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Home My WebLink About8160-zFORM NO. i TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfificnte Of Occupnncy THIS CERTIFIES that the building located at .2.0.p .'F.~..n!~U.N~-...~.~.~.~. .... Street Map No Block No Lot No '- conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~tl 6...W..~. ....., 19.7. ¢. pursuant to which Building Permit No. ~.t.~;.~ .Z. dated ......... A U ~... ~ 4.., 19.g&, was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is · .h .... ~I~.~.ff~. ,.~ .... ~b~...Ft{¢4..~ .( .... ~.~ ¢.¢¢).¥.~ .............. The certificate is issued to . ~ e (t. ~..~... & ¥ ~ .... [~ ~ ~.~ ~... W~..~.} ~ ~. ¢.~ ...... (own , of the aforesaid building. Suffolk County Department of Health Approval .Q g. ~ ..~. ~7' ('~ ~''' ~k~ff' ~ ~' '~' ~ UNDERWRITERS CERTIFICATE No ...... N....~.+.5. ~. ~( ~ ...................... HOUSE NUMBER ...... '30.~... Street .. ~Fth¢l.b[~. ~x~ ~... ~.(~.¢ ................. B~lding Inspe~or ~B~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLJRK'S OFFICE $OIJTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8160 z Dote .................... &~g.U~.~;.....2.1 ............. 19.~.. Permission is hereby granted to: to ..~..~w...o~..~..~ ................................................................................... at ptemi~ I~ at ....~~..~.~.~..~ ...................................................... ...................................................... ~..~ ............................................................................... pu~t ~ a~lication ~t~ .... ~ ................ ~ .......~ ............... , 19~.~..., a~ approved by the Buildi~ I~. Fee $.].~.~,.l~J ......... TOWN OF SOUTHOLD Building Department Town Clerks Office Sou~hold, 1~. 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 Jines, 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 e~ectrica~ 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 compleled site plan requirements where applicable. EL For existing buildings (prior to April 1957), Nomconforming 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 ......... New Building ........~.. ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~f.~Q~.~..n.~Tt~D~.a..~.~.n.~.~..~.~Q~.~.~`~..~.~1~.~.~`~ Owner Or Owners Of Property Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~.~.~.Q ......... Date Of Permit .~./~/.~.~...Applicant Health Dept. Approval .~ .~.~.~...~.~ ...... ..~......'~...?.....(.!....~k. abor Dept. Approval .............. ~. ................................. Underwriters Approval ~.~..~.~..~..8. ............................. Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .......... ~'~ .......................... Construction on above described building and permi~eets all applicable co,?nd regulations. Applicant ............... .............. ............................. Sworn to before me this ? ................ day of ............................................ Notary Public .................................... County (stamp or seal) 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~e~w~ //~/~A~'~ /~t/~?f~honeT~ ~o~ 5. Subdiv. Address ~o'~ ~ ~¢' ~'~~ ~. Section Lot 2. Propert~ ~6'ca'tion c~.,,,q ~'~ ~'f~/ ~d~7. Number 8. Private WeTi ~ ~vt~/~' Township 5~i~ 9. Public Water- 3. Public Water Com~an~ Name Distance to main 4. Lot size: Width20~ feet Length, 5~ feet 10. ll Sewage Disposal System: A. l~O~ga?on septic tank: Precast Equivalent Block B. Leaching pools: ~ Number of pools / ~ Precast ~'°Block_ __Special If private well, fill 'in the roi- co lowing blanks: ,~'IA~ Tank capacity 'T¢'~ _gallons ,~.~Bo Pump G.P.M. .~ Co Total well depth D. Depth to ground water E. Amount of water in well_. ~/~ _ (For Health Services Dept. Us~e) 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 ~../~z/~¢./~ Signed ~e.~ (~~ ===================================================================================== 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 THE NEW YORK BOARD :OF 'FIRE' uNDERWRITER$ BUI~EAU'0F ELECCRICITY , ' , '' ~- ak 85 JOHN STREET, NEW YORK. NEW YORK 1OO38. i John Fishbr, Fanning Road,:'orath~o'~'Road, in thefoBowing location; ' Ba~bment' ~ ~ '2nd'FL ~ (O~S 1de '~ ~.~..,i.~ao., De eembe~']q_l," ' i975 ' I' , andfoundtobe[ncomplta.cewtththereqatrementsofthtsBoard., . 42 DRYERS (ECEPTACLES SWITCHES 53 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS V ~ *Exhaust Fans: Furnaces· Oil Motor/s: l-l/2bp Gustav Bartra, , " . ' ER #1, 227 East Breakwater Rd., Mattituck, L.I. 11952 ' I This cer$1ficate must not be altered in any manner; return to the office of the I2/0 Boer, i{~ incorrect. ,nspec{ors mar% idenf'fled by ~ INSTRUCTIONS Building~ a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Inspector, with 3 sets 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 o~ areas, and giving a detailed description of layout ofprpperty must be drawn on the diagram which is part of this application. