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Home My WebLink About6319-zNo Z-5180 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date JUNE 4~ 1973 THIS CERTIFIES that the buildin~ Location of Property 725 CRi'~'£~N LANE House No. County Tax Map No. 1000 Section 70 Subdivision Dw~r.r. ING SOUTHOLD ~ N.Y. Street Hamlet Block 11 Lot 4 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DE~ER 29, 1972 pursuant to which Building Permit No. 6319-Z dated DECEMBER 29~ 1972 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING * The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *ABOVE INFORMATION FROM BUILDING DEPARTMENT FILES. OF OCCUPANCY MISSING FROM FILE. EDWARD & LINDA WISNIEWSKI SO-12-69-JUNE 1973 ORIGINAL CERTIFICATE Building Inspector Our files didn't contain the original Certificate of Occupancy. Our record books indicate that a Certificate of Occupancy No. Z-5180 was issued for Building Permit #6319Z for a One Family Dwelling. Building Inspector Rev. 1/81 FOBM 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? 6319 Z Permission is hereby granted to: ........... 5' ' Z ....... ~L~,.~.~..~.......¢..,~ .............................. ...... ~z..~.,.~...v...~..~.~. ......... W.:./, .................. ~o ...f~..l.~..~....~..~..~J......c~.~.~......~..~.~,..~.,--.,/__ .......... /~.,::.~.~-~....~.~, ........................... pursuant to application dated ........................~...~...~....~..$ ....... , 19.~..1,,, and approved by the Building Inspector. Fee $ I....~....~.. :...../'/..~... Ce,'tilicate Of Occupancy June $ Southold ~.:.y. ~ '~ da~.<,,.t. Dr~c 29' , 19..7j2 pursuant to ~h~h..~uilding Permit'No. 6319Z dat(.rl .... Duc: 29 , )9 ~2 , wa~ issued and conforms bo all of ~he require. n')t'/ll,f; Of tit~) apphcabl( provi::im'v; ol the Jaw The occupancy for which this certificate is The c("rt~qcat.e 1,. issued to ~ 'rjr" ~[ L.inc]a . ,, . ...... nY h~, if )r('said bu!)dln~ (owner, lessee or ~enarLt) SufloH: C(,tmty Department of HeaJth /~pproval )'!ay.. zqQ.. 1,~73. by f~. Vi/la t.~Nm )...,,~,iki<s(r-)~ ifr1(',~'rr x,, N. 89087.. )lay .9 .1.~3, JJl),hhlu. I APPLICATION SUFFOLK COUNTY DEPARTMENT OF HEALTH H.p. Reference No. FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM , , , og/5 6 1. Applicant~f~60~l~ G~t ~/~t~,V(! Phone__ 5. Subdiv. ,~Off,~f~VO~ Address ~ ~G~ C~ ~L~,~'~ ~,~ 6. Section 2. Property location ~~, ~ ~)~K~ 7. Lot No. ~7 .~O~or,i)~. .~.'~O~ ~. ~. ~ 8. Private well ~ Village~ Township'~r).~ 9. Public water 3. Public Water Company name Distance to main ~ 4. Lot size: Wide--feet Length /~f~O feet (Enter on center ~ot below) 10. Sewage Dispos~ystem: / A. ~ gallon sep[ic tank: ~recast~ Equivalent Block B. Leaching pools. Number~recast~lock ~cial ' The undersigned :ERTIFIES: be in accordance with the ards thereto." If private well fill in blanks below: Tank capacit~als. Pump G.P.M. ~ Total well depth Depth to G.W.,~ Amountwell of ~r~ , Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 "Construction of authorized installations will Suffolk County Department of Health's current stand- Owner or 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 /~/~./~__ Signed C, ~ ~ S-15 Revised 4/1/72 FOItM :N'O. ! 1tOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , 19 ........ Pemit ~o ......................... Disapproved o/c ...~ ........................................ (Bulldln~ Inspector) Application Plo ............. ,~. ................ APPLICATION FOR BUILDING PERMIT ote ...................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 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 ercas, a~ 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 permit shall be kept 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 snal have bc 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, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lay. ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspection (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde ................... ............................................... ....... ' ............. ....... : .......................................................... If applicant is a corporate, signature, of duly authorized officer, e ~/ (Name and title of corporate officer) 1. Location of land on which proposed work will be done. M~p No.: ..~:~./...~../... Lot No......~.....,~.. ............................... Street and Number ...~..)..~.L~-...~T..~...~....~/~.~. ....... .~..q..c:~....~..//. ...... .¢~....0...0./~..~. ..................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... j~.../'./.'~....C~,'.~.:t./2~..'.,.