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Home My WebLink About6290-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z.~I?~ ...... Date ............. 11~...3'1 ....... , 19.7,~. THIS CERTIFIES that the building located at .. ~nehor..La~ ............. Street Map No.liarbol~. L,t~tlli~ck No ........... Lot No.. 2~ ..... 8caltho~.. I~.,.¥ · ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... D®e .... ¶l., 19 ~2. pursuant to which Building Permit No~90Z ... dated ......... D~ICl ...... ll.., 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 ... ??~.~.&.t~...0.~!...f .~...1.y .d.¥~..]:l~ .~. ..................................... The certificate is issued to . .l~oJ,D~lu.l~lmn~ ..... O~n~l, ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... lf~ir...~l..1:~73...birR,..~.~.l.& ... UNDERWRITERS CERTIFICATE No11,~0¢).~.~.8~... l(lir. ~..~... ~ .9.~.3 ...................... HOUSE NUMBER..~2.~ ...... Street .... Jill. elaOF, l~tllO ................................ .... Bttilding Inspector ( FOEM 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? 6290 Z Dote Deeemb®l. 11 19 7~ Permission is hereby granted to: $outhold to Build ne~ one family dwe]linz lot .~. Harbor Li ht at premises Iocoted ot .................................................. ~.....$. ............................................................. ............................... ,~ J~l.~. · · I '~'~J .......... ~.U.~iJO~.... M A ~. A ................................................ pursuant to application dated ..........................~.e.g......~..'J. .............. , 19.~..., and approved by the Building Inspector. Fee $. ,~,,~ ~..~..0.. .......... Building Inspector ~'~ FORM NO. S TOWN OF SOUTHOLD Building Depo~tment Town Clerks Office but'hold, 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 oil 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 o~= 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 3. Copy of certificate of occupancy $1.00 $5.00 New Building ......./.... ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~....~.,'~..~,.~...~..q...~.~.../..Z~...~.~.(~.~,n(4[...,~., ......................................... Owner Or Owners Of Property ..~..,..J.~:...l~..~.~,.~,~z~.~) ..................................................................... Subdivision ~.~.,q.~....l~xC,~.~',~ ........................... Lot No. ~...'~..... Block No ............. House No ............. Permit No..~..~0..*¢~.. Date Of Permit ~,~'C,./~..~.,~.Applicant . .~...~.~.~)J~.~....,~.~..~,~'.../.~...~.: ........... Health Dept. Approval .~ ........... Labor Dept. Approval .............. Underwriters Approval ..,~..~,...Z.c~./.~2. F~,~, ................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ...~... .................................... Fee Submitted $ .................................... ................ day of ............................................ Notary Public .................................... County Construction on above described building and permit meets all. applicable codes and Sworn to before me this (Stamp or seal) MAY 3 i 1.~73 ~. ~. ~z.~. ~.ffd-/~?-_Y/ .... ~ ..... ~ . . Supply Sorvico~ ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date~ Approval to constract said systems is requested,pertinent data herewith: 1-Applicant~'~ ~ ~A~~ ~¢ Phone~4~_~6-Sub div ~_~.~_ Address ~ ~, ~,~l.~,.,~ ,.x. ,~ ~.--~"~k~ ~'~ 7-Section ~et ~ ~.~,~ "To~',~o 9-Private 3-~blic ~ter suppl~ ~me ~, Distance to nearest ~in 4-~t Size~ Width~ ft. Length2~$ ft. (also enter on center plot plan below:) lO-Pro~s~ syst~. Septic tank ~Precast y~yCess~ols ~ /Shallow ~ols il-Septic ~ inside dimensions; ~ol~Gals.Length ft. Width ft. Liquid depth ft. 12-~ecast sections: ~Number~Sq~re Ft. Cesspools: Block sizeL incs. D ~s.H , ,ins. Total blocks below inlet: ~1 $~$3 ~T PLAN Capacity ~ ~ls. '-1 G.P.M. ~ Street Ind~ e No ~tb Data feet 0 2 6 8 10 12 ~6 18 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Dat$)J~- ~ t~t~ Signed ~ ,x4~'~-~,~ ~., ,, ' ~ FOR HEALTH DEPART~NT 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 X/~4~% Signed ( o/65 evis.) S-15 ~ (Building Inspectf) '"~'~ ~ ........ a. This application must be completely fill*d in b~ t~rit~r or in ink and ~ubmi~d in tripli~t~ to tbe 8uildin~ In~etor, b. ~lot ~lan *howino location of lot ~nd of buildings on ~m~ise~, r*lation~hip to adloinin~ ~r~mi~ or ~i~in~ ~ detailed de*cri~tion of I~out o~ ~ro~r~ mu~t ~ dr~wn on diagsam Which i~ pert of thi~ *~limfion. e. lbe ~ork m~rad b~ thi~ a~plication m~ not ~ communed be~or~ i~u~ of 8uildin~ ~rmit.' d. H~n ~ro~ of thi~ a~lie~tion, th* Buildin~ Inspector will i~u~ a Buildin~ ¢~rmit to th~ tbe ~r~mise* ~ail~bl* for in~ction throughout the work. ~. ~o buildin~ ~h*ll ~ o~co~iad or u*~d in whol~ or in pe~ {or ~n~ pur~o~ Wh~t~er until a ~ificat~ of ~ran~ b~ th~ Buildin~ In~ctor. 