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Home My WebLink About8189-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z..6.~.6.~. ...... Date .......... Ja~t,. ~. .......... , 19.7.~. THIS CERTIFIES that the building located at ,~e~.&~, l)l~.~lV~ ............ Street Map No~a~ .g$~d .m~ock No ........... Lot No. 1.1.~... ~$~...~.~ ...... .. conforms substantially to the Application for Building Permit heretofore fried in this office dated ........ . .SeP~ ... 8..., 19~.. pursuant to which Building Permit No. ~] ~9~.. dated ........ .~e~...lO ..... , lg~..., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is . P~I~ .~..~$~l.~y. ~q%~g ....................................... The certificate is issued to .Qa~e~e .&. ~le~. ~,~. .... ~$r~. .............. (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health ApprovalDe~...2].. ].~Y...~y ~.~ .~-: ..... UNDERWRITERS CERTIFICATE No. ]~62~9~... ~e~...~9...~.97g ................ HOUSE NUMBER . .~gQ ......... Street . D~a~ .D~I.~ ........................ ' Buil~ing'i~; ' FOI~ NO. 2 TOWN ~F $OUTHOLD 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) No. 8189 Z Permission is hereby granted to: ..../.!!.!..>..::Z:..~:!.~ ......... L..~!.:.::~ ......... C..:?..~ ....... ~ c ~:~ ............ (~':.! ...... :?/. ....... ~'~.~.!.:.~i~,(.(. .....! * ~ ~ ~- at premises located at ~° I~ hj -7 /,. /q i... Z];i: t ,/ LT ~' ~ /~ -'T[ ~ ~ ~ ~' .... · / .......................................................................... .~ ...... ~. ............................. pursuant to ~pplic~tion do~ed .............................. ~:.~....d ....... ~...., ~...;._., and approved by the Building Inspector. Fee $ ~7~J f~'5 Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number -.5""'-Jd- APPLICATIO~ [,OR A~RROUAL TO CONSTRUCT A PRIVATE SE~AGE'DI~'P'O~i.S¥STE,~. A SUPPLY ,,AND WATER~,,~ ..,~?~ , '~.' :' 1. Applicant-~:~X' ,c~t~-~'.'~F,~-~ ,Phone,"~?t~,~l~,'~ ,:~ ,,5.~,S~bdiv.,~ 3. Pub].ic ~at~ Company. Ng~.~ ~,~o~,,.~~,.-q~;~iS~,b~tb~ainx'~~'~ 4.~.Lo'~'~'lze~:' ~W~t~&~'~ , ..- ~,.~eet'~ ,:: Leng~ht~: %_ , , f~e,t~..~ ,~ ,,., ,.'.,.,, :, o~' ' F~ he lth s~¢~iC S pt ) 10.. 8ew~e. D~s~os:al~ System: " ( a e De . Use ; ,Numb~¢::6f'pools'~ ~ .~ '~o ~', ~: .. . Precast~'~:'t~ '~ ~l:Oek "' ,Special ' ' ":-*" '" 11; f, e, - fol~',, ~ ' "-"' ' ' , ,;.: ,, ,, ;! 'v -_. ; ,, ::~ :?..- , :,:, '.} . ' , . : ..... ~. -, ~.'i,,.~ ,,,.[~,, ,, ,- .~ -?, ~, , ':,, ' . The undersigned: C~Rl[~F'I~S::?Construc~bn of 'au~hor~Ze~ ~nsta~l~g~ons ~11 be ~n accordance ~th the Suffolk County Cepartment of ~ealth ServSce~' eurr~nf gtandards thereto:," ~ ~Th~s appJ~cat~on ~11 Be~ va~t~d~f6r~on~ YOar'~o~ ~h~:'d~ ~O~'~OP'~gal ~fidScated bel'o~ and may be rene~ed ~f a current local Bu~ld~n~ Department Perm~ ~sdn ef~ecg; ~ Date ~'q~'~;l~ ~ : ~ - ~ ,'. ,,,S}g,ned_ FOR THE DEPARTMEN~ OF ~EAE~:,S~E~C,~:~!,,,US[, ONkY, .,xBa~,e.d On..the, ;~D~0rmation presented here~, w~th,-~t ,~s~theop~n~on. of ~he Department of ~ea~th 5erwces that an adequate and sat~sr factory sybase D~sposal System~-~and ~ater Supplg can be,~n'stalled~°~ .;th~s p!o~. , S-15- ' 4/1/73 ; '' '".,/''. ~'"" ....... "," · , Rev. FOI~M NO. $ TOWN OF SOUTHOLD , Building Deportment 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, end 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-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 Date ..... .J....~.. :....~.. '..?. ~ ... ................ New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. L~ation Of Property ............................. ) ................................................... ) .......... -c..f.~ .......... .....~l.......~w.¢x...~. ~ner Or ~ners Of Prope~y ~1 ~ ~g~tl ~ ~ Subdivision .~.~.~?...~.~.~...~.~.~.~ ........ Lot No. JJ.~... Bilk No ............. House No...: ........ .er t ...... Da*e Of .... ................. ...................... Unde~riters Approval ...~.~.2.~.~ ................... Planning B~rd Approval Request For Tempora~ Cedificate ........................................ Fin~ Certificate .......................................... Fee Submitted $ ...:r:~...~ .................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ................. r ...... C~ ............................................................... (stamp or seal) Sworn to before me this ................ day of ............................................ Notary Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS Catherine: Tsoun~ , Central Drive, Breakwater Rd & Miriam 'Rd 18 42 27, 18 DRYERS FURNACE MOTORS TIME CLOCKS SYSTEMS NO. OF FEET x 1 )THER APPARATUS: *Furnaces: Olt.l-1/8hp, 2-1/12hp Elec.room heaters:~ 2-1.Skw, 1-.75kw Gus tav Bar tra,. Mattltuck,227 East BreakwaterL.i. 11952 ~Rd' ..]LI'c.1529E ' ~' " tne Board ,f~,ncorrect. Insoectors may be',denhf,ed ~y their credent,als Examined Approved 19:_,. Permit Disapproved a/c .................... TOWN OF TOWN CLERK'S OFFICE~/x~' Aprflication No...,~3,/..,~,..