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Home My WebLink About7896-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy I~o. 7_ '7 / ~ 5 Date /% V~ ~- O '76 ~IS CERT~IES that ~e b~ding located at .......................... Street Map No ............. Blo~ No .......... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office M~'r 7 .~ 7~ 79 ~ Z_ dated ................. , xz .... _pursuant to which Building Permit No ........ dated .................. , 19 ...., wa 'ssued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to ............................. ~ ........ (owner, le~e 6~ ten~) of ~he aforesaid building. Suffolk Co~ty Dep~tment of He~th Approval ~ ~-//~ ~97& ~*~ ~- ~0 -7~ U~DER~ITERS CERTIFICATE No ............................................ HOUSE ~ER .......... S~t .......................................... Bffilding 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) 7896 Z Permission is hereby granted to: ............. .o.~J..~.t,. ................................................. to .b~i]~ct ..~e~...one...fe~-~.l_~.. dw~13.~g ................................................................................... at premises located at ...~/~...~t. ft;L~..,~a.¢~ ......................................................................................... pursuant to application dated ........................... J7~.~.....~ .............. , 19.~.~.., and approved by the Building Inspector. Fee $.5~,,~0. .......... TOW~ OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled m typewriter OR ,nk, 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 disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwnters 4. Commercial buildings, Industrial buildings, Multiple Residences and s~mdar 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 exist,ng buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~sting" land uses: 1. Accurate survey of property showing all property lines, streets, buddings 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 build,ngs or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: I. Certificote of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $1 O0 Rte ....... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... .~../...~.. ..... ~.~.....~ ............................ ,..~.,.~.....,~,..¢..~.~. Owner Or Owners Of Prope~y ....... ...~....~ ............. Subdivision ............................................................. ...Lot No ............. Block No ............ . Hog~e No .......... Underwriters Approval ,A~'....~..Z..Z././..y. ..................... Planning Board Approval ........................................ Request For Temporary Certificate ...... ~ ......................... Fincd Certificate .....~ ............................. Fee Submitted $ .................................... Construction on above described building and permit meets all applicable~f:odes and regulations. Applicant ..... .~./.~.......~.~ .~~ .................................... Sworn to before me this .~...0,.7.~ ..... day of ...~...~.~.~...?...~.. ...................... Notary Public ....... ..~, .~.. ,~...~, .~..~. ......... County (stamp or seal) /~c ~ / 1-7 c~..~).~ 7_ FLOYD F. KING, JR. ~ Notary Public State of New York No. 52-7267800 Suffolk County Term ~plres March 30, 197~ THE NEW YORK BOARD OF FIRE UNDERWRITERS d II BUREAU OF ELECTRICITY I 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS C~RTI~I~ THAT only the e~trtcal equipment ~ ~sc~bed beiow and i~tr~uc~ by t~ applic~t ~med on the a~e appl~atlon numar in t~ premlzes oJ FIXTURE I I FIXTURES OUTLETS ~CEeTAC.~S1 SWITCHES ,.C^NOESCEN!,t ~tUO.~SCmZ 19 42 21 19 DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS SERVICE DISCONNECT OTHER APPARATUS RANGES SPECIAL REC'PT. 1130 S · R t COOKING DECKS J OVENS I DISH WASHERS I .0 .3 I I .5 TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET AMT , .~,~.p$ TRANS ,~? H p SYSTEMS NO OF FEET V I C E EXHAUST FAF DIMMERS AWG i/o Motor/s: I-I/2hp Theodore Rohloff Orchard St. Orient, L.I~ ' 11957 ' Lic 608 Th~s ced~f~cate must not be a~tered m any manner; return to the of~ce o{ the Board ~f incorrect Inspectors may be idenhfmd by ~he~ cre'"--d~nhals. SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~ Address ~'~.~'~ 2. Property L6C~f6n Village ~)~, 3. Public Wat~r'COmpany Name ~/~ ' 4. Lot size: Width j/~feet th J~ feet 10. Sewage Disposal System: 5. Subdiv. 6. Section 7. Lot Number Private Well ~ Public Water Distance to main .... (For Health Dept. Use) A. 900-gallon septic tank: Precast Y~'l~quivalent Block B. Leaching pools: Number of pools ~- Precast ~ock Special ll. If private well, fill in the following blanks: A. Tank capacity B. C. D. E. Pump G.P.M. ~ Total well depth Depth to ground water Amount of water in well gallons The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's 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. FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. ~.~ S-15 Rev. 4/1/73 "' SOUT,,°W SlZs77 - ~ ~ ne BUILDINg . Examined ~ ~ ' ~ ~plication No .................... ~...