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Home My WebLink About8226-zFOlt3I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office South&d, N. Y. Certificate Of Occupancy. THIS CERTIFIES that the building located at . !3, .~../-~.F./.[. .~.0.0..0.. ~.~!f Street conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ .... ~..., 19Y~ pursuant to which Building Permit No. dated 19~. was issued, and conforms to all of the requir~ ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to ~B~ ~ ~T~T ~h ~ (owner, ~) of the aforesaid building. Suffolk County Department of He~th Approval ~] ~ ~ /~ ~ E - ~ 0 - UNDERWRITERS CERTIFICATE No. ~ ~ ~ ~ ~ 0 HOUSE NUMBER ~ ~ Street LhU~EL~SV~ Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING , P,E~MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 8226 Z Permission is hereby granted to: ~.~.t/.N.Z.~ .Y......U.~.t.~. .¢.......~. :.~..~.~..~:. s..~..~...~....~ at p?emises located at ............ L,.~...V...~.~.E..L..W..~.~./~. ........ ~.~.~..~. ~.~L~...~..~..L........A./.' /, .......... .L.o..~....~...) ...... .L.~..u..t~L~.~.~..~. ~ ~..-c~.. ~-..:~./...t.(.~.e.. ........ .~..~...~ ........................ pursuant to applic~ation doted ........................................................ , ]9 ........ , and approved by the Building Inspector. Fee $..!..~..../..~.... Building Inspector TOWN OF SOUTHOLD , Building Depnffment 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 suwey of property with accurate Jocation of ail 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 electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and instalJatJons, 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: 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: I. 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 /:-~'E~ ~.~ lsd7 New Btlilding ..... f..... ...... Additian ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ......... .?...~...~..~......~..~...?.....~...~..~ ..... ..~J....~.b...~, ....... ,..~...~..!..g. I~ ............. ~.~.~.~..~..~ ....... Owner Or ~ners Of Property ....~.~.~]~.(...,~..~'~.~'......~.~.~ .................................................. Subdivision ................................................................ bo~ ~o ............. Block No ............. House No..~[~. ......... .......... P~it No. ?Z ~ ~ ~-D~te of Pe~t ..... ~.f...App~ca.t , ................................................................ ........ .................... .................. Underwriters Approval .............................................. Planning B~rd Approval Request For Temporaw Ce~ificate ........................................ Fin~ Certificate .......................................... Fee Submitted $ ..........~ ....................... Applicant ................... ~.~ ~. ~_ .~~, v. , .... Sworn to before me this ........................................................ Z Notaw Pu .................. Coun~ THE NEW YOrK BOARD Of FIRE UNDERWRITERS nr BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORKi NEW YORK 10038 /'"'" February 9..~1976 ~,,.t~..,~,,,,,~o..,,f~e, 828897 n 268840 Robert Shawl. Jr., 935 Laurel Wood Dr., Laurel , ,~ ~..,,,i,,.d o,, ' Feb ruary 6 ,, 19 76 .... dyo,,,,d to 6~ ,,..,,,-v~,,-,,~. ,,~,t~, t~,,, RXTUR~ FIXTURES RANGES DISH WASHERS 25 5O OTHER APPARATUS: OF CC CONO C E 2 I Motor/s: 1-3/4hp. ~ Mt. Sinai Elec.,Inc. ll5 Mt. Sinai Ave. Mt. Sinai, L.I. 11766 Llc. "898 D Per-- SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number~'$o -151 APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Appllcant~)~¢7~,>V' ~'/.~,~,,~¢~' u,~e?~ Phone 2. Property Location ~. ~,,~'~ ~r- ~ ~:, ~ ~ X ~ ~ ,>/~ ~,q ~ .+ /S,~- ~ ,~,~h, 8. Private Well ,,,, ,~., ~, Township ~ ~ 3. Public Water Company Name 4. Lot size: Width iCFL~ feet 10. Sewage Disposal System: A. 9~O~gallon septic tank: Pr~ca~st~uivalent Block B.j ,Leac~ng pools: ~ Numar of pools Precast~,~ Block ·Special 11. 'If private well, fill in the fol- lowing b~anks: A. Tan~ ~apacity ,~"~gallons B. Pump G.P.M. C. Total well depth D. Depth to ground water E. Amount of water in well Distance to main Length ~- feet (,For 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 indicated below and may Permitappr°val be renewed if a current local Building Department is in effect. 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 SIG,ED .... S-15 Rev. 4/1/73 18-157N Z LOT · 7 LOT. /.I k..~..r~l., .,,v,c.oD ',~T,kTl,~g "i'~l,.,.~'l; IN TI'Il:' l~OZl~ NO. ! BUILDING DEPARTMENT / ~"OLO, N.Y. ~ [x~mined .................. I~ ........ ~. _ Appfic~fi~ ~o ......................... ........................................................... ...... ...... ....... ............... AFFLICATI~ FO~ IUILDING FE~IT INSTRU~IONS ~9~ a. This application must be completely fill~ Jn by ~ewriter or in ink and s~mi~ in triplicate to Inspector, with 3 sets of plans, accurate pl~ plan to ~ale. Fee accoffiing to schedule. b. Plot plan showing I~ation of lot and of buildings on premises, relationship to adjoining premiss or public stree~ areas, and giving a detail~ description of layout ofpr~e~ must be drown on the diagram which is ~ of this application. c. ~e work covered by this a~lication may n~ be commenc~ before issuance of Building Permit. d. Upon approval of this application, the Building Insp~tor will issue a Building Permit to the applicant. Such pe~i~ shall be kept on the premises available for inspection throughout the work. e. No building shall be ~cupied or u~d in whole or in pa~ for any pu~ose whoever until a Ce~ificate of ~cu~ncy shall hove 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 ir) buildings for necessary inspections. (Signature of ia'pplicant, or nome, ~f a corporation) (Address of applicant) //?d°7 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.. ........... Name of owner of premises ~.0~...~.'-..~.....~.. C/~/,~C~ ...~...~ ~- ~O~o....~..X/~'f.~...~.. o.~ /7"/~ C.///x'~- If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .......................... .% ..................... ? Electrician's License No ....................... ~ ..................... Other Trade's License No ............................................... Location of land on hich proposed work will be done. Mop No.: ....... ...~...~..?....~....~.. ....... Lot No ....... .?... ............. Street and N~m~oe~rr ..~...~..ff.?..~:.~.....~Z...~.°..~. ...... ..?...~Z.~.?.: .......................................... ~....~ ......... : ................... Mumcipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... ..~..~.~..'~.....'~..?~......'~...~....¥~....-~... ............................................................................. b. Intended use and occupancy ........................... ~,~. ................................... ~ ................... ~...: ............................. 3. Nature of work (check which applicable): New Building' .... /. ............. Addition .................. Alteration Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... '/'/C~ [/00 ~ (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 ................................ :.E..'.'... 8. Dimensions of entire new construction: Front ....... .............. Rear ....... Depth .....~......~......o~...-... Height ..... '~'~/./~....~....'... Number of Stories ................... ~ ............................................................. Size of lot: Front ........... ./...~.,..,~..: ............................... Rear .......... ;.....,....-,......' .:....-~.... Depth Date of Purchase ...... .,'~.-...~....~.. ......... ../...?....?...~... ............ Nome of F,g~j~e~' Owner/~t~.~/./~'...,..l~...~...~./..~..~.~..J. .......... Zone or use district in which premises are situated ..................... i~..~. ................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ...~.~.. .......................................... Will lot be regraded . ...... ~..O.. .......... Will excess fill be removed from premises: ( ) Yes (/-~No Nome of Owner of premises ~..~..~,...~....~.~.o,~,~..~,....~'....~..~.....~..., Addresst~.~,~,~.~e;,,.,~.:~.:.. Phone Nome or Architect ..../.[...o...,~..~..z..~ ......... ,...../..~....~...,~...~...~.(..c../.... Address ..~..<~..~...e:..~..z.~....,~,..~.~/~,.. Phone No.~...~'...~.;..~....7.~.~../... .............................................................................. No. °. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-1~3ck 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. 10. 11. ~12. 13. 14. STATE OF NEW '~ORK. ~ S S · COUNTY OF .?~..~.-Lr"~..~.J./~ ........ ~ ' ........... ~....~...~..0.~.1~. ....... .~.~ ........ 1~..0..~,.1~. ....... being duly sworn, deposes and says that he is the applicom (Name of individual signing contracf) above named. He is the ........................ t~.~.~..~./~,~.~.~. ............. ~,.~.~ .............. ~).,~..~V~.~. ....................................................... (Contractor, agent, ~orporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that oil statements contained in this application are true to the best of his knowledge and belief; end that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .... ~·..-~..!.l ........ day of J~£..~..¢?.L{~..I~. .................... , Notary Public,. .......................... .~.~.~T~.~?.J,..~... County .~. ................. Z;~..?,,,~,~,.;:.,~i~,,.,,., ,.~..; ....... ':...~ ........................ [LiZAB[q[H ANN N[VILLE NQTARY pUBLIC, State ol New No 52 8125850 Suffolk COU~.Y ,t J I · 5gi-TH'fOWkl,L. L- ,/ APPR~E/Do ~.S NC)Tim NOel,Fy BUILDING DEPARTMENT A'~L, 765-~E60 9AM TO 4PM I:QR REQUIR. ED INSPECTIONS: 1 BEFORE BACKFILLING FOUNDA- TION OR SYART FRAMING ~ BEt'ORe COVERING PIPbLINE '' J. FINAL WHLN JOB COMPI. ETED ~Ol REbPONSIBLb FOR DE£~GN OR 2ESIDE.HC~_ I L .9 0 ' I ~ iNkUD 'P. L-$ I DBHCE WIAU'~ I