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Home My WebLink About5330-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 .~..~g..Y~.v.. ~ ........... Street ~Iap No.Te..rr_~..l~.a.te.r. ~lock No .... Il; ...... Lot No.~' .... 8011ttl~O~gl..I~,~., ........... ~nforms substantially to the Application for Building Permit heretofore filed in this office dated ........... dT.~..e..] .... , 19.~.. pursuant to which Building Permit No. dated ........... J.~..e..] ..... , 19. ~., 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 ~i~e ~e ~mi~ dwell~ The certificate is issued to ...D~lg .~O~110 ....... ~e~ ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~Y..~. ~ ~.. ~ .R~. ~!a. ..... uNDERWRITERS CERTIFICATE No.. ~OUSE NUMBER... ~0 ...... Street ..... ~g. ~. ~O ........................... FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5330 Z Dace ........... ~ ............................................ , at premises located at ................................................................. ~:.....' .................................................... Building Inspector. Fee $~.~ .......... i ........ Examined ......~..~....~...~..., .......... ,19..?../... Approved ......~....~. ............. , 19..~/.. Permit No......~....~....~...O......~.,. ~/~..~ Disapproved a/¢ .............................................................................................. BUILDING DEPARTMENT ., /, / TOWN CLERK'S OFFICE ~ ~/~.~,~,~' , SOUTHOLO, N.Y. // ': Application No.....~....~...~....~.. ........... APPLICATION FOR BUILDING "PERMI'T ~'~.' Date ....i:",i .............. ~,.../ ............ , 19..~...( .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat plan showin.~ location of lot and of buildings on premises, relationship to adjo ning premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port 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 impection 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 Occupanc~ shall hove been granted by the Building Inspector. ~ .A.P..PLI_CATION IS HEREBY MADE to the Building Department for the issuance of a Bud ng Permit pursuant to the . =ui,aing ~one Ordinance of the Town of Southold, Suffo k County, New York and other an-licoble Laws n,~ ~ ~Regulations, for the construction of build ngs, add't'ons or a terat'ons, or for ;emova or de~n~ol tion, as h~re~j~de'~scr"~e~'. · The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regul6tian~ (Signature cf applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title 'of corporate officer) -~,~ ~J~ 1. Location of land on which proposed work will be done. Map No.: .....~.('~...~..~ ....................... Lot No.: .....~....~... ....... Street and Number ............................................................................................................ .~. ............................. 2. State existing u~ and ~cu~ncy of premiss a~ intended use and ~cuponcy of prop~ constm~i~: b. Intend~ use and ~cup ~ ........................................................................................................... 3. Nature of work (check which applicable): New Building..................~/ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (l~'~cribe) ....... : ................................ 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on fi!lng this application) 5. If dwelling, number of dwelling units ............................ Number of dwel!i~g units on each floor ........ ~.~I..;C:.~. ........... 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 s{ructures, if any: Front ..... ..~.0...N..~.. ............ Rear ...... I~..~..~?. .............Depth ....N..?.~..~.. ..... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front....................................~0N~' Rear ....' ........................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front "5~,' I1" ... Rear ~01' I~" Dopth ~~ ~') Height ......... J..~ ...... Number of Stories ..... ~..~...~,~ ...................................................... ~, ............................................... 10o R 9. Size of lot: Front ............................ ear ................ ~ .................. Depth ......... !...?...0.....