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Home My WebLink About5252-zFORM NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~9 ...... Date ............... Bt. 20 ..... , 19~2. THIS CERTIFIES that the building located .at 8/8. l~th. ii,at..re. ~reet Map NoBI~ 'DEW" · .Block No. ' '14~n~' .Lot No..~ ....... 8~..- :I~Y, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. It/~Ll' ' .~9. ~ pursuant to which Building Permit No..~2~ · dated ...... &~l*~...~1 ...... , 19]ri.., 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 .. Pri~tt~ · ~' fail, l/' ~elltll[ ..................................... The certificate is issued to .G.~..am,~l~l~ .&. 8~-.I~-]~t'l~eZ~. 8~ll~..l~~t (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..0~t.- UNDERWRITERS CERTIFICATE No.. ~ ....................................... HOUSE ~qUMBER...%~ ...... Street .... l~th. P.~d..tO .~' .................... Building Inspector FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 5252 Z Permission is hereby granted to: at premises located at .........~.....]~l..~dl~d...t&.~l~ .................................................... ......................................................... t~.e~l~e~( ................................................................................... pursuan~ to application dated ............................ ~i,~..~.~ ....... ~.$ ....... , 19...~..'J., and approved by the Building Inspector. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No EASTERN DISTRICT, RIMERHEAD,N.Y. APPLICATION FOR APPROVAL. TO CONSTRUCT PRIVATE SEWAGE. DISPOSAL SYSTEMS . Da -~ ·~,//~-~ Approval to construct said systems is r~uested,pertlnent data herewith. 1-Applicant ~/ PhoneT~ -]& 6~ 6-Sub div /~//~/~ Address /t)A/AM ~-/P~ _ ,/~¥ ~,~ ~ ~-Sect~on 2-Detailed prope_L~ty location /~fr/~F~¥f~e,~ ~(¢2~F f£~-Lot No. Hamlet ~.) ~ ~ ~ ~ ,3 . To~ r~ 0 9-Private well? 3-~bllc ~ter supply name~-fM(~Fr~$;C& 6~ Dzstance to nearest ~in ~2 4-Lot Size: Width//DD ft. Length~ft. (also enter on center plot plan below:) 5-~elling: Singl~ Family ;~T~ily? / /Cellar? /~lab? ; fCrawl S~ce? lO-Pro~sed system: Septic tank ~ /Precast ~ ~Cesspools /~Shallow ~ols / /Other / / !l-3eotic ta~ inside dimensions: Vol~e Gals.Length ft. Width ft. Liquid depth ft. !n-Precast sections: /~/Number/ >/Square Ft. Cesspools: Block sizeL incs. D ins. H ins. Total blocks below inlet: ~1__~2 .~3 ~ % ] pacity C~3Gals. .P.M. /~ No~th Data Feet L~ ~} 0 -. ,- 3 t~ The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the 3uffolk County Health Departments' current Standards, Bulletins, Date 9~/Z'Z/~' Si6ned ~~ ! ' ~ Builder fOR H~ALTH D~PAR~MENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date (10/65 Revis.) s-if S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Date OCT 1 ? 1972 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located J (Civ~ dee~t location) J have been inspected by this department and found to be satisfactory. Chief of General Engineering Services OCT 1 ? 1972 TOWN OF SOUTHOLD Building I)epaftmeM Tm Ciera Office Southold, 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 form or equal). 3. Approval of electrical installation fram 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 ,~,pril 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survp~, of property showing all property lines, streets, buildings and unusual natural or topographic/ features. 2. Swam statemYnt of owner or p~wious owner as to use, occupancy and condition of buildings. 3. Date of any housing code or /~afety inspection of buildings or premises, or other pertinent in- format on required to prepare~ a certifica New Building ................. ~OId or Pre-eXi~ting .Building ............................ Vacant Lond ............................ Sul~djvision .......................................................... "....Lot No ............. BlOck No ............. House No, ............. ,prova, .............................................. .arming rd prova, ...... Underwriters Request For Temporary Certificate ........................................ Final certificate .......................................... Fee Submitted $~..* .............................. · Construction on above described building an,'~;~mit meets~all applica~l~c,.~odes aid regulations. Applicant~.................* ................ Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County I~OB~ NO. ~ TOWH OF SOUTHOLD Building Delmdment 'Town C:laks Office Southold, H. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instmctioee 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: !. Final suwey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Heolth 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 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 of property showing all property lines, streets, buildings and unusual naturol 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. New Building ....~ ..... Old or Pre-existing Building ............................ Vacant Land ............................ .... ~¢....~...o ~. atlon Of .... ............................. O ,r Or O ners Of P, ,y ........................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit NciZ~. Date Of Permit ..'~(/M~..~..i~bC)plioant ~..,...~..~.~...~.../'~....~.~.~./.~....~... ...... H..,th ~t. App~vo, .... 7/~/.~..~...-../gb/~°r ~t. App.~a, ..... ::. ........................................ Underwriters Approval .............................................. Planning Board Approval~.~,~..