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Home My WebLink About8128-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy / No. Z6877 ....... Date ............... l~eb..3 ...... , 19..76 THIS CERTIFIES that the building located at . .S/S. l~.ne..Tx'e®. Rd ....... Street Map No... X~ ....... Block No..xx ....... Lot No.. xx .... ~u];~hogue.... ~...~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. 14e~.. ](} 19 .~.~. pursuant to which Building Permit No...8] 2~7, dated ......... ~lg.. ~. ...... , 19.?~., 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~'~.y~J;.e..0r~.e..~a~..~...d~r.e.~.~.$n.g ..................................... The certificate is issued to ...(}~-e.r~. He.:~dJ;.~.~r~V. ~ .~0~. ~.~.~ ...... ~.w~. ~.~.~ .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ja~...27...].~...bY. ~ ~. ¥~-.~],~ ..... UNDERWRITERS CERTIFICATE No...~2~2.~.~.(~ ..... ~4~...8,..197~. .............. HOUSE NUMBER ..... ]2].~. · · Street .. P;Lz~e. t~'ee. Road ....................... .... ...... Building Inspector ( 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? 8128 Z Permission is hereby granted to: G~Lerm...~e~:ct.t~mmt~ -.~:..~n ........................................ .................. ,T..al~e ~o.~ ........................................ to .tl'ozL1/L..r~ev...one..l'~u~i~L~..O, we.~l~nt~ .................................................................................... at premises located at .l~/.l]..~.il~..~io...P~l~d ........ (~.(~..3..I~IIQ~...I~A~). ............................... ........................................................... ~'~tQhogue ....... N..¥., ............................................................... pursuant to application dated .................... ~......'[10 .................. , 19..~..~.., and approved by the Building Inspector. Fee $..~. ................... ............. ..~. ...... ;;,i.y,i......~....;c.~,r l .......... FOltM NO. $ TOWN OF $OUTHOLD , 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), Non-conforming uses, or buildings and "pre-ex'st'ng ' 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 occupancy $1.00 Date ....~...~ ..~...; .~ ..~....~....~.. ...... New BLiilding ...~ ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~J~,.~.'.~.t.fk~k,.....(~.: ....... ..~...~...C...'.......~...~.~.~...~,~.~.......~..~..~.~..~..~....~.~,....~.....~...: ....... Owner Or Owners Of Property ~..~i~.~...~.~.(~..~/~L~"~..~..~?.~....q...~..~.~.~...~..~.~.~..~2~.: ................................... Subdivision ............................................................ ..'..Lot No.....Z~.. ...... Block No ............. House No..!..~..!. Permit No ..................... Date Of Permit .................... Applicant ..~..L~.~.[~'~.'.~'..~).~c~..~....l~........~...?.~...C~.t..~.~....~. ~,~c,-, Health Dept, Approval .,.//.~..~../..~..~.' ...................... Labor Dept. Approval /J Underwriters Approval .............................................. Planning Board Approval /~[ /~2 Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ ..?... ............. .c.~..c.~. Construction on above described building a.n.c[~iermit meets all ~oppI)cable codes and regulations. Sworn to before me this ~ (stamp IE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038L Heldtmann?&'Son, Bl~s.,~Plnetree Rd., Luper. Dr. & Redwood Lane, FIXTURES :OOKING DECKS OVENS EXHAUST FANS 12 FUTURE APPLIANCE FEEDERS TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET D/MMERS SYSTEMS [ NO OF CC COND · A W G NO OF H LEG A W G NO OF NEUTRALS A W G 1 , 2 17 q Motor/s: 1-1/2b'p :' Robert A.-.Goodale, RR #1, Box 15A, Main Rd., Mattltuck, L.I. 11952 This certificate mus~' not be ~ tered w any mannel L'ic. 783E D SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~%~¥)~)~.~ ~.) Phone ~'Ia~-~(~ 5. Subdiv. Address 6. Section 2. Property L'o'cat'ion~-l~,~'f~(~(~.~__~ . ,~, ~ 7. Lot Number C..~'t~r~o(;~-~.. 8. Private Well ~/ill~ge ~ Township ~O~.~.l~ i' 9. Public Water 3. Public Water Company..Name ~ Di§tance to main 4. Lot size: Width $ ~ feet Length ~'~ fee~ 10. 11. Sewage Disposal System: A.~gallon septic tank: Precast~.Equivalent Block B. Leaching pools: Number of pools Precast 7~Block Special If private well, fill in the fol- lowing blanks: A. Tank capacity_~O~ gallons B. Pump G.P.M., (0 C. Total well depth, D. Depth to ground water E. Amount of water in well Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health 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 FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based~on the information presented here- with, it i~' 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 TOWN OF SOUTHOLD ~/~'~ ~/~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~UTHOLD, N.Y. ~/~ ..... ........ ........... ......... . . ,, ~ ~ ._7~ ..... ~/~ ~ ~ ~ ~ ~/~ · . ................ : ................ } ........................... , .... APPLICATION FOR BUILDING PE~IT INSTRU~IONS a. This application must ~ completely fill~ in ~y ~p~writ~r o~ in ink Insp~tor, *ith 3 ~ of pl~ns, accurat~ pl~ ~lan ~ ~al~. F~ ~cco~in~ to b. Plat plan shying I~otion of lot and of ~uildings on pr~mis~s, ~lationship to adjoining premiss areas, and giving a d~tail~ de~ription of layo~ oJpr~ must be ~rown on th~ diagram w~icH is ~ oJ ~His application. c. Th~ ~ork cov~r~ ~y this a~lication may n~ ~ commenced ~for~ issuance of Building P~rmit. d. Upon approval of ~is application, tH~ Buil~in~ In~p~or will issue a Building P~rmit to s~all ~e k~pt m th~ p~mises availa~l~ for ins~tion througH~t th~ wor~ ~. No ~uil~ing shall ~ ~cupi~ or u~d in ~hol~ or in pa~ ~or any pu~ose wHOever until shall hav~ b~en grant~ ~ th~ Building Insp~tor. APPLI~TION IS HEREBY ~DE to the Building Depa~ment for th~ issuanc~ Building Z~ Ot~inanc~ of th~ Town of ~uthol~, Suffolk County, N~w York, and other applic~l~ ~, O~inances o~ Regulations, ~or th~ const~ion of ~uildings, additions or aJt~ratims, or for t~moval or ~emolition, ~ h~i~ ~ri~e~. ~ applicant agr~s to comply with all applica~l~ laws, ordinances, ~uilding admit authorized in~cto~ m premises an~ in ~uil~in~ fo~ n~essa~ i~tions. (Signature of applicant, or name, if a corporation) 9.0 ~,o,c ~-, '~ne,,e_S.