~ .............. g Inspector) APPDCAT~ON FOR BUILDING PERMIT INSTRUCTIONS a. This application must De completely filled in by typewriter or Jn ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. g. Plot plan showing location of lot and of buJldings on premises relationship to adjoining premises or public streets o~ areas, and giwng a detailed description of layout of property mus~ be arc ~vn on me diagram which is part of this application. :. The work covered by this application may nor De commenced before issuance of Building Permit. d, Upon approval of this application, me Buiidinc~ Inspector will ~ssue a Building Permit ~o rne applicant, Such permit snau be kept on the premises available for inspection throughout the work. No building shall be occupied or used in whole or in par~ for any purpose whatever until a Certificate of Occupancy shall nave aeen granted b~ the Building Inspector. APPLICATION IS HEREBY MADE ro the Building Department for the ~ss~ance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Yo'r~, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The aaplicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to~ ~dmit authorized inspectors on premises and in buildings for necessary inspections. State whether applicant is )wrier. lessee, agent, architect engineer, general contractor, e!ectricion, plumber or builder. Nam, e of owner of premises .... : .......~,~Z4?.¢:x ......... ¢?m:/,~. X J; ...... f~(/. .......... :[~:~? ...................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No Other Trade's License No Locatio, of and on wh ch proposed work w be done M~p No ..... Lot No Street and Number .... ~....(~.~,x:{~.~;6~,.!..,~.~..~..V.,e.~, ~ ~ ~ *~'~> .' M~icipality State existing use and occupancy of premises and iht'ended use and occupancy of proposed construction: a, Exisiting use and occupancy ........ ~,~,~;~,~, b. Intended use and occupancy .......... ~::~ :~;~ .................................................................................... ~ .Nsture of work (check which applicable): New Building Addition Alteration "~ Repair .................. Removal .................. Demolition .................... Other~Y~k" ............................................i ....... '~ ~'~" :~ (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 .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ............................................................................................................ ~ ....... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated .................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No ]4. Name of Owner of premises .................................................... Address ................................Phone No ....................... Name of Architect .............................................................. Address ................................Phone No ....................... Name of Contractor ............................................................ Address ................................Phone No ....................... ~,.:' PLOT DIAGRAM ~o eLr~va~nClear?v:n;dtrdiStinctly all bui~din-~, whether existing or proposed .end"indicate all set-back di~~ L?P P Y ' es. G' seet and block numb~ or description according to deed, and show street names and indicate ~'h~ether interior or corner lot. '~ STATE OF NEW.YORK -, [SS ..... ~'..~.zS..1~',~. ...... ././~':..~. ·. ~.. ~. t~J..'(..'~ .~...t.~...I. ,~. ............................ being (Name of individual signing contracf) above named: duly sworrt~ deposes and says that he is the applicant He is the ......................... ~.,¢'JIL?.~.~c...-~.~3~. ......................................... ~ ........................................................................... (Contra~Nor, agent, corporate offi(~er, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that oil statements contained in this application are true to the best of his knowledge and belief; on~ that the work will be performed in the manner set forth in the apl:~C~on filed therewith. Sworn to before me this ~, '~ [ ~ .................... of ..................... ............ \ \ Notary Public,~ ,~..~ ~¢.. ~ .~ ...c~.., 1~eulfif~/',~ ~ ............. ...~.....~....~.~ .~. ~'i~'~' 'c~ .............................................................. of applicant) ~;~*¢63 Suffolk Coualy, , · LoP C.C. suFF°LK Lot III Lot 115 (Publ/c water) Lo/ i1~ Io!//~ The ~s~age d~ facilities fo~ this lc . ........ ,,~ been - ,.~ inspected ~o b~ ' TIT/ENO. 2-030-270 NO TE: · =M~NUMENT SUBDI VIS ION MA P FI AFD /N THE OFFICE OF THE CAE~K OFSUFFOLIf ~UNTY~ JA~ 19~ 1949 AS PI~F~ 1672. UNAUTHf~ZED ALTERAT)ON OR ADDITION TO THiS SURVEY J$ A VIOLATION OF SECTION .EV,S,ONS YOUNG & YOUNG .gEPr. zg, Ag?5 400 0STRANDER AVENUE, RIVERHEAD, NEW YORK A[.D£N W. YOUNG HOWARD W. YOUNG SURVEY FOR: CL[O ~ F~OUNI~ ~ C~F~/NE ~OUNI~ LOTNO 115, "CAPTAIN KIDD ESTA~~~ TOW. OF ' S~ THC '~ S4~t~t~4~ ~ ~ SOUTHOLD [ k ~r?':'~'~ / ~ ,I C T T