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Home My WebLink About8155-zleO~M NO~ 4 TOWN OF SOUTHOLD BUH.F)iNC DEPARTMI~T Town Clerk'o Of[ice Sou~hold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the bul]ding located at . £/5./~queat~:ian .Ave ..... Street Map No.. ~ ........ Block No... ~K .....Lot No ..... XX... v isherr~ .1 $1~nd ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........J..up.e..2..8.,., 19. ?~. pursuant to which Building Permit No..81 ~.~z. dated ............. .J..~.y....2.0., 19..7.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~sued is . .P.r.~.v.a..t.e..o.n..e..f.a.m..~.~ ................................................ dwellin§ The certificate is issued to . .Sr..~ .~ra .~ldr. ew. Bl'aull ..... 0~mel'.S ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~.' .Rr.l.~.0..~...b.y..C.: .55~.%h .......... UNDERWRITERS CERTIFICATE No. N2~2.~... [~y.. 2q.. ~ 92.6 ................. HOUSE NUMBER ...n.o..n.e ....... Street ... E.ques.t~.ian. Ave ...................... // Building l-.Im, eto/ FORM NO. 2 TOWN OF SOUTHO~.D BUILDING DEPARTMENT TOWel CLEP~K~$ OFFICE $OUTHOLD, N.. Y. BUILDIt~G FERM~T (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8155 Z Permission is hereby granted to: z~s ...c.~.t.~.~.~.~.....~../. ,c......~.~..e.~...~ ........ ......... .r...t.~.~ ...t:.~ .z..~ .r...a. ..................................... at premises located at ..~....~..~..~..q~q..e.:~.~.~.~t.~...~`.~..e.....~.~.~[~..~.~r.~.]~4~.~.~.:~. ........................................ ................................................... ,r..t..~....x.~..x...a~...a......~.!.:.~.: ............................................................. pursuant to application dated .......................... .~'.~.,...~. .......... , 19..~..~., and approved by the Building Inspector. Fee $~.~.?,,1~... ......... ~SU~. LK COUNTY DEPARTMENT OF HEALTH SER¥ICES Health Services Reference Number ^PP, ICAT ON FOR ^PPROV^' TO CONSTRUCT ^ P V^TE SEUAGE DISPOSA: 1. Applicant ~S ~~ Phone Address ~C I~ MI~ 6. section - 2. Property Location ~ I~ J~ ~ 1~ ~'~ ~. Private We~l -- Vil'lage Townshi~ 3. Public W~ter Company Name ~x~ 4. Lot size: Width feet '- Length lO. Sewage Disposal System: (For Health Services Dept. Use) ..... Precast ~Equival ent Block. B. Leaching pools: Number of pools ~ -/~0~ Preca~t ~ Block Special ll. If private well, fill in the fol- lowing bl ~ks: ~ A. T~ cap~ty~gallons ~.B. P~ G.P.~. ",~ ~.; ~/ Well oe~n ~ ~h to groundwater :z>~J ~t of water l~well Y~ unde~9ned CERTIFIES. CODS~PUC~OD of au~hoMzed ~ns~]]a~ons w~]] be~ acco~aDce app]~ca~o~w~] be valid fop ode ~ea~ f~o~ ~he be ~enewad ~f a cuP~en~ local Building FOR THE DEPARTMENT OF HEALTH SERVICESI USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal Sys_tem and Water Supply can be installed on this plot. S-15 Rev. 4/1/73 FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFI(~E ~OUTHOLD, N. Y. Exam nedk/U L"/ ? 7~'~-' . . . .............................. ...... ......... ,.. ................. ,, ........ ._ ^pp,,co,,on 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 o~ 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 Deportment for the issuance of o 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 nome, if a corporation) A~ress .... ap I' '~ ............................... OG State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... ~l~.~.J~JJ/~....J~.~-~c,4~, ,,,,~,,.~... ,.~... .......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~.'.~..~..::'..~J:~. ......................... Plumber's License No .... ..~'.....~'...~......~'....~.. ...................... Electrician's License No...~.'.~...4....~..~. ........................ Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ~ ......... J~ ............. Lot No. ........................ Street and Number '~.~.. ~.~......~.......~.....~.~.~.~..L...~.....J~..'.~, ..................................... .~jl)~..J~ - M~'nici~ i6' ...... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy J//J ¢/~/'~ ~ 3. Nature of work (check which applicable): New Building ..... ~ ....... Addition .................. Alteration ............... Repair .................. Removal .................. Demotitior, .................... Other Work .................................................... ~, /~/__/~ LJ O~ (Description) 4. Estimated Cost ............ .!.E.[~.~..E .................................. Fee .....~....I.')~..t~......~[~......-~....,~...). ...................................... (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 ....~O. .................................................................................................................................. 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 entire new construction: Front ......... .................... Rear ...... .~..~..~.. ............... Depth ...?..~,,. .............. Height ...~,;~! .......... Number of Stories .....~.. ............................................................................................................. 9. Size of lot: Front .~'~:...~J-J~.... .................................. Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner .~.....~.. }.~.~,...~...0,~ ................. 11. Zone or use district in which premises are situated .~fl/~r~.. ............................................................................. 12, Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded .~....~.. .......... Will excess fill be removed from premises: ( ) Yes ~.m~...~!L.~..~. ., 14. Name of Owner of premises i.:.~..:.:wz.-.[;.~,.=r, xi.,..w.,.~.m ........... Address Phone No..J.¢.~..'.,,..~.~.~,.p Name of Architect .~. ~...~.~...~. '~ ............................. Address~.....~....~. Phone No..~..".~.~.~' Norne of Contractor .,Z~..... ~;~,--~ .,4/., ........................................... Address---- --,l~,,.~.u..~ . ....... Phone No.,;...,..:.:.".*~.*.! ~ PLOT DIAGRAM Locate clearly end distinctly oll 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 end indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ...,../k'..,.~,.3,$.~..o.. ........ ..................... '.x[..~.?r...~ ...... ~.~. ,'.1.~.~..J:..~..(...Cz.. ................... being duly sworn, deposes and says that he is the applicam (Name of individual signiF~g contracf) above named, I-le is the ................................................................................................................................................................................. (Controctor~ agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work end to make and file this application; that o[I statements contained in this application are true to the best of his knowledge end belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... "~'""~" ...... day °f ~' 3'"'~"~'d'"'~" ...... Notary Public, . ........ ..~..~,.; ........ ~ ......................... County ................................................................................ ~,.~ ~ ~ ~/~~ S licant) "RbBERT M. BUGGE~EN._ j// ]NOTARY PUBLIO, State of New 'tore No. 30-45].8377 Qualified in Nassau Count'] Term Expires March 30, 1976~ t ^PPROVED AS NOT~.~Q NOTIFY BUILDING DEPAKTMENT ~' 765-26&0 9AM TO 4PM FOR REQUIR- 1. B~FORE BACKFILLING FOUNDA. TION OR START FRYING 2. BEFORE COVERING PIPELINE · 5P_/_.oNP FLOO¢._PLAN PP__-TA t L.,5 L dr · /, 't '% /