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Home My WebLink About8100-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . I. ! .~..~.....~.!.L..k .E.- ~ .E....l~.? ~eet Map No. '~ e ~ ~ Block No. "' . Lot No, ~ '~ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ?..V k '.~....~.'!, 19.7 ?..--' pursuant to which Building Permit No..~.. I..~..0. Z_ dated ,J L'L~( 2 '/ 19.7.~'~. 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 ...A.....P..~)?..~..-7..~.....0.~.[ .E .... .~ .~).~.[ ~. :¢ .... J~?...~..~k. ! ~..~. .... : ....... The certificate is issued to .~ h ~ F~ T~ 'T I=t ~,1~, (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ~.C?...~..V.~ ! ?..~..~. .... .?.ff..~...~.~ .~.0.-. ( 0~ UNDERWRITERS CERTIFICATE No. Iq ~. 5 0 5 D .~ HOUSE NUMBER { I '-I 5 Street ~.tc.~ L-- "ff' F_. .~T~ ~'~'- ...... Building Inspector FORi~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N.. Y. BUILD)NO PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 8100 Z Date ...................... ~'L+~ ....................... , Permission is hereby granted to: $.~ ~& ..:,~i$.n. ~...~.~..~.s...... A/~......,~!r...~,..~:.~r.~ .. ~,.. ~:i~-zk ~o ............. .~&~..~L.S~:,/~..Ef~.~...~.~ ~.~g ......................................................................... at premises located at ...~O~..~....}~L~..~¢a~O~. ........................................................................ ................................................... ~3~.¢~..D~ ......... ~a.¢..t~e&.on .............................................. pursuant to application dated ............................ ~.~ ....... ~ ...... , 19.~.., and approved by the Building lnspector. Fee $...13:~..'.3..O. .......... --Building Inspector FORM NO. $ TOWN OF SOUTHOLD , Building Department 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), 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 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 New Building ...~. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~/.~.....c~...//./~.~-~/~..4~.~;.(.?....~. ........ 4~..e~....~,~,~,~,~,~,~,~,~....~.4'~4~,' .................. ~_,~..____~.....~..~..~.. ..... Owner Or Owners Of Property .~..~...~..~:.~../~.~/)J~.~j~...~.r.~.~.%~A.~.L.~..j~.. ........... Subdivision ....~...~....J/~.~ .............. Lot No...~...~;... Block No ............. House No ............. Permit No..~../.l~./~..]F .. Date Of Permit ...~..,~.~/..~..~/...AppJicont Health Dept. Approval .... .~'.~.~..~....~...l.~,.:,~.. ................. Labor Dept. Approval ............. ..4~.../...~.. ....................... Underwriters Approval .N.~-~~..~...~.~..(~...~] ................ Planning Board Approval ........ ~ ......................... Request For Temporary Certificate ........................................ Final Certificate ...... .~..(..-~.. ........................... Fee Submitted $ ........ ..~..~.d..~ ................... Construction on above described building and I~ermit meets all applicable codes and regulations. Applicant . .~...,~_~. ~ '~. ~'L.. ~,/~..... ~i ........................ Sworn to before me this /0//~//~- I day of .... c5 -7 p or sea,, .................................. (stamo/o/~o~ ~"~'~.., ! J7 (~ ~ 2.- Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Nealth Services Reference Number 10. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Appl icant.~<~,~ ~, W~y~, Phone L~7~,~[/~_y~] ~. Address ~'~-"~ ~ ,,~i~_~' o. ~ec~lon ~ ~ Property"~E~tion ~.~/~-~' ~.~ 7. Lot Number ~y~ · - .~ 8. Private Well ~ Village ~---~j~~,~ Township ~s2~~~) 9. Public Water ~ZJ Public w~t~r~Compan~ Name' -- Distance to main Lot size, Width /O~feet Length~feet' Sewage Disposal System: (For Health Services Dept. Use) A./(~"~gallon septic tank: Pre~ast~Equivalent Block B. Leaching pools: Number of pools Precast_~Block ~_Special__ ll. If private well, fill in the fol- ~)owing~anks: ~,' TaFFk~¢apacity . gallons ~. PuD]~ G. P.M. ~,~C. T~I well depth. !i i~D. D~)~]~h to ground water ~ E. ,~A~unt of water in well The undersigned CERTIFIES: "Construction of authorized 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. Date Signed ~x_ ~-_~ ~~ 