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Home My WebLink About8373-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No.z?0?8 ....... Date ..... ~ '8l ............ , 19'76' THIS CERTIFIES that the building located at 1~/~ 4~ol~l~d~..AVe, ....... Street 8outhold, ~:, 'E. Map No..~]~ ........ Block No...~ ..... Lot No, .~.~ ............................. conforms substantially to the Application for Building Permit heretofore filed in this office dated "~b~ ~ .... , 19..~(~ pursuant to which Building Permit No.. dated 'I~e~l'~-1~', ...... , 19.7~., was issued, and conforms to all of the ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ' 'P;~:~va~' 0~,~' F~:..~ t~e~];~g ................................... The certificate is issued to . ~e~Je '~c~e ..................................... of the aforesaid building. (owner~t) Suffolk County Department of Health Approval ;/ume 7) '].976 (BO%~ '¥i~:~:a) ...... UNDERWRITERS CERT~ICATE No .... ~28~ ............................... HOUSE NUMBER . ~0 .... o~ree~ ... ~md~ · ~ ~ · · ~U~'~O~ · ~'~ 'Y,' FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUiLDiNG PERH, IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 8373 Z Date ................................ ~....~...~.*...., Permission is hereby granted to: at premises located at ... ,]J~.~, ..~!J;.;~ttl~J~.~ ................................................................. ............................................................. ~,.~e~L....~,~.,. ...................... '. .......................................... pursuant to application dated ............................................ , I ,~.~ on~iopprozed by the Building Inspector. Fee $1 .~.~.;?.4:..0. ......... FOI~M NO. 6 TOWN OF SOUTHOLD , Building Departmeut Town Clerks Office Sou~hold, 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 Budding 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 end "pre*existing" land uses: I. 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 occuponcy $1.00 ......... ................ New B~tilding ..... ~../.. ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Loca,ion of Property .... Subdivision ................................................................ Lot No ............. Block No ............. House No,~../..~...~.. Permit No ~..~.'~ .~.~. ~- Date Of Perrcit ~...//..//~.~-.Applicgnt Z.~..~..'..~......~(-?.'~. ......................._ ......................................... Health Dept. Approval .~./..~.../.~...~).. ...... /l~Pt. A~proval ............................................... Underwriters Approval ~...c~....¥....~.....~......~.. ............ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .................................... Construction on above descrih::plbi~:dnitn.g~~~:..c~~:.r..:.:.:l..:t.'..:.:: Sworn ,o b:::e this Notary Public .................................... County(stamp or s.o') THE NEW YORK BOARD OF FIRE UNDERWRITERS .d I BUREAU OF ELECTRICITY e5 JOHN STREET. NEW YORK, NEW YORK 10058 HIS CERTIFIES THA~ nl) the clectrt( al equtpment as desr~bed below and introduced by the appflcaat named on the above application number in the premises of Gruhi II Homes, cot. of Hope Lane & Sound View Avenue, Sou~hold. L.I. ~ta~A,n,,.,~g~,,c.no., ~ B~,.~.t ~ ~tF~ ~ ~.~ r~ outsi de S~ctlo. ~oc~ ~t 346 ..,.~,,,,,,,,.do. May 20, 1976 andfoundtobeln~o.tphancewtththercqu~rernent~ofthz~Board. SERVICE DISCONNECT J NO OF J S E R NO OF CC COND A W O ~? __~m ~PE EQUIP W ~ 3 ~ 4W PER ~ OFCC COND Ij 200 ~ CB x ......... J /IxJ i ~HER APPARATUS v I c MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET A~n~ I WATTS AWG I 2/0 Hotor/s: I-3/4hp I GFI Surdi Elec. Co. Box t33 Holtsville, L.t. 11742 L I C// 42 I GENERAL M,I~ D hts cerhficate must not be altered m any manner, return to the ofhce of the Board ~f ~ncorrect Inspectors may be ,denhfmd by thmr S~F-FOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number-5'~J-O l. Applicant Address 2. Property Location APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY JENNIE JOYCE Phone 924-7310 788 Bartlett Road. Middle Island, NY V~llage 3. Public Water Company Name 4. Lot size: Width feet ~%'%~wage ..~posal System: ~,Z . ~L~',~90~r~allon septic tank: lO. -cas~~' x Equivalent ~ L~ing pools: ll. Township Length feet Minor Subdivis 5. Subdiv. of Manning 6. Section 7. Lot Number 2 8. Private We'll YES 9. Public Water NONE Distance to main (For Health Services Dept. Use) Block N~er of pools 1 Prec.? x Block Special__ If private well, fill in the fol- lowing blanks: A. Tank capacity_ gallons B. Pump G.P.M. C. D. E. 82 5 Total well depth 150' Depth to ground water 110' Amount of water in wel]~ 40 ~e undersigned CERTIFIES: "Construction of authorized installations will be in accordm with the Suffolk Coun~ Department of Health Services' current standers thereto." This application will be valid for one year from the date~ app~v~l--~ndicated below and ~y be renewed if a current local Building Department ~t is i~ect, FOR THE DEPARTMENT OF HEALTH SERVICES USE ONLY. Based on the information presented her~ with, it is the opinion of the Department of Health Services that an adequate and satis- facto~ Sewage Disposal System and Water Supply can be installed on this plot. S-15 Rev. 4/1/73 Examined ...... .~.....~.~ ..... /~ ................ Approved .........../! ........ //. ............... , TOWN OF $OUTHOLD ~'~. BUILDING DE.P~RTMENT TOWN CLERK S OFFICE ,, 7 ........ Permit No ........... & ........ ~..