[....~.. .... 10. Date of Purchase ........................................................ Nome of Former Owner ...~.~..~..¥.~-~.~.......~...?...~..~....~...~ ........ 1 1. Zone or use district in which premises are situated ....... ~..~..~.~..~.~.~...~...~ ..................................................... 12. Does proposed construction violot~ any zoning law, Lordinance or regulation? ....... ..~J.....~... ......................... ~..r,-~u ........ 13. Name of Owner of premises ~ C.~.~..~.L~-~? Address ..~..~-lg (~NC~ Phone No Name of Architect ...................................................... Address .~,4~FUG[,i~.~..~...~...-~..: ......... Phone No ..................... Nome of Contractor ...J~.~.. ...... Address ................... .-(~ ................ Phone No ........ ~ ......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according tO deed, and show street names and indicat'e whether interior or corner lot. STATE OF J ~, .,v.r(. rl!/;l~l ! OF ..C..O.~..U..b.N~..~.~..~,.C~,..~.L..?. ...... ~:~:~L~.~..'.~.~.~.....~..~]].....] ............ being dui, sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the' ............... .0..~.~....~.......~..~.~...L..~..~.-.;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/perfo~ed in the manner set forth in the application filed therewith. Swam to Joe.fore me/this ~,s FOBM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. ¥. 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 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 o'f property showing all property lines, 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-existing dwelling or land use $5.00 3. Copy of cer)ificate of occupancy $1.00 Date ..J~J..~....~'......~....~...,..~.~..?.....~....... .I New Building ...... x ............ Old or Pre-existing Building ............................ Vacant Land ............................ Location Prope,y ........... ....... Owner Or Owners Of Property .i.~..~.~.~.~J~.(,~.~....~.......~....~.J~.~..J~.~J~-: ........ ..f~.~.S.~.J~.L-~.~... ....... Subdivision .....~..~...~..J. ............................................... Lot No...')....~.... Block No ............. House No ............. Permit No....~....~...-~.'~... Date Of Permit .~....~..~...~..~!.~?plicante-~..~.~...~.~.~...~..~.~...~.~l~.~ Health Dept. Approval ..... F)~c~...~ ...................... Labor Dept. Approval ................................................ Underwriters Approval .............................................. Ponning Board Approvol ........................................ Request For Temporory Certificote ........................................ Final Certificote .....~ ......................... Fee Submitted $ .........~. ......................... Construction on above described building and permit meets al[applicable codes and regulations. Applicant ...... ...~~~~J~ ......... Sworn to before me this ..... ~......~.. day of ...~-~..../..[. ................. Notary Pg~ic ..~....:..~....~.~.~nty f./ ,,; .... f (stamp or seal) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks 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 dispcsal--(S-9 farm or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, AAultiple 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 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-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ....,.~. ............. Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property Lt...~..~.(:~.~..~..~.. ....... ...L~.~.~......'T'..~..~....~J. Ic~'~..'T.......~..~.~.H,.0.~) Owner Or Owners Of Property ..~.~.~.\.~...~. ....... :.....~..~&~...~......~. ............. .~.1~.~..~..~.~.. ~)'.,OL~,~ .~ ;. LotNo ,.-~,,,,~mBIockNo ~u~No · · Subdivision ................................ ........ ........................ Permit No..~,...~,.~,,.(~,'Z... Date Of Permit .................... Applicant ,,~,,,.......~.,~,.~...~...,~. ,..~. ',.~...,,.~,,~,,~,~,. Dept. Approval~' -.~...~......[.~..?.....>~.......Labor Dept. Approval ......... J.'..~..:..(~. ........................... Health Underwriters Approval ......L/.'....~.......~.~...~....~.....~.... .......... Planning Board Approval ..../..U..j.!.