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Home My WebLink About8691-zFOI~,M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z?370 ...... Date ............. ~IOV ....1.~ ....., 1976. THIS CERTIFIES that the building located at . .~ez~phal$& .~ve..¢lioa~t) · Street Map No. X~ ......... Block No...XX ...... Lot No~3~..l~t~tllek.. N.,.Y, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~uno,--29-., 19.76. pursuant to which Building Permit No.8.691Z... dated .......... Jane...29. ., 1976., was issued, and conforms to all of the require- ments of the applicable promsions of the law. The occupancy for which this certificate is issued is .'P-z'2vate .one..~am~,.ty .~lwel:[lng ....................................... The certificate is issued to .1to ~.~.~ t. & .I)O~lUt .~ll~l~ek ..... oWnel'~ ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval NOV...~. ].9.7.6.. b.~ .R,. ]/~lla ...... UNDERWRITERS CERTIFICATE No. N~06~3... Oe2. ,~ ..19.~ ................... HOUSE NUMBER .-~.3~. ....... Street ....%qesgt~ha]:~, .Road .................... ..... ..... ~uilding ~nspec~or FORM NO. 2 TOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFI:ICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8691 Z Permission is hereby granted to: ......... Z/.,~.....~'!:.!~.!.,::.~..~. ...... 2:.~. ?. ~.~.~. .... pursuant to application dated ,,J U/ME' 2~ lO'~ and approved by the Building Inspector. ?1 ~o Fee $....:'. .................. Building Inspector FORb~ NO, 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. ¥. 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 /- Date ......//..//../...~.~../)~ ............................. 7 6 New Btlilding ~ Addition Old or Pre-existing Building Vacant Land Location Of Property S~ Axe'J':r/~,'J~/~)}4 /'~, ,~2~/~7'/~u C/<.. 4_ ,/ · Owner Or Owners Of Property ....~..;..../.~...~....u.....~...C.~...~.~..~ ......................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No../~..~.~.~.....~... Date Of Permit ~/...Z...~/).~Applicant ~%.~.,~.)~'~')/~)~0~ Health Dept. Approval ..../.././../.?~..~?.~ ....................... Labor Dept. Approval .......... ..~...'.....~... ......................... Underwriters Approval ..../..~././...~./...7..../'. ...................... Planning Board Approval .... ~...J..~..! ........................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ......... J..~.~.... ................ Construction on above described building and permit meets gll applicable codes end regulations. pp ca ..... :../.~ .............................. ~...: ............ ../~....~....~. ............................. me this // SwornJ'~'~t° before /~ A~"~' ]~)~ · . 0-~ .......... L.V.. day of ...... /.-v.-'.Z..'.......~../..~. ...... ,stamp or seal)t~-/_~c~, County //~ Notary Public .......... ~... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY - ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only ~he electrical equipment az described below and introduced by she applicont named on the ab°ve applicatlor~ number in the premises of Robert Neudeck, S/S/O West Phalia Rd., g5d' ~E/O Coxneck Rd., Mattituckl i,, sl,~.folto~i.~ loc,,tlo.; ~ = [~X B~,;,,~.~ . ~ l~t rl. ~ ~..,i.~d o. 0 ct ob er 5, ,19 ? 6 a.d/ou.d to be 12 DRYERS SERVICE' DISCONNECT 1 1/2hp .......... ~otors: - ~ - 1 Smoke Detector ,, ~ , '-:' '.', ' Joseph~D; ~azzoni' :~'.. :: 227 Waverly Ave. I This certificate must not ~e obeyed ~n any manner;, re~ur~ to the office of the ~oord if incorrect. I~spectors moy be identified by their ~nt[als. ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number 0 ~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address ~,,/f .~,~. " 2. Property Location, '~Z~S Public Wa~er Company Name ' ' Distance to main 10. 11. 5. Subdiv. 6. Section 7. Lot Number ~. Private Well 9. Public Water Lot size: Width/~o feet Length Sewage Disposal System: A. gallon septic tank: Precast/~" Equivalent Block B. Leaching pools: Number of pools ~ Preca~Block,. Special If prigate well, fill in the fol- lowing)blanks: A. Tank capacity__~2~ .gallons B. P~mP G.P.M. C. Total well depth D. Depth to ground water~ E. Amount of water in well ~?'mfeet (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorize, installations will be in accordance with the Suffolk County Department of Heal th 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. 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. S-15 Rev. 4/1/73 Examined .................... -" ....~...~...[...S. .... .............................................................................. ~i1~ I~) ......... ................................ a. ~is ~lic~i~ I~, ~ 3 b. Pl~ pl~ ~ing ar~s, and g~'a~ll~ ~r~ti~ ~ ~ ~p~ m~ ~ d~ ~ t~ di~mm ~ ia ~ ~ ~ ~lic~. c. ~ ~ d. U~ shall ~ ~ e. No ~ ~1 ~all ~e ~gm~ ~ ~ ~l~i~ I~r. