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Home My WebLink About5208-zF TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING pERMIT "(THIS PERMIT MUST BE KEPT ON THE ,PREMISES UNTIL FULL COM.P ~L~ION _OF THE WORK AUTHORIZED) 5208 Z ' ~ ~,:.,: .................. i.;~,l~J,~...'....~. ....... , 19......~ ~permis~i~ Is he~ gmnt~ ~ .... ....... ............ ~.~...~..~. .................................... ............ ~..,.~, ............................................ ..~.~...~..~:~.~~ ................................................................................. at premises located at ....~..~1~..~ ............................................................................. : .... .................................................. I~ea~, ......... I1,'~,, ............................................................................ pursuant to application dated ............................ ~i~l, ....... ~.~ ........ , 19...~.~., and approved by the J3uilding Inspector. Fee $.~e.~ ........... NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ... ' ~. ~ ..... ' ...... ~ ....... Street .... .... ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. . - :ilJ. ~...., 19 2/. pursuant to which Building Permit No .... ; .... dated ..... ~i~.~.~.".~ !...~'...., 19.?}., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy ~r which this certificate is The certffmate is issued to .,' ..-. ~ .. ~[. ..................... ~ ... (owner, lessee or ~n~t) of the Moresaid building. S~o~ County Department of Health Approval ~ .[. ~...[. ~. ~ ~ ............ UND~WRITERS CERTIFICATE No ........ ~ v ................................ HOUSE NUMBER / ng spe~ FORM NO. $ TOWN O~ $O~TgOL~ Building Department Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s 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 from Board of Fire Underwriters. 4. Commercial buddings, Industrial buildings, Multiple Residences and similar buildings and installations, a cerhficate of Code comphance 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 buddings and "pre-existing" land uses: 1. Accurate survey of property showing all property hnes, streets, buildings and unusual natural 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-ex~sting dwelling or land use $5.00 3. Copy of certihcate of occupancy $1.00 ~,,~. /~_/~7,~ Date ................ ,~, .......................... New Building ........... // . .... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .............. .'~...~....~.../~....l~?..~,, ....... ..'~....~. ~.~....,~... .......... ~,,,,~J.,,~,,,./~,,~ ................................ Owner Or Owners Of Property ................................................ .~. ............................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ...~'...~...~...~.... Date Of Perm,t ...~..'J~..~.I/pplicant ................ .~....~.../...~..~ ...................... 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 ~er~j.~. meets aJl/al~61ical~l~-~l:odes and r~ulati~s. Applicant .................................. Sworn to before me this ..... ..... 7 7 Nota~ Public ...... ~....~/~- C6.un_ty I~m ~p~S ~a[ch 30, 1~ (stamp or seal) -,~ '' THE NEW YORK BOARD OF FIRE UNDERWRITERS ,,* ,: BUREAU OF ELECTRICITY '[" pm ,~ '?~ 85 JOHN STREET. NEW YORK. NEW YORK 10038 ' rate October 26' 1977 ,~ppt,eat,o,,No.o,,ylte 658101 N .3 6 1 4 3 3 THIS CERTIFIES THAT ~ only the electrical eq~ipmen~ ~ ~scrib~ bel~ and int~d~ed ~y t~ appllca~t named on the above appl~atlo~ ~umber in the premises of in the followmg location; was examined on 0 ~ ~ O ~ e ~ 2 0 ~ ~ ~ ~ ~ and found to be in compliance with the requirements of thts Board. RXTUEE [ FIX~UEES EANGE~ COOKING DECg$ OVENS DISH EXHAUS~ FAN5 OUTLETS SWITCHES ~NCANDtSCENT FLUOreSCENT DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS ~,ULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE-DISCONNECT '- "' NO OF CC COND A W G NO OF HI LEG A W G NO OF NEUTRALS OF CC COND OF HI [EG 1 1/0 1 OTHER APPARATUS: ',~Multi-Outlet Systems No. of,Ft., ~, Elec. Room Heaters: 1-g.0 ~, 2-2.5 ~, 7-2.0 ~, 3-1.5,'KW, ~1-1.25 KW, Paul R. Burns Town Harbor Lane Southold, L.I. 11971 S E ..... 'R "' q~' V-~sl~ 1.1 ~'- Cf' .-*E-~ AWG OF NEUTRAl This certzficate must not be altered ~n any manner; return to the office of the Board if incorrect I~spectors may be sdent,fied by 1/0 Lic. 282 E their credentials TOWN OF SOUTHOLD BurLDI~C, DEPARTM~NT Town Clerk', Ot~iee Sou~hold, N. Y. Certificate Of Occupancy No..~...0.?..~.... Date ' /~ . , THIS CERTIFIES that the building located at ./~....