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicent, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~....,...~ ...... .~....~..~J~./~.J~.~.....J ............ : ..................................................................... If applicant is a corporate; signature of duly authorized officer. ~ (Name and title of c~rporate officer) 1. Location of land on which proposed work will be done. Map No.: .~..~..~.~t....l~...~.~ ........................ Lot S'o.,T .... Street and Number .....~.. .......... ~J'.~...~.. ....... ~,.~..~.~- ............................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing useand occupancy .................................................................. Intended use and occupancy ................................................................................................................... .~,~.. ~ 3. Nature of work (check which applicable): New Building ......./..... ........... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~,~ ! Description) 4. Estimated Cost .... ..e...o...~.. ........................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~..., ...... Number of dwelling units on each floor ..I...~..~..o..~....'~..0. ................. if garag~ rdu~ber of cars ..... a~ .............................................................. ~:.~.:\ .................... :~.~:~.....~ .......................... 6. if business, commercial or mixed occupancy,-~lec~f-~n~'re, -~ and extent q~ech type of u~ ..~ ................................. 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 ....~,,,~,,~,....~....~ ......... ~... N~'nber of Stories ........................................ I .... . ' I / 8. Dimensions of entire new construction: Front .....~, ................ Rear ...~l.~..: ................... Depth ..~.~..~.. .................. Height ...J.~.! ....................................... Number of Stories ..... ! ................................................................................... 9. Size of lot: Front ..... J.~..O...~ ....................... Rear ....~...?.~..' ......................... Depth ..~...o...o...: ................................... 10. Date of Purchase .t~/e.~...:../..~..~. ......... Name of Former Owner, .......................................................................... 11. Zone or use district in which premises are situated ..................................................... ;; .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~.~..= .............................................. 13. Will lot be regraded ........ ' . .. Will ~(cess fill be removed from premises: [ ] Yes fy']'"No 14. Name of Owner of premises . .F....J.,.....~.i~.J,~...~..?....~.~.. ............................ · .......................... ~ .............................. (Address) ~ (Phone No.) Name of Architect ........................................... ~'....~ ................................................................ '. ................................. r-- / . ~'~-.. (Address) ~ (Phone No.) Name of Contractor ..[7.~,..~..~..P....~..~..-/..../~/~..~.....~.;~..../.X~....~..: ...... j~//.~.~c.£j,~.~...u....../~.?..~ ....... .~..~...~..T.s,~.~..~. ....... ~ (Address) (Phone No.) -~ ~I~.OT DIAGRAM Locate clearly and d~st~nctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from ~p~o. perty lines. Give street and block number or description according to deed, and show street names and indicate wheth- er'interior or corner et. STATE OF NEW YORK, ) SS COUNTY_OF ...................................................... ) .... · ~.j..~.~.., ....... '~.~ ................. being duly sworn, deposes and says that he is the applicant above named. ( ~=rr~ of' ~d~vjclua~=Jo~ co~tr=ct ) He is the .......................................................... ..~.~.~...L~.~k..~... ....................................................................................................................... (Contractor, agent, corporat~ 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 ell statements contained in this application are true to the best of ~is knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ...................................... day of .................................................. lg ............. Notary Public ...................................................................... County ...~..~~.. .......... ( ~lgnature of app~cant ) :/ i4L~" 8aD P-, oo M ~'~ I. lO]] FI F. L o c9 P--, · 4" 1-~ U ooOF HERBERT C. STRUPPMANN Z 9.0'- LAD-, PLO o 17. l~l T C, H e.,M HERBERT C. STRUPPMANN MEMBER --AMERICAN INSTITUTE OF ARCHITECTS~CHURCH ARCHITECTURAL GUILD OF AMERICA CERTIFICATE, NATIONAL COUNCIL OF ~RCHITECTt~RAL REGISTRATION BOARDS DW CHK .~g~ FILE 1 J I HERBERT C. STRUPPMANN SCALE CHK RCS