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Home My WebLink About8037-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at Eo~e.y ,]gd, & ,No~.th. ~a. D~treet Map No..XYag ....... Block No...:l~ ..... Lot No, ~,~g...8.~..th.o.~.~$...N.,..Y: .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. J. lme. 3~) 19. ?~. pursuant to which Building Permit No. 8.03~... dated ............ J~®.. ~.0., 197.~.., 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 . P~.iva~;a .o~o~..famfl~r. d~.el~'~l~g ....................................... The certificate is issued to . 0tastes..Ya~.Vi~$1.0.1;~Z ....... 91~ .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval NOV...1 ~ ~. 19~.~... bY. .I~,..V.~. ~.~ ..... UNDERWRITERS CERTIFICATE No.. I 2 3997.... i o.v..3..t.97 ................... HOUSE NUMBER ......... )+.~.. Street.. :]~21~ · ~e& .Drive ..................... ....................... 397.Q .... Ke~u.ey..l~oad .................................. Building Inspector FOR1H NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8037 Z Permission is hereby granted to: ~.q.:.~.~.~.q.`~`~.~.~:~`~..~.~.~`4/.q.~..~.~.t..e.~va~w~tsi~tes & w, .............. ~e~t.t.~,~ack ....... ~.,I., ........................... to ~.~;L,10,...~,e.W...~ne... £amily... d~e 11 in~ ..................................................................................... at premises located at .....~../..~.~..~...~.~....~.....N./...S...~..~.?..t~.....S..e..$....D..~..V..e. ............................................. · 8outhol~ ~.Y. pursuant to application dated ........................... *]'..1J, l~.~. ....... S.Q ....... , 19~.~'..., and approved by the Building Inspector. Fee $...~.~.~O. ......... Building Inspector FORM NO. 6 TOWN OF $OUTHOLD , Building Deportment Town Clerks 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 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 ........ .~........~...I.]. ................... New Building .....~.. ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... -J~.,/.~.~T~?.1~L¥...~..]~./.:~..]'~g.~.~..~.e..~...~.~.y..q~ $outhold~ .~.,.¥~ Owner Or Owners Of Property ...... O.¥.~...~.~,~'.~L~;~;L~.[.~.~ .............................................................. Subdivision .... Lot No Block No ............. House No ............. Permit No ..... .8..0..~..7....Z.... Date Of Permit .6. J...3..q/...T..5.....Applicant .~/L..$T Cons~r~ct~o~ Co~p. Health Dept. Approval ....... ~.x.~.O..T..8..T. ..................... Labor Dept. Approval ...... .~T.~/..~.. ............................. Underwriters Approval ....... ..N..Z...5..3..9..9..7. ...................... Planning Board Approval ....... ..N.../..R.. ..................... Request For Temporary Certificate ........................................ Fined Certificate ........ ..X. ............................... Fee Submitted $ .....5.,..0..0. ........................ Construction on above described building and permit meets oil applicable codes and regulations. Applicant ..i~..ST Construction CorD. Sworn to before me this ......... /./... of Notary Public ...... .~. (stamp or seal) f-~z~ ~oc' + {/ THE NEW YORK BOARD OF FIRE UNDERWRITERS BURI~II~ OF ELECTRICITY ' dl 85 JOHN STREET. NEW YORK, NEW YORK 10038 Arestes Varvltsiotes, kenney ~'~ ' ~,~. Beach & North Sea Ct., Southold X X ~n 0~ ~ S~'ctlon Bh~k fix~u~ ~ RXIUE$$ i ~A~$S ~~"~ OVENS [7 26 16 [7 . -~--"'~-.Z~~' I.~; ~- , , _L_ .. . ~ , ~ 1 100 ; CB xl [ 1 2 Gustan Bartra RE 1, 227 E. Breakwater Ed - GENERAL MANAGER :.iattituck, L.I. 11952 ; f/ J[~j~m~r~a~F~;~'~f~.~-~-~- , ~- .............. c u.,~c u. H,e Doaro IT IncorrecT. Inspectors may be idenfifi~.d.b~ ,tj~eOentials. ~iotor/s: 1-t/3hp 1-4.Skw }iT Water }{eater SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number_~'~o~7 APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant~[~'~s~'l~'~'~''~ ~Phone ~q~'~ 5. Subdiv.('~'~'~' Address ~~ Section Property Location Lot Number 8. Private Well Village ~-,m~ Township 3. Public Water Company Name -- -- 4. Lot size: Width I~feet Length. i~- feet 10. Sewage Disposal System: 9. Public Water Distance to main (For Health Services Dept. Use) A.' 900-gallon septic tank: Precast ~'~[quivalent Block__ B. Leaching pools: Number of pools ~" Precast~"~Block Special If private well, fill in the fol- ~'~)'~gallons lowing blanks: A. Tank capacity B. Pump G.P.M. C. Total well depth ~4~4~ D. Depth to ground water E. Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance wi th t~e 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- Department of Health Services that an~.ad, equate_,_~ .~y~atis- with, it is the opinion of the and Water Supply ca~¥~at~'l~st~lledon~'t)~lS and factory Sewage Disposal System S-15 Rev. 4/1/73 a. This application must be completely fiiled in by typewriter or in ink and submitted in triplicate to the Buildi,ng Inspector, 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b~.'PJot rilarr shbwing Iocafidn of lot and of buildings on premises, ,relationship to adjeini~g~'premiscs or public streets ~r areas, 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 ~6mmencad 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~ 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 Occupancy shall have granted by the Building Inspector. 'APPLICATION FOR BUILDING I~RMIT ~c%. ',,D ............... . Date .... ~.......... r ~' I NSTI~U~C~TIONS ................................ ' ~~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant tp the BuiJdJ~g Zone Obu~annca o.f..th., Town .of So.uthold, .Suffolk County, New .Y.ork, and other ,ppli..cabl, Laws. Ordinances or Ragulati.0 for the ~struetion .? lis, a?a?.o, ns or alterat?ns, or Tar removal or demoht~on, as harem descrlhed. The appl cant agrees to comply with al applicable arm nancas, Building code, housing code, and regulations, and to admit authorized inspectors on promises and in buildings for neoeseary inspections.~l' · ,, ............ (Signature of applicant, or name, if a corporation) i, State whether applicant is owner· lessee, agent, architect, engineer, general contractor, electrician, plumber or ......... Na~e o~ owner o~ pramises .............. .~.......~. ................................................................................. ~ ........... If applicant is a corporate, signature of duly authorized officer. ! Num.'and title of corporate officer) Builder's License, No .......... .~.....' ........................... ~? ~c- /, _ / _~ ~ Plumber s LmenSe No ......... ,..~. ................. ~ ................ ,-- -- ~, E ectr c an sL cense No ~ ~ ~-.-l't~-~ ~.. -- .~ · .................................................. /b Other Trade S Licen~ No ................................................... lye ~ , $~/t~ DIvi ~'/ , , 1. Location of land ,.,~n Which proposed work will be done. Map No..../..~?...f.:....~ ....... : ............~.~'~of No./.....~. ........... Street and Number ..~ ~.~.....C'.~.?.,. .~..~. ,~..1~...~.. ~.~....~.~..../~.~.*.~....~.~...~..~*.~..~.~*~**~**~:~..~!`'`~`~.~`*..~...~. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ! '~Existing use and occupancy ~J~l¢~ C i~.~'T' b. Intended use and occupancy -.~--~E'& 3. Nature of work which Repair .....................Removal .............. Demolition ........................ Other Work .................................... ............... (Description) · . Fee..~......~. (to be paid on filing this application) I ' umber of dwelling units on each floor 5. If dwelling, number of dwelling units .................r~ ......................................... · . ~0 ~.~'r ........................................... : ..................... If garage, numoer OT cars ....................... .~. ............................................... I-' 6. If business, commercial or mixed occuoanc¥, specify nature and extent of each type of use ..... , ...... ~..~.. ................... of existing structures, if any: Front ..~~Depth ................................... 7. DtmQ~ns nt~lyll[ .,..,., ...,.....,.-....,..-..,., ..., .,,., ~~ ........ Rear ...: .................................. n,,...*~, . ............ .u.~.~.,-. .................... · ................. ,'.;,..,,,,L,~r.,.,[ 3':.rles ......................... : ...... ,: ..... 8. Dimensions of ent~ new construction: Iron ........... · . · ................. ,-~, ............... ~, ................. Height ~ ......... ..~L"~l~ .............................. Number of Stories .................. "~ ....... .(;.~..1~...~:...'1j~...~....%.~ ............................... ............... il .......................... Depth 9. Size of lot: Front ............ I~.~. .................. Rear r~ .......... ./....~.. ................................ ..... _~ ~.~-~ -rr~.~.~.~ .................... 10. Date of Purchase ..................................... aame oT former uwner ...........~..~......~..~- ..................... 11. Zone or use district in which premises are situated ............... . .~....~'..~...~..?..~..~..~ ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .................................... ; ....................... uum ~,,t be renraded .-~.~,.'~ ...... Will exCess fill be removed from premises: [ ] Yes _ [~]"1~o , 13. :.. ..... -- ' ' i~;. ;.~.~ ...~.....~...~.~...-~...t.~...~...~[~,. ~...I..IL....v.!.~.~..~..(,a..~.~...~... ......... 14. ~ameoTuwneroTprem ........................ '-' ~. [;~o Address)~l ~ v ~' /e~l~ (Phone No.) ~1."'~......- Name of Architect ...................................................................... i~i;~';;i ..................... ~'"'" ....... ~i;~'~"~'~'.~'"'.'~'~ .... _. _. . .......... .... Name of (Phone No.) ~ontraczor ................................ ~ (Address) r · PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set4~ack dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner Int. STATE OF NEW YORK, COUNTY OF ...................................................... .......... ~~~'~i';~i;;~'~;;:,~:~:;~ .................... being du~v sworn, de~o~es and says ~h~ ~ i~ ~h~ ~,c.~ ~Uove ~am~d. He is the ................................................... ~ ~~ ' ' ......................................... ( ~ntractor, a~nt, co.rate officer, etc.) of ~aid owner or owners, and is duly authorized to ~rform or have ~rformed the said work and to make and file this application; that ~11 statements contained in this ~plication are true to t~ best of his kn~led~ and ~lief; and that the~rk will be ~orm~ in the ~n~r set forth in the application filed t~ ~~S~ New Yor~ ........ ~.~....day of .............. : ............. 1~.~ 0~ -5u,,oik Court. motary Public ................................... Y ~'"~"':"~ ........ ;'"'"'. ..................................... ~ // ~ ' (Si~m~ of applicant) 7¸: / ! 158 V~P~v~I'T~I OTE~ ~T .~ U Ir rCt,,,.b( C.O L.' [,./T' "',', .I II 'I ./ !i