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Home My WebLink About8501-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ...E/S. Colonial. l[o~d ..... Street Map No. ~ ........ Block No...ll;~ .... Lot No. ~ ..... 8.o~..t.h.O..ld.....N...Y.: ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............&p.r..~... J.~ 19.?.6. pursuant to which Building Pemit No..8. ~0.1.Z.. dated ......... April... ] ~..., 19. ?.6., was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P,-ln.t,e. o~..falslly..d.~. 1.1.1Ilg ..................................... The certificate is issued to .,~latt~. Abl~l. 0~tl~r (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ,~ . ~ 1~. by R, ~t. ll~ w~?,~ l~ot~ water not to be used for preperation of baby fo~ '~'~//~p'liibis' '!~' infants UNDERWRITERS CERTIFICATE No. I~...0~..~0...¶.~?t~ ..... v~ader. ~ .l~o~kths of a~? HOUSE NUMBER ...... !~0 ..... Street ...C..o.l.o.n..i.a.1..D.?.i.v~.. ..... 8..o~..$~..o. 1..d ........ ui mg nspectorI Itlii.~lN~ mit (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION Of: THE WORK AUTHORIZED) N? 8501 Z pursuant to application dated .......................: ................ ....... , 19..~..6., ,, and a{~raved by the Building Inspector. Fee $...~.~.e...~. .......... FORM NO. 6 TOWN OF SOUTHOLD , Building Depo~tment Town Clerks Office Sou{hold, 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 oil buildings, property lines, 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. 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 .............. Location Of Property .... .~..?...~..~,,,~..L-~....I.7~..~2.. ....... ~.~..~.~.~L.~.~.f,.~...~ ..................................................... Owner Or Owners Of Property .....~. g..~.'~.t~.....~....~.~...~....~....~ ..................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. .................... ' . ................... Permit No. ~/0 ~/01 ~ Date Of Permit ..~..J...!...~'/~.~pplicant Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificote ........................................ Fin~ Certificate .......................................... Fee Submitted $ Construction on above described building and~rmit meets all applicable c~es and regulations. .................. ............................... Sworn to before meth~ ~/7~/~/'_ , , z, , //-~ , ~ , ......... · ~,.~ day o~.~..~//.../.../.. .... ~ c~r'/,,,~,~ocZ,~.(stamp or seal) THE NEWNORK BOARD OF FIRE UNDERWRITERS RXTURES C~KINGDECKS OVENS IDI~ WASHERS EXHAUST FANS ~TU~ SW~~ES~ ~t~ ~. ~ ~ DRYERS FURNACE MOTORS RANGES ;PECIAL REC'PI i 30 SERVICE DISCONNECT OTHER ~ARAT~: ~-~.~.~.~. TIME CLOCKS BELL V '' I UNIT HEATERS 4ULTI-OUTLET DIMMERS SYSTEMS ~S,· i W^T~5 C E " 2/O Robert Goodale ' RR l'Box:15A.Main Rd. ~tt!t~k~.Y. n952 This certificate must not be altered in any manner; return to the office of the Board if incorrect· Inspectors may be identified by TOWN OF SOUTHOLD ~/',~,<,1 --~..N,,.,~. ~ ~* ~ BUILDING DEPARTMENT ~ ~ '~ e ~ ~-~ . TOWN CLERK'S OFFICE ~/~D ~~--~ O~ ~UTHOL~, N Y ~/~ ~ * ~ - ~ 0 K ~ Examined ..... ~.~..~. ~ , 19/.~ L ._ ~,..~ . r~ ~,_, ~ /~ ~ ~.~ / ~pro~ .................... ~)...~) ............ , 19..~.~ Permit No ~...?_.~ / ~~-~ ~'"'~ "~'~ ..... Di~ppmv~ a/c .................... ~/ /~ / ~ ~.~ - ~/~ '~) ~ ' .......... ~ .............................................................. ~ ...... ~....'.....,' ~ I~ / ~ ~ - ~ ~ ~ ~/~ .... ~u,,u,n~ mspector) / ~/~/?~ ..... ~ /~ ~./~. . .~' /~- - ~~/~P~ ar~u~c*t~O~ For .u~LD~N6 ~T~ ~ ~~ ~ D ' I I ~l~ ~ ~ ~~ ............................ :~].:~ ...... , z~..~... ~nstru~oNs..~¢ ~ ~ ~. ~~ ~ ~. Thi. ~ppllc~tlon muir ~. completely fill~ in by ~pewriter o~ in ink ~nd submitted in triplicate to the Bui~ing In,pector. with 3 Iltl of plQnl. ~ccumte plot plon to ~le. Fee ~ccording to ~chedule. b. Plot plan ,hawing I~tion of lot ~nd of buildings on premises, r~lotionship to ~djoining pr~mises or public streets o~ ~r.as. ~nd giving ~ ~t~ll~ deloription of I~yout ofprope~ must be drawn on the diagram which is p~ of this ~pplic~tion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon appr~al 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 ~cupied or used in whole or in part for any purpose whatever until a Ce~ificate of ~cupancy shall have been granted by the Building Inspector. B ~.PLI~ATI~N .~S HERE~Y ~DE to the Building Department for the issuance of a Building Permit pumuant to the uno,no Zone Uramance at the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constru~ion of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building c~e, housing c~e, and regulations, and t~ admit authorized inspectors on premises and in buildings for n~essa~ inactions. .......... ~.~.~.... ~ .... u; I~ r~ (S,gnature of appl,ca~] or name, if a'~porat~' ....... ....... (Address of appli~'~ ....................... {;'""l' o, ow.., ...... ' ................................... If applic,~,~ a corporate, signature of.dally authorized~f~c~r. (Name and title of corporate officer~ ......... Builder's License No .................... ~/'--~'O~ ~ P'umber's Ut, ns- ,,- ~_~/~'"'/;~"Z'",/.: ...... ~, , · , / Other Trade's License No. /~0 -- P7~- [ - ~ / Location of land on which proposed work~ill be done. Map No.: .................. Lot No .... Street and Number , -~;~-- O J~Z~J D .... ' ............. ~'" ~.: ...................... ..................................... ~ ...... :.~.t..~.v:l~ ................................... ~ o ~¢~L ~ Munici~li~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and ~cupancy ..................................................................................................... b. ~,ten~ed ~,e ~,d ~u~n~y ........ ~.~..~.~.~.~.;.~ .... ~.~..~ t~ t ~ ~ ........................... '~ Nature of work (check which applicable): New Building.. ........ Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior .................... Other Work 4. Estimated Cost .......... "L~''~*''~''~..0''-¢ : ............ Fee (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ..~.../d ~......Number of dwelling units on each floor ........................... If garage, number of cars ............ ...'~...(,~.D ......... ..'7~.....~....~....~...~./~.~......~...~..~.!..(....L~.......~..~......O~...k!~ ..... 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 sarne structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ r ' ,, ..... 8. Dimensions of entire new construction: Front ........... ,..~-,....,., ............ Rear ..... , t Depth Height ...... ~,..'~.. ...... Number of Stories ......... ..~..62'./~.. ........... 9. S~ze of ot Front 1 J O R i ~ Ln -- ,2' i ................... ~ ........................... ear .......... t./'.... 4 ~...~.. ........ Depth I 10. Date of Purchase ............. J..~.h.')..~. ............................... Name of Former Owner ..:~. 1 1. Zone or use district in which premises are situated 12 Does proposed construction violate any zoning law, ordinance or regulation: ....... ..~..~ .......................................... 