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bulldiq Permit i~uom to the Building Zone O~dinance of the Town of Soul, old, Suffolk Cou..nty, New York, and ottmr al~iic~ble Lmm, Ordinenc~ or Regulations, for the construction of building~, orldltions or alterations, or for removal' or dem~itlen, a~ her~i~ n d~cribed. laws, ordinances, building code, housing The applicant agrees to comply with oil applicable cede, and mgutgtiom, and to admit authorized ins~ctors on premises and in buildings for necessary inq~ctions. (Signature of pl~licgnt, or(lame, if O.~Or~er~tion) .......................................................... : .......... ~........ .............. (^ddmss of ~pplicanf) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0/// zJ~ /~ . ............................................... ''"~'""-'"'V"t ................. ~' ~'"""~'"~'2~'"~'"' '~-" ......................................................................... Name of u~m~r of :..2.. ,..... Builder's License No ................ 7~"/' ........ Plumber's License No ....... ~2~..~Z.~.~..~ .............. £1ectrician'5 License No ............................................. Other Trade's License No ............................................... 5/,,~ ' Street and Number .................................................................................................................................................... Municipoli~y State existing use and occupancy of premises ond in~ended use and occupancy of p~ comtmcfl~: o. Exisiting use and occupancy ................................................... ~ ............................ v ........................................... / /- ,-/, ,',/~-/' ~. / ,.. ~ ~, b. Intended use and occupancy ................................... ; ............................................................................................ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... LO (Description) 4., Esth-nated Cost ............... .~..?..~..~..~..O. ....................... Fee ............ :.~.../. .................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... ./.. .............. Number of dwelling units on each floor ............................ If' ~arage, number of cars ..~ ............... ~...?...,A~....~.. .......................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7~ Dimensions of existing strucf, ures, if any: Front ...... Z~...r~( ............. Rear ............. .~..,~'.. ........... Depth ...~....~.. .......... Height ....~../...~.,. ........ Number of Stories ......... .~.. ................................................................................................... Dim'ensions of same structur~e~with alterations or additions: Front ...... ~ ............................ Rear ............................ Depth ........... ; ...... ~.' ............ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ .~...'~'.. .................... Rear ......... .~...~.. ........... Depth .....z...~ .............. Height ...../..)..'~....:.... Numb&r of Stories ..... :./.. ....... z .................................................................................................. 9. Size of lot: Front ........... /.~,~?...~ ..................... : ............ Rear ............... /..~q...~.. ................ Depth ...~...~...i/?. ................ 10. Date of Purchase ........................ : ............................ :~:Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..i ...... ~J..: ...................................................................................... 12. Does proposed construction violate ony zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ....... ~..O. ............ Will excess fill be removed from premises: ( ) Yes (~'~) No 14. Name of Owner of premises ,~..O...~...~'..?Z'...'.i..~I~/..~..'~"~.,.e...q.~..,., Address ,,,, .~..~, .?Z..7.../.,.~..~,..c~.. PhOne No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of ~.:~.~./.~.~ .~...~...~.]. ....... ./.~...~ ..... Address ......~..~..n.Z:..r.~?~hone No. PLOT DIAGRAM Locote ~learly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to de~d, and show street names and indicate ~vhether interior or corner lot. ETATE OF NEW~YO__P~/J,- COUNTY OF .r,~.CTF_L.~I~ ......... .............. ....... ~.~. .......... ................. ~... ........................ being duly sworn, deposes and says that he is the applicanl (Name of individual signing contrac~ above named. He is the ............................... .~.~.~.~.~.~. ....................................................................................................................... (Contractor, agent, co,orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and. thor the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ..... ............... ........ ........ ...... ..................... ~LIZAB~H ANH NEVILLE ~TAffY PUBLIC, State of New york Ha. 52-8125850. Suffolk Term Expires M~rch ~. ' ' , ' U ,It