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Home My WebLink About6310-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No...Z.~.~..~. ..... Date ............. A~g .... ~7 ..... , 197~. THIS CERTIFIES that the building located at · H~ekor~y .Road ............ Street Map No.~/.e.$.~...nd .... Block No.. ~ ...... Lot No.. xx.. Sautho3A.. N.,¥o .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. Dee...27., 19.~.3. pursuant to which Building Permit No...634 0Z dated ............. D..e.c...2.?.., 19.7.3., 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.?.~.v.~t..e..o.n.e...f..a~..i~y..d..~.e.1.;l:..$n.g ...................................... The certificate is issued to . P. atr£e~.a. ~arrcd! ..... ~ne~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Aug...16...1973 .... by. .I~,..Viii&. UNDERWRITERS CERTIFICATE No. ~. 10k~l*7 .... Ju,l~... ~$ .. 197.~ ............. HOUSE NUMBER ...~70 ........ Street .Hickory. ~o&ck .......................... ........ ....... ~uilding ~nspec~or FORM ~0. 2 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? 6310 Z Date ..................... r~ee. ......... 2,7 ............. , 19..~,. Permission is hereby granted to: ....... 2~..~..L~ ................................................ .............. ~to,~,o~.~. ........................................... to .~uLLcL .~e~.. ~r~ .. £am;L~.y ..c~e&;L,t~g. ..................................................................................... at premises located at ....~/4L.~L;La~o~.y...~o,~d ........ (-we.~:.L~..) .................................................... ...................................... ;~c~u.t. hoJ. d. ...... ~L,.~ .o ...................................................................................... pursuant to application dated ......................L~,e .......... -~.'~ ............ , 19.~..., and approved by the Building Inspector. Fee $.~.~.,~ ~.Q ........... FORM NO. 6 TOWN OF $OUTHOLD 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: i. Accurate survey o'f 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 ....~,,.~x~,~,~....~.,~.(-~....l ............................................... Owner Or Owners Of Property ..~,~...~...~.z~..~.,..*...~,.~..~..-.~,~,~ .................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~..;~....~.... Date Of Permit '~../.~-.~./?,~7~.Applican, ...:~-~..~...~.~' .................. Health Dept. Approval ...~/~......~../...~..~ ................. Labor Dept. Approval ................................................ Request For Temporary C ....................... e .............................. Fee Submitted $ ....~..,.~.0. .................... Construction on above described building and permit meets all applicable codes and regulations. Applicant..~J-~ · ~'~.~... ~(~/(~Zf..'~' ............. . .~...-~../~ ... ~-/~ .... Sworn to before metes ........ [.7.... day of ........ Notary Public .................................... County (stamp or seal) /~- ~'~' .f; ~ Unauthorized a[leratlon or addiEon to this su~,ey is a violation of section 7209 of the New York State Education Law. Copies of this survey map not bearing the land surveyor's inked seal or embossed seal ~hall not be considered to be a valid copy hereon, and to the assignees of the lending instilution. Guarantee~ or certifications are not transferable to additional institutions or ELEVATIONS .ARE REFERENCED TO AN .ASSUMED DATUM. SURVEY FOR PATRICIA A, CARROLL AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SCALE: I'% 40 ' DEC. 8, 1972 DEC. 2.6, 1972 REFERENCE: gUARANTEED LAND SURVEYOR N. YS. LIC. NO. 287~. RIVERHEAD, N.Y. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference NO EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval tn construct said systems is requested,pertinent data herewith: 1-Applicant Phone~z~-Sub div Address ~ ' _~'"~'~' ~"----~' ....... ~?-Section ~' ~~9'Private well? 3-~bl~~ly ~me ~='~e to nearest ~in S-Lot Size:. WidthS%. Length~f%. (also enter on center plot plan below:) 5-~elling. Sin~ily~ T~ly? I ;Cellar? ~pl~ ~ Crawl S~e? ~ 10-~o~s~ ~st~. Septic~~ecast I yCess~ols ~llow ~ols ~Other il-Septic ~ ~ide dimensiof~: Vol~Gals.Length ft. Width ft. Liquid depth ft. 12-~ecast sections: ~N~r~q~Ft. Cess~ols: Block size~incs.D ~s.H ins. Total blocks below i~et: ~1 '-~2 PLOT PLAN ra: .G .adq G W.L. Capaci~Gals. Data Feet % 0 2 , 4 ~% 6 '16 18 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendmentSDate//..,~, thereto,4~ ~ covering SignedPrivate Sewa~l Sys~ ~'~ ~/~ ' ~'~ Owner Wot Builder 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 r ~/)~,~- Sign~ EXCAVA110H PF. C11 IIF. QU . s-15 FORM NO, 1 / BUtLDtNG DEPARTMENT TOWN CLERK'S OFFICE ...... ............ , ................. ................................ ...................... ~l~TIO~ ~OR 8~l~l~ ~R~IT ............ ............ , INSTRUCTIONS a. This application must be completely filled in hy typewriter or in ink and submitted in triplicate to the Building Inspector. witl~ 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, ar~ g~vlng 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 permit shall be kept on~] 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 ~o the Building Department for the issuance of a Building Permit pursuant to the Building Zone ~rdinance 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. ~pplicant, or nam~oration) (Address of applicant) ~/ ~i~ie .whether applicant is owner, lessee, agent, archite~~l contractor, electrician, plumber or builder. Name of owner of premises ........ ,~/--~....~......~.~ ............................................................... : .,..~....p p.J ic~f~t~, i a i~re~ ~i1~~i~,.~ .~ .~..~ .f.,.i.~.~ i:.. ~ 1. Location of land on which proposed work will be done. Map No.: ................................................... ,. Lot No ............. N r /,_,~,,0,~/ ~-///'~/>~7~~ · , ~ .. Street and umbe ..... ~c/~..~.~.:..-;.~?~...~w:q-.~4, ................................................................... ~ ~ ..... / Municipality'"- 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................. ~..~ ........................................................................................... b. Intended use and occupancy ............ ~.~,~,~ .................................................................................. ¸8. Nature of work (check which applicable): New Building ..... ~ ..........Addition ..................... Alteration ............... Repair ............. . ............ Removal .................... ,.,.. DemolitiOn ........................ Other Work .................................... 7-~ ~ i Description) Estimated Cost ..... ~- --~'/'~ ................ ,. Fee (to be paid on filing this application) if dwelling, number of dwelling units ...... Z. ....... Number of dwelling units on each floor ../.. ................................... If garage, number of cars ......... ~ ....................................................................................... ~ ..................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ......................... 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 ........................................ Dimensions of entire new cpnstruction: Front; ......... ~. ......... Rear .......... ~ ............ Depth ..... ~ ............ Height ........................../~z'.~ ..................... Number of Stories ....... Z .............................................................................. Size of lot: Front .......... ~..~ ................ Rear .......................................... De,th ........................................... Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. 12. 13. 14. (Address) (Phone No.) Name of Architect ..................................................................................................................................................... . Addr ss) (P e N .) Name of Contractor ~...~.~'./~..~.~A~ ...~ ......... ~~./...~. ...... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-beck 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. Zone or use district in which premises are situated ..................................................................................................... - Does proposed construction violate any zoning law, ordinance or regulation: ................. ~ ................................... Will lot be regraded ..~'~'~....~,,. ............ Will excess fill be removed from premises: [ ] Yes /[~ No N STATE ~,~ , ~ ) .............. ~ ......................................... being duly sworn, deposes and says that he is the applicant above named. He is the ....................................................................................... ZT-n~r~ ................................................................... · of said owner or owners, and is duly authorized to~ pe~¥~i~HoT. I~F~rformed the said work and to make and file this application; thet ell statements con;~ained in this application are true t°t~ ~:~Co~ ~Ve~kand belief; and that the wOrk will be performed in the manner set forth in the aDO cat on f ed therewith ~,~. 5~ 03~4963 Suffolk ................................. 4- y ........................ ........ ......... ................ ....... .......... .......... : ............................... ~,' - m · 'i