13. YVill lot be regraded . ...... ~.: ........ Will excess fill be removed from premises' ( ) Yes ( 14. F4ame of Owner of Dremises ...~.~,[/~ ~RPlI~,~(' /~le,~/~"/~, F~~-~, ................. ~,'-~.-m:,,.~. ........ ~aaress .il.'~mr~, ~ Phone ~ .O?..~..:T..~...~'.~.-'...~... Nome of Architect ...................................... , ............... ~ ....... Addre/~s ~..~ ........................... Phone N0.,~ ..................... hJ;me of Contractor ~.i..~..l~.,.~.l/J .I~=.~ .~.y..[J..~.,.~.}.~..~ Address ' 0oj,~:-/e~ .~.2 '"~(~¢~ .... ....! .............. ~ .............. Phone No..J..:~..3..¢~. ........ PLOT DIAGRAM ~:~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propcrty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~cT,ATE OF NEW YORIC ~ ~ COUNTY OF ........ ~1~'~.0.~ ....... f ............................ ~]:;t~-~e'~"~'~'o-"~13~:t~-~l.*l ........................... being duly sworn, deposes and says that he is the applicarn (Name of individual signing contract) above named. · He is the ........................... . (Contractor, agent, corporate 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; ~hat ~11 statements contained in th'is application are true to the best of his knowledge and belieF; tha~ the work will be performed in the manner set fo~h in t~e a~plication filed therewith. Sworn to before me this ......... · J.~ .....day of ............... ~Z .................. , 19...Z~ ~ ~ __/ ~, ~ ~ Note ~ Public, . ..................................... ~ ~ ~ ~ O ~ ~oun ~ ..... /~~~~~~~ ~ ....... Z, E ',, ,~ t'.'~,., NOTARY PU~', 'rC S[;1¢~ of ~ev/ York No. 52-8125~50, Suffolk C'cunty Term Expires March 30. 19~ TN[ WAI'E~ SUPPLY AND ~WAe[ ~ SYSTEMS FOR THIS RF~IDENCH WILL i TO THE.TANDAIOF TH~ SUFPO~K COtINTY DEPARTMENT OF HEM.TH SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL'OF CONSTRUCTION ONLY APPROVED C '~_~ ~ DtETZGEN 135 lt846 /NAUTHORIZED ALTERATION OR ADDIFIOI~ O THIS sURVFy IS A VIOLATION OF ~ECTION 7209 OF THE NEW YORK STATE !DUCATION LAW. REVISIONS TEST HOLE 14.0 ....... NOTE: I o -' PIPEI ASSUMEO 0,4 ~'UM. N£,4/~EST PU~£1C W,4~'E,~- ~ MILES IK47'gR SUPPLY-PR/FaTE it/ELL YOUNG & YOUNG 400 0STRANDER AVENUE, RIVERHEA~ ALDEN W. YOUNG LAND SURVEYOR, N,Y.B. LIC. NO. 12845 SURVEY FoR: ~T OUNG BAYVIEW TOWN OF SCALE: S0UTHOLD j SUFFOLK CO., N.Y. JB INO. ~' ~ J" = 40' J DATE: APR. 14, 1976 J 76-268 /PO~70 ., THE WATER SUPPLY AND SEWAGE OISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDAROS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. APPUCANT /~DRESS j 'DIETZGEN 135 M846 0 0.0 /4.0 T~'ST HOLE' S&IVD THE LOC,~TfON OF WELLS AND CESSPOOLS SHOWN HEREIN ARE FROM FIELD OBSERVATIONS AIVD/OR FROM DATA ORTAINED FF, OM OTHERS IV O T£ : £L£VATIONS ARE R£FER£1VC£D TO AN ASSUMED DA TUM. W&I'£R SUPPLY-PRI¥&FE WELL REVISIONS NO V 2, 1976 YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W, YOUNG SURVEY FOR: JULIA ABRAHAMS AT BAYVIEW TOWN OF SOUTHOLD SCALE: SUFFOLK CO., N.Y. I': 40' DATE: APR. 14, 1976 EE .... '~ 76~268 APPROVED AS NOiE[ DATE: FEE: J~/~ .~-BY NOTIFY BUILDING 765-2660 9AM TO 4PM FOR BD INSBECTIONS: 1. BEFORE BACKFILLING TION OR START FRAMING 2. BEFORE COVERING, 3. FINAL WHEN JOB NOT RESPONSIBLE FOR D~SIQN 5TBUCTION ERRORS , i ~ ~, ~. , ~ ~0 E,~T~t.~';~FL, C~ ..... '-T T~ ~ ' ~T~OOM ENCLOSURE ~ ~D~ C~ON WhC~ WO N~V~ F~L THIC~ '~ J ; _ ~ iSTFLR, ~ND~ NE~T, -~- ~ * ~TON~ V~NE~ OV~ ~ FELT Ov~ ¥~' pLYWOOD ~N~THI~. . FL~. Jo~sTs 5 X ~/~ X S/I~ LINTEL] tS"X I~" T,c: FLUE " . -. /:-X ::