~..d~. ...... Request For Temporary Certificate ........................................ Final Certificate ..................................... ~... Fee Submitted $ .~'~..... ................... Construction on above described building and p~'mit meets all applioabJlcodes arW regulations. ................ day of ............................................ (stamp or seal) Notary Public .................................... County Scale: 5;~ '= BUILDING DEPARTMENT ~,~ TOWN CLERK'S OFFICE ~/~"/~. ~. SOUTHOLJ), N. Y. Examined ...... ~ ............... 19 ........ ' t~ 19...~!.. Permit No .................. Approved ........................................ , ,..~...& _ .D~....,~_ .~ Application No .......................... - · .-:b Disapproved a/c ............. , .................................. APPLICATION FOR BUILDING PERMIT "~ ....... ................ ;..., 19..2/: ..... Date INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plat plan showing location of lot and of buildings on premises, relationship to adjalnlng premiee~ or public streets or _ areas, and giving a detailed description of layout of property must be drawn on the diagram which il part of ~hll 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 I~ue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of 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 pumuant to the~,~ Building Zone Ordinance of the Town of Southold, Suffolk Cou~nty, New York, and other applicable I. av~, Ordinances or - Regulations, for the construction of buildings, additions or alterations or for removal or .demolition, al herein deecrlbed. '~ The applicant agrees to comply with all applicable laws, ordir~an,~les, building code,.housmg .code, and regulations. ~ , II~ - (si§nature of applicant, or name, If a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nom~ o{ owner o{ premi .................................................... ~ If applicant is a of authorized officer. ~'~ corp~orate, sigpature d.91y ......... (Name and title 'of corporate officer) ~ ~ _~ 1. Location of land on whlc,.__,h' proposed~work will be do. ne.-,,,,.~..e.... ~...~,--- --~ ~__.e~e..~ . AAap No.: ............. : ...... ~t~Lat ~,.~._..,~ ....... ' be ..../...C..'..~....r. ' L Street and Num r ~...,..~.;..:...:...-w~.. .......... ~ ........................... ~ / -- · / 7 ~0 ~:~ Municipality 2. State existing use agd occupancy of .prem. ises and Intended use and occupancy of prppoeed conltructlon: a. Existing use and occupancy ....... ~...... b. Intended use and occupant', . ................................................................................................................................ ~%~.,4.df~.'f,~ 3. ture of work (check which applicable): New Building ~ ................. Addition Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... ....................................................................... 4. Estimated Cost ...................................................... Fee (to be paid on filing this application) §. If dwelling, number of dwelling units ...................... Number of dwelling units on each floor ............................ If garage, number of cars ....... ~ .......................................................................................................... 6. If busine.~, commemial or mixed occupancy~ speci~ nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ I~pth .................... Height ........................ Number o{ Stories ................................................................................................................. Dimensions of sama structure with o~terations or ndditions: Front .................................... Rear ............................ I~pth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~..~. ..................... Rear ...~.~ .................. Depth ..'~....~.. ............... Height .....~.~.. ......... Number of Stories ...... ~ .................................."V ............ i ........................................... 9. Size of lot: Front ....~....~..~.. ............. Rear ..... ~..i..~'..~......~ ............. Depth ...~.......~.~. ........ 10. Date of Purchase ................ ~ ....................................... NOme of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ....~...~i ................................................................................. 12. D~s proposed construction~ e..,~_.~ ~ ,~l~.y~°ning law, ordinance or reg"lation? ....~ ............................................... 13. Name of Owner of premis~~......f~..Address Phone No Name of Architect .................................................... Address ........................................... Phone No ..................... Name of Contractor~.~~......Address ~i......~..~.. Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or prpposed, 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 comer lot. STATE OE NEW(~O. I~1[,#~ IS.S. COUNTY Of .~'~,,~.. .......... ~ _ I , .........................' 1~' ,~'s~J~/..~~~:...being duly sworn, deposes and 'says tho, he is the applicant (Name Of individual signing application) above named. He is the ............ ',...~J~ .............................................. ~' ....................................................... (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 ppl~lication filed therewith. .... ...... : .......... :. ......... . ............................ O' I~( TI REyLI~uB, [E~C. ^~teNef~ Yar~ County~ (Signature of applicant) No. 52-8125850, Suffolk Cou, j~ Term Expires March 30,