~..~. ~ .... Street ...... .... ..... conforms substantially to the Application for Building Permit heretofore ~ed in this office ments of the applicable provisions of the law. The occupancy hr whi ~c~h t_bi.~ certificate is ~suea ,., ....~. .............. /'7 ........ ~'~ .....t ........... ~>),.. _ .~. ....... certificate The is issued to...~.. (owner, lessee or tenant) of the aforesaid building, s~on~ co~t:~ Dep~t~e~t o~ aoalth A~proval ......... t. 9...~. 7. ?.~..--'. ............ um~aWaIT~aS c~.a?n~CAa~ ~o..../3/....~. ~/. ~...~.. ~ ..... . .~......~ ./..q..~.7.... $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ,June 10, 1975 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at~_, s/s Harbor Road 100' w/q King Street~ Orient~ NY (Give deed locatiom) Town of Southold have b~em inspected by this department and found to be satisfactory. Owner - Yah Rieger Based on standards in effect prior to July~ 1972. Chief of General Engineering Services EASTERN DISTRICT Couuty Ceuter, Riverhead, New York PA 7-4700 ~.D.Re:~. No..50 ' APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SEWAGE DISPOSAL AND WATER SUPPLY SYSTEMS Inspection for approval is requested, pertinent installation data herewith. 1-Nme of _ er f, -Subdiv. Address '~]-~ b'v7' ~. ~.~,~1 Al.~"'Phone£1~-L~Va- ~7~4-Section No. 2-Name of Builder ~S'a ~'~- Phone 5-Lot N~ber Address 6-Bldg.Pe~it No. ~s;~'~a 7-S~age Syst~ installed by .~¢.~,~ ~.~. ~. Phone ~2~--~F~ 8-(a)Deed location of pfoper~y - ~.-u~ ~. ~.~/6~i ~J (b)Halet or Village ~pr~A~ ,' ~ ' - / (c)Town _~of~ 9-Septic tank-Gal L fi.W ~t.Liquid Depth ft. - lO-Cesspools-(a)No.pools ~(b)Blocks below inlet-l) 2) 3)__ (c)Block size-L in.W in.H in.(d)P~ecast pool ~ (e)~2 (h)Backfill Material~.~ ll-Water Supply: Public Syst~ ; Private Well ~ If Private, the following questions are to be answered: Address Phone 13(a)-Total Depth of Well .(b)Depth to Static Water Level 14-Diameter of well pipe in. 15-Name of Laboratory 16-Method of Disinfection 17-Date ready for inspection The undersigned CERTIFIES: Above systems have been constructed and are in compliance with the Suffolk County Health De%la~tme~tt's current Standards, Bulletins and ~endmen~s thereto. 19-Inser~ sketch of location of water& Sewerage Facili~s with accurate d~ensions. ~ I STREET~ ~c~~ k .................................... ~R~LT~ DE~ENT USE ONLY Base~ upon ~ tn~o~a~~/~ sa~isfactory func~iontn~ of above syst~s can be expected wi=h~per main~enance and care. · Date~[)~ ~(I ~ Approved Chief of General Engineering Services S-Se SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No _ ~ ~ ' EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date .~.72~'~_ 1-Applicant '~/;~ k) ~ ~ ~'~'6r~ Phone~-Sub div Address ~O %?..'5 S'~ W'~ ,~"r' .~)l;~'~'~_( Kkc::t4J~-./n~' I~' 7-Section 2-Detailed property location ~p ~_ ~ 8-Lot No. Hamlet O ~ ! ~-aJ ~- Town ~ ~T~! [~m ~ 9-Private well? 3-Public water supply name Distance to nearest main 4-Lot Size: Width_~j~_ft. Length_~ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~j~ Two Family? y ! Cellar? ~ ~Slab? ~ Crawl Space? 10-Proposed system: Septic tank · yPrecast y yCesspools · ~Shallow pools ~Other 11-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: ~_~fNumber/$~quare Ft. Cesspools: Block sizel.' "' incs.D ins. H . .ins. Total blocks below inlet: ~1 ~2 PLOT PLAN Da%a ?eet 0 2 4 ~-m~ 6 8 ~? ~ Street /~ ~ ~/~ ~:::)4 ~ The ~ndo~sSgned CERTIF~S: "Cons~ruegSon of au~horSzed ~nsga~Ia~5ons ~11 be 5 ~ aeeo~daneo wS~h ~ho Suffolk Court[7 Hoa~[h Do~r~men[s~ eurren~ S~anda~s~ and amendments thereto, covering Private Se~ge Disposal Systems". Date Sign~~/~~~ ~ or Bui~e~- FOR HEALTH DEPARTMENT 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.) Examined · .. Apallcation No ............................. Approved ......................................... 19 ........ Permit No.... ..................... a. ThIs ~ ~atl~ muir be complefely filled"In by typewriter or in Ink, -,nd ~brmtted I, d~olleate to the BulldL;~ I~'tor. b. PI.at .plon showing location of lot and of buildings on premix, relationship to odjotnln~ I~ml~ ~ ar~, aha gn~ng a cl~ailed deKriptlan of layout of proparty must be drawn on th~ diagram ,,~lch M ~ M ~ ~ c. The wc~k covered by this application may not be commenced b~fore iseuance of ~ulldtng Pem~t. , d.;. Upon al~..~val of .this application, the Bul.lding Inspector .Will I~ue a Building Permit to thealNl#¢i~% Such snail De kept an mt p ~:r?n~ ~ses available for inspact,on throughout the pragre~ of the work. · h e. No I~llding~lhall~-.be occupied or used In whale or in port for any puq~o~e whatever until a C~tlflalM ~f O~c~-~ s oil hove ~ ~ I~y th~ Building In%o~ctor. ' ,..A..P. PLI_CA?I _ON IS HIRE!