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Home My WebLink About6154-zFORM NO, i TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cedi[kate O{ Occupancy No. 1;~02[~ ..... Date ............ lial~h.. ]~ ...... , 19.73. THIS CERTIFIES that the building located at . (l:],~al, view. Ave ........... Street Map No. 8aLti;hftel~l Block No~&l~. ~ .Lot No. 3 .... 8~l.t, hold...1~.~... ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ 8el~t; .. 29., 19 .~2. pursuant to which Building Permit No6i dated ........ .8.eA~.....~.9. .... , 19 .?.2., 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 .. Pl'tvat, e..o~, l~mil~..dwelling ...................................... The certificate is issued to . .Idtllla~. llQeohll~l' ....... 0vllel'. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~...tit. :l.~.3.. hy .R,..I[IL].~ .... UNDERWRITERS CERTIFICATE No..l~ell~l~. ,,- .,T,. )l~&Ok~ ........................ [dOUSE NUMBER.. 1~30 ...... Street ...... ~1e~'~t8¥. ~,~ ........................... FOEM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N; Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6154 Z Permission is hereby granted to: at premises located at ...... ~t,..,~ ...... ~.~.~e;lJl~..l;~A~d; .............................................................. ................................. ~.~ ~. s. ~e . pursuant to application dated .............................. :~.~.....~....., 19~..., and approv~ by the Building Inspector. Fee $...~.'.~. ........... Building Inspector FOEM NO. S 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 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 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 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 $5.0~ 3. Copy of certificate of occupancy $1.00 ~ 1-~. ~ / ~ "'~ / New Building .... Old or Pre-existing Building ...... ~ ...... .v. Vo~;ant Land ............................ Location Of '""-'"' '"-"~'~--' ----"i~"' ~ - ~ --~' ~'--Pr°perty""/~C~~.~',<~-.'..~r...-...~.,~'.."C"~z.. ................... ~ /C-/~ ~.- ~ /~" · Owner Or Owne)s Of Prop~erty ..~/~...~ ..... ' ....................................... Permit No.~.....~....Z~.. Date Of Permit ~.,~.~..~'...Applicont,~'~....~..'.~~ ..... Health Dept. Approval .././/.(./Z.~, ......................... Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .~ .................................. Fee Submitted $ ~...~.~ ....................... Construction on above described building arid permit meets all a~licable r, pdes and regulations. Sworn to before me this '¢~/~ ~'0~ day of ............................................ (stamp or seal) Notary Public .................................... County ~ ~ 70 ~' C/ /rF SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS . ~/~e~ Approval to construct said systems is requested,Pertinent data herewith: Dat// 1-Applicant~Ot ~/.~ ~ 7'~t~ Phon~ '.~.~6-Sub di~);~T/~,¢&tl ~'~ Address ' ~ ' --7-Section 2-Detailed property location ~A~a~U~ ~4~ ~ 8-Lot No. Hamlet ~ ~ .~ ~-/, ~ ~ O Town ~7 W r~ · ~ 9-Private well? 3-Public water supply name /~ t' ~,.~l~-~¢~d ~' ~, Distance to nearest main ./~ 4-Lot Size: Width/~ ft. Length_~ft, (also enter on center plot plan below.) 5-Dwelling: Single Family l~Two Family? ~Cellar? / /Slab? ; ~Crawl Space? i0-Proposed system: Septic %ank {~,~Precast ;~-/Cesspools ~Shallow pools ~/Other il-Septic tank inside dimensions. Volume~w Gals.Length ft. Width ft. Liquid depth 12-Precast sections: ~JNumber~Square Ft. Cesspools: Block sizeL incs. D ins. H T o ta~ bl o ck~.i nl et: ~1 $2 ~3 PLOT PLAN H.D.Reference N ~.~ -//~/ / ins. I I Capacity?~ Gals. & Ind] Nc Test 5 ~1~ Data ?eet L~ ,~ 0 &~,~ 2 Dm"~ 6 10 12 3.8 ~te The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current ~Standards, Bulletins, amendments thereto, co ering Private Dispo.1 FQR ~ALTH DEPAR~NT" USE ONLY. Based on the info~ation presented here~th, it is the ' ~o~ion of the ~lth Pediment, that an adequate and satisfacto~ S~Ee Dis~sal S~tem c~%e inSt~ll~ ~on. this Plot. (10/65 Revis.) ,~ '- / SUBDIVISION MAP FILED IN THE OFFfCE · X~ ~ / O~-T-HE CLERK OF SUFFOLK COUNTY ON 'XOj~ ~ DEC. 27, 1966 AS FILE NO. 4770. ~// -. REVISIONS JAN. 2, 1973 YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: WILLIAMHOECHNER,~ ~ ~ , = SEPT 2, 1972 I~ ~711 TOWN OF soUTHOLD/~/-~"-7~> (~ ~;~ .,,~ '/'A/ BUILDING DEPARTMENT ~ ~ TOWN CLERK'S OFFICE ~,d~G. ~ ~'~/-"' ........ . ........... ....... ........ ? .......................... ........................ ~ .................... ~.22 ................. ~ ................... ~ ~ ~ ...................... ' .... ?i~il~!ng ~n~t°rl ................................ a. * ~is application must be completely fill~ in ~ ~ewriter or in ink und submitted in ~plic~ ~ the Bui'lding~ In~r. b. PIm plan showing I~ation of I~ a~ of buildings on premiss, relationship to ~jolnl~ pmmlm ~ p~llc struts or~ arks, and givl~ a d~ailed ~ri~l~ of I~t of p~ must ~ dr~n on t~ did.mm ~lch Is ~ of ~b a~llcati~.