HomeMy WebLinkAbout8085-z· O~,M NO. 4
TO~ OF SOUTHOLD
Bt~t'.rtHqC, DEPAR'I'~.fRNT
Town Cderk's Office
Sou*hold, N. Y.
Certificate Of Occupency
THIS CERTIFIES that the building located at ~/~. Bain. Streei; ......... Street
Map No. x ....x .....Block No..xx .......Lot No, . ~xx.. ~ouf, hold...N,I[,~ ........
conforms substantially to the Application for Building Permit heretofore filed in thi.~ office
dated ...........Ju~y....1.1.., 19. ?~. pursuant to which Building Permit No.
dated ...........~.I~Ly... 1.8..., 19. ?~., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is
issued is . Nunicipal. Buildin$.. ~ i'irehouae), with. an. additiom .............
The certificate is issued to .. Southold .Firi .Diatric.t...0traer. ...................
(owner, lessee or tenant )
of the aforesaid building.
Suffolk County Department of Health Approval .Apr..20....1.976...bY. R~.¥1J,~ .....
UNDERWRITERS CERTIFICATE No .... N~06%~... Oat. ~...197~ ...............
HOUSE NUMBER... ~%.13% ..... Street ...... 1~ ~u. P~a~ ..... Sottthol& ..........
Building Inspector
TOWN OF SOUTHOLD
BUr~.nIN(; DEPARTM~,NT
Town Clerk'~ Office
Southold, N. Y.
Certificate Of Occupancy
No. Z6992 ....... Date ...........Apt. il .... 27 ..... ,
THIS CERTIFIES that the bugdlng located at l~/~q · · ~ia.~.n. Road ........... Street
Map No... xxx ...... Block No...xx~ .... Lot No,. x~x. · - ~etttbol~l. · .E og., .......
conforms substantially to the Application for Building Permit heretofore filed in thi~ office
dated ............. ~u3.y... 1.% 19.~. pursuant to which Building Permit No. ~08~/~.
dated ............J~y..l&., 19.?~., was issued, and conforms to all of the require.
ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is
issued is .~un~tc ipa~. buL~ding. · (. F~e. Houa~) .................................
The certificate is issued to .~.o.~.t~q~l. F.~O. ~).~;~'.~t ..... .OW~p~. ..................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .... p~n~n~ .......................
UNDERWRITERS CERTIFICATE No..9~n~ng ...................................
HOUSE NUMBER ..... ~.~3.~... Street ...... l~r~ .l~oa~.. ~°aut~o~lA .............
..........
Building ln~pocto/
FORM NO. 2
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
'TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS P£RMIT MUST BF_ KFPT ON THE PREMIS~:S UNTIL FULL
CO~MPLETION OF THE WORK AUTHORIZED)
Ne 8085 Z
Permission is hereby granted
l~eha~]Lt~.&..~3~l~....A~h~te~ts-A/-C..Sce~hold F~re D~st
....... ~0~.~ .... ~:~]a~o~e...~,ve .............................
................ ~;l~.e, ...~.~I.,..,....1.t.~..tO ..........
to ~..u.~..d......~.....~.~ ~..t.~.o. ~....o..n.....e.~ ~...t..~..g...~.e...~.~.e ............................................................
at premises located at .~'~',~..~z~[,~,.~e,t ......................................................................................
.................................................... ~.~ut~h~:l~,....l~ ,L ...........................................................................
pursuant to application doted ........................~'l.l~. ......... .~.$ ........ , ]9~.~..., and approved by the
Building Inspector.
Fee $....~.O....~_ ............
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
Riverhead, New York
Building Permit No.
80~57
TYPE OR PRINT LEGIBLY IN INK
Health Services Department Plan No.
S-40
Application for Approval of Commercial Sewage Disposal, System
TO: The Suffolk County Department of Health Services Date April ? i976
Application for approval of commercial sewage disposal system is hereby requested.
Location:
n/s Route 25 Southold NY
Name
(Name, sideofstreet, nameanddistancetonearestintersectingstreet)
Sout~old Fire Mouse
Hamlet Soutkold Town
Village
Sout~old
,:.% Applicant's Signature ·
r.:~ Title plumb er
c~ (Builder - Owner)
'" 2612191
Address 10 Lawrence St Greenlawn NT 11740 Tele. No.
Ready for inspection
FOR USE OF HEALTH SERVICES DEPARTMENT ONLY
Inspected by L/~J/~--~ "~ ~- .,--~ Date
Installation satisfactory - Yes 4:~-; No
Rased on the information stated hereon by the applicant and other information made available,
it is the option of this Department that this system with proper maintenance can be expected to
function satisfactorily and is not likely to cause a nuisance, provided designed sewage flow is not
exceedec~. Structural features are not included.
