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Home My WebLink About7897-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Of Eice Southeld, N. Y. Certificnte Of Occupnncy .................................... , 19 .... THIS CERTIFIES that the b, dlding located at .......................... Street Map No ............ Block No .......... Lot No ................................ conforms substantially to the Application for Building Permit heretofore filed in this office 7, z_. dated .......... ~ ~ ~,"L~' 19 .... _pursuant to which Building Permit No ......... dated ............... , 19 7..~., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .~.. ?.'.V..~.J'..'ST....~..~..E....ff.h.e'~.'.~.',( .... ~.~.&.L! ~[f .................. The certificate is issued to ..................................... (owner, lefsee o~ ten,t) of the aforesaid building. Suffolk County Department of Health Approval ]~/~- I~/ I~Y~ ~F~ UNDERWRITERS CERTIFICATE No ............................................ HOUSE NUMBER ~ ~ ~ ~ 0 [vi ~, ~ N '1~ ~ A ~ ........... Street .......................................... Builrllng Inspector FOB,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERJ~IT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 7897 Z Date ........................ .J'J J~y.. ......... .~. ............ , 19...~. ~. Permission is hereby granted to: T~n~...l~r~!~u~...~C..l~a.vl~..&..&~amae..JBrawner ........... .o..~. ~.~.o..t,. .................................................. at premises located at ...... ~..~':~ ~..[~Da,~ ...................................................................................... ............................................................................ Or£~.t...).~.~.~... ........................................................ pursuant to application dated ............................J~...~.. ......... ~.. .......... , 19..~,.~.., and approved by the Building Inspector. Fee $...lJ..0. ~...0~) .......... FORM NO. 6 TOWN OF $OUTHOLD ~ Building Department Town Clerks Office Southold, N0 Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A This applicahon must be filled in typewriter OR ~nk, and submitted in DUPLICATE to the Building Inspector w~th the following; for new buildings or new use. I. Final survey of property with accurate location of all buildings, property hnes, 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 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. D. For exmsting 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 inspechon of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: J. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelhng or land use $5.00 3 Copy of certificate of occupancy $1.00 Rte ....... New Bt~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Lo o,,o ............................ Owner Or Owners Of ~'~2~2~ ii~~i~.i~......~....~ ............. Subdwision ............................................................. ...Lot No ............. Block No ............ . Ho¢~e No ............ Permit No Date/, C'/~ '~ L/Of Permit ~..~.,,~..Applicant ..~...~.......~...~~ Health Dept Approval ..?,...-....~...Z.,.~'...../....7.... ............ Labor Dept. Approval .................................. Underwriters Approval J~....~..~..?././..y. ..................... Planning Board Approval ........................................ Request For Temporary Certificate ...... -- ~ ......................... Fincd Certificate .....~ ........................... Fee Submitted $ .................................... Construction on above described building and permit meets all applioable~f:odes and regulations. ................................... Sworn to before me this .~Z,./(. .... day of ...~...~.~.~..~.7.. ...................... Notary Public ....... ..~..~...~...~..~ ..~. ......... County (stamp or seal) /~ ~ / t '7 9'..g.. FLOYD F. KING, J~ ~ Nota~ Public Stale of New York No, 52-7267800 Suffolk C~n~ Term ~pires Mar~ 30, 19~ THE NEW YORK BOARD OF FIRE UNDERWRITERS d ~ BUREAU OF ELECTRICITY I B5 JOHN STREET, NEW YORK, NEW YORK 10038 1,..' August 6. 1976 4pZmea,,on~'a. onfi~e 862439 N 297114 THIS CERTIFIES THAT only the eh.~trical equipr~ent as described below and in traduced by the applicant named on the above application number in the pren~ises of Jeremy Bell, s/s t'4ain Road l/4mi.e/o State Park Road, Orient, L.I. tru, ¢'xtm~rted on A U § u s t 2, [ 9 7 6 and found to be zn comphance w~th the requlrements of this Board, FIXTURE c ~ FIXTURES I RANGES 19 42 21119 [ t DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT K W OIL H P t GAS H P A~T i~O A .W G A/~T ,Ij~p .. 3 F i 30 SERVICE DISCONNECT I NO of: I ~ S --E R AMT AMP j TYPE EQUIP ,.~2w 1,6'3W 3,8'3~/ 3.~4W NO OF CC COND A~W O PER ~' OF CC CQND OTHER APPARATUS Motor/s: I-I/2hp ICOOKING DECKS [ OVENS IDISH WASHERS I 7.0 ! 4.3 I '1.5 TIME CLOCKS I BELL JUNITHEATERS MULTI-OUTLET SYSTEMS ,U*T A~tPS TRANS MAT H P NO OF FEET V I C E A W G NO OF NEUTRALS NO OF HI EEO OF HI LEG EXHAUST FAN: DIMMERS AWG OF NEUTRAL I/0 Theodore Rohloff Orchard St. Orient, L. le 11957 Lic 608 ~ENE~[~ ~__~ Per D This certificate must not be altered m any manner, return to the ofhce of the Board tf incorrect Insp~ors may be tdenhhed by their ~aJs, SUFFOLK COUNTY DEPARTMENT OF HEALTHReference Health Department Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address F~] j ' ~T~ 'C 2. Property L~C~6n ~.~ Village 3. Public Wat~r'Company Name 4. Lot size: Width~,~/,~I/feet 10. Sewage Disposal System: A. 900-gallon septic tank: Precast Y~Equivalent B. Leaching pools: Number of pools ~- Precast ~,q~ock Special ll. If private well, fill in the B1 ock gallons following blanks A. Tank capacity B. Pump G.P.M. C. D. E. Total well depth ~0 Depth to ground water Amount of water in well T~pwnship '' Length m~j~l, feet 5. Subdiv. 