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Home My WebLink About5677-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .l.l.7..0...~..~:.N.~. ~$ .... L.&.N..~.-. Street Map No .... I~..I..~. I... Block No ........ '---...Lot No ...... .~...~. ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~. ....N. 0..~. ....., 19~. [. pursuant to which Building Permit No..~'..~..-~7...7_.. dated ........ ( .~.....~..~..~...., 197J.., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is iss,~ed is..A...v..~. ~ ..... .~.~..~.~. ~ ..... .~..W.~.-..L.~..,.~...~.. ....................... The certificate is issued to ~h~ k ~ $ (~10C H ~ ~ 0 (ow_~..~ner, lessee or tenant) of the aforesaid building. UNDERWRI*ERS CER*IFIC^T No ..... ............................. HOUSE NUMBER.././..~...~.. .... Street..' ...... .~.[..M...~..~. ~ ...... ~..~...~..~.- ............... ................................... . .~..E. ~.o. ~.l..c.......~...~..~, ................. Building Inspector FOEM ~qO, ~ TOWN OF SOUTHOLD BUILDING DEPARTM~ENT! TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5677 Z Permission is hereby gronted to: .... ~. ~, ..~ffi~..4~l~ I..$~te ..... ~....~...~ ................................. ............ ~-X* ......... .~.~ ............ ~ ................ ~ ~'~ ~ ~eXl~.. ,. . ~t premises I~ated at ....~-~.....~-.~ ........... ~ ......................................................... ..................................................... ~..~....; ......... ~..,..]~.~. ..................................... ................ ; ........................................................................... :....,,;.~..:.~: ....... ; ........... ; .............................. pursuent to ~pplicotion doted .:. ............................ ~:~:..~.:.., ]9...~., ond opprov~ by the Building Ipspector. Building~lnspec7 TOWN OF $OUTHOLD Building Department Town Clerks Office Seuthold, N. Ye 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter aP, ink, and sqbmitted in triplicate to the Building Inspector with the following; for new buildings or new u~e: 1. Final survey of property w th accurate location of all l~uildings property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewe,Fage disposal--(5-9 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~Arch~tect or Engineer responsible for the building. 5. Submit PIonning Board approval of completed site plan requirements where applicable. 1~. For existing buildings (prior to April 1957), Non-conforming ~ses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, s}reets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, o~cupancy and condition of buildings. 3. Dote of any housing code or s~fety 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 usd 3. Copy of certificate of occupancy $1.00 $5.00 Dote Suffolk County Henr, ,*e 37b eoon e Location Of Property ....................................................................... ~. ............................................................ Owner Or ~ners Of Properly .,~.~..~..~!~.~...g~.~.~ ............. , ........................................... ~p O~ PeG~tG ~eB 2~ B ouse o Subdivision ................................................................ Lot No..; ....... ~. ack N0 .............H N ............. Hnderwriters Approvol .............................................. ~lonnin~ Booed Approw! ........................................ Request For Tempora~ Ce~ificote ........................................ Finol Certificate .......................................... Fee Submitted $ .................................... , ~ ) Construction on obove described buildin~ ond pormit moets oil: ~plic~blo c~es ond re~ulotions. ~pp I f CQ~T ........ ~ ............................ /.~,., -~ ....... e ................... ~ ..................... [.~ ........ day of ~;.~Ft .................................. (stamp or seal) S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date JUN 9 1972 Bldg. P~rmit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a (Give deed locat~n) structure located have been inspected by this department and f6und to be satisfactory. JUN 9 1972 Ch~e£ of G~yie~'al Englnee~.i~g Services SUFFOLK COUNTY I]~PARTNEI~ (~ HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT PRIVAT~ $EWAGE. DISPOSAL SY3TE~B Date Approval t~ construct said syStem~ ia requeSte~,pertinent data herewith: 2-D tailed ropert l~ca.tlon~ 8-Lot No. ,,,~& 9-Private well? ~.~ 3-Public water suppl~ name ~istance to nearest main ~-L~t size:. Length /~ ft. Width ~/~t. (Also e~ter on center plot plan below:) ~-D~el~4'~g: Single famtly?/X/Two flm~l~?/ /Cellar? ~_~Slsb?/ /Crawl Space?/ 10-Proposed system:Septic tank/ /Precast/ /¢esspools~/$b~ll~w,.~eels/ /other/ H-Septic tank inside.dimension~:Volmae Gals.Length . Ft.Width.__ft. Liquid depth___ft. 12-Precast sections:/ /Number./ /Square ft.Cesspools.Block sise~ ins.D ~.~s.HLin~. PLOT PLAN ,/ Test Hole Beta Feet 0 2 8 The Undersigned CE~TIFIE~: "Coastructton of authorized insta!