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Home My WebLink About5047-zl~OEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No..~....~.~ .~...2~ Date ............... .~. ~'~.~..., 197./. THIS CERTIFIES that the building located at . .~. ~ ~.~... ~g~... ~.~.. Street Map No .... ~ ~ Block No. .~ .~... Lot No..~ ~ ....... ~.~ ~ ~ ~ ~ . .~..y~ co~orms subst~tially to the Application for B~ld~g Permit heretofore filed in t~s office dated ...... { ~. ~t.O.~. .... , 197.~. p~su~t to w~ch B~ld~g Permit No. ~O ~ 7. ~ dated .......... I.~.. ~.~.. , 197.0., was issued, ~d co~orms to ~1 of the req~ ments of the applicable provisions of the law. The occupancy for w~ch this certificate is issued is .... .~ ~. ~ ~ ~. ~ .~ ..... 0.~.~ .... ~ .~.,t. (~ .y .... ~.~,L ~. L~ I ~. ~ .......... The certificate ~ ~Sued to ....... ~.~.~. ~. ~ ..... ~ .( ~.T ..... ~0~.~.~ .~ ....... (owner, lessee or ten~t) of ~e Mores&d b~d~g. Suffo~ Co~ty Dep~tment of He~th Approv~ .. ...... Build~g ~spee~or TOWN ,OF SOUTH, OLD EUILDiNG DEPARTMENT TOWN CLERK'S OFFI(:E SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREM?S~$ 'uNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: · ........~ ............................ to ............................................................................................. .?..,.... ......... ............. ~ ......................... at premises located at ...................................................... .... pursuon¢ to application doted Building Inspector. ~ee,.../.~.~.... ' rov~ by the Exa '~ f~ /Var~ 70 mmea ........................................ , 19 ........ fORM'NO. I lX)WN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S (Building Inspector) APPLICATION FOR BUILDING PER~II ~t, /-7 /1~- ~9....~... ~' INSTRUCTIONS 'a, This application must be completely filled in by typewriter or in ink and submitted In dupllaote to the Buildtn~ In~3ector. b. Plot plan showing location of lot and of buildings on premises, mlationlhlp to adjoining pmmieal oei~llc lt~et~ areas, and giving a dMalled description of layout of property must be drown on the dlagr~n whic~ il part of Jhle a~licMtan. c. The work covered by this application may not be commenced before issu~,~ce of Building Pem~lt. d. Upon ppproval of this application, the Building Impector will Issue a Building Permit tothe alN~llJ~nt,r~ ~ shall be kept on the premises available for inspection throughout the progre~ of the work. ' e. No building shall be occupied or used in whole or in part for any purpa~ 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 I~,~n~ant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable ~ OMinanom m Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, al helen dlJcribed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and rejul~tlom. (Address of at~llcant) State whether applicant is owner, lessee, agent, architect; engineer, general contractor, electrician, plumber or builder. coru T~ ~.~Z~....~..' ............................................................................ Name of owner of premise~ .......................... ..T.. ..................................................................... if applicant is a corporate, signature of duly authorized officer. ~- (Name and title 'of corporate officer) I. Location of land on which proposed work will be done. Map No.: .......... ~ ........................... lot No.: ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of prapaeed coaltmctlan: ' a. Existing use and occupancy ~-' ~ IV")' .~..~ ..'~.. b. ~nt,nded use o,d occu~an? . ................. ./.....ff~.~..!.~...T. .......... .~.~.~./..~.~ ......................................... 3, Nature of wo~k (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. ~Ot.~. Work (Describe) ...................................... I 0oo ' 0 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 ...... /...~-,.~...~. .............. ..~....~..C:C.H....~.....]~.. ............................. 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ new construction: Front ................ ~.....~r...'t ......... Rear ........ '-''.~......~... 8. Dimensions of entire ........ Depth ........................ Height ........ /...~...~ ..... Number of Stories .............