~oa'T' . k~ . ......... : .............................................. n: ............. · ........ :~': ............ (Address of aplfllcant) ~ us?( State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... ~....~....~.~...~. ................................................................................................... ~ ......................... Name of owner of premises .................................................................................................................................................... If applicant.. -- is a corporate, Signature of duly authorized officer. :. (Name and title OT corporate offlcerl . Builder's License No ..................................................... Plumber's License No. 11~..~l~.~.t.j~jj~ ~ Electrician's License No. ~.c~c~.{~.~-~...-~-~.~.(:.~'-(Z'~.'~.. ~.j.-~v~' Other Trade's License No ............................................... ~ ~m' 1. L~ation of la~ on which proposed work will be done. Map No.: .......... ~...; .........................Lo, No: ....~ ................ Street and Numar ~'~ ~g- ~ ~% --~'~'icipali~ 2. State e~i~tino use ond ~cu~ncy pr~mise* ond imended u~ oho ~cupanc~ o{ pr~osed con~tmcfion: a. Exisiting use and occupancy .~ ........ ~..~;~.~.C;.~_?.~.,.'.;::; .................................................................................... b. Intended use and occupancy ............ '~'3'~'~"~,.:'"'~'t~'{'~/%'~'sf4~'~':'"'s~l' "~';~r,. ( ~-~ ....... ~"~" ................... ; .................. - Approved ........................................ , I~OEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ,, Permit No. , , Application No. ~/ ~- ~ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sate of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot 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, if a corporation) ................................ ........ .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... .............................................................................................................................. Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No......(~....~ .'~....~..~..~.......~.~.~.e,~.'~ Electrician's License No. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ........................................ Lot No; ....~ ................ Street and Number ~'):...~.....~,~ ...... ..~..~/~"_~,,, . .~l~ ..................................... ~.~.~F~,~...~z...;~.~ ..................... -- ~'~ ~ '~ ~ ~f~icipality 2. State existing use and occupancy of premises and in,ended use a~Jd o~cupa~dy of proposed construction: o. Exisiting use and occupancy ............ '~'~'~,:'~l'~"~" ......................................................................................... b. Intended use and occupancy ............. ~.;~4.~t~..;-...~ti~.r~.i.~l~L.~....~J~.~.~.~.~ ....................................... 3. Natu're of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Rec~air .................. Removal .................. Demolitio~ .................... 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 ............................................................................................................................................. 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 ............................ Ngmber of Stories ~'~'~ .............. Depth ........................ 8. Dimensions of entire new construction: Front '~(~ Rear 9. Size of lot: Front t~5~ ' Rear .......................................... Depth,~......... ]0. Date of Purchase ........................................................Name of Former Owner ,..~."~ ~"'~J~. .............. 11. Zone or use district in which premises are situated ........... 12. Does proposed construction violate any zoning law, ordinance or regulation: .....'~.._O. .............................................. 13. Will lot be regraded ...... .~.?,~.,,~ .........~Vill excess fill be removed from premises: (~es ( ) No Name of Architect . ............................................................. Address ................................Phone No ....................... Nome of Contractor ~'~¢~T~ .~ ..................... Address Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, arid 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 Id. STATE OF NEWr~vOI~ ,, ~. I S S COUNTY OF ........................ ...~/:1~....~.~..~..~ ........... being duly sworn, deposes and soys that he is the appliconl (Name' E~f individual signing contract) above named. He is the ................................................................................................................................................................................ (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 end file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ 'the work will be performed in the manner set forth in the application flied therewith. Sworn to before me this .................. /...0.. day of .......... Notary Public,. .................. ~,,~/~.~.. ..... County ~~.......~....t'~...~..'~...~....~~ ............ , ,~J ~/ , (Signature of applicant) / APPROVED A~ NOTED DATE . FEE: BY NOTIFY BUILDING DE~ARTMi:NT 765-2660 9AM TO 4PM FOR ED INSPECTIONS: I. BEFORE BACKFILUNG FCUNDA- TiON OR START FRA~ING 2. BEFORE COVERING pIp~LINE 3, FINAL WHEN IQB COMF~TED NOT ~ES~ONS~BtE ~o~ ~S~GN oR c~- 4- ~'-o ....% 4.L , © J 91 s~,/~ ~" l'-o L Co c ~O~OL ~,