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Home My WebLink About9433-zTOWN OF $OUTHOLD BUll.nlNG DEPART]I~-~ Town Clerk's Office Southold, N. ¥. Certificete Of Occup; ncy May ~ :79 No.Z?~.... ...... Dete.......... ............... . - - ,~9 .... THIS CERTIFIES that the building located at . 700 Gagens Landing Rd. ~ Map No . Block No . Lot No ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated September 1 7~ .97.5. 5. Z. ...................... , 19 .... pursuant to which Bui]&ing I'ermit No. .. dated September 1 19.. ~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is Private One Family Dwelling Lena Butkovich The certificate is issued to - - - (owner, ~ of the aforesaid building. 7-S0-118 December 1, 1978 * Suffolk County Department of Health Approva/.......... ........................ - . UNDERVgl~ITEi~S CERTIFICATE No ................ 700 Gagens Landing Rd. HOUSE NUMBEE............ . . Street ......................................... - Southold, Ne~ York Building Inspector WAT]~ HIGH NITRATES NOT'TO BE USED FOR PREPARATION OF BABY FORMULA OR CONSUMPTION BY INFANTS UNDER 6 MONTHS OF AGE COUNTY TAX MAP NUMBS{ 1000-70--10-22 BUILDING' DEPARTMENT Towhi c,:.K's OmCE SOUTHOLD, hi., Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9433 Z Se~t 1 Date ....................................................... 19...../.. Permission is hereby granted to: at premises located at .......~.,~.~,~...*,-.-, ..... ; -- ....................... S.a~.t,h ~.l& ..................................................................................... pursuant to application dated ............................ L~;;;..t.,.j ................ 19...,!;L, and approved by the Building Inspector. Fee $...~..b¢.*.?..O. ......... TOWN OF SOUTHOLD BU~.DING DEPART~g~NT Town Clerk's Office Southola, BI. Y. ~~' Certificate Of Occupancy No. Z9~1 Date Dec~ber 6 .~. THIS CERTIFIES that the bugal,g located at 7..0~....~...~...~...i~. ;.. ~ Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . .8..ep.~..e~...1~......q ..... , 197~.. pursuant to which Bui]Sing Permit No .... dated . .8..ep.~..~..~. ?.....q ...... , 19.~'.~., was issued, and conform~ to an of the require. ments of the applicable provisions of the law. The occupancy for which thi~ certificate is issued is ......... Pr&.~e~e..O~e. l~,d~y. D~ell~.ng ............................... The certificate is issued to ........... Lmm .Bu.'tkov~b. ............................ (owner,'- ' -- '----~'-~-~-~,_; of the aforesaid building. Suffolk County Department of Health Approval 7-80-1~, Decembem 1, 1978 ............ VLll~a'" ' ............ UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER ... ~ ....... Street ..............G..a~..9~.' ...L~....d~...Rd., ....... ................................................... ~t~.~d,. ~Y, ............ ~u~cung NITRATES-NOT TO BE ~ ~ PR~ARATION OF BABY FOI~tULA 0~ KIIKOM~ION ~Y IN~L~S ~ mm, OF ~E. County Tax Nap Ntmber iF 1000-70-10-22 FO]gM NO. 6 TOWH OF $OUTHOLD Bulldlng Depmtmenf Town Clerks Office Soutbold, N. Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 disposal--(S-9 farm 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 o'f 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 ~.. -- New Building .~'.,OId or Pre-existing Building ............................ Vacant Land ............................ Owner Or ~ners Of Propedy~ ~~ ............ ~.~.~Z.~ ...................................... Subdivision ................................................... , ............ Lot No ............. .~lock No. ............ H~use N? ............. Permit No... ~ ~. ~ate Of-- ~ ,,~ Permit. ~ ~7'"" Applica nt~ ~'... ,~ f~ ~ ..... Request For Tempora~ Ce~ f cate .,~ .......... Final Certificate .......................................... Construction on above described building and p~ermit meets all applicable codes and regulations. Applicont .................................. Sworn to before me this ................ day of ............................................ (stomp or seal) Notary Public .................................... County /¢ FORM NO. 6 TOWN OF SOUTHOLD BUilding Department Town Hall 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 Inspec- tor 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 featu res. 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ....... .~-.--..o~..'-..? ~ ....... New Building ..... ~ ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property... ~.~.. ?~.~./.~':~.. ?; ~ .~., .d~.~. ~ ~ ...... .~..~, .................... House No. Street Ham/et Owner or Owners of Property ~'-~/¢ ~/- "~ ~ ~'/I/"¢~ /. ~ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Map No ............... Lot No ............... Permit Uo.¢..-~.~.~.~. .~.. Date of Permit · .~:-/.':~. 2.Applicant .......... '.~. ............ Health Dept. Approval ... ~..'-;-. ~'~,~. 27 ./'../'. ~....Labor Dept. Approval ........................ U nderwriters Approval..z/~/... ~./.~.~, ~ .~i ~. ....... Planning Board Approval . ..................... Request for Temporary Certificate ..................... Final Certificate i ..... ~ ............. Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. - Applicant ...... ..... