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Home My WebLink About6305-zNO. ~ TOWN OF $OUTHOLD BU~.BING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...~...~..~..~.~.. Date ~ ~//~- 197--~ THIS CERT~S that ~e b~g located at ~ 3 o ~Co~ ~ ~ S~eet - ..... confo~subst~i~ly to ~e Application for B~&g Pe~it heretofore filed ~ ~s office dat~ ....... ... ~.~..~., 19~ p~su~t to w~ch B~l~g Pe~it No..~. dated .......... ~.~. ~.%.., 19.~, was issued, ~d co~o~s to ~1 of ~e r~ men~ of the applicable pro~sio~ of the law. The occup~cy for w~& ~ ce~fficate ~ ~sued ~ ...A...~H ~ ..... ~.~ ~A Y ..... ~.~ ~ ~/.~ ~ ...................... Thece~fficateis~su~to ~ ~ ~ ~ ~ ~ ~ L: ~ (o~er, lessee or ten~t) of ~e Mores~d buil~ng. Suffolk County Department of Health Approval ...7...~. ?.?.../. ?..7..~. .... .L;¥.~.'..~.... UNDERWRITERS CERTIFICATE No ..... ~...../..~.../..~.~. · .-~. .................... HOUSE NUMBER..~...-~...P. ..... Street ..... . ._~?. ?.?.~..1~. .... .~-. ?..~."..~...-~...~?. ?..~. !~_ · .7.~.o...~.~..~..~. ~ .... ~ .e.~..~.- ................................................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL CO~MPLETION OF THE WORK AUTHORIZED) No. 6305 Z Date .......................... .D..e.c.e.~,he.~'.....22., 19..2.2. Permission is hereby granted to: Roma.~t...B~tt~e ..s ...t. ne ...f.~/¢-.-.. ,l. ol".m... ~ehoe~dorf ..... $.1.~ ....~ ,...Ma.~n..-S ~. .................................... ............ ~.i.v~. r hea~ .............................................. Build new one family d~Telling at premises located at '"'Z;OT,'~"I'TI"'&'"I'I'2'""P~'~'O~T~'"§~'~5'f/fg ............................................... .......................................... .,Seeo~...;,ve ............ Peeen.i-e .......... l~.,.~., .............................................. pursuant to application dated ................ ~3~'~"'"'2~ ...................... , 19~7~..., and approved by the Building Inspector. Fee $~,,~0 ............ FOUM 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 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 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 3. Copy of certificate of occupancy $1.00 $5.00 .... New Building ..... .~. ............ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ........ ~ner Or ~ners Of Prope~y ...~.~' ...... ~ ............................................................................. /// Su~ivision ~..~ ...... ~.~.~..~.....~.fl..~.~Lot No...~/.~... Bilk No ............. House No ............. . ~ Permit No. Date Of Permit :.~/.~.~..?.~.~plicant ~.....~.~.n..~..~..~..~Z: ................ H~olth ~p'. Approval ..... '~.~X~...~..~ ..................... Labor ~pt. ApprovQI ................................................ Uflde~riters Approval .............................................. Planning Board ~provol ........................................ Request For Tempora~ Ce~ificate ........................................ Final Ce~ificate .........~ .............................. Fee Submitted $ ......... ~.. ...................... Construction on above described building and, permit meets all applicable codes and regulations. Applicant ..~./~.....~..~.~..~F ~/~ /) '~' ~'~'' ' ...................................... Sworn to before me this ~ /'/'~.~/ /t~,f~b/, Notary Public ...........~... · .~'..~/~..... ~2 ./x' .~'. · County (stamp or seaT) OEP~RTMENT Oi HEALTH A V~'/',/&/~' RIVERHEA[, N.Y. '/3 ~U$,°~? .,II I: q3 / ,. J The SewaCe disposal and water suDp].¥ facilities for this location have been inspected by this department and found ~hi~f of ~cncral Enginocving A7 ,/~C O/VIC SUPPOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference APPLICATION POR APP~OV. AL TO CONSTRUCT~EWAGE DISPOSAL SYSTE__~_H Lot No. ~!' ~i · ~~ ~8. private well 9. Public wateree , '~ .... ]~;~ .Distance tO main 3. Public Water Comp~ name t. Lo~ size: Wid~h~ feet Length ~/ _fee~ (Enter on ceR=er plo~ below) 10. Sewage Disposal System: Block A. 900 gallon septic ~ank: Precas~ ~ Equivalent - B. Leachin~ pools: Number_~..Precast'~ Block Special N If private well fill in blanks below: Tank capacity ~.Cals Pump G.P.M. Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet 0 4 6 10 12 14 16 18 be in accordance with ards thereto." The undersigned ERTIFIES: "Construction of authori,.ed installations wil~ the Suffolk County ~,~artment of Health's current stand- Owner or Builder ~TH DEPARTMENT USE ONLY. Based on the info~ is the opinion of the Health Department, that an adequate and satisfactory SeW Disposal System can be installed on this plot. ~~ . D te /F ) Signed c~'~' TOWN CLERK'S OFFICE '~ ~ ~ - '~'~"~'~ - c ~ ,.,~/ ~ ,: ,, .. 2.- .... £3 oS'Z--X' /'x- M,.; Disapproved a/c ............................................................................................ /-~ ~ ..................... ........ -.r APPLICATION FOP, IU'ILDING PERMIT ~--'-~-,~~' ~L~, ~ ~ Dote .~..~ ...: .............................. , ]9 ~/ ~-- INSTRUCTIONS ..~ a. This application must be completely filled in by ty~writer or in ink and submitted in triplicate to the Buildin~ Inspector,~,tith 3 s~ts of plans, accurate plot plan to scale. Fee accordin§ to ~cbedule. b. Plot plan showing location of lot a~d of buildin§s on premises, relationship to adjoinin§ premises or public streets or areas ghtin§ a detailed d*~cript!on of layout of pro~etty must be drawn on dia§ram which is part of this application. c. The work cove'red by thi~ application may not be commenced before issuance of 8uildin§ Permit. ~ d. Upon approval of this a~plicafion, th~ Buildin§ Ins~ctor will issue a Buildin~ Permit to the applicant. Such I:~rmit shall be ken'on th~ premi.~ a~ailable for insl:~¢tion throughout the work. e. No buildin§ ~bell be occu~ed or u~d in whole or in part for any purpose wh~t~¢er until a Certificate of Occupancy ~hall ha~e be~n grant~l by the Building ~ns~ctor. 'APPI_ICATION I$ Hl:~l:Sy MADF to the Suildin§ Department for the issuance of a Buildin§ P~rmit pursuant to the Buildinfl Zone Ordinance of the To~n of Southold, $uffo[l~ County, ~,lew York, and other applicabl~ I-aw~, Ordinanc*s or ~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein d~scribed. The applicant agrees to comply with all applicable laws, and regulations, and to admit authorized in~e,ctor~ on premise~ ~nd in buildings for necessary inspections. ...................... (Signature of applicant, or name, if a corporation) ....... (Address of applicant) ]/~ 0 / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; If applicant is a corporate, signature of duly authorized officer.' ~T1V~' ~ ~V;~ ~ ~ Mun~ipali~ 2. State exi~in~ um and oeeu~ane~ of promi~s and intended u~ and ~eupane~ of ~ro~omd construction: b. 3.~ Nature of work (check which applicable): New Building ......... .......... Addition ..................... Alteration..,,........~ Repair ......................... Removal ......................... Demolition . . . Other Work .................................... (Description) 4. Estimated Cost ....../..~../~ .~..~...~.....'~.. ................... Fee .......................................................... ; ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......~... ....... Number of dwelling units on each floor ~...D..~k~'....~......~...~....c/.~.. .... If garage, number of cars .......... ..A~..~..4..~......~ ............................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....... Z~..~.. ..................... 7. Dimensions of existing structures, if any: Front ...Z~.P..t~.~..."... 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 .....~.9..'. ..................................... Number of Stories .....gn:.. ....... ........................................................................... 9~ Size of lot: Front ....~..~..-.~..a.. .................... Rear .....~...~.:...~..~. ..................... Depth ...Z'.~./....~..~. Height .................................................... Number of Stories ...................... 10. Da~e of Purchase .~...~..~...c~.~.~....L~.. ..... 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: ...... t~...O.. .............................................. 13. Willlot beregreded ___ yA~..~ ...................... Will excess fill beremoved from premises: [ ] Yes [~ No 14. Name of Owner of pram,see' . .~uV.....~E'A(.,~.,0.4q.~G ....... /X'J~...J~..'.t~./~x'8~.....~.., ' /- ."~ {Address) ,~ ~,~, (Phone No.) Name of Archi ct ............. t (Address) (Phone No.) Name of Contractor ..~....o.....~..~..~.~...g~.~.~.,~ ............ ~//..~..~......~....,.~.~./.~....~...~..~.....~...~..~....~..,~.,~..~.~........~...~... (Address) (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 topee a~lt.~how street names and indicate wheth- er..interi°r or corner lot. . /~/]~'r' ~,~-tJ ~'~~~ STATE OF NEW ~'OR, ) COUNTY OF ...~....~...~...~....O....~...[.~.. ................... ) SS · ..-~'...~.../l..~........~..~.~.~...~...~..~....t~...~...~........i .............................. being duly sworn, deposes and says that he is the applicant above named. (Name o£~ndividual signing contract) ............. s the .................................................................................................................................................................. (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 ~tatements 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 tht~r~w~h. ........ ,/~ .......... .// .......... day of ~.~':;~'~'---,~E(:~ .......................... 19 ......~.~. .... -- · &2-$O4]ba5 J