~ ~'~Eto ~ Building .D.~a. rtment for the .issuance ~f o Bu.i!dlng Permit .~.~.,,at~i~,, ~ e,...c.~t..~. ~ .~ o.',buildJr~... ,:,~lt~on~ or at~,'at~o,'~, ar 'For .~,'~. ). dd,~ State what ~her applicant is owner, levee, alent, architect, engt.eer, general contractor, IlectHIll., I~.1~ ~ I~i~,. ................................... "' ......... : ................................................................ t ............................. ' .......................... name ....................................................................... · .................................................................. (Name ant1 title .01~'corparate offl~r) - 1. Location of land on which propa~cl work will be done. Map No.: .................................... ,... Lat N~.: ....................... Street and Number ..... '. .......... ~ ................ '~ 3 76 y,u~er Rend ........................................... 2. State existing use and occupancy of premises and Intended use and occupancy ~f a. E~istlng use and occupancy ...................................................................................................................... ;.....: b. Intended use and o¢cupan.-, .................................................................................................................. lelJ. dmltJ.~l. ~ 11. 12. Nature of work (check which applicable): New Building ~..~ ............ Addition .................. Alteration ............... I Repair .................. Removal .................. Demolition .................. Other Work (Describe) ............ ~ ....................... Estimated Cost ...... ~,.4J~.e.4~. ............................. Fee .......... 83~O.,.00. ................................................................. (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 .......................... 3, ................................................................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 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 ............................ Number of Stories ................................ Dimensions of entire new construction: Front ...... ..~.? ....................... Rear ......Jj~..e. ................. Depth ....~jj.e. ............. Heidhf .~..~...e....e~.'. Number of' Stories ......~....: .......................................................................................................... Size of lot: Front ......~...e..., ............... Rear ..,~...~.~..e. ...................... Depth ..... JJJlJJ~..e. ....... i ....... Date of Purchase ...... ~..~J~L.~.[~...~ .............. Name of Former Owner ~.lJlJJlljJ,JJjl~Jl, JlJlJ&JJkJ.~.~ ..... Zone or use district in which premises are situated ........ ..~.~jJl~4.~.lJJ.~ll~ .................................................................. Does proposed construction ¥iol~.te any zoning law, ordinance or regulation? ........ JJ~ .............................................. Name of Owner of premises ....~........~.....~.~....~....~ ............ Address .~.....~...,~..~[~J~J~..;lJj~J: Phone Name of Architect ..~..~.~.......i ................. Address ~..~...J~J~L~t~.~aJJJ. e.~. Phone Name of Contractor ..J~....~....~..~.......~... ....................... Address ............................................ Phone No ............... ' ..... PLOT DIAGRAM ~ Loca.t.e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from ~..rop~.rty hnes. Give street and block number or description according to deed, and show street games and indicate ,~ether interior or corner lot. k STATE OF NEV~O~I(~.~I S.S COUNTY .......... 13 ..................... ~.~. ....... ~ .......................... being duly sworn, deposes\:and says thor he is the applicant (Nome of in~vidual s~,~, above name, He is the ............ :.~~ .............................................................................. ~ .............................. (Contm~or. agar. co.rate officer, etc.) t of said owner or owners, and is duly ~uthorized to pe~orm or have perfo~ the said work a~ to ~ke ~d file his application; that all statements contained in this application are tree to ~e ~st of his knowledge and ~lief; and ~ the work will be performed in the manner set fo~h in the application fil~ ~er~ith: / ~m to ~fore me ~is ~' , . ~ , / / / o ic,~~.~.. C~n~~ (Signature at app~ic~ ~ ~ PUBLIC, ~ of ~ . ~% m. s2-8~2~0, ~olt ~u~ / ~ t~m ~pim ~ 30. 1~