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~P BUREAU OF ELECTRICITY I--- ES JOHN STREET, NEW YORK, NEW YORK 1OO38 ,,..,. ,,,.pl,c..t,o..~o.o,.;,,, N412364 THIS CERTIFIES THAT C~PI ~%tt~',OV1Ot~ ~3,~erl ba. DO]fl~ orr oavlawrt AYe, ~xc, ~ ooutr, t%OAG~ in the followlng Iocatfon; [] Basement [] l#t Fl. [] 2nd Fl. Section Block Lot ~as examined on ,I,~ OV ~ r~b e ~'~ 2 7 ~ I ~1 ? q and found to be in compliance with the requirements of thb Board. FIXTURE LECr:~TACL~$] EWIT J RXTURE$ DRYERS I FURNACE MOTORS I FUTURE API~ANCE ItEDIRS SPECIALREC'PT SERVER DiSCeflh~i I ND. OF I S E 1 200 C~ x 1 iOTHER T ; 1-Smok~ 3/o OVENS I mmwAs~Rs EXHAUST FANS 3/0 Pete~ Bogovlc ~ , 11 ~ ~ ~ ~ILDI~EPARTM~ THIS COPY OF CBTIFI~ : ~ COUNTY DEPARTMENT OF HEALTH SERVICES The attached apprgval ,,;as issued subject to the ~ *~*~ ~ ccn..a~ned below .our apprOVal st~_~.p, Uoald you please t~j?e the foi!owin~ condition of approval oH the £~nal C of 0 as this ~.~il ensure tn~- mat future o~,-.~ar %ill~ be made aw~-e os~ the nitrate problem, 'L INSTRUCTIONS Disapproved ........................... ........................................................... o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building ~ Inspector, with 3 sete of plans, accurate plat 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 or areas, and giving a detailed description of layout ofpraparty must be drawn on the diagram which is part of this application. c. The work covered by this application may nat 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 for the issuance of a Building Permit pursuant to the';d Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and ather applicable Laws, Ordinances or~3 Regulations, for the construction of buildings, addit ons or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. i ~/7 / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. D. ~"n Q- ~ .......................................................... owner of prem ses ..~ J:~ ..~ Nome of ....................... ~. ................................................ A ................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... /oo0~ 70~ /o - z ~ ~, ~ (SJgnotu re of app icant, or name, if a corporation) .... , · ........ (Address of applicant) ~ Other Trade's License No ............................................... /:J)/32L / ~ ~' Location of land on which proposed work will be done. Map No.:,,~..9..~o..~...~.~....B/6~/~.ot No ..... ,~..j~ .......... Street and Number ......... .~....~....?...~...J~.,,~......~,..q...~Z..~..}...LI'J,..~ ....... ~.~..4~...~7...r_~'~24~..~.~..~.....~t..~././.,~,~/ / Municipalitry State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. ~,si, iag use ond ~cupancy ......................... ..~....~...~..~..~...+.. .......... Z..'...~ ................................................. b. Intended useandoccupancy .................. p.....~...i..,,.~.~...~..7 .......... t?_...~..~..;..&,~.~.e.~.. ................... 3." Nature of work (check which applicable): New Building-. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition ................ ..... Other Work ................................................ . .... 4. Estimated Cost ............................................................ Fee ~ /'/ ~ (Description) (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 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 ........................................................ Nameof Former Owner ........................................................ 11. Zone or use district in which premises are situated'--;~^ '~ ]2. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~ ........................................ regraded ....~....-~..; ............... ~/i~l excess fill be removed from pr~d~es: ( ) Yes xC~ No 13. Will lot be 14. Name of Owner of premises .~'"~..~.~?.~.. ......... Address ..~ ........ Phone No ....................... Name of Architect .................... Z~._..._._...:.....; ................. Address ................................ Phone No ....................... Name of Contractor ............................................................ ~ Address ................................ Phone No ....................... 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. STATE OF NEW,-Y-~RI~ .................... ~..~......: ................. being duly sworn, deposes end soys tl~t he is the applicam (Name~f individual signing contracf) 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; 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 forth in the application filed therewith. Sworn to befc~re me this ................... . ...dayof ...... ....... Notary P~ic, . ............... ,~...w:~,~.~;/.... County ...,~.~m~.......~r~..~.;~ .......................... NO. 52-4643721, Suffolk Term Expire~ March 30, I/I'IlMENT Oft ,l~lN'r , 1~- Water not to be used for ~arati~ or baby fora or con~ by ~f~t.-~r-6-mos. of age., o~ ,,,- .. ~ - ' : ' ' F-' '-~O' "R ~ .~ d 0 ~ to ~ ~, LIe. ~ND ]U~V~G~[KN~, N. Y. SUFF. P.O. DE/~'F. C)~ HEALTH Ji~.RVIC~ ~TAT~34ENT ~ O' ~ FOR APPROVAL OF ~U~ON ONLY ~o~ -I' ~E WAT~ SUPPLY AND :~'~ DIS~L BY~EMB FOR -~' DE"CE WILL C~F~M TO THE ~O'~) 7-- 5~ '- //~ STAND~ OF SUFFOLK CO. OE~. AppROVED AS NOTED DATE:~ F I ri