The URL can be used to link to this page

Home My WebLink About6284-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. ~09% ..... Date ...........&Pr. Il ..... ~ 9 .... ,1973.. THIS CERTIFIES that the building located at . geawond. Drive ........... Street Map No. Sea.~tood..~l~l~ck No ........... Lot No..!+. ....... 3ou~chO:~d.. N. ~¥.o ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Dec .... 1[.., 19.72. pursuant to which Building Permit No..628brZ.. dated ........... Dec .... 1 ...., 1972.., 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~iva.te. on~. family, d~te 1 ling ...................................... The certificate is issued to .~l'J..a.'. P4'.a .Wll,l],a~. ~.~(},laeg~,l ....... . .Ow~rl~ ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Al~r$;[... $ .8...~. ~73....by..R~.. ¥~..l~.&... UNDERWRITERS CERTIFICATE No.. ~..859~'2 ...... .April .21,.. ,1.973 ................ HOUSE NUMBER .... ~0 ....... Street.. 8e&~oed. 1~1.¥8 ................................ Building Inspector ~O~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 625 Z Date .................... .~)~.(~ ............ .~. ............. , 19....~.~ Permission is hereby granted to: ..... 320....~r~t..St ............................................ ......... ~ae~po=t~ ................................................ to ..~ ~L./..~w..mte..£am:Ll~...fl.well/n& ................................................................................... at premises located at ...... ~o.t...~. ....... ~l~o~..AnrP-s ................................................................... ................................... ~,~. ~t... ~.ea.~.O0.~..D~L~.~ .............. ~t23old ................................................ pursuant to application doted ........................D~ ............ $ .......... , 19.....~ and approved by the Building Inspector. Fee $'"'~'1'~'L~) ......... Building Inspector FORM NO. 6 TOWN OF $OUTHOLD Building Depar~ment Town Clerk~ Office Southold, N. Y. 11971 APPUGATION 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 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 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 ~...~...,~.. / /? /97.~ New Building .................... Old or Pro-existing Building ............................ Vacant Land ............................ Location Of Property ...... '.T,~,~.~.~....C.Z.~....~...~....C~... ...... ~....C. ....... '.~....~..,LJ.: .~.~..~../¥.. ..................................... Owner Or Owners Of Property ................................................ ~./.~ ........ =~r.. .................... Subdivision ..~.~./.~.(.~..~...~.~/..'~ --' ...... ~.....:...~.:~'~5 ................ Lot No. ......................... L~ BIock~/No .............C./House No Permit No.~....,~'..,?..~.....2~.... Date Of Permit ,,~.',.(...././.?Z~pplicant .... ~/:.....~........~~ ...... ' / Health Dept. Approval ....... ~...~Z~......Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........ '""7 .................. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all ap~plicable codes and, regulations. App,,con, ..... ............. Sworn ,o before me this . ~'~~' ~ ~(-~)~g'~-~/2 '~C/gZ''' ..... .~..~ ..... day of .....Q~..~..r~..~..:..~.~..l-/3 ........... Notary Public ~T~.~.~-~.. ~ County TERRI LEE ELAK NOTARY PUBLIC, State of New York No. 52-6168295 Qualified in 5u~cqk Bounty ~ommis$ion Expires March 30, 1¢ ~ (stamp or seal) MAP OF PROP:RT"/ SITUATE AT SO'~*'~OLD TOWN OF SOUT~OLD ~ ~.Y. § < \ ~'"'"1:; LOT NUMBEES $140Wkl OF 5EAWOOD ACEE5 - 5EOT. THE SUFFOL~ COUNTY CLEEK'S ,&5 MAP N~ Z575 DATUM ~ ASSUMED 20.~ ELEVATION AT NOrThEAST CO~NE~ OF P~EMISES APP Ap~ i SUFFOLK COUNTY DEPARTMENT OF HEALTH ! H.D. Reference No~ ~_5-/ ~CATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTE~ Date ,~ ~val to const~ct said systems ts requested,pertinent data here~th: 1-Applicant ~ ~ ~/11,'~ ~ ~one 7~ 6-Sub div ~,,~ ~ Address ~o,~ ~. ~.~%~ 7-Section 2-Detall~ p~pe~y%ocation 8-~t No. ~ ~mlet ~gu~o /~ " To~ ~o~A~l~ 9-Private well? / 3-~blic ~ter supply ~me Distance to nearest ~in 4-Lot Size~ Width /~ ft. LengtW~o ft. (also enter on center plot plan below:) 10-Pro~s~ system. Septic ~nk ~Precas~ ~Cess~ols ~Shallow ~ols / /Other / / ii-Septic ~ inside dimensions. Vol~e~ Gals.LenEth ft. Width' ft. Liquid dept~ft. ins ~ 12-Precast sections: / /Number/ /Square Ft. Cesspools: Block sizeL Total blocks below inlet: ~1 ~2 ~3 3-~-~ /~. PLOT PLAN Street incs. D___ins. H Indi No "Construction of authorized installation: :ate 'th Capacity Gals. '-1 G.P.M. q/z_ will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Dater ~")'Z.