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Home My WebLink About6285-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No. Z. E.123 ..... Date ............ !~7 ..... 3 ...... , 19. '7'~ THIS CERTIFIES that the building located at P~.~i. Rd .&. Jaakmo~ .I&g. · · Street Map No. ,Ta~Ikmolx .~lt~l~lg No ........... Lot No...1.~ .... 14atdP. tuck ...l~.,vo ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Dee... 6., 19.72. pursuant to which Building Permit No.. dated ........... Dee .... 6 ...., 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.~Ya.~.~ .Ol~,e..Ealat,l~t. d~.~l~3,~llg ...................................... The certificate is issued to .. 8t,~phelx 14elqabb ..... 0~el. ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ',~10~'].'' .26...$97~...by. UNDERWRITERS CERTIFICATE No.. l~..871 .kk.... Ap~.t.1.30~. 197.3 ................... HOUSE NUMBER.. -1-020 ...... Street .....~..[{:I.,l,.]..Roall ............................. Building Inspector FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6285 Date ...................... ~ell~ll~ ....... 6...., ] 9.72.. Permission is hereby granted to: A. ............. · M~tm.~.%~ck ............................................ to ..B~,~&..~ew..~e...ge.~.ty.. ~lwe .1.t ~i~ .................................................................................... at premises located at ...... LO~..:~.[[ ....... tT&c~,$ozl..[~l~ ............................................................ ........................................ W.,, ..~45.1.1... ~,ea~t.. &.. ,T~aekeen...~e~nd.~n~ .. t~ ......................................... .............................................................. ~la~et~..tuek ............................................................................. pursuant to application dated ............................ 'D~ ....... 6 .......... , 19..~9., and approved by the Building Inspector. Fee $...9:~-e,~0 ......... POR~ 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 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 aT 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. Dote 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 occupancv 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 ................-~'.. ../..~. ....... .'~..xL.C..,~.~J.<~..~...~. ...... .~..~.~..~..../....~.....~.: .......................... ........................................................ LOt r~o. Block No ............. House No ............. ........................,,_-- ............... .y. ...... Health Dept. Approval ..... .~../...~.~/2~ .................. Lobar Dept. Approval ................................................ Underwriters Approval ...... ~'./~...o..?..~.~. .................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... ................ day of ............................................ Notary Public .................................... County Construction on above describedApp contbUilding and permit.~.....~ ~-'~..'meets all appli?bie~ ......~codes and regulations. Sworn to before me this ~'/Y~'~¢~ (stamp or seal) /~'.5""i SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Phone ~¥~'~5. Subdiv. 3--~<~)~J 6. Section 7. Lot No. 8. Private well 9. Public water Distance to main (Enter on center plot below) Precast ~/E~uivalent Block__ Precast Block Special 1. Applicant~~ S~ f Address~ , '7~ 2. Property location ~__~_~_~"~/~ ViIlage Township. 3. Public Water Company name 4. Lot size: Width /3~ feet Length ~m~' feet 10. Sewage Disposal System: A. 900 gallon septic tank: B. Leaching pools: Number Street If private well fill in blanks below: Tank capacity~Gals. Pump G.P.M. /~ Total well depth ?~ Depth to G.W. ~ Amount of water in well yD Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned :ERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date /~// /) 7-- Signed '/~7~-or ~ Bu~e~- ''/~''~' ~/~ ~f 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 / ~ ~ ~ ~ Signed ~ S-15 Revised 4/]/72 EXCAV IN!PF..C'[a IIlIIRF. II ~UFI~OLK COUNTY HEALTH DEPART~ENT APR 6 1973 DATE N.D. REF. #~9-~ The sewage disposal and water su~Y facilities for this location have been inspected by this department and found to be s~ctp~Y-fl ~'~ --~ ~ Services / '.I ACKSON,s LANDING / / 95.00' LOT 14 WELL AND ~L LO~TION$ ~ER. BUILDER ELEVA~ONS ARE REFERENCED TO AN ASSUMED Unauthorized alteration er addilio~ to this sun, e~ section 7209 of the New York Stale EdUcation Law. Copies of this survey map not beaflhg the io.d su~eyor*s sea~ or e~bossed ~eal shall not be COhsldered to be a valid Guarantees or certificafions indicated here~n shall rUn o~ly h person for whom the survey is prepared, and fan hii behejl~ hereon, and to the assignees of the lending insfitutlea. or certifications 0la zhl~t 9~Ee~l/fa~J~ ~l~ ~ DATUM. SURVEY FOR STEPHEN S. & ANNA M.E. MCNABB AT MATTI TUCK TOWN OF SOUTHOLD SUFFOLK COUNTY~ N.Y. SCALE~ 1"'40' NOV. 3 , 1972 JAN. 5, 1973 APR. 23,1973 REFERENCE ' "JACKSON'S LANDIND " FILED MAR. 28, 19 g9~ FILE NO. 5280 ~JARANTEED TO, CHICAGO TITLE INSURANCE CO. SOUTHOLD SAVIN~.,q BANK STEPHEN S. · ANNA M E. MCNABB LAND SURVEYOR N.Y8. L/C. NO. ZDTLS "IACKSON'S LANDING / / LOT 14 ELEVATtONS ARE REFERENCED 1'0 AN ASSUMED~.DATUM. SURVEY FOR REFERENCE "JACKSOI~S £ANDIN~ r~~~ AT MATTI TUCK TOWN OF SOUTH~D ~ARANT~D TO, SUFFOLK COUNTY~ N. ~nauthodzed alleration or addition to this suwey is a violation section 7209 of the New York State Education Low. SCALE ~ III= 40 I Cople~ of this survey map not bearing the land su~eyo~s inked ~V. 3, 19~2 ~.