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Home My WebLink About6307-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .i/Kl~mr~ ./.. W&~I~I~t.~I. A~treet Map No. Wa~l~, .11~ Block No ........... Lot No..[~.~& .~0 .... 01'0.~1~0~[~.~ .~. ~..~.*.... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Doa..2.~ ...... , 19.~?~. pursuant to which Building Permit No. dated .......... ~00 ..... 2~.., 19.72., 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'~v. at~. ~. f~al~:Lly, liwolJ.~ ....................................... The certificate is issued to lmo. & lla~.. ~lllt~xf, h~wt ..... ~.H .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~. 13..tg'/~. l~lr. g,..t~'~ ....... UNDERWRITERS CERTIFICATE No..~1~...(~b~'~. ,T~,IIIOWl~O~t ~ ............... HOUSE NUMBER.. 3~O ....... Street.: .¥~l'th. ~'~ ................................ ................. 980 .............. .lO, Hb,t.l~t, cmt..A~'e .............................. Building Inspector FORM NO. ~ TOWN OF 5OUTHOLD 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? 6307 z Date ........................ l~.....~.~ ................ 19...~.~. Permission is hereby granted to: L~o..~l~.~J~ghaat ........................................... ...C~.eenpo~.t ....................................................... to ~t ~L~ .. ~e~;...one...ga;n ~,.Z.y.. ~;e~.Z.~r~g ..................................................................................... at premises located at ..~,~t, il..)~.l...&...~....:4a.~h&~.t, ol~..He~.~.th.s ............................................ .......................... :a'~lmar. t~ ../....;,i~sh~.t on .~va ......... .~ r~.~.e ~ o~.t.* ..~.. ~.% ......................... pursuant to application dated ........................... ~Oee.....~.~ ............ , 19.~.., and approved by the Building Inspector. Fee $.~...QO ........... SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Addres~ ~ ~~ ~ ~, 6. Section 2. Pro ty ~ ~: ' ~; ~'~ '~ ~' 8. Private well Village~N~o~ Township ~0~ 9. Public water Public Water Company name ~~ , Distance ~o main Lot size: Wid~ feet ' Length ~eet (Enter on center~ plot below) Sewage Dispos~ S~stem: ' ~ A; ~gatlon septic ~ank:~recas~ E~ui%alent Block B. Leaching pools: Number~ Preca~ck Special The undersigned CERTIFIES: "Construction of authorized the e 4. 10. be in accordance with ards thereto." Date /~. 2; ~ '~ If private well fill in blanks below: Tank capacity Gals. ttea~ w~ll depth Depth to G.W. Amount of water in well Test Hole Data Feet 0 2 6 8 10 12 14 16 18 installations will Suffolk County Department of Healt~'~,..~ ~ c~rrent, stand- Signe~/ Owner or FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Mealth Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date Signed S-15 Revised 4/1/72 FOR~ 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 of property showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner os 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 occuDancy///~ $1.00 Date. ~/~/~...//... '~..~......~7'~~ '~'' ' 'c~''' ''/''''''~'' New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ......~.....'~....~... ...... ~..~.....~.~...~....~....~...~.........~:..~.....~...~.~.....~..~....~.~....~...~.....'~....~...~.. ~ff'y, Su~ivision ................................................................ Lot No ...... ~. Bilk No ............. Hou~ No ........ ~ perm t No ~22 Dote Of Permit/~'~'2~.,,cant ~' ~' ~X~X/ Health ~pt. Approval ............................................ Labor ~pt. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ .....'~<......~: .................... Construction on above described building and~pet~it meets all~gl~licgble cod~ and regulations. Sworn to before me this ................ day of ............................................ (stomp or seol) Notary Public .................................... County FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Examined ......~.~....~..~....., 19...~....~ Approved ............. .k. ........... ~. .......... , 192..~.. Pemit No.....~.....~....O.. ..................... 7~7' Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT Application No ........ ~'.0,..~. ............ Date ............................... .;..z.:..-.:..x.., INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector,.~it 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 areas~m giving a detailed description of layout of property must be drawn on diagram which is part 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 perm t shall be ke~ or the premises available for inspection throughout the work. '~ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have bee~ granted by the Building Inspector. 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 applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ ............................... .¢......w....~..~......~. ............................................................................................................................... Name of owner of premises ........ ..~....~'....~........~... ...... (~....~...~.f..../~....~......~.. ........ .-~..../....L:..L..../...~....~-_.....~....~....-~..T..' ......................... If applicant is a corporate, signature of duly authorized officer. ..................... i~'~'~T~'~'~';i~iT~f'~;~'~'~i~i;i ..................... ~. ~o~a~io. o~ ~an, o. whic~,ro,o., work wi, be ~one. ~No.: ........ ~ ........ ~No ................ Z .......................... Streetand Numar ~1 ~ ~ ~ ~V E '~ ~ ~ '"" ~'~r L¢~un,.,.a,,w 2. State exi~Jng um and occupancy of premims and intended use and occupancy of propo~d con,ruction: a. Existing u~ and occupancy ............. ~.~.~.~.~. ............................................................................................... b. Intended u~ and o~unancv ONE ~1~ 3. Nature of work (check which applicable): New Building ....................... ~' Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost / 5 0 00 -~_ ~. _~ ~ (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 ........ ..'~...T...-~ Depth ................................. · /f --/- . ,~x,,z-'- . Height .................... , ............................ Number of Stories ........................................................................................ Sizeo,,ot: Front ........... ................. Rear ............. ................... Depth ........ .................... Height .................................................... Number of Stories ................ ~o. Dateof Purchase ..... ~ ............. L~.Z.~meo~ Former Owner ....... .~...~. ....................................................... 11. Zone or use district in which premises are situated ~z~-~S I ~ ' )C)" 12. Does proposed construction violate any zoning law, ordinance or regulation: .................... . .~.....~.. ............................. 13. Will lot be regraded ..............................Will excess fill be removed from premises: [~Yes [ ] No 14. Name of Owner of premises .,.& ............................................................................................................................. (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No,) Name of Contractor ........................... L'~ ..C.~..~C2 ............................................................................................ (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 to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ..~ l~.f), A/ COUNTY OF ....................................... ~ ......... ~ ~ ~"~-- d ~"r'! L;L. !/~.~/./t~- being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) ~'~.. .................................... of said owner or owners, and is duly authorized to perlelolTN)ffhe~(~lrformed the said work and to make and file this application; that all statements contained in this application are true t~Y~l~'lJL~l~fSh~l~d'~d~nd belief; and that the work will be performed in the manner set forth in the application filed therewith. ~ No. 52-0344~63 Suffolk /'7