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Home My WebLink About9842-zFORM NO. 4 TO~[N OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Ot[ice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .. 76./4.9...~.¥.~..'.~...L..~.e. ..... x~azkx Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . .J~. Y.....~.7. ......... , 19..7..8 pursuant to which Building Permit No ..... 9..8.~.2Z dated . .Ju~.....~.? .......... , 19.7.8., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this eartifieate is issued is . .Ag~ioul.~ura]...Building..~ith. Gneenhoxm e .......................... The certificate is issued to Ernest Schneider (owner,:~ of the aforesaid building. Suffolk County Department of Health Approval .... D.e.o.e.m. ~.e~..7~. fi.9.?.8..~. .......... UNDERWRITERS CERTIFICATE No. N41~0.11 / * Wager supply to Be used only fox' eomaeroiz3, purposes, not to be consumed tgr infants under 6 months of age. County Tax Map Number 1000-101-1-1/+. 2 FOI~M NO. ~ 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) N? 98 2 Z Permission is hereby granted to: ...... l~,.~h~.~,....s..~..¢.~ ...................................... ...... al~ ...... ~me~..,~c~e.~.e..z'.. .................... at premises Iocoted et .~,640 A3.vah~ s Lane . .................................................. C~tl~h~t.e.,...~..e~......Y..e.~ ................................................................. pursuant to. application ~eted ............ .~..~.. ....... .?..~. ...................... , 19...?..8.., and: appr6ved by the Building Inspector. Fee $.....,.~,1~.1'.~'~' ...... 1000.101-1-1/-1,. 2 Building Inspector 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-iS-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. B. 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 requ ired 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 New Building .... ,~,~ ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .......... ,~,~, .C~, ,~. ......... ?.././:~..~. ,/,~., ,~/?, .~- ...... House No. Street Hamlet Owner or Owners of Property . . .'.~.~.A.~,~T-.5.~....~.~. ~'../~,¢~.-~e~ ............................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ....................... ~p No ............... Lot No ............... Permit No. ~. ,~.~.~..~.. Dateof Permit..~.Applicant~ ........................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ~ ............... Fee Submitted $..~.~...~ .................... Construction on above described building and permit meet~ all~pplica)~le codes and regulations. Applicant ..... ..................... Rev. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~5~JOHN STREET, NEW YORK, NEJN yORK 10038 THIS CERTIFIES THAT o~dy t~e deer u' t ' A ! io~ Block I~OV~t~e~ was examined On a~ found to ~ in ~mplia~e with the r~ui~ments of th~ B~. RXTURE FIXTURES RANGES ~ .._ 1. DRYERS FURNACE I~TORS nJTURE AIIpUANCi FEEDERS Slt[ClAL A~AT. K.W. ,C~ .~. GAS H*P. k~?. NO. I 2nO ~]~ ;: 1 3/0 Y, ototV=: 2-1hp TIMECLOCKS BIUL UIMTHEATEIIS MUL'rI'OUTILq' ~q4T. ,M~S. TR~S. ~ V I C E EXHAUST FANS 3 1-5clr.-12· . ..-)amp Pul~.nd ..le..Crl¢. Co. ~at ti trick, l.I. 11952 !,lc. This certificate must not be altered in any mannerr return to the office of the Board if incorrect. Per COPY FOR IUILDING DEPARTMENT. THIS COPY. OF ClRTIFICATI MUST NOT 'BE ALTERED IN ANY MANNER, SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Riverhead, New York TYPE OR PRINT LEGIBLY IN INK Building Permit No. - ~ ~ ~,~ ~_ Health Services Department Plan No. Application for Approval of Commercial Sewage Disposal System TO: The Suffolk County Department of Health Services Date //3 ~/~ Application for approval of commercial sewage disposal system iS hereby requested. ! (Name, s~de of street, name and distance to nearest intersecting street) Hamlet Village Title (Builder- Owner) Address ?/5 /~/~ll~- L~,J[J09~T~OL~) Tele. No.~'~':. Ready for inspection FOR USE OF HEALTH SERVICES DEPARTMENT ONLY Inspected by ~ / ~~_~ Date Installation satisfactory - Yes ~"J ; No Based on the information stated hereon by the applicant and other information made available, it is the option of this Department that this system with proper maintenance can be expected to function satisfactorily and is not likely to cause a nuisance,~F,~3.v~ded ~Jesigned sewage f!~w is not exceeded. Structural features are not included. "~;j~--~. ~/~ Date ~ ,. ,~l~ ~;~3~ ~ Oet~x,~ ~ ~.... ~, l~aCe: supply to be ueed only for co~e:¢ial pu:poses~ no: :o be eona~efl by tnianCs unde~ 6 mos. of age. $CHD · $-13 NOTtFy BUILDING D EPAR~MENT AT 765-2660 9AM to 4PM FOR REQuIR. · ED INSPECTIONs: 1. BEFORE BACKFILLING ~:OUNDA. TION OR 5TART ~RAtI~?~G 2..FRAMING 3~ BEFORE, COVERING Ph%'S OF A~Jy KIND 4. FINAL WHEN flO~ COMPLETED ~ NO~REsPoNsiBLE FOR DESh?N OR CONSTRUCT~GN ERROr5 5. ALL CONsTRUCTioN MUST REQUIREMENT~ C~ N,Y. STA?E AND TOWN HOUSING CO[~f~ D 700.11 ' / Examined ............ ~'t~'""~j' ........., 19...~8 Application No ......... gJil/~J ............. Approved ............ ,y1].~:;......~j~, ........ , 19...~,1~ Permit No ........... ~1~I~ ............ ?'/~?/7 ~-- ~--- D,sopproved ..................................... , .............. ................................................................ :', .......... : Z . ~,~.~ ~,e~ ~.m . . .~. . . . . ~ ~. . ..~.. ?~m,_-,~" ' /~' ~-'- ~ ,~.'~ ................. ........ ~ui:aing ,nspectorl C,-O xl"~/~ APPLICATION FOR BUILDING PERMIT '/'~ ........ ~ ...... ~ ................... , ~ ...... :.....~ INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and subm Ired 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 relationsh p to adjoining premises or public streets or.,,~ areas, and giving a detailed descr pt on of layout ofproperty must be drawn on the diagram which is port of this opplication.~, 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. B .A, P,.PLIC~ATIO~N ,IS HEREB. Y MADE to the Building Department for the ssuance of a Buildina Permit oursuant to the~ unamg zone urainance at the Town of Southold, Suffolk County, New York, and other a~lic-ab e Law; nrHi gulabons, for the construchon of buildings, add tons or a terat ons, 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 in buildings for necessary ~pections. ,. ~.~ I' ~,~gnature al pp icant, or nar~-, if a corporation) .............................. iX;~;i;;;';';;T;;j;~;ii;;'~';i .......... ~ .............. '~,' State whether applicant is owner, lessee, agent, architect, engineer, general contractor electrician n umber "r ...... ..&:.~:~,~..,~..,,,.d....C,...}.: :,~Z:,- .,, ~'~ , ......... ................................................................................................. Nome of owner of prem ses 1....~.,,¢ ~.~ ;: ./.,'¢¢/; '?4L,, ~ ...... !..? '. ........ _.;, ................................................................................................................. If applicant is a corporate, signature of duly authorized officer. ~ ~,~e~ ~_ ~ /~co(~-~9' (Name and title of corporate officer) '------- ~J. zT--~,xot_ Builder's License No ..................................................... /~r~o~'~{ ? f,q /'? ~ Plumber's License No ................................................. ~-~e- /'~- Electrician's License No ............... ; ............................. Other Trade's License No ............................................... ~:rC~j:Oan~f ~;dm;;rWhic~,~:~!]~6~r.~,ii, l,~;.done. Mep No.: ~...../.~../.....~...~.....! ........ Lot .N.o...L..~..:...5 ....... Municipality State existing use and occupancy of premises and in:end.ed use and occupancy of proposed construction: /_ ~__' 7/-~ _ a. Exisiting use and occupancy ............ C~.(~.:',/Z,L,:.:.C~Z:,'..S ......... b. Intended use and occupancy .LS...,.,...~.. 3. Nature of work (check which applicable): New Building' ...... f'............ Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work (Description) 4. Estimated Cost ....................................................................................................................................................... (to be paid on filing this application) 5. ff 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 ............................ '-/ixJu~ber of Stories ................................ Z..E).. 8. Dimensions of entire new construction: Front ............ ./......, ................ Rear ...... ..............Depth .......~......~. .......... 10. Date of Purchase ....... ' ~/.,/~.....~..~.. ................................... Name of Former Owner ..... 11. Zone or use district in which premises are situated ............................................................ ~.¢. .................................... 12. Does proposed construction v)olate any zoning law, ordinance or regulation: ......................................... .¢, ........... 13. Will lot be regraded . ....... ./..~...O.~ .......... ,Will exgess fill be removed from premises~ ( ) Yes ( Name of Architect ........... ~ ................... ~ ......................... Address ................................ Phone No ....................... / PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock dimensions frore property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~TATE OF NEW Y~)RI<, COUNTY OF ..... Z;..' .......................... : ........ .... . ... .... ;... .,.'~ ...; ............ .2 ......................... being duly sworn, deposes and says that he is the applicam (Nome 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; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...................... day of ...................... '....,/. .............. , / ~ ~ ~, (Signature of applic~n~ (TPl 1974) 2X6 TC 2X& {{C ~'_. ,~. 0 U T H F R {~ P I N E ~, t ~c~s~ ~o ~'- o* ~t'- o' ' [~g island Ave.,Medford N.Y, ] ' ~ - 2452 ~0 46'0~ ~2~0 ;N~E SEL. 9TR, DRY 49'- 8' ~1'- 0' .~~I~ ~ ~ ~ / MC-IS 42'- O' ~1'- O' 2.5-9 38'4" ' ~2'0" ' ~60 ~ 46'0,}1/4 ~C-15 37'- ge 48'- 9' 2.5-I0 42'8" ~6,8, ~7 ~ 51'0" BTM. C~.5~ L STR. D~Y 43'- 4' 51'- 0' 2.5-11 47'0n · 51'0" ' ' D~Y 39'- 4' 51'- O" 2.'5'12 ~1'0~ N 0 . . . 2~82 ~'0" 39'4" E ~ ~ E ~ 8 E R S 2490 37'0" 42'8" ......................... 2{P7 ~0'0' 46'~' 4t l~ HE~'FIR, EQURL OR BETTER. 2~13~ ~l'O" 51'0" .. B~, CHD ~ 7'8 7282 --~ ~ O/A SPAN c,,u,m *s *~u~o ~,,~C~V m ~o~0~ c~o~s.r.l~ ~4~ ii ~-C~O ~r ~w~ ao~ I~l m~ ~ B~m Chord Li~e Lood 0 p*{~ SEL