6. Section 7. Lot Number ~. Private Well · Public Water Distance to main (For Health Dept. Use) 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. ~'~ ~ O ~~ APPROVAL DATE ~'///h~ SIGNED ~. S-15 Rev. 4/1/73 a. This application must be completely filled ~n by typewriter or in ink and submitted in triphcate to the Buildir 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, relat~onship to adjoining premises or public streets ~ areas, and giving a detailed description of layout ofproperty must be drawn on the d~agram which ss part of this applicatio, ~ c. The work covered by th~s application may not be commen.ced before ~ssuange of Building Permit. d Upon approval of this application, the Building Inspector wdl msue a Building Permit to the applicant. Such perm shall be kept on the premises available for inspechon throughout the work. e No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADF~ to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances · Regulations, for the ~:onstruction of buildings, addmtions or alterations, or for removal or demolition, as herein describe~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admmt authorized inspectors on premises and in buildings for necessary 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 buildm Name of owner of premises ..... .1~....~.........~..,....c~..~... *~..:..-~.~.~ .......... If applicant is a corporate, signature of duly authorik~l officer. (Name and htle of corporate officer) Builder's L:cense No.....~....~...ZT.....~...../.. Plumber's License No...~...~......"~.... ,,~.... ........................ Electrician's License No Location of land on which proposed work will be done Mop No ........................ Lot ................... Street and Number...~...~ ..................................................... Municipality State existing use and occupancy of premises a~/~z?ended use and occupancy of proposed construction' a Exlsiting use and occupancy ..~.....~'.~'.....c~, .~.~ ............................................................................ b. Intended use and occupancy .... ~.~ ..... . ..~..... ·..~.. · .°z:. · · ~,.~¢~,~ ................................................................. of work (check which apphcable). New Building ...~ ....... Addition .................. Alteration .... Repair .................. Removal .................. Demolihan ............... Other Work .......~..~. 4 ~timated Cost ~ ~ ~ ~ ~ .................................................................................... (to be prod on filing th~s apphcation) 5. If dwelling, number of dwelhng umts ....... ~ .................. Number of dwelling umts on each floor .......................... 6 If busin~ ~rc~ ~m,xed occupancy, spec~ nature and extent of each ~pe of use .......................... 7. Dimensions of ex~sting structures, if any: Front .......................... Rear ................................Depth .................. Height ........................ Number of Stones .............................................................................................................. D~mensians of same structure with alterations or additions' Front ................................... Rear ..................... Deplh ................................Height ............................ Number of Stories .............................. Height .... ~..~..~ ...... Number of Stories ......... ~ .................................................................................................. Size of lot' Front ...~.J.Y.~..~ ............................ Rear . ~ 00, 0 .. Depth ~ Date of Purchase ............. ~.~..~..~ ............................ Name ~...~~" Zone or use district in which premmes are situated . .~.~ ......................................................................... Does proposed construction violate any zoning law, ordmance or regulation- ~ ......................................... Will lot be regraded ..... ~ ~ .......... Will excess fill be removed from premises: ( ) Yes (~ No Name of Owner of prem,ses ~.~.~...~.~~. Address ..~~ ........ Phone No. Name of Architect ..................................... ~.~ .......... Addre~ ............... ~ ............... Phone No ...................... Name of Contractor .~~.~~ ...... A~ress ..... ~ ....... Phone No~ ........ { ..... .~.. Locate clearly a d dmt~nctly all buddings, whether ex~stmg or proposed, and ~t~ck d]mens~o~ fror ~t 10. 11. 12. 13. 14 property lines. Give street and block number or descript,on accordmg to deed, and show street names and ind whether interior or corner lot. ,~, STATE OF NEW YORK,. t CgUNTY OF .~.~,.~...~.?...Z..~. ........... ,,..i.....,.7.?...~....~.....,../t~.,.~...~...~./..,~...~.-- .............................................. being duly sworn, deposes and says that he ,s the apphca (Name of indwidual signmg contract) above named He ~s the ............. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or hove performed the said work and to make and f, this apphcation; that all statements contamed tha~ the work will be performed in the manner set forth m the application filed therewith. Sworn to before me this ~.. 7/4 day of '. ..... ..................... ~ , ' ,- J/ (Signature of applicant) FLOI~'E~F-~'KING, No}ew Public Stato of New York No. 52-7267800 Suffolk County Term Expirc.~ f',,~rr'~ 3D 197~ Approved ................... ~.2 ........... ~.!...., FORM NO. 1 TOWN OF SOUTHOLD "",LD,"G vow. CL..'s O F= Date ................................................ , ]9 .......... INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in trlphcate to the Buildin, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule b Plot plan showing location of lot and of buddings on premises, relattanshlp to adloming premises or pubhc streets o areas, and gwmg a detoded descripbon of layout ofpraperty must be drawn on the d,agram which ~s part of this application c. The work covered by this applicahon may not be commenced before issuance of Building Permit. d. Upon approval of this applicabon, the Building Inspector will issue a Budding Permit to the apphcant Such permi shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in part far any purpose whatever until a Certificate of Occupanc; shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th, Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o, Regulations, for the construction of buildings, addibons or afferat~ons, or for removal or demolition, as herein described The apphcant agrees to comply w~th oil applicable laws, ordinances, budding code, housing code, and regulations, and tc admit authorized inspectors on premises and in buildings for necessary inspections. (Slg~ure of applicant, or name, if a corporation) (Address Of applicant) ~/ State whether applicant ~s owner, lessee, agent, arcbtect, engineer, general contractor, eJectrioan, plumber or builder. Name of owner of premises ....~.~...~..~..~:..~.~..~¢..~.~......~<~.¢.~,~ ..................................... If applicant is a corporate, signature of duly authorized officer (Name and title of corporate officer) Builder's License No ...... :..~'....~.~. ..................................... Plumber's License No....¢.~...Z...~.......~... ......................... Electrician's License No .... ..~?.~....~.../..-~.~. ...................... Other Trade's License No ............................................... 1. Location of land on which proposed work wi.il be done. Map No · . .....................................Lot No.. ...................... Stree! and Number ~....~ ............................................. ...47..~~.....-~,...~ .................... Municipality 2 Dote eximng use ana occupancy of premises and intended use and occupancy of proposed construction' a Exlsitmg use and occupancy ~" b. Intended use and occupancy .... ~.,~ ....................................................................................................... of work (check whfch applicable). New Budding ................ Addition ................ Alteration ........ Repair .................. Removal ................. Demohhan ..................Other Work ............................. ..~..~....~.. (Description) 4. Estimated Cost .... :..6..~..~..~.:..D...?.. ........................... Fee ........................................................................ (to be prod on fihng th~s application) 5 If dwelling, number of dwelhng units ...... .]. ................. Number of dwelhng umts on each floor .................. If garage, number of cars ......................................................................................................................... 6 If business, commercml or m~xed occupancy, specify nature and extent of each type of use .............. 7. Dimensions of existing structures, Jf any: Front ......................... Rear ................................ Depth ............... Height ........................ Number of Stories .................................................................................................... -D~mensions of same structure w~th alterahons or additfons. Front ................................... Rear ........ Depth ................................ Height .......................... Number of Stones ............................. 8:_ Dimeosions of entire new construchon: Front ..... ~. ...................... Rear ...,~..~.. ................ Depth '-~ '~' z Height ....~-......~.../. ....... Number of Stones ..... ~ ..................................................... ~ S~ze of lot Front ...... .?T....]..~...,....;~..,,~ ............................ Rear..-'~- 6~ .~ .. Depth ~' ~--,z,,'_~_ .. 10 Date of Purchase .... ../..?..?..~. .................................... Name ~; ~'~;~'~' ~ ~%~....~..~~ 11. Zone or use district in which premises are situated . .~..~.. .................................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulahon ~'..-- .................................. 13. Will lot be regraded ....~.~.....~ ....... Will excess fill be removed from premises' ( ) Yes (Jo No ............. NoT. Z~, 14 Name of Owner of premi~es .-......~.,..~.~..ar .......... Address Phone ................... Name of Architect .......................................................... Address ............. ~ ................. Phone No ...................... Name of Contractor ~..~-'¢7:e~,..,/~'~...~..z,~¢. ~ .......... Address ...~..v.~ Phone No.~..~.?...T:..~..~...'~. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmng or proposed, and indmate all set-back d~mens~ons fror~ property lines Give street and block number or description according to deed, and show street names and indicat,- whether inlerior or corner lot STATE OF NEW YORK, [ S.S COUNTY OF ..,~1~ ............ ........................... ~l~,t/JJO~.Jl;:;l~t~ ..................... ., .................. being duly sworn, deposes and says that he ~s the apphcan (Name of ~ndw~dual s~gmng contract) above named. He ~s the ............................................ ~4;~t~"~J.e'tJ~ ........................................................................................... (Lontractor, agent, corporate officer, etc.) of smd owner or owners, and ~s duly authorized to perform or have performed the smd work and to make ~nd th~s applicahon, that all statements contained m th~s apphcahon are true to the best of h~s knowledge and behef, tha~ the work wdl be performed in the manner set forth m the application filed therewith Sworn to before me this .............. 2~ day of ............... ~Z .......... , 19~../ ~ ~RY pUgt u , ~uunt' 52 81Z5~50 SU[~t[K ~t~