~ c. ~e work c~e~ by this a~licati~ ~y not h commenc~ before i~ua~e of Bulldlr~ Pe~lt. · d. Up~ ~roval of this appllcati~, the Building Ins~ctor will i~ue a Buildl~ Pe~it to the ~llcont. ~h ~it~ ~all ~ kept on the promises ~ailable for ins~ction throughout the pr~rfis of the w~. e. No building s~ll ~ ~cupi~ or u~d in whole or in part for any pu~e ~ate~r until a Ce~iflcate of shall h~e been gmnt~ by the Building In~r. APPLICATION IS HEREBY N~DE to the Building Department for the issuance of a Building Permit panluant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other .(::~)pllcable Lev/I, Ordinances or _~ Regulations, for the construction of buildings, additions or alterations, or for remova~or demolition, os heraln delcrlbed. - The applicant agrees to comply with all applicable laws, ordin,grj, ces, building code,~ousing c~l~, and regulations. ~ State whether applicant is owner, Isesee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corp,?te, ~ianature of duly authorized officer. (Nameand title 'of corporate officer) ~~.,~~ 1 Locat on of and on which -ro-osed work w II be done Mao~o/.,~l~......../......~..~..~.... · p p . ~p ,~~~~.... LOT r~o....'~1~ ................... S,r. and ,umber ...... ............................. Municipality 2. State existing use apd occupancy ofFp ~//r/~/ses and I,nte_nded use and occupancy of prppaeed construction: a. Existing use and occupancy ..... .~,..~ ................................................................................................... b. Intended use and occupan:', .... ~ ......................................................................................... 3. Nature of work (check which applicable): New Building ........ Addition ................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ................................... 4. Estimated Cost .~.~..~...~..~.. ............................... Fee .................................................................................... (to be paid on fi!lng this application) S. If dweIHng, number of dwelling units ..................... Number of dwelling units on each floor ....................... 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 structures, if any: Front ............................ Rear ................................ Depth .......... Height ........................ Number of Stories ............................................................................................. Dimensions of same structure with alterations ar ad;:litions: Front .................................... Rear ......................... Depth ................................ Height ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ...,-~.'"~.... ................... Rear ...'~...'.~.~....'~... .............. Depth ..~,~ ................ ! Height ~.~. ......... :... Number of Stories ..... ~ .............................................................................................. 9. Size at: lot: Front ...~...~..(-,~.. ............. Rear ...../....~...(~. .................... Depth .~.../. .................. 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zone or use distri~;t in ~hich premises are situated .....~.~-.~......~. ........L ............. , .................................................... 12. Does proposed construction violate any zoning law, ordnance or regulation? ..~.~ ................................................. 13. Name of Owner of premJses~....~...~....Address ............................................ Phone No ..................... Name of Architect ................. · ............ .~ ...................... Address ........ ,, .................................. Phone No ..................... Name of Contracto ......... Address ~ ............ Phone No. PLOT DIAGRAM Locate clearly and distinctly oll buildings whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicat'e whether interior or career lot. STATE OF NEW yORK,' ! S.$ '/ '~ couN** OF .................., ............................ ......... ~.,.~f_,~,....~.~.~..~be, ing duly sworn, deposes and says t~t he is the appdcant (Name of individual signing a~plic~i~~~~ ~~ above named. He is the ..................................... ~.~..; .................... ......................................................... (Contractor, agent, co~orate officer, ~c.} of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this appl cation are tree to the best of~ know edge and bel el' and thor the work wild be performed in the manner set fo~h in the application filed therewith./ ' Swam to ~fom me ,bls ~ ,~ _ ~ ........................ o, ............................................ ........ Natal/Public, . ........................................................... Cou~h, (Signature of applicant)