~... ............................................................................................ b. Intended use and occupancy .2 ........ /.,...~.,~z~Z.<~/.......~./~..~....~=,~'.¢r~ ..................................................................... 3. Nature of work (check which applicable): New Building ..~ ......... Addition ..................... Alteration ............... Repair ......................... Removal ............. Demolition ........................ Other Work .............. (Description) 4. Estimated Cost ....~.~/u .~..t~l...~,.~r .................... Fee (to be paid on fiiing 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 ...... i~ .................. 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 ..~...~.......O. ........I~ear ...~,..z .................... Depth ..... .~..~...~.....o~..~ ...... Height ...... ..~.....~......?.. ........................... Number of Stories... / .-~ ................................................................... 9. Size of lot: Front ../.~.~.,..{~...~. ................ Rear / ~" Depth .....Z..~... ~....~.. .......................... Height ........... i ........................................ Number of Stories ...... .~........'~.. .................................................................... 10. Date of Purchase...~.,~..V'...../.~.....~....2:. ..... Name of Former Owner ..../-~.~;~...A~...~r,~..~. .......................................... 11. Zone or use district in which premises are situated ........ c~.Q. fcM..Z"~....f~'f~..~..°.z?.-~. .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ..z~....Q. ........................................... .... · , ,,,. ..<r, 14. i~lame of Owner o1 premises .../~.~,..~,v.~7.~x.,~.....~..~.~.,~,~.~.~.~. ................................................... , (Address) {Phone No.) Name of Architect ...~....~...~../~_.(~.~. ~,...,~....~...t(~L~.£~1~ ....... ~......~...~..~L~z.~ex.~...~..(. ....... ~z~..~,~r~.q~.. ...... {Address) {Phone No.) Name of Contractor .~..'.,/.~.. ....... ~.',~.....~../.'.-~. ................ ~Z~./-.~:.~......-''~-..-,~z~..~-~. ......... .~...~.~.-.-..~..~.-.~..."~'- .... {Address) (Phone No,) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and er interior or corner lot. show street names and indicate whet '.~ STATE OF NEW YOR~K,/.. ~///.~ ~¢,~ COUNTY OF ............. ~ .......... ) SS {Name of individual signing contract) He is the ............................................................................................................................................................................................................ [Contractor, agent, corporate officer, etc. c~ said owner or owners, and is duty authorized to perform or have performed the said work and to make and file this application; th, ;tatements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the m~: set forth in the af~lication filed therewith. y c/~,~...~..~..t, ............... :~',~.a~.V~. ..~..~ .......................... : ......... ,.....~......;.: ....... ;....~ ............... ~./ ~ {Stgnature o] appucant] TO,W. tq OF SGUTHOLO ,~-la' TOWH CL~RK'S OFFICE ~ , ' - ~,, hqed ..... .u ....... , ~ OplicOtion No ............. .~. ................ ~proved ,, u, " No. ~.~..~..?...~.L~ ........................................ , 19 ........ Pemit ....... .. .. APPLICATIO~ FOR BUILDING PERMIT Dote ........................ , 19..2~._ INSTRU~IONS a. Th~s appli~t~on mus~ be completely f?Hed in by tg~writer or in ink a~d submitted in ~ripli~te to the Building Inspector, w 3 sets of plans, accurate plo, plan ~o scale. Fee according to schedule. b. Plot plan showing location of Io~ and of buildings on premises, relationship to adjoining premises or public s~reets or are~, giving a de~ailed descript;on of layout of property must be drawn on d~agram which is part of Ibis appli~tion. c. The work covered by thi~ application may no~ be commenced before issuance of Building Permit. d. Upon approval of this application, :he Building Inspe~or will ~ssue a ~uil~ing Permit to ~he a~licant. Such ~rmit shall be kept the premises available for inspection throughou: the work. e. No building shall ~ occupied or used in whole or in part for any purpose wha:ever until a ~ifi~e of Oc~ncy shall have granted by the Building APPLICATION IS HEREBY MADE to the Building Department fo~the issuance of a Building Permit pursuant to the Building Zor, Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable law ordinances, building code, housing code. and regulations, and to admit authorized inspector s on premises and in buildings for necessary inspection: (Signature of applicant, or name, if a co't:poration) (Address of applicant) State whether applicant is owner, lessee, agent, arChiteCt, engineer, general contractor, electrician, plumber or builde Name of owner of prem ses ................... O...