~ Disapproved a/c "'7~ ............................. ~~ APPLICATION FOR BUILDING PERMIT Date ...................... .... INSTRUCTIONS a This application must be completely filled m by typewriter or in ink and submitted in triplicate to the Buildin,_ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showmg location of lot and of buddmgs on premises, relahonsh~p to adjommg premmes or public streets al areas, and giwng a detailed description of layout of property must be drawn on the diagram which is part of this application c. The work covered by this application may not be commenced before issuance of Budding Permit. d Upon approval of thru apphcation, the Buildmg Inspector wdl msue a Buildmg Permit to the applicant Such permi 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 Certificate of Occupano, shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regu~ahons, for the construction of buildings, additions ar a~terations, or for removal or demolition, as herein described The applicant agrees to comply with all apphcable lows, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in buildings for necessary inspections. ...... ................................. (Signature of applicant, or name, if a corporation) ...... ...... ....... ......................... (Address of appffF:ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde, Nameofownerofpremises "~ e /1.//u/ / ~ 0 .o.~.~'i' e ~ ~/"/ ~ If apphcant ~s a corporate, signature of duly authorized officer. (Name and htle of corporate officer) Builder's License No ..................................................... Plumber's License No ...... ..~....c~.~...Z.......~... ................... Electrician's License No ...~.~..L.~:'..Z.....Z~... ..................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No ...................... :! .......... Lot No ................... Street and Number .~..~.~...~..~.~../..i..~.....~ ...~..1~ ..~...~..~. ~.. ~..~.~.~...~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisiting use and occupancy b Intended use and occupancy '"'.~.~~*"'"'"""'""'.."***"'""*'**"*'"'*"'"'"""""" 3 Nature of work (check which applicable) New BuHdmg ..... Addition ................. Alteration ............ Repmr .................. Removal ................ Demohhon ................ Other Work ................................................. .....................................................· -/~'-- 0 0 /' ^ ~ ~0 (Description) 4 Estimated Cost .~....~0 ,.Fee ....(2....~¢.. ........................................................................ (to be pa~d on fdmg th~s application) 5 If dwelhng, number of dwelhng units ....... .~. ......... J ....... Number of dwelling units on each floor ................. If garage, number of cars ...... /. ........................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nat.ure and extent of each type of use ...................... 7. Dimensions of exmtmg structures, ~f any: Front ..... [¥~/...~... Rear ................................ Depth .................. Hmght .... ~ ........... Number of Stories ..... ~.r. ........................................................................................ D~mensions of same structure with alterations or addmons. Front .................................... Rear ....................... Depth ................................ Height ............... Number of Stones ............................... 8 D,mens,ons of entire new construct,on' Front ...~..~. t Rear ..... .~....~. ................ Depth ....~...~..~.... Height ...~.~.. ....... Number of Stories ...... /. ............................................................. 9 S,ze of lot Front ..~..[.~....~. .......................................... Rear .......~...~.? ...................... Depth .2....~..'i.~.'"iiiiiii[i['ii 10. Date of Purchase :...../...?../...~.. ............................... Name of Former Owner ...................................................... 11 Zone or use district in which premises are situated ................................................................................ 12 Does proposed construchon wolate any zoning law, ordnance or regulation ~...4'? .............................................. 13 Wdl lot be regraded ........ ~ ...... Will excess fill be removed from premises ( ) Yes ( ) No 14 Nome of Owner of premises ......... ~... Address ............................... Name of Architect . Address .......................... ~.~...P~gne ~1o. .. PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~sting or proposed, and ~nd~cate all set-back d~mens~ons fron property hnes G~ve street and block number or descnpt~on accordmg to deed, and show street names and ind~cat- whether interior or corner lot STATE OF NEW YORK, COUNTY OF ...S.~I..~J~O].~ ............f o S .................... .~.~.J~..~.Z'.O.C;D.~g~.O ...................................... being duly sworn, deposes and says that he ~s the applicar (Name of ind~wdual s~gning contracf) above named He ~s the ..................................... C~gZl.'bZ:.~O.~O~ ........................................................................................................ (Contractor, agent, corporate officer, etc ) of sold owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and this application; that all statements contamed m th~s apphcohon are true to the best of his knowledge and behef, an that the work will be performed in the manner set forth in the a~J+e~t~ filed therewith Sworn to before me th~s ......... .J..J..'bT1 ..... day of ..~bZ'Z~.I~L-TT'.'.'.',~K ................. , 197~. Notary Public,. .......................... SU~'~)-I k ......County ~/r~...~ ........................................ v' ~ (S~gnoture of apphcont) ~" NOTARY PUBI lC ~tate No 52-8!25850. Suffolk Cou,~ Term £¥p, re.~ ?~rch 30 to ~e m:~--f /- '3'-