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Home My WebLink About6117-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte O[ Occupnncy No. Z~.8~.0 ...... Date ............. A~r.l:[...8 ..... , 19~... THIS CERTIFIES that the building located at . Sh'~ps. Dr~e ............. Street Map N~.'aY~r. ~-~.~. i~P.qd]~lock No ........... Lot No..~ .~. ......~..o.u~;.ho..~d..N. :.~: ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... .3.e. lq~...1.2..., 19.~2. pursuant to which Building Permit No. ~11 ?z. dated ........ 8.e!o~;.. 2R ..... , 19.72., 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 .P..r~,7(~t..e. 9.n.~..f.a.m.~.].y..d.¥.e.]..~.~.r~g ....................................... The certificate is issued to O..~..t.e~'...~.qr..e.h.e.l. ..... . .Oficn..e.1, .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.r... J. 5.. J.9.?.~ ..................... UNDERWRITERS CERTIFICATE N~ .1078.c).1.... Aug...~.. ~ ~.~.3 .................. HOUSE NUMBER ..... -~7.5 ..... Street ...... 8 .hl[p.~..DI'. .......................... ..... .......... Bmldmg Inspee~ol FOEM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6117 Z Permission is hereby granted to: ~,~eaa. J~,ex'f~ea ..&..~ .~j~ ..Z,,e.... A~C.....G~the~, Ho~.e~el ....... l~'.w..~ ~.~'~k ;;'--..~ ....................................... to .J~i3~..ae~..eae..~t~...d~e.~t~ag .................................................................................... at premises located at ........~t.....ll..~ ....... J~&~t~J~V...~eOlJ~.-~$ .................................................. .................................. · k~t.s"g~'ive .............. {l~tho~:d ............................................................... pursuant to application dated ...........................~..~.p.t,. ......... J.JJ......, 19..~J~., and approved by the Building Inspector. Fee $'!.~.11~. ~. ......... , FORM NO, $ TOWN OF $OUTHOLD Building Depmtment 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 DUPLICATE 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 disposa[--(S-0 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, o 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 Date z~...~.~'/..A...... J., ..Z. ~...7...~. ........... New Building ..... ~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... ~,,~.tZ..~.~..,~.. ...... ~..£.I.Y...~;...., ....... ,~..~../~..-~..~/..o...~..~. ................................................. Owner Or Owners Of Property ~../...-~..~.~...~.....Y'.....C~....u..,~..'~...~..C......Z~...o..C..C../-/.C~....~, .................................. Subdivision/~/~ ...9~... .................................................. ._. ..................... Block No ............. House No..~-- Permit No ..................... Date Of Permit .................... Applicant ...~....'~...."7~,. ~'..~..~....~.....-~...~.4,'~....~......~.....~.....'~..~ Health Dept. Approval <~.~..~.~..../_.'~...~...~....~'.. ........ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ...~...../..~..-/...~....~....! ............ Final Certificate ......... ~ .......................... Fee Submitted $ ..~....~..., ....................... Construction on above described building an~p mit meets all applicable codes and regulations. Sworn to beforeme this .......... · ~--~. day of ......... [...~....~.... (stamp or seal) Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pertinent data herewith: Dar l-Applicant~ Phone 6-Sub div ~,~ Address ~-~ ~, ~ ?-Section 2-Detailed'~e~ io~a%ion ~ ~F..t~ 8-Lot No. Hamlet ~)U%-~e~-~ Town ~%4~%-~ 9-Private well 3.Public water supply name Distance to nearest main ~-Lot Size: Width~_~ ft. Length~f%. (also enter on center plot plan below:) 5-Dwelling: Singl.e Family ~ ~ Two Family? / /Cellar? / /.Slab? ; ~Crawl Space? lO-Proposed system. Septic tank .~Precast ~/Cesspools ~__/Shallow pools il-Septic tank inside dimensions. ~olume~Oals.Len~th ft. Width ft. Liquid depth ft. 12-Precas% sections: ~-~Number~sqUare Ft. Cesspools: Block sizeL incs.D ins. H___ins. Total blocks below inlet: ~1 ~2 PLOT PLAN Data ~eet 0 2 4 6 8 10 12 18 th ~ ~ Nc The U~ersigned CERTIF~S: "Const~ction of authorized installation: will be in acco~ance with the Suffolk County Health Departments' current Standa~s, ~lletins, Private Disposal Systems". ' a~ amendments thereto, covering Sewage .~7~t.' Date Signed~hu~ FOR ~ALTH ~MENT USE ON~. Based on the info~ation presented herewith, it is the opinion of the Health Department, that an ad~uate a~ satis~cto~ Sewage Disposal S~tem can be installed on this ~ot. (10/65 Hevis.) s-15 ;Z ...... ~~ TO~N 0 SOUTHOLD ~(¢'/ BUILDING DEPARTMENT q~' N CLERK'S OFFICE ~ ~, ~ . ~UTHOLD, N.Y. ................. ........................................ , ........ No. Disapproved a/c .................... ,,.~ ......... ~.~ ...... ............... ~' (Building Ins~tor) APPLICATION FOR BUILDING PERMIT Date ....... ...~a. ~..~.....]: .2.. ....................... , 19..?..2.. ..... ~ INSTRUCTIONS be completely filled in by typewriter or in ink and submitted in duplicate to the Building~ This application must Inspector. b. Plot p an showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or~/~" areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this app ication. 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 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 o Certificate of OccuPanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or. Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) New Su£folk, N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. gemaral ~ontTac~or Name of owner of premises ............ ~'~....~Jl~l~Rlt..~lqX'~J~1 ............................................................................................ ...~.. If applicant is a co.orate, signature of duly authorized officer. .................. [~ame and title of co.orate officer~ ...... 1. k~otion of I~nd on which pr~o~od work will be done. M~p ~o.: ................................. t ~o..~ ............ Street ~nd ~umb*r ..... ~.[~...~..~..~.~$...~.~.~.;~g~G~.,...~,. ....................... Munic~ali~ 2. State existing use and occupancy of premises a~ intended use and ~cupancy of pr~osed construction: a. ~isiting use and ~cupancy ~aO~ ~o~ ......................................... p~vate ~ ~ b. Intended use and ~cupancy ............................................................................................................................. 3. Nature of work (check which applicable): New Building .....Z.. ........... Addition .; ................ Alteration ............. Repair .................. Removal .................. Demolitior .................. Other Work (Describe) ........................................ 4. Estimated Cost ..........~...~..0.~.0...0. ........................... Fee .......................................................................................... (to be paid on filing this application) $~ If d~welling, number of dwelling units ......... .]-.. ................ Number of dwelling Units on each floor ....]'.. ...................... .' If g~rage, number of cars 2 · . ~. . 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 same structure with alterations or additions: Front . .......................... ~: ....... Rear. ........................... Depth ................................ Height ............................ Number of S~ories ................................ 8. Dimensions of entire new constructioh: Front 58~ . . , Re°r ~.8.;e · th Height ........ ~,.~..t. ..... Number of Stories ..... ~, .......................................................... 9. Size of lot: Front ........... ~.ff,...~..e. ....... Rear ....... ..[.~..0..t. ................... Depth ........ .~...~..~.i.t ............... 10. Date of purchase ........................................................ Name of Former Owner .............................................. ' .......... 1 li Zone or use district in which premises are situated .................... ................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~ .............................. remises GlO.feZ" NO~I - ,, 13. Nome of Owner of p .. ...................................... ~,aaress ....................... ~ .................... Phone No..2..?..8.~..~.. Name of Architect ...... ..~.....~...[...~....~ ................... Address ~rt-~L-~b~a~1' Phone No72'/'82~-~ · Name of Contract0r~...1~..~.~/~,...Sz......~g.....a.~........~...g~...^ddress ...}~....~.....%~....~..~..e.~.~.......~..~.... Phone No.7.~..~...2.... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existinD or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to d~,d, and show street homes and indicate ~hether interior or comer lot. STATE OF COUNTY OF .......... ........................ './....-~.../~...ff',g~fl~ ......................... :.....being duly swam, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ~ltt~ er~'leez' ' . - (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized t:o perform or have performed the saicf~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 application flied therewith. Swam to befqre me this F' :. ............ .... - _,_%_ Notary Public,. .......... , · ..... ."...~......'~,,~ounh/ ' 6 (Signature, of ~;;lica;~) .......................... TERRI LEE EL~K NOTARY P'JBMC, State of New York No. 52-6168295 Quaflfied in Suffolk Count)' 1~4Nttl~lllion Expires March 30, 19'~,~ THE NEW YORK BOARD OF FIRE UNDERWRITERS - ~:' BUREAU OF ELECTRICITY · ~-- 85 JOHN STREET. NEW YORK, NEW YORK toO38 THIS CERTIFIES THAT ~unter ~orchel, s/s Ships Lane, 500' s/w/of Bayview Road; North, Southold, L.I. in the follo~ing ~ation; ~ B~e~nt ~ Izt FI. ~ 2nd Fl. outside Section Bilk ~t ~examin~on AU~USt ~ ~7~ andfoundtobelncompliancewi~htherequlrementsof~hisB~rd. RXTURE / I I F XTURES ~NGES C~KING DECKS OVENS DISH WA~ERS EXHAUST FANS OUTL~S ~E~ACL~J SWITCHES JlNC~SCENTJ FL~E~ENT J ~[~ J ~T. [ K.W, J ~T. J ~,W, ~ ~T. J K,W. J ~T, J K.W. ~T. J H.P. DRYERS I FURNACE ~TO" I mTURE AmlA~E ~EDERS S~OAL REt'PT TIMECL~KS I ~ ~ MULTI~~T DI~ERS ~T. K.W. OIL H.P. J GAS H.P. ~T. NO. ~W.G. ~T. ~P. ~T. ~ps.' TRANS. H.P. N~Y~;~T ~T. WA,S * j ~ 1 2 10 1 ' 30 v E 2 gOC ERVIa DI~NNECT I o.o I s E BR)ncm , c OTHER APPARATUS: CB Per K t COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT SE ALTERED IN AN? M~AN~NER~ SUFFOLK COUNTy HEALTH DEPAETMENT ---~____ H. ~. ~,. ~i/~ !, :', ~,-¢~L4 ,-... T ;THIS PLAN SHALL NOT BEF!LED WITH ANYBUILDIN ;WITHOUT THE ARCHITECTt~ S~ xi 18': 4." "Z4-'- 6" 5&'-8~" D©IXlAL:D': & L .... t. I' ,,, 4 LIV 4L PLAN ~ - DRAWN THIS:PLAN SHA,LL"NOT BE WITHOUT, TH~L~ARCHITECT'S r~ -! t TH~S P~N SHALL NOT BE FILED WITH AN~ BUiLDiNG DEPARTMENT WITHOUT: ~HE ARCHITECT'S SEAL AFFIXED HER~O. P~ ' J J khI THIS PLaN SHALl- NOT BE FILED WITH ANY BUILDING DEpARTMEN, T WITHOUT THE ARCHITECT'S SEAL AFFIXED HERETO.