The URL can be used to link to this page

Home My WebLink About9897-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Of[ice $outhold, lq. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .8..9.5...I~.9.1.1.w.o. 9.d' . .L~...e. ..... Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .....A%z~qs.J; .... 5. ...... , 19. ?.8. pursuant to which Building Permit No....9.8.9.7.Z dated ....August ....1~ ...... , 19..?..8, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....... .Pr£vate. 0~e. Family. Dw. elZing ................................ The certificate is issued to .......... S..t.a.n.1..e¥..C.h..a.s.e. .............................. (owner, of the aforesaid building. Suffolk County Department of Health Approval November lb, 1975 5-S0-Z~? ........... Rb]5~i~c' 'A; ' '~i'Ila ....... UNDERWRITERS CERTIFICATE No ..... N/~2.7.515 ................................ HOUSE NUMBER ..... 89..5 ...... Street ...............Kn..o.l.l.w..o.o.d...L??.e. ........... .................................................... :. ..... ........ ~...'"1.4z1,,4 , // Building Inspector County Tax Number 1000-107-6-3 FORM NO, ~ TOWN OF $OUTBO~D i~UILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9897 Z Permission is hereby gronted to: ....~...A~..,~.~..'.~. ...... ....... pursuant to opplication doted Building Inspector. ~..., Fee $ I 0OO -- I O '~ - b- ~J TOWN OF SOUTHOLD Building Department ~ ' Town cler~ office AFPLIC Instrucfions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the roi!owing; for new buildings o? new: USe: 1.Final survey of property with accurate location of ail l~uildings, property ines, 'streets, and unusual natura or topographic features. 2, Final approva'l of Health Dept. of water supply anc! S~verage ,disposal~(Sk9 form or equal). 3. Approval of electrical installation from,,,!Boa rd o~f ~ :Un~riters. 4. Commercia~ buidngs, InduStrial buildings; L,M~{~i~e:~LR~i:~en¢~",'~nd ~itar buildl:ngs and installations, a cert ficate of COde ~OmplJance f~Om ~t~e~L A~chitect or Engineer resPOnsible for the budding ~ .... 5 Sub,it P ann ng' Bd~r~ ~ppc0~al 0f' ~ompl~t~ s.te ~ptan,:req~t~eme~ B. For existing buildings (prior to April 1957),"N~o~.conform~ng uses, or buddings and pre-ex~st.ng land uses: ' ' .... bmldmgs-,~and unusual natural 1. Accurate survey aT, property Showing all pr0p~r~y llnes, ~{reets, ' or topographic features. 2. Sworn statement of, OWner or previous ~ner as to use, ~c~ncy and cohdition of buildings.. 3. Date of any housing code or safety inspection .o~ buildings or premises, or other pe~inent 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 ~,~ New Bud ng .... Old or Pre~exi~ing~.B~i~; ;~;~:~..~,~',,'.~;... vacant ~a ............................ Location ~ Property ........ t ................................................... ;~ ........ ,??~"~':~'~"~'~%;'~'~; ""~; Owner Or ~ners Of Prope~y ....................................... ~,..~ .......... T ..... ~.~...~,,,.~ ~'"~ .....' ........ ~:;~-~' ' ': ann n Boo ~p Underwr,ters Ap~e~ ............................................. ~ ~{.dP royal ...... ?' ................................. FG C ca e .................... ,?.,, ..... Fee Submitted $ .......... Construction on above desR~ib~d buil~ing~and perm!'[ regulah~s. A~plicant~ ~ Sworn to before me this ..... ~ ....... day of. (stomp or seal) Notary Public THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 STREET, NEW YORK, NEW YORK 10038 ,.JOHN 27. A.,,c.t,o. No.../,,. 9 ge6s N4 5 .3 THIS CE~IFIES THAT S~anley C~e, Knol~o~ Dr. ~tattltuc~,~.z. w~ exami~d on and found to be in compliance with the r~uire~nts of ~h~ ~rd. DRYERS I FURNACE MOTORS I RJTURE AFtRJANCE FEEDER~ RANGES iPECIAL REC'PT I 30 ICOOKiNo DC<KS I OVENS I DISH WASHERS TIMECLOCKS BELL UNITHEATERS MULTI-OUTlET EXHAUST FANS 2 ~MMERS SERVICE DISCONNECT I tO. Of METER ~THER APPARATUS: 3 zmoke detect:o~s 20 *-0' 6 C OF NEUTRAL 4/0 Sal Praco Oreenport, N.~. 11944 Ibis certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified by!,their credentials. COtY FOR BUILDINg DIPAI~r,/I~L THIS COt'/' OF CERI'IFICA?i ,MUg NOT BE ALTERED IN ~ 'MANNIR. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES 10. 11. Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY icant'~,/~/~Y~a~/~ /~v¢ Phone ol?~ -o~e;? 7- Appl Address_x~a~ ~ --~ ~ ~/~uc~ ~ Property LOcation ~Y /%~w~o~ ~m,u~"~ Village momr~ru,~ y/y Township ~au~o~ ~/ Public Water Company Name ' ~o~ Distance to main 5. Subdiv~ 6. Section 7. Lot Number 8. Private Well 9. Public Water Lot size: Width ~o feet Sewage Disposal System: a A. /~O~Lgallon septic tank: Precast~ ~"~[quivalent B. Leaching pools: Number of pools ~ Precast~ Block If private well, fill lowing blanks: A. Tank capacity ~-- B. C. D. E. Block Special in the fol- gallons Pump G.P.M. Total well depth Depth to ground water Amount of water in well Length, J ~t~feet (For Health Services Dep,t. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' 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. Date ~//~ ~-- Signed FOR THE DEP~TMENT OF H,EA~TH SERVICES~ USE O,~LY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE · SIGNE~ '~Z~-- ~ , ~---~ ~ S-15 Rev. 4/1/73 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN (~LERK'S OFFICE ~OUTHOLD, N. Y. Examined ..................... '.:: ................ , 19 ........ Application No ............. ';...~/...~£...?.~... Approved ..................................... ~.., ~ ...... , Permit No. Disoppraved ale (Building Inspector) APPLICATION FOR BUILDING FERMIT Date .......... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to ~chedule. b. Plot plan showing location of lot and af buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout afpraperty 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 for the issuance of o Building Permit nursuant to the B~u~ld ng Zon.e Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or xegu arians, for the construction of bu Idings, additions or alterat ohs, or for remora or demo ition, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .......................................... ~.......%~.......T. ;T..l~..~ .A~. ............................. (Signature of applicant, or name, if a corporation) ................................. (AddFess of applicant) //~/c~ Name of owner of premises ......... ------ ~ ..~...'..~..'~.~....~....~'..~... ....... ....~...~__~..~,~ .............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License .................................................... c 'c' ns 'cerise No. ~L~..~:~//'.~/4z. ................. Other Trode's License No, .;z..4~,.../.~.~:.u.J;~,: ................. ~/~ /~¢ ~o~t~o, of ~,od o, which prop¢,ed work w~, b, do.e. M~p No.: ¢~¢~./¢Z,..~&.~.. Uot. No..~ ................... N mb,, ......... ............................................. ----~----Municipah~ Stme existing use ~nd occupcncy of premises ~nd intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................. b. Intended use and occupancy ....... ~..~/~..~.....~.~.. ...................................................................................... 3. Nature of work (check which applicable): New Building,. ....... ;~dd t on .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... oc~5~"-- (Description) 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..~..~..~.~....~... .................. .~....~}-~..~ ....................................................................... 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 ......~..~.~.~...~..~........~..~...~...~,...~...~.. .~..4..~....~-. .......................................... Dh'nensions of same structure with alterations or additions: Front ...... .~...~.:....~..~ ..........Rear .."~..~..?..~...~. ......... Depth ~ i, ~/' Height ~ ~'' ~' ~' Number of Stories 8. Dimensions of entire new construction: Front "~'~' ~ '~ ~'~:~ ~ ~ ~ .................................... Rear ............................ Depth ........................ Height ...,~'....~../.'...~.... Number of Stories ............ ,~t... .................................................................................................... 9. Size of lot: Front .................. ..~...~..~.~....~.. .................... Rear . .~...,~,.:.?..~.. ................. Depth ...,..~..~..~....~.. ........ 10. Date of Purchase ...~.~.~'~......'~.../~..~..~...~, .~.. .......... Name '~ ;o~r~er Owner ...~.~.~.....~..*. ]1. Zone or use district in which premises are situated .~.4~/~-~-/~...~.~, ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .~.~.. ............................................... 13. Will lot be re,~raded .....~..~.. .................. Will excess fill be removed from premises: ( ) Yes ( 14. Name of OwnCr of pre~i~s .~.'~...~...~...~......~.~...~.C ....; ............... Address~~.~.~..~.~ Phone No. . . ' >,~ ,~4~ - ,6 ~-~,~' , Name of Arch,tect~..~, .'...~.~4 ............. '~..~'.~.~..~. ........... '.Z'~....(.. ..... Address ........ ~'~.~.~..,~..,~...'.~'.: Phone No....~....~.......~..~.. Name of ......... A ress Phon No ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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. CTATE OF NEW.~,YOP~.. I c ¢ EOUNTY OF ...~....C~....~T~.~.....~..(-,, ....... f"'"' ' ................... ~ ....... ~.~.~..CZ~ .............................. being duly sworn, deposes and says that he is the applicanl (Name of individual signing contract) above named. He is the ................... ~.~ .......... ~.~ ......... ~?.~.~.~..~.~. ...... ~..~.~.~..~ ............................................ (Contractor, agent, corporate officer, afc,) of said owner or owners, and is duly quthorized 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 thac the work will be performed in the manner set fo~h in the application filed therewith. Sworn to_before me this ,~ ~ - ........... ......... ...... ............. , // , . ~~ (Signa~re of applicant) Notaw Public,. ...................................................Coun~ ........................ Z~....~~ ........................... NOTARy PUBLI~ ~e of NoW~ '1 % Co REVISIONS: JOHN L. TERAMO CONSULTING ENGINEER ~ 175 WEST BROADWAY HEWLETT, LI. NEW YORK P.E. DWG. NO. 4 4II Il i -[4- i JOHNI. L. TERAMO PL.,E.. CONSULTING ENGINEER 1 1 75 WEST BROADWAY HEWLETT, L.I. NEW YORK DWG. NO, '1' 4,1 ,,¢ I T REVISIONS: JOHN L. CONSULTING,' ENGINEER' ,- 1175 WEST HEWLETT, L.I. NEW YORK' ' '