~ .............. 19 ......... ~ ................... ~prov~ ........................................ , 19.L(.. Pe~it No....~ ............... ~ ................ ~* ~ ........................... ..... /. INSTRUCTIONS a. This applicotion must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building inspector, with 3 sets of plans, aocumte plot plan to scale. F~ occo~ting.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 detail~cl description of layout ofproper~ must he drawn on the diagram which is part of this application. · c. The work covered by this application may not be corem, eh.ced before issuon~:e of Building Permit. d. Upon approval of this application, the Building Inspector wi'Il issue a Building Permit to the applicant. Such permit shall I~ kept on the premises ovoiloble for inspection throughout the work. e. No building shall be occupi~l or used in whole or in part for ony purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY/V~DE to the Building Deportment for the i~s. uance 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 ~:onstruction of.buildings, addition{ 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 necessery inspections. (Signat~e of applicant, or name, if a corporation) ...................... ........ ....................... (Address of applican~ State. whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......~...~...~4....~.. ...... ~...,.~.~ ............. If applicant is a corporate, signature of duly authorized officer. Builder's License No... ,~,,,.73..,,.'~,,. -~..,Z .................... Plumber's License No...~...~....'~......,~.... ........................ Electrician's License No .... ,,~,,.,,~,,.,,~'..../,'~,. ................... 1. Location of land on which proposed work wi]l be done. Map No.: ............................... I;..ot ..................... t · Street ond Number ..~...~ ........................................................ ~~, ..'.~; .......... Municipality 2. State existing use and occupancy of premises and iptended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~......~/....~.. ~.~ ................................................................................. b. Intended use and occupancy ...........................;.[.. .............. ~ ................................................................... of work (check which applicable): New Building ...~ ....... Addition .................. Alteratio~ ' · Repair .................. Removal .............. ,.... Demolition .................... Other Work ...~..~ .................... ~,/ ~ ~ . ~' (Description) " Est mated Cost ~Z/~.. ~ ~ ~ ~ ~../'~ Fe- -~'~" 3 '~ 4 .... ~...~ ..... ~ ......................................... ~ ........................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~ ................... Number of dwelling units on each floor ...... ~ ..................... ............................................................... ............................................................. 6. If busin~l~,~ll~lll~rc~.~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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height .................. ~ ......... Number of Stories ................................ 8. Dimensions of entire new construction: Front ....~....~.J~...~..;~ .............Rear ...~...~..:...~..~.; ...... Depth ...~.....~...~ .......... /'.- Height....-~...~....! ...... Number of Stories ........ ~ ........................................................................................................ 9. Size of lot: Front ....."~....~..~..¢..~..~. ............................. Rear ...... .~;....O....O...~.....O. ................. _ ~ . .._....~.._._....._..._,Depth ..,?...~...~...;....~.~...~Z, ..... ............. /...~...~....~.. ............................ Nome of Former Owner ~...~... 10. Date of Purchase 11. Zone or use district in which premises are situated ...~.~ ...................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~ .......................................... 13. Will lot be regraded ..... ~,~ ~1 .......... Will excess fill be removed from pre~ti,ses: ( ) Yes (~) No 14. Name of Owner of premises ~.¢..~...i~.a...~..~. Address ..~..~ ........ Phone Name of Architect .................................. ._..._~.~ ~ ............ Address ............... ~ ............... Phone No ......... Z ........... Name of Contractor ..~..~..~...~ ...... Address ,....~.,.~ ....... Phone No~...~...~..,...~.....~.../ Locate clearly and distinctly all buildings, whether existing or proposed, a~ all set-bac~ dimensions from property lines. Give street and block number or description according to deed, and show street names and in~' whether interior or comer lot. ~-05 s ATE OF NEW YORK,. t,. ,- )UNTY Of ..~..~.,~'...~...~..Z.Z~. ........... ~'~ ~?F ~/ 0~0- 3- /~ ~ ~ ~/~~ ..... · ~.~..~.....~.~.~.~. ............................................... being duly sworn, d~oses and says t~t he is the applicant ' (Name of individual signing contrac~ ,. abOVe name. He is the ........................... ~.