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. APPROVAL DATE SIGNED ~ S-15 Rev. 4/1/73 ~ND~RWR! ~ ~.RS ' THE NEW YORK BOARD OF FIRE{ ~' ' "= DE BUREAU OF ELECTRICITY Alfred.Fink, 1145 G~llette Dr., East Marion, L.!. , ,- DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ~PECiALREC'PT ~'ME CLOCKS ~ BELL ~NJT H~ATERS 4-1.0kw, 3-.75kw,' 4~.Skw ' ,. Elec Room Heater/s: 1-3.0kw,'!12.0kw,~ 1-1.75kw, Motor/s: 1-3/4bp t-4o5kw Water Heater W.B. Ru=ana Electrician Mattituck, L.I. This certificate must not be a!tered in any manner, return to the office of the hoard if incorrect. ]nspecfors may be ~denfified by their c .... .................. ~amin~ ~r~ 19.~.../ ~it No .......................... DJ~ a/c .......................................................... ~lT APPLI~T~ ~e ....... ~.~ ...... , 19.~...... c. ~ work e. ~o ~uildi~ ~holl be ~holl haw ~on Oren~ APPLI~TION IS HEREBY ~DE to the Buildi~ ~pa~ment for the i~uance of a Buildi~ Pe~it pu~ont Buildi~ Z~e Ordinance of the T~ of ~old, ~f~lk C~n~, New Yo~, and ~er a~lic~le ~, O~i~es or R~ulati~s, for the constru~i~ of buildings, a~iti~s or altemti~s, or for ~al or ~liti~, as ~min ~ri~. ~e ppplicont agr~s to c~ply with all a~lic~le I~, ordJ~, ~ildi~ c~, h~i~ c~, a~ ~l=i~, admit aut~Hz~ in~o~ ~ premiss ~d in ~i~l~ ~r ~e~ i~i~s. (Signature of applicant, or name, if a corporation) ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....Z~.....~.....~.....~. ........... ~......~e~/~. .................................................. t. is a corporate, signature of duly authorized officer. (Name and tit e o corporate officer) Builder's License No ........... ,~-,,~.,~,...,,,'~.-~'--,.- ............ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which p ~ro~:x:~l work.will be done. Map No.: ..... ~.l~.~.._. ......... ,. Lot Nob..,..-~.~ ........ Street and Number~'~//J~l~..~:[.~.~.i~,~...~..~.~../...~?...../..~..... .................. .~(,~.~l~.~.. ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. ExisiUng use and occupancy ..~.~ ............ ~/....'~'~. .................................................................................... b. Intended use and occupancy .................. ~Z'.x~"~ .......................................................................... 3. Nature of work (check which applicable): New Building........~... ..... Addition .................. Alteration .....:...',. ..... Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) (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 .............. /.,~1~'.... .............. ; .................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ..... ~ ................. 8. Dimensions of/./e~tire new construction: Front .......... ..~JJi~......~Rear ~..... Depth ....'~lJ~j~..~ Height . /~,~Z,.. Number of Stories /' . 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 I. Zone or use district in which premises are situated ............................................................. ..;;.?.~ ............................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded .........~.; ........ Will excess fill be removed from premises: ~Yes ( ) No 14. Name of Owner of premises ......... ~; ......................................... Address ................................ Phone No ....................... l~ame of Architect .............................................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ,, ,~ ~ ¢ t .......... ~......~...../~'..~.~. .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ................................... C,,-g~..~.~.....~ ........................ ~ .............. - ............................................................................... ~;~t~, ~c::~, cbmorate officer,~ of said owner or owners, and is duly authorized to pedorm or h~e per~ormed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his kn~ledge and belief; and that the work will ~ performed in the manner set fodh in the application filed therewith. Sworn to before me this Nato~ Public,. ................... :......~ C?n~ .... ~,~ ....... ~ ...... /~ ............ ~ ~IZAB~H A~ N[~ ~b67" Iv'],~I~IOfl, IV. Y. FINK VI N LEFT VIEW L Z£-