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this apphcotmn; the Building Inspector wdl ~ssue a Budding Permit to the apphcant. Such perm, lt~. 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. APPLICATJON 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 lOWs, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. \ ......... ,. ................... (Signature of applicor)~, or name, if a corporation) (Address of applicant) ........................................................................................ ~Je AIm~le Z~l~elit (Name and title of corporate officer) Builder's License No ...............~.?..~.....J.~ ........................ Plumber's License No ................................................. Electrician's License No ............................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~'~'r~'~ ~i 'owner of premises .................. ~.....~.....J~.....1~.. ............ ~~....~...~ .................................. If applicant is a corporate, signature of duly authorized officer. Other Trade's License No ............................................... ~' 1. Location of Iond on which proposed work will be done. Mop No.: ......................... ~ ........... ?.. Lot, No ......................... Street and Number ........... JJlJJlilJJ~..Ji~..J~illll~J..JJ~l~J..e..~~-.JJJ~j..JJjl~..~ii~ ........ 2. State existing use and occupancy of premises and intended use and occupancy Of Proposed construction: a. Exisiting use and occupancy ............... ~...J~...~ ............................... i'. ...... : ...................................................... b. Intended use and occupancy ................................................................................................................................ 3. Natur.~.work (check which applicable): New Building ......~. ........... Addition .................................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (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 ............................ 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 ...I[.~.?.....; ...................... Rear .'[.~l. ...................... Depth ...~.e. .............. Height ........ .~..&..?. ..... Number of Stories .............~ .................................................................................................... Size of lot: Front ............... ~ .................................. Rear ....~..~... ............................... Depth .~.~.,,~.,e..~. ................... Date of Purchase ........................................................ Name of Former Owner ...~l~l~Jl~'..~;..~l~* .......... ~ ...... Zon, e or use district in which premises are situated ............. ..~.. .................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................. ~1~ .................................. Will lot be regraded ....... ~,.~1 ............. Will excess fill be removed fr~jt~sj~l~ Yes (il) No Name of Owner of premises ..~..~...'.~....~...~.,.,~.~ .................... Address Jlli~.~ll~l~l~ll~.... Phone No ....................... Name of Architect ............................................................. Address .~ ................... Phone No ................. ' ~.~ Name of Contractor .~.~..~..,~.~..~...~.,.~....~..JL... Address ~l~ll~l~lll~,l~..~l~ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ~11 buildings, whether existing or proposed and ind!cate all set-back dimensions fro~. property lines. Give street and I~ck number or description according to deed, and show street names and indicafe whether inter or or corner ot: L ~ 10. 11. 12. ~!13. 14. STATE OF NEW ii~l, li,,,,~, I ¢ ~ COUNT OF ................................... ....... ................ ~.;t,?lq,,.:.,...~r ........... :,?..~. e g d~ly sworn, d~osq~ a~ .says t~t he 4s the applJcanl (Name of ~nd~vtdUal s~ning cbntrac~ ' above name. He is the ~.~ ......................................................................................................................................................... (Contr~ctor,,eg~t,L~o~ate officer, etc.) of said owner or owners, and is duly aut~rized to perform o~ have performed the said work a~ to ~Ee ~nd file this application; that ~11 statements contained m th~s app ~cahon ~re tree to the best of his knowledge and 5elief; ~nd tha~ the work will be performed in the manner set fo~h in the applicatio~ filed therewith. Sworn to before me this ..... .................. ............... ....... ..................... ELIZABETH ANN NEV OTARY PUBLIC, State of New yot~I N0. 52.8125850, Suffolk Ex,i,,, M,,~, .lO. Term G,rc~ ~ OA D K T~'s 7- /-/oz_ E' t APP~,OVED R~ NO'~,ED