~.(~. .................................................................................................................................. (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swam to before me this .............. ~ .......... . ........................................... , 19 ........ .......... ................................... o, ..................... . KING, J~ u NoteW PuSlic Stofo o~ Now York No. 52-72~7800 Suffol~ Term Exp~ros f,~ 3~, Iq7~ FOB3K NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ................... .~.?. .......... .?...., 19........7~ Permit No. Application No..2.~.....~....~.. ............. Disapproved a/c ~ ................ n.....: ........ ~,~, ....................... :~ ................ :~ ........ · ~ .......................... ................................ ................................. APPLICATION FOR BUILDING PERMIT Date ................................................ , 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 of lot and of buildings on premises, relationship to'adjoining premises or public streets az 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. fo.r the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app icab e Laws, Ordinances or Regulations, for the construction of buildings, additions or alCeratiohs, or for removal or demolition, as h6rein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on 3remises and in buildings for; necessary inspections. .... (Sig~l~ure of applicant, or name, if ;' ;;'~;';;~i;~ ....... (Address 6f applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumbe~ or builder. Name of owner of' premises .....~...~..~:.....~..~....~.....~~ i 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 .... ..~....~......~....Z.~,~ ...................... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: .......................... .~ . Lot No Street and Number .~ ~ ...~_.~ .~i~ .................... Municipality 2. State existing use anc] occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~', b. Intended use and occupancy .~ · of work (check which applicable): New Building..................~ Addition ......... ...... ... Alteration ................ Repair .................. Removal .................. Demolition ........ ~.~ ........ Other Work ..................................................... ..~..~.. (D~criptlon) 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 .............................................................. ~t' ............................................................................ 6. If business, commercial or mixed occupancY~ specifY nature an~l 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.~ DJme~sions of entire new construction: Front ....... .~....~. ...................... Rear ...~...~.. ................ Depth ,-~ Height ....~......~.../. ....... Number of Stories ...... ~ .............................................................................................. -"gT'. Size of lot: Front ~'/~.. , ~'.~ Rear ?- O~ .~ .. Depth :Z ~"~--o'.-~'z_ .... 11. Zone or use district in which premises are situated ...~ ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~ ............................................ 13. Will:.lot be regraded ..~.....~ ....... Will excess fill be removed from pre~nises: ( ) Yes (JO No 14. Name of Owner of premises ...~...~J~....~.... ............................... Address ....~..~ ......... Phone,o." ~....~.,,~. -~,r~-.3.... ............... Name of Architect ............................................................ j~._~........ Address ............. ~: ................. Phone No ....................... · ..~...~-..~..~ ........... Addres~ ...~...~ .......... Phone No.D.?..~..-;.?..~....~/. Name of Contractor PLOT DIAGRAM Locate clearly and distinctly all 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 and indicate whether interior or corner lot. 114 lv' If'P, STATE OF NEW YORK, COUNTY OF ............................. ~...~ ......... : ....... : .................. being duly sworn, deposes~ and says that he is the applicam (Name of md v dual s gmng dontract) above named. He is the ............................................. ~.~...~.~;~;~.~.~[~.~..;..~..,~ ............................................................... of said owner or owners, and Js duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true 'to the best of his knowledge and belief; and thaz the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .............. ~t~ day of ................. ~ .............. · 19~1~...,) ,.__/,.~¢::>.~.~..~¢.-:..~'...~~"~.~. ~/(Signature of applicant) ~To 52.81258~0, Su~fol~ Cop~.t~. A"r /20' ~>OoF '~ITch~ L I cE/caR 1 ~"_ /,cT. ,5'c,~E ---5' ~ BUlL.DING -- PLUMt~ING -- HE~TI~4G ORIENT, N. Y. ?~Ji. 516-323.2421 13' ORI£F¥, ~. ¥. 1",.95'I TeJs. 516.323-242'1 5~6-323.-2634 TONY NORKLUN BUILDING -- PLUMEtiNG -- HEATrNG ORIENT, fi. Y. ]].957 T~ls. 516-323-2421 §16-32~-263~