__ Signed ~/6o~/(~s~/~ ~- O~r_..er or ~ilder FOR ~ALTH DEPART~NT USE ONLY. Bas~ on the info~ation presented here~th, it is the opinion of the Health De~ment, that an ad~uate ~Se~ge Dis~sal System can be i~tall~ on this ~ot. S-15 .G 'ade J GW.L. The Undersigned CERTIFIES: Data Feet 0 ~ ~ 2 ~ 4 v 6 ~6 · ~'-~'~'bl~ $ ~3',P..I'00" - J;. I ~1 ,I ~ ~,~ , ,~.,~n~.so~su~m~ -~ OF SEA~VOOD AC~E5 'SECT. I FILED IN Z DATUM =ASSUMED 20.5 ELEVATION ,'" ~ W RD ~VILLI~ ~~7" SOUTHOLD Sc~. ~n,=~" · su~wv~ ~u~ ~,,,~ , ~-. ~~UT.eL~,..v e=~o.~.~ VAN TUYL & SON ~" = TVELC OWN CLERK S OFFICE S~THOLD, N. Y. Examined ........... ~.....~ ............. , ' Y.....'.. ~proved .................................... 19 ........ Pem~t No ..................................... Di~pproved a/c .................................................................. INSTRUCTIONS completely filled in by typewriter or in ink and submitted in duplicate to the Building~ This application must be Inspector. b. Plot plan showing location of lot and of buildings on premises relationship to adjo n ng premises or public streets or~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicat on.~ 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 Occupancy~N. 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 theH'~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordnances 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) .................................................................. !~.~. [~,/..~.....t~.L. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................................................. ........ .................. ............................................... Name of owner of premises ....J~..~.....~.......~. ........ .~...!.~..~.(m,J,~ ........ ..~.(....~.....e?7...~..~.~./. ............................................... If applicant is a corporate, signature of duly authorized officer. . .................... ........ LU. .............. , ........... (Name and title of corporate officer) Location of land on which proposed work will be done Map No' ~ ~'/'/'u~"' Lot ~u,, Street and Number ....... ..~.....~.~..~....~...o..0 ......... /~..~-.~ i ii ;;]iJ;il;;~.~.'~'~.'~.." '7 ~ MUnicipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .............. . .............................................................. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building u'/ Addition Alteration Repair ................. ~ Removal ........ ~. ...... Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....:......~...2...-~..?...o...~..!. .............................. Fee ......... {to be paid on filing this application) 5. If dwelling, 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 or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ..~....~...'. ...................... Rear ..'~....~. ..................... Depth .....~.,.?. ............. Height ...~..~.--' .......... Number of Stories ..... ~. .............................................................................................................. 9. Size of lot: Front ...... )...Q..~. ............. Rear ....... ~..O....~. ..................... Depth ..... ./..~'...O.. ................. 10. Date of Purchase ............~...q..'/....~.. ................................. Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violatf~..,fle .~o _ r~a~Y zoning law, ordinance or regulation.;> ....~...o.. ................................................ 13. Name of Owner of premises ...U~....~...!.~....)~..?...~..~?.~ll~ddress ..~..~/,~('.¢Rt/l~.e..~.....~.. ............ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...Og.....~,~..~....~ ............................... Address ..~...?..¥..."~....?..J.~ ...................... 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 indicate whether Interior or comer lot. STATE OF NEW YORK, t c ¢ COUN r OF ............................... ................... ~.. .............. ........ ............................................ being duly sworn, deposes ond says thor he is the oppli¢om (Name of individual signing application) - above named. He is the ............................................................... ~,,.'.~..~..q.~...,.~...~.. ............................................................ (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 Jn 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 filed therewith. Swam to before me this , .......... do o, ............................................ . 19 ........ Notary Public, . ........................................................... County (Signature of applicant) jll. A. REILLY & SONS t-;.UI LDERS B~OX 4~4 ~ATT. 8889 ;, [,,/'.TTITUCK, L. I,'~&~LTT. 869~- . A, REALLY & SO~