¢~hLef of General ~ginee~i~ Se~ice~
$CHD - S-13
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
Examined ......... l..(~, I9....?.~ Application No...~.~...~.....~....~......~... ....
Approved ..... . .~.......!!......~......L.~ii, 19..2.~ Permit No.~..~.....~.....~...'~...~...
Disapproved a/c ...............
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of tot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and giving a detailed description of layout ofproperty 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 Building Permit·
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit
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 Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code· housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
..................
(Signature of applicant, or name, ifa corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
· ~
.............................
Name of owner of premises ..S_o..~..1;.~.o.~..~...~.;i..tL¢...l~.~.l~.[j.f:.l;., $.Q~..l;b.O.~.c~ ~o~ ...................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .....................................................
Plumber's License No .................................................
Electricians License No .............................................
Location of land on which proposed work will be done. Map No.: ................................ Lot No .........................
Street and Number ....... .LM~£~..]Roa,d,~...$~.~zt. bo/z:t~..N...Y. ......................................................................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed c~nstruction:
a. Exisiting use and occupancy ...?...~..r..e.~..~...u..s..e..'.-.....a.P.~.~..r~.~..q.~...`s~g~..~.~ .....................................
b. Intended use and occupancy ...~'..i.~.O~,~f~..~ara,....s~ox.e. ge.,..mee.t£ng..~:o~ms ...................................
3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................
Repair .................. Removal .................. Demolitior ..................... Other Work ................................................
f~ ~-' ? /,~ ,/4V/~/tJ ,~ (Description)
4. Estimated Cost ........................................................... Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units ............ ~ ...............Number of dwelling units on each floor ...... '.:: ...................
If garage, number of cars ............................................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing structures, if any: Front 5'7' Rear 36' Depth 76.5'
Height .......... .3..6..! ........ Number of Stories ........ .2. .......................................................................................................
Dimensions of same structure with alterations or additions: Fro t .......... (~..=.~ .................. Rear .... .8...5.: ..................
..................................... Number of Stories ................................
Depth 117.5' Height 36' 2
' " 1~7,5'
8. Dimensions of entire new construction: Front ....~9...-.b....., ................ Rear .......(1~!..-..~'.' ......... Depth
Height ........ .1.7.,~. ...... Number of Stories .......... .3_. .........................................................................................................
9. Size of lot: Front ........... .2. .8. .5. ... ,B. . ~ ................................. Rear ...........2.?..6..:..4.,1..~ .................. Depth ...... .3..2..?.:.98. .............
]0. Date of Purchose ........................................................Name of Former Owner ........................................................
] 1. Zone or use district in which premises ore situoted
12. Does proposed construction violate ony zoning law, ordinance or regulation: ........ z~o ...........................................
13. Will lot be regraded . ......... D,°. ............. Will excess fill be removed from premises: ( ) Yes t'~) No
14. Norne of Owner of premises ...$ou.tl~o,tcl..~'.£ze..D. is.l:z.i¢~:. Address ,~:~,,J~,d,$~u~¢Jl~one No .......................
Name of Architect ..Sc~a~:d,t..~x..E~,l.~&~l ....................... AddressB...e. B.°...~..e.¢...~.:..Y.:... Phone No..?..8..5.,%2.,3.~.8. ....
Nome of Contractor ..~.~.__.....~...~, .................. Address ................................Phone No .......................
~LOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property fines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
/c/A/t} r&
STATE OF NEW YORK, t S $
COUNTY OF .I',IAS;S~TJ' ...................
.......... W,...%boma, s..Scb~Azd.t ............................................... being duly sworn, deposes and says that he is the applicon
(Nome of individual signing contract)
abow; named.
He is the ............ A~.qJ).$J;.C..c..t. .................................................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file
this application; that all statements contained in this application are true to the best of his knowledge and belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Swam to before me this
........ ']:'~'~',',;~7" day of ............. .J...~..]:~. ....................... , 19.~.~... //~
Notary Ru, talic, . ......................... ~/~A~ ............. County .~~.~ ...................
¢ S'~noture of apph'cont)'"'
/"~'/-'~'t-~-4¢~..~ ~"~g~'~g~2Notary Public: St,,.o of New York ,
, /~ ~ No, 30~4[~05705
qualificd nl Nassau County
Commission expires,March
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW yORK 10038
,,,,,~ Oet~be= 5,1976 ',','""'"'" ~ ....... r,~ 8775
~l: X frac.~ l~X, ~-22, 225~ e~-
~. Ka,~k Tepezek_. ~
return tO the office ot t~ ' tt ~
~~ ......................