~.. .......................... Request For Temporary Certificate ........................................ Final Certificate ..... ~ ............................. Fee Submitted $ .................................... Construction on above described building and permit meets gll applicable ¢~and regulations. Applicant .. ~~~...~ ............. Sworn to before me this ....... · .~...,~.. day of ......... ~.....(.?..?......~T. ...... (stamp or seal) Notap~-~°ublic .......~ ........ ~...,,~ ......~unty FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks 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: !. 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 dispcsal--(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 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-existing dwelling or land use $5.00 3. Copy of ~lrtificate of occupancy $1.00 ~.~. ,..~,.~ .~.,~. 3 ~. New Building ....?. .............. Old or Pre-existing Building ............................ Vacant Land ............................ Subdivision ..%..~..~....~ .................. Lot No ,~. ~"~ Block No House No Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .................................... Construction on above described building and permit meets all applicablet,codes and regulations. Sworn to before me this ...... ~ ..... doy of Notary .P-~lic ....................... ~ .......~ounty (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No ~-~; Date EASTERN DISTRICT, RIVERNEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is reques~ted~,per, t~n~ent data herewi~th: Address q ~- ~ ~,~%%~ ~_ ~v,~ ,71~ t~ {.~( 7-Section' 2-Detailed property location ~_nr4~W~-~'~UO~~- .8-Lot No. Hamlet -~,~N %e;~-~_;l~ Towu _~%mT%%~ u~3 9-Private well? 3-Public ~rater supply name Distance to nearest main 4-Lot Size: Width ~8 ft. Length_~_ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~Two Family? ; /Cellar? ~JSlab? ~ ~Crawl Space? 10-Proposed system: Septic tank ~ /Precast ~ /Cesspools ~Shallow pools / /Other / / Il-Septic tank inside dimensions: Volume ___Gals.Length ft. Width f~t. Liquid depth_~_ft. 12-Precast sections: / /Numb,e?l__.?~Square Ft. Cesspools: Block sizeL-~'_ incs.~_~lns. H~ns. Total blocks below inlet: PLOT PLAN Data Feet 0 2 6 8 10 12 ~4 ~6 ~ ~o Street m o ~ ~ ~ Indi e ~ ~ ~ Nc ~th The Undersign~ CERTIF~S: "Construction of authorized installations ~11 be in accordance with the Suffolk County Health De~rtments' current Standa~s, Bulletins, and amendments thereto, covering Private Se~ge Dis~sal Systems". ~er or Builder FOR ~ALTH DEPART~NT USE ONLY. Bas~ on the info~ation present~ here~th, it is the opinion of the Health De~ment, that an adequate and satisfacto~ Se~Ee Dis~sal System can be installed on this ~ot. Date Si~n~ ' ' (10/65 Revis.) s-15 THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NEW YORK, NEW YORK 10038 ..t~ August 7, 1972 ~4ppllr.tio. Y,,.onfile 414784 N THIS CERTIFIES THAT only the el~trlc~ ~ulpment ~ ~scrib~ bplow and introduced by thp applicant ~med on the above application au t~lber in Ibe premises ~f ~on Costello. w/side Longview Lane, ~67' s/o Main,Bayview Rd. outhold, L.I. ~,, ~/o~to~,,gt~.,~..~ ~ ~,.~., ~ ~, rt, ~ ~,,~ rt. outside .,~..,~..don aUgUSt ~. 1972 ..,~.f,,,,.d~o~,~...o,.p~., e FIXTURE ' ~ FIXTURES j RANGES COOKINGDECKS OVENS ;DISHWASHerS~ EXHAUST FANS DRYERS FURNACE MOTORS ~TURE APPUANCE FEEDERS ~SPECIAL REC'PTI TIME CLOCKS BELL ~NIT HEATE~OU~ET ' DIMMERS SEEVICE DISCONN~T I ~. OF S E -- R V C E Wate~ heater: Elec.ro~m heaters: 1-2.0kw, 5-1..~5~, 1-.TS~, 1-.5~ Motor/s. 1-1/2hp D'Angelo Elec.Svce., 485 Farmingdale Rd., West Babylon, L.I. 11704 Per_ ~£' ~717' This certificate must not be a}tered in an). manner; return to the office of the Board if JncorrecL Inspectors may be identified o¥~bek/'credentiais S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH TO WHOM IT MAY CONCERN: at The sewage d~osal facilities for a structure (Give deed location) ' located have been inspected by this department and found to be satisfactory. Lo:" 72. ! £,...~. 'it Bz%Td %--- F~O OM -i -! i d /~ I L--J ~,"co~c. ~- o c~ '1 ILO" M ALL F~-F_ S 5 h/I A_ LL_ L -F~ C~ ~c~.L-~_ ~/4--- 5'-0'~ .~