~ations will be in accordance with the sUffoikcounty,HealthDapart~ents' current Standards,~,~etins, and amendment~ thereto,covering Private S~ DSeposal.~tems". Data O~n.r or Builder FC~ HEALTH DEPAH~ U~E ONLY. ~a~ed on the 4n*or~ation presented herewith~it is the opln~on of the Health Department,that an ade~,_ate and satisfac~o~ewage Disposal System can be installed on this Plot. __ // Date /~///f~ Signed~ a. This application must be co~n~letely filled in by typewriter or in ink and submitted in duplicate to the Building Inspec'oor. b. Plot plan showing location of lot and o/buildings o n premises, relatiormhip to adjoining premises or public streets or area~ and giving a detailed description of layout of p~operty must be drawn on the dial~un which is part of this application. c. The work covered by this applic~,tion may not_ b e commenced before issuance of B~tilding Permit. d. Uvon approval of this application, ~he BUilding In spector will issue a Building Permit to the applicant. Such permit shall be k~pt on the premises available for inspection throughout the pro~z~s of the work. e No building shall be ..occupied ~ .used in whole oV in part f~r any purpose whatever until a Certificate of Occupancy shall have b%e~,grantedi'~ }the Building InspeCtl0r. aPPLICATION IS I-IERF.~ MADE to ~e Building Department for the issuance of a Building Permit pursuant to t-- eh Bui- ---]~ling Zone Ordinal. ~' of the Town"o~ ~uthold., Suffolk Oounty, New York, and other applicable Law~, Ordinances or Regulations, fgl' the.construCtion of buildings, additions or alterations, or for rmnoval or demo- lition, as h~rein d~scribed. The applicant agrees to corn ply with all applicable laws, ordinances, building eode, housing ,c~l.e, and regulations.,. ~ /~ r.~ J I 9 ~ (Signature of applicant, or, name if a corporation) -, ,;,,-. .,,//, .~y,~'/~"~ /~'*~ ~5 ........................ ~ ..... ~ ~ · ',~? .l~?,~/f ~},'/ ' ' (Address of appilcant) 2/~'~ 2-- ~N St~te whether ~icant is owner, lessee, agent, architect, engineer, general contractor, electrician, pl.: tuber or builder ...... '~' "~' !'~ ' '/' '~' '~' '~' .................................. ; ............. : .............. i .... ......-- Name of owner of premises ...... ~ ./.e. ~ .... .d..e. .................................. If applicant is a corporate, signature of duly authorize d officer. '-7'-~ ~ ~ · · {Name ~d tia~ of co~,orate om~er) ~,~ L ~ 1. Location of land on which propoeed work will be done. Map No ..... .~./.,~:~./. .... Lot No...~..~;. ....... Street and Number ........... ~.~.. 'Munieipaltt~ 2. 8tare ex,ting use and occupancy of premises and intended nsc ~ occupancy of pt~o~ed oonstmction. a Existing use and occupancy ................................. ,,,tended '/ ... b. use and occupancy ................................... 3. Nature of work (check which applicable): NeW Building ...../... Addition ........ Alteration ........ Repair ......... Removal ........ De,molitton ........ Other Work (Describe) ...................... 4. Estimated Cost .~.glr ~,~..Q. ...... . ............ 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 6ccupancy, specify nature and extent of each type of use . .~ ............ 7. Dimenskms of existing structures, if any: Front ..: ........... Rear ............. Depth ............. Height Number of Stories ..................... Dimensions of same structure wiih alterations or additions: Flxlnt .............. Rear .......... ~.? ;. Depth 'Height Number of Sixa-ies 8. Dimensions of entire new construction: Front ...,~ .~.f. ........ Rear ~ / Depth . .~.' ........ HeiF~ht . ./~. ~ ..... Number of Sixties .... /. ................................. .... . 9. Size of lot: Front ...J.(..~. ....... Rear' ~' . ~Z'/..~, ...... Depth ... ~..~.O. ....... '10. Date of Purchaseff..~7~-J:/.../~..7./.~ -- .......... Name of Former Owner ............................. 11. Zone or use district in which premises are situated .................................................... 12. Does proposed construction viola_le, any zoning law, ordinance or reg~lation? ........................... Name of Contractor . .~..AZ~.~...~...~.~..~.~...~q~-... Address .~x-.~.~i~...~..~.4~f'.~.~. ~-~., Phone No.~ff.~..~.-~' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate aH 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 YORK, )S.S. COUNTY OF .............. ) (Name ;of indiwdual signing j~pplica_tt'lon) , , cant above named. He is the ..........................v- (~bntractor, arrant, eo~,porate officer, etc.) of said owner .or owners, and is duly authorized to perform or have performed the said vaork and to make and file this application; that aH statements contained in this application are true to the best of his knowledge and belief; .and that the work will be performed in the mann er set fortl~ in the application filed therewith. Sworn to before me this [ ~/-/A £L ~-$ ,'~T o !'~4 PLAT~ 8532 Il:' 9_. 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