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Home My WebLink About8359-zFO~M ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificete Of Occupancy No. 2~6966 ..... Date .............. ~,p~.il...8., lg. 7.6 THIS CERTIFIES that the building located at .tl.,.0:~.,..N./.~. ~...R.q~.d .... Street Map No. XXX ......... Block No...~:... Lot No, ~: . gr. JLen~;...~,~., ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ,Tez~ . .20.., 19.~.~. pursuant to which Building Permit dated ........... .J.~ . ~f).., 19. ?.6., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Pri~aCe..one. f~lly..d~e~L~L$~g ................................... The certificate is issued to ~.a¥. ~o].d ....... ~.~me~. ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . A1)r..~... J.~.(~.. ~Y. FL,..¥~llt ..... UNDERWRITERS CERTIFICATE No. ~27~0OP... ~[a~-. 2.~.. ~ 9.7.6 .................. HOUSE NUMBER . . ~L~.~5 ..... Street .... ~a~e.~-Roa~ ......................... FOIIL~ NO. IB 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) Permission is hb-~eby graflt ~.c~l, tqi ~, TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APFLICATION FOR CERTIFICATE OF OCCUPAHCY In.tructlons 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 disposal--(S-9 form or equal). 3. Approval af 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 bu,ldings (prior to April 1957), Nan-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 prevzous 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 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 BLtilding ....... ~.. Addition ................Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ..... ,,~..,.~. ,.,~-~Lq?..~. ............................................................................................. Subdivision ........ '. ...................................................... LOt No ............. Block No ............. House No ............ Permit No, ~.~..~3 ......... Date Of Permit ...//.C°./..?..~..,..Applicant V Health Dept. Approval ...... ~ ................................. Labor Dept. Approval ................................................ Underwriters Approval ...... ~ ................................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate ~ .................................... Fee Submitted $ .........~...:.O...o. ................... Construction on above described building o~ applicable codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITE BUREAU OF ELECTRICITY '-- n]~ 85 JOHN STREET, NEW YORK, NEW YORK '10038 ".,e Ma~ch 23. 1976 z,,,i.o,.o.,'..o.~i,~ 84o87o N 275002 THIS CERTIFIES THAT only the el~tri~a] equipment o~ described below and introduced by th~ applicwnt named on the abov~ application numl~r in the premises of Golds Right of Way Orient Pt., e/o ?latt Rd., Orient, in ttv~ followlng I~cation~ [] Basement [] tst Fi. [] 2nd Fl. CLlt S i de S~ction Block Lot ~.~x~,.i.~d.. ~arcn 18, 1976 and fmtnd to be in compJiance tvith the requirements of this Boordo RX'~UEE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS . FLUORESCENT DRYERS FURNACE MOTORS APPUANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO OF FEET DIMMERS SERVICE D~ONNECT O'(HER APPARATUS: 1-GFI * Future appliance feeders: 1-3#8, 1-3#6 Fran Elec. 75 Gillette Ave. Bayport, L.I. ll?05 GENERAL Lic. 567 D Per , This certJkate mu~t nat be altered in any mannerr return to the ofhce of the Board ,f incorrect Inspectors may be iden'1,fmd by thmr 't ; . · "t4t ~.60.10 EDUCATICN LAW ow~ '~"~ t . . ........ ;. :~ ~ :_,- ........ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~Joo)~fo~,~w ~,i','~ ~. Phone Address ~ p~ ~, ~F~-~-~ ~t, 2. Propert~ Location [~ ~i,~ ' - Village O~T Township 3. Public Water Company Name 4. Lot size: Width ~o~fee~ Length ~Q ~ feet . 5. Subdiv. ~ 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: (For Health Services Dept. Use) 11. A. 900-gallon septic tank: Precast ~Equivalent Block B. Leaching pools: Number of pools Precast ~.~-B1 ock Special If private well, fill in the fol- lowing blanks: A. Tank capacit~ 4~ .gallons B. Pump G.P.M. )~ C. Total well depth ~om~ D. Depth to ground water ~o~ E. Amount of water in well .... The undersigned CERTIFIES: "Construction of authorized installations will be in accordam with the Suffolk County Department of Health Services' current standards t~feto." This application will be valid for one year from the date of approval indicateO ~low aQd may be renewed if a current local Building Department Permit is in effect. Date }~}~ (~ Signed ~~~/. ,~ FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here with, it is the opinion 6f the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on thi~.plo~. S-15 Rev. 4/1/73