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Home My WebLink About5920-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 7~+89~. ..... Date ............ lion,.. '6 ........ , 19'72' THIS CERTIFIES that the building located at .Ba~'shot'~ .Road ........... Street Map No. Pea-...Bay. t!Is~lock No ........... Lot No.. i--91~ .&..95.. 6~.eellport;. · ll,X.. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... J-uric ....1 ", 19"72 pursuant to which Building Permit No.. 5920Z' dated .......... J. uae...4 .... , 19.72., was issued, and conforms to all of the require- ments of the applicable provisions o£ the law. The occupancy for which this certificate is issued is . .Pti. rate. ~n~..family..dwe.l.$ing ...................................... The certificate is issued to . 6race .T ~. Bancroft ...... 0~nal- ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . Oct. ~'. 19~'2 ..................... UNDERWRITERS CERTIFICATE No .... lq. -53577. - -l~ov..6.19.7.2 ....................... HOUSE NUMBER.1 :~0 ....... Street .... Bay~hol'®..Itoa~l .............................. Building Inspector / FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~4~ ..... Date ............ ]io~f... 6 ....... , 19. THIS CERTIFIES that the building located at ...lla~,~o~'e. ttoa~l .......... Street Map NoPeo,..B~}t II,lock No ........... Lot No. 1~9l+. &9~" Gl'eeapo~-...}I,~-,. · conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Jttl~l. · $ ....., 19.72. pursuant to which Building Permit No.. dated ............ Jura ....1.., 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 .. Pt*.~,~r&~;e..0~e. ~.a~$~..dwe.~:~.ng ...................................... The certificate is issued to .(}eO~'$ .]k~n~.o£t~ .... 0~ne], ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .43ot. 2g. 19.7~ ..................... UNDERWRITERS CERTIFICATE No...Pll3~g ....................................... HOUSE NUMBER.I,I~O ....... Street .....~81101'0- -l~&~, ............................. , ..... Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z.beS.9.~ ..... Date ............ Nov... 6 ....... , 19. THIS CERTIFIES that the building located at ...Bayshore. t~oad .......... Street Map NoPe¢....Bay. EstBlock No ........... Lot No. ~..91~. &9.~.. 61~eemp.ort;... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ O~ulle...$ ..... , 19.72, pursuant to which Building Permit No.. dated ............ .~txI~e.... ~.., 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 .. p~i.y.a~;.e..9.n.c..f, aa.i~y..d.~.e.~.~..l~g ...................................... The certificate is issued to .6eorg .Ball~rof.t .... 0.wrier ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .0¢i;. 2~..l 9.72 ..................... UNDERWRITERS CERTIFICATE No... P.~ncllng ...................................... "HOUSE NUMBER. '13.~.0 ....... Street .....Bayshol'.e .P, oad ............................ Building Inspector ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH*OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 592O Z Permission is hereby granted to: ....... ~u,t, ebDi~e. .................................................. at premises located at ....~t..~m~li~..&..~l~....~lMl~..il&ll..~.el~ll~e..~..J~l:Jl~t~ ...... ............................ ¥/&..]~,~lJ~ ~'l ..~,~e ~ ............. G~eez~pc~J~ ...................................................... pursuant to application dated ................................ ~'.~t.l~. ......... .~...., 19.~..., and approved by the Building Inspector. Fee $.~,~.