~s ~al or ~ seal shalJ ~t ~ com*dered to be a valid copy. Guarantees or cmhhcat~on~ ~ndicate~ hme~ shall mn ~ly ~ the ~rson f~ whom the su~ b pre.red, and ~ his ~haff to the title core.ny, ~v~monto~ ~ an~ t~d~ In~titut~ hereon, and to the as~ign~ of the len&ng insh~tion. ~a~nt~ or ~f~cahon~ am n~ transferable to add}banal imhlufl~l ~uent ~e~. SURVEY FOeR CHARLES & ANNE HOMMEL AT M,4 TTI TUCK TOWN OF $OUTHOLD SUFFOLK COUNTY, N. Y, SCALE: I"= 40' DEC. X, 19 75 MAR. 23,19?6 ,JULY 1,1976 REFERENCE' ~ARANTEED ~ SOUTHOI-D .~,dV~NG~ _ ~ ~ I N/ES. LIC. NO. RIVERHEAD RI GH T OF V~A Y I00.0' F, · SURVEY FOR CH.Zl RLES 8 41VALE HOMMEL A T/YLZl TTI TUCK TOWN OF $OUTHOLD SUFFOLK COUNTY, N.Y. SCALE: I'~ 40' DEC. 7, 1975 REFERENCEt GUARANTEED T RIVERNEADI N.Y. ,) T