~.....~...E~... .......................................................................................... ! ! 9. Size of lot: Front .........l..~....O. ......... Rear ......... ./..3....0.. .................. Depth ........ ..~..~....,-~--~' ........ 10. Date of Purchase .................................. ./.~...,..'~....~.. ...... Nome of Former Owner ....~..-t....~.....~.../.../T....~... ..................... ! 1. Zone or use district in which premises are situated ....................... ~.~../..?.. ............................................... 12.. Does proposed construct;on violate any zoning law, ordinance or regulation.;) ............ ~ ............................. 13. Nome of Owner of premises ..~... ....... ..~.../.~?..~...-~.. ........ Address ........... ~ .~....~...~....L...'Q..L~.... ........ Phone No ..................... Name af Architect .................................... .f ..............ss ............................................ Phone No ..................... .................................................... Address .......................................... Phone .. . PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensior~s from property lines. Give street and block number or description accordinq to dm,,4 ,~"d --~.:m-.. street names and indicate whether interior or comer lot. i,~0 STATE OF NEW YORK, ! ee,~f A COUNTY OF ................................ ,f.a.a~ ~. , ]¢'br~l'v/lar/~ ~:~"/J-,L?r_. ha,,, duly sworn, deposes and says that he is the applicant (Name of individual Signing ~ . above named. He is the ............. i".~a~--~q;~ ................... ~..!/~.C~..~..~. ~._...'~._~..J...a.~(_c.....z~...~...~ .......................... (ContraCtor, agent, corporate officer, itc.) 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 ore 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. Swam to before me this ................. /.~ day of ............. ]¢'~9...~., 19..?..0 Notor'/Public,. ................................... ..~....r..Q.T....~._...'~ou~tG'' · (Signature of appl~ont) / S-9 SCHD SUFFOLK COUNTY DEPARTMENT 0F HEALTH Date, Bldg. TO WHOM IT MAY CONCERN: at The sewage £- (/ (Give have been inspected by disposal f acilit i~es deed location) this department and found to be for a structure ! located satisfactory. D~strtct Engineer FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TBMPOI~RY CerfificaJe Of Occupancy No. Zhd38 ..... Date .......... gan .... 19... , 19. THIS CERTIFIES that the building located at }+.20.[..Main. ~oad .......... Street Map No...XX ....... Block No .... xx ...Lot No. x~.~.. Latlx'e.1... ~g~f, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Iqov...,12. , 19.. 70 pursuant to whicD Building Permit No...50!+~ dated .......... ]~Io~... 12. , 19 (0, 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 .~'r~Lvate..one. £ami]4,: .d~.~e.2&ing .......... .......................... The certificate is issued to . .ktar~en. W. ielt ........ O~n~r .......................... "~(oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~..~E.. ~ l .~ // .......... .i. ................ ~Building Insfpector SUFFOLK COUNTY DEPARTMENT O~ HEALTH EASTERN DISTRICT county Ce. er, Riv rhead, PA 7-4700 APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SEWAGE ~$AL AND ~TER /~PPLY SYST~S Inspection for approval is requested, pertinent insfH%%~{ltd~}da~a ,herewith. 1-Name of ~er ~ .'. 3-Subdiv. Addres~B~~''~ 2-Name ofslider Address ~ z>~ ~ 7-Sewage Sy~t~insZall~d by~ Address ~fV ~ 8-(a)Deed location of prope~y ' (b)Hamlet or Village 2i/~ ~&~ (c)Town 9-Sept ic tank-Gal L (c)Blo~ si~ in.~/~ in.H ~ in. (d~)Precast pool (e)l ~3 (f)H ~ft. ~i~.~. ~g)Fi~ished grade t~er -- ~t. (h)B~ilf ~erial ll-Water Supply: Public Syst~ If Private, the following questions are to ~e ~nswer~d: 12-Private W~er Supply S~p[em in~lled_~y 13(a)-Tota1 Depth of Well~'f t~ /~7 (b)Depth to Static Water Level__ 14-Diameter of well pip~ 15-Name of Laboratory__ 16-Method of ~Distnfection 17-Date ready for inspection ~ff ~ ~-'??_. The undersigned C~RTIFI~S: Above syst~s ~have been constructed and are in compliance with the Suffolk gou~ty Health Department's cu~~dards, Bulletins 18-Date ~//~?C. ~" ,' Signed ~er z~uilder H.D.Ref. NO.