~ or embossed ~e~l ~hall not be ~n~id~d to be a valid copy. LAND IUR~EY~ v title company, qo,,ernmerdal agency and lending inslilulion list~ hereon, and to the assignees o~ the lending institution. Guamnt~ RIVER~EA~ N.Y. INSTRUCTIONS . a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspecto~vith~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or are~, and giving a detailed description of layout of property must be drawn on diagram which is pert 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 irispection throughout the work. ~l a. No building shall be o~cupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have, ls~en granted by the Building Inspector.~,/~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Ordinance of the Town of Southold~ Suffotk 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 ell applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .................. (Signature of applicant, or name, if a corporatio~ ...... Nl.~t.:Ltaak ................................................... .~L (Address of applicant) State whether applicant is owner, lessee, agent, amhitact, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... ~[ttl~l~-.&..Allll~..N~l&~l~ .......................................................................................... if applicant is a corporate, signature of duly authorized officer. Builder's License No .......................................................... ./~ Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ........ ~ll[~[ll~..~r, llt~..Lot No.....~. ............... Street and Number ........... ]~' "'~"~"~:&e]l:l~t'"~' ....... ]~ ...................................................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .~rla~[ .............................................................................................................. b. In~ended use and occupancy ............ IOltl..P~..C[qd~,~,;iJll ......................................................................... 3: Nature of work (check which applicable): New Building ..... ~ ....... Addition ..................... Alteration ............... Repair Removal Demolition Other Work .... (Description) 4. Estimated Cost .......... ,~{X)~.~ .................. Fee ....~tt~$~.24)..: ........ :"'":'.""':v: ....... ::"'.;"": ................................. (to De paicl on thing tins app.cat~on! 5. If dwelling, number of dwelling units ....~1~1. ..... Number of dwelling units on each floor ......................................... If garage, number of cars .......~;IRII.~~. ........................................................................................................................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of usa ..................................... 7. Dimensions of existing structures, ~f any Front ..................... Rear ........................... Depth ................................... Height ..: ................................. ? ...................... Number of Stories., .......................................................................... Dimensio~ns of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ..................... Height ............................. ..,:,, ..... Number of Stories ......... 8. Dimensions of entire new construction: Front ....... "~,.,6 ....... Rear .......... ~ ......... Depth .....~..~.~, ............. Height......; .......................................... Number of Stories ..~l;Id~ ................................................................................ 9. Size of lot: Front ....... te~..~...9,~ ..... Rear ..S,.~9..~...~)~. .................. Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated .............. R&~..d~, .................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... IM~ ............................................. 13. Will lot be regraded ---~l~ ...................... ,. Will exceSs fill beremoved from premises: [ ] Yes [~1 No 14. Name of Owner of premises ..8~..&..&W..~]i~i~ ................................................................................................... (Address) (Phone No.) Name of Architect .............................................................. (Address) (Phone No.) Name of Contractor ...&...~al~.~N~n.~.~.,~l~e ................. i~.~i~;~]~lb~tl~ ............................................... (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. ~ aee f~l®d plan~ STATE OF NEW YORK, ) ~ COUNTY OF ..........J~ff~L~ ............... i ........ ) {Name of individual signing contract) He is the ...................................................... ~O~t~ ............................................................................................................................... {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 performed in the manner set forth in the application filed therewith. T£RRI ~E El. AK ...... ti0T;~RY'?tt~;l~'~T~dllgnOq0tk'iN°' ',n52'~8~Z955 fl ' ................ 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