~..Z~. ~.-.~_ ............ ~C~/,~,~ 7.~' ~ ~ ................. ~~ ; ....... ; ..........................~ ~ ........................................................ * ' If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Lo~fion of land on which prooo~d work w be done. Map No.: ..~./.~/. ............................................... Street and Numar ...~.~Z(~.~..~ ................ ~.~.~.~.~ ........................................... Municipaliw 2. SLate existing use :no ocvupancy o~ pmm~ses aug mtenouu ~e ar~o Occup6ncy of propomd construction: a, Existing u~ and occupancy ..~~ ....................................................................................... b. Intended use and occupancy .~ ........ ~,..~. ..... ~'.~,~ ............................................................... 3. Nature of work (check which applicabl~): New Building ..~ ......... Addition ..................... Alteration .............. R6pair ......................... Removal ......................... Demolition ........................ Other Work ........................ ..~ ( Descript~cni 4. Estinlated Cost ....,~,~.~.~-......~, ....... ' ............ Fee .............................................................................................. (to be paid on filing this applicatioc~ 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 ...... 2 ................... Depth ................................... Height ..... ~ ................... Number of Stories ...~ .......................................................... Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... ight. ........ ~.. .......................................... Depth ............................................. He ; Number of Stories .......................... 8. Dimensions of entire new construction: Front ..~..7.. ............... Rear ..~..z .................... Depth ......0../.. .................... Height ...... ..c5-...~-......./.. ........................... Number of Stories ........ ..................................................................... 9. Size of lot: Front ../.~'.~.,..l~...~. ................ Rear ..... ~.....~...~....: ...................... Depth ......~...~..~/....~..' .......................... Height .................................................... Number of Stories ...... .~.....~ ................................................................ '. 10. Date of Purchase..~../..~...d'...j..~...,.~....~.. ..... Name of Former Owner ..../r~.~ ...... .~.,z~ ............................................ 11. Zone or use district in which premises are situated ........ c~.(?..it~-..~'~....f.-¢~'..~.?.~..~. .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ..,~.....O. ........................................... 13. Will lot be regraded ___~-...~..-.~ ..................... Will excess fill be removed f.rom premises: iX] Yes ~ ] ,No 14. Name of Owner of premises ...,~).(,~./~.~./~.....(.~)..l:~¢~J.~.~.7-.r.,.~.~z'~.< ........~..~..~...~..~....~)....~.../~'..'.~.~...~./..~.:~.~.. {Address) {Phone No,) Name of Architect ...C;..~/~'~ ............ ~.....~..~ ................ ~..~.~E'z~'~r4~.~.~-. ............... ~./.Z~..~.(~.eZ.:.~..~..~ .~... {Address) {Phone No.) Name of Contractor .~..'../.~.. ....... .~:...'..~....~../..~.~. ................ ~'~Z~)~./,.~.~..~.,..,-~'...~x(~9...~.~.....,....~....~..~..7..~..~...~.....'~. .... {Address) {Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed,·and indicate all set,back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. STATE OF NEW YORI~ / / / ... ' COUNTY OF ...... ~ ...... ~ (Name of individual signing contract) He is the ............................................................................................................................................................................................................ (Co~.raclor, age,,t, corporate officer, etc.} c* said owner o' owners, and is duly authorized *o ~erfo'm o' ha,~e pe,*grmed the said work and to make and file this application; thc .;tatemen~ contained in this application are true to t~ best of his ',<nowledge and belief; and that the work will be pe~ormed in the mc set forth in the application filed therewith· ......... o, .... Not~ Pug~~..~.,.,,,~,~.~ .. -.-~ ................................................................. ~'y ~ - ~: . ~ {Signature of applicant} he is the applicant above nam; ~io ~ ~ ~/-'o', _ P:hl .I .q-4 'o B'-,,I ,~ '-'-/'0 IZ F v~