-C~~ O' 7 ~ 19-Insert sketch of location of Wate~i.~werage Facilities with accurate dimensions. ~-x ~ ~, \ STREET .......................... ......... ......... -¥7 ...... Based upon the ~nfo~ation stated above, s~isfactory functioning of the above systems can be expected with proper maintenance ahd care. 0~ Of ~e~yal ~gineering Sez'vioes S-Se Instructions for Submission of Installed Private Sewa2e Disposal and Water System Application Applications are to be submitted in duplicate. Required information should be typed or legibly printed in ink. Inspectors are not permitted to make inspections of installations until applications have been submitted to and accepted by this de- partment. The item number on the application form and item number listed below are the 1. Owner's name and address - if owner and builder are same, so indicate. 2. Builder's name and address - approvals will be mailed to this address. 3. Give name of filed realty subdivision map. 4. Section number of realty subdivision map. 5. Lot number of plot on which disposal unit is constructed. 6. Building permit number assigned by the Building Department. 7. Name of person or firm who actually constructed the sewage disposal fac/lit/es. 8. (a) For example: s/s Jones St., 100' e/o Smith St. (b) Hamlet, (unincorporated area in township), for example: East Moriches. Village (incorporated area), for example: Northport. (c) Township, for example: Brookhaven, etc. 9. Give inside length and width in feet. Liquid depth is measured in feet from bottom of outlet pipe to bottom of tank. 10. (a) State number of pools, (b) State number of blocks below inlet pipe for each pool. (c) State length, width, and height of cesspool blocks in inches. (d) Indicate by check if precast sections are used. (e) Give number of leach- ing sections per pool. (f) Give height and diameter of each leaching section. (g) Give depth in feet from finished grade to cesspool cover. (h) Describe backfill material used. i1. Indicate by check if water supply is public or private. 12. Name of person or firm who actually installed the water supply facilities. 13. (a) Give depth in feet from top of well pipe or casing to well point. (b) Depth in feet from top of well pipe or casing to water level in well. 14. Inside diameter of well casing. 15. Name of laboratory performing the examinations. 16. Describe method of disinfection, for example: quart of laundry bleach in ten gallons of water poured into well and allowed to stand six hours. 17. State date on which installation will be ready for inspection. 18. Application must be signed by builder or owner. Signatures of subcontractor, superintendent, etc., will not be accepted. 19. Indicate location of Water &. Sewerage Facilities with accurate dimensions on sketch. TOWN OF SOUTHE)LD DFFIQE OF BUILDING INSBEE:TBR TOWN BLERK'S E]FFIBE Suffolk County Yophank Ave., Yaphank, N. Y. Middle Road CR Dear Sir: In accordance with Section 2391( of the Genera Municipal Law of the consolidated Laws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk ~o~ ....... ¢~f"-'-N~t,t~ t~,ek ¥" ?,?;'Y; ............................. ...................................... has applied to the Town of Southold for a permit to~ a building os shown on the attached plot plan, submitted in tril~licate, dated ....... ¢)'?/" ............................................ and titled ~"'0~'~i'(~O'j"'~',~"]P~'~" We shall withhold fu~her action on this application for ten days or as otherwise provided in the aforementioned Section 239K. 3/6/63 A~o~e~ ~u~s~ ¢o Sea, 239~Ve oE ~Ae ~e~e~A~ M~1o1~ ~; beEo~e ~ truly yours, building access road. to the County Road, ~pllcant must obtain a pe~t ~der Sec. 136 of the Highway LI , {~ SD~*FOLt( COUixt%% DEPT PUBLIC WORKS 'r H. t". Bis.hop, Co~m~issloner Building InmeCtor By Willf~ S.' }.[atsunaye, Z~./ ~ ,. :~+~ Permit Ho ......................... PERMIT UNDER SECTION 136 of ARTICLE Vliof HIGHWAY LAW ~hereof, WHEREAS, a certain highway known as the ~L~ ~0~,~ ~:,~, ~ No ~ ~, has been improved and is on the Suffolk County Road System and ~'"~ WHEREAS, ~..'~1~ NOW, THEREFOr, pe~lssion is hereby ~ant~ to s~id permission to pen the following conditions: Date .IVIAI Ii U~,,x, ]',i:..V~ .fORK Commi 1. When co~crete Is removed, cut concrete with concret~ s~w two feet outside the limits of the proposed excavation a~d for the full l~.el width. ~g~hen the cut is made in pavement within 10 feet of the panel Joint~ th~ pavement shall be removed for full panel width from the cut on the far side o~ the ~xeavation lethe l~nel joint. $. Bael~R1 and thoroughly compact fill using power la,riper, placing soils so that various types of sell are in same relative position as before excavating. Grade to original surface. g. Replace pavement, sidewalk or surface .same as e~l, sting; ff concrete, replace using l:lZ~ gl/z mix stone mix concrete, ff bitimfln~us material; replace using same type as removed. 4. If concrete curb is removed, replace with similar cul-b 1:1~:8~/~ mi~ 5. Notify the Maintenance Department at Yaphank 4-845~ when the Work Is to begin so that an inspection can be made of the operation. This permit shall not be assigned or transferred without the written consent of the Commissioner of Public Works. The work authorized by this permit shall be performed under the supervision and to the satisfaction of the Com- missioner of Public Works or his representative. Particular attention is called to the necessity of thoroughly cor~pacting the back fill, which will be required by tho Commissioner of Publin Works. The Commissioner of Public Works shall be given one week's no,ice by said applicant of the date when it in~ tends to begin the work authorized by this permit, and prompt notice i~f its completion. The said applicant hereby agrees to hold the State, County and T~own harmle~ss on account of damages of any kind which may arise during the progress of the work authorized by this permit or by reason thereof. Applicant certifies all persons concerned with actual work under thib permif are duly covered by workmen's Com- peasation Insurance and the State, County and Town shall be bold harr~less on accotmt thereof. The Commissioner of Publlc Works reserves the right to at any ii'ne revoke or annul this permit should the said applicant fail to comply with the terms and conditions upon which i~ is granted. · The ~applicant ag.r. ees to pay all necessary expenses incident to sqpervision and inspection by reason of the granting o~ such permit as certified by tho Commissioner of Public Works, such payment to be made within ten days from the rendering of the certified account. Work under this permit to be commenced within thirty days frOm the date of permit and continued in an expeditious manner. The applicant shall submit a detailed plan of sfructure to be built, with a description of proposed method of construction. ; t ~s understood that should future changes ~n the ahgnmont or ~rade of the highway require changes in the work covered by this application and permit, the applicant shall on roasm//~ble notice from the Commissioner of Public Works make such necessary changes at his own e. xpense within the th~ so specified in notice. Traffic shall be maintained by the applicant on this section of thd highway while the work is in progress and until its final ~ ~ A ~1~' .... ~ in the sum of $ ~ _payable toithe County ?reasurer of Suffolk County is ~as secRrity that the highway will be restored to its original co~,dition where' disturbed at the expense of the applicant, as soon as the work has been completed, and the said Commissioner of Pub~tic Works is hereby authorized to expend all or as much of such deposit as may be necessary for that purpose, should the said applicant neglect or refuse to perform the work. ~ In consideration of granting this permit the undersigned accepts lit subject tb conditions described. TO AVOID SERIOUS DAMAGE TO VITAL UNDERGROUND GAS AN: LONG ISLAND LIGHTING COMPANY AT JUNIPER 2-9000 BEFOR BY THIS PERMIT. i~ne~ o¥ I~ublie Works,( ~u~olk~ty ELECTRI~ FACILITIEg pLEASE CALL STARTING THE WORI~ XT. ITHORIZED DETAIL OF '¥YPfCAL DP~"CW~LL ~ CESUr'OOL 3CALE- Fl. UN3 IN£~ H '- GHI S AND LOCATION~ SHELL O1l COMPANY .. 41-70 MAIN ST. FLUSHING, L. I., N.Y. TEL HICKORY D- 6¢20 77-1 CURB, SlDEkVAL~ AND SHOULDER CONSTRUCTION ~.,~~~,~~v ~o,~,~ /IDJ,'iCENT TO ;LCR. 2 7 PERMIT No. $£cTIofil THi~OI}6H D£PR£&$ED CURB SPcTIOIV TI-IROU~H ELF VAT'IOhl SFIOI/YtlV6 DEPRESSED ¢Ui~-~8