~1. .......... Building Inspector !,, J FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructbns 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 oll buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(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 · ~J ~ ~n <~ occ~ ~-o~...~ ,..~ Locat,on Of Property ........ I .................. ..cJ ............................................................................. Owner Or Owners Of Property ...... ..(~..~.?...l~J..~......'~....P/H...~.~-~.~.~..~ ................................................................... Subdivision J~t~.~.~.~-~...(~D~...?.tC.~.~.N.%.q'...~.t~/..... Lot No.~.9..~.'~gh-Biock No ............. House No..../...~...~..c3. Permit No...,~...~..~_.D. ...... Date Of Permit .~.~.H~...I.)..~..7..~pplicant ..~I~,~9,~J.~...~J~.J~.....'~5....'.~.~.~......L.IVC- Health Dept. Approval .Q~.T.,...~,~..J.~.7.~,. .............Labor Dept. Approval .................~..j...Pt'.. ....................... Underwriters Approval .~..~.~,.,~,,~,.?,~.L~ ........................... Planning Board Approval ........ .~..~.,~. ....................... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...~...!~ ....................... Construction on above described building and permit meets all app~lic0ble codes and regulations. Apphcant .............. (....~.~ ............ ~ .................................................. Sworn to before me this Notary Public~-~.~.,~ County (stamp or seal) FOBM NO. 6 TOWN OF SOUTHOLD Building Depa~tment 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 disposal--(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 $5.00 3. Copy of certificate of occupancy $1.00 ~~ ~ ~,~.,~..~ Date ........... : ..... New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..... .~..1.~.....~.........~...~...~.~ .......... ~..(.~...: ............. Owner Or Owners Of Property ...... .~....%-:~..~..~..~.,.....~...~..~¢~..~. ............................................... Subdivision .~.. .Lot . .?.~Block No ............. House No.../..~.Z.9 Permit No.~..~...'2...~. ..... Date Of Permit~v.~.~.'4.J.~Z2Applicant ~.~.~'~L~, ~'~'~k.c~-~. Health Dept. Approval .~...~..~..~?t..~.~bor~ Dept. Approval~'(.W.~.~..~,~. ....................... ..... Underwriters Approval ~.~.~.~.~ .......................... Planning Board Approval ........... ..[?~.~. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .~.....~.~.~... ....................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ..... t~ ........ day of ...~....g.%.....~:~...~.~.~..~...~.~.."~.. Notary Public .................................... County (stamp or seal) TERRr LEE ELAK NOTARY PUBLIC, State of New York No 52-616S295 J)u~ii[ied in Suilolk County Commission Expires March 30, 19 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [~5 JOHN STREET, NEW YORK. NEW YORK 10038 6, 1972 ..Ipplieetlo.~..c"',]'ile 597673 N 53477 ~'~ November TIllS CERTIFIES THAT Dr. Roger Bankroft, s/s 1350 Bayshore Rd., Greenport, L.I. ............ FI~T~R~--- - ~N~ES 'C~KIhGb~CKS~- O~E~S '-- ~[~RS EXHAUST FAN~ W.B. Ruland, ~ Mattituck, L.I. Per~ . This certificate must not be altered in any manner; return to the office of the Board ~f incorrect. Inspectors may be identifi~ by their cr~enfia~s. .., ~/~ ~-m~T CL",V '" '--~=,~, ,,.,---~..,. ,,~,----.~:~=' ,, ..~,~r ,. :o,.~o,. tVATEI~ c,.i · .~- ¢/ , - lJ~ ~.- -. ,-./,-...-- / I~ MAP OF PROPERTY -~' ~'~ ~" ~' GRACE T. B~NCROFT ' , ~ JJ~ I~ ~ "ARS~AMOMOQUE" L~ , z ~ ~,. ~ ;~,:~.~,,...,o.o..=,o. SCA L E 30 =, ,~,o. ~w. ~ = MONUMENT coP~s o~ ,.,s so~, ,.,~, ~o~ ~,~.a ~= WELL ~HE LAND SURVEYOR'S iNA O SEAL OR 25.0 50.O ~s,~ ~,~ s,,~ .o~ ~ co~,o,~o ~= CESSPOOL ~1 N.~'I2'40"~V. - TS.O GUARANTEED TOTUE C~ICAGOT~TLE . ~NeT.~S- ~S~AN~ VENTUEES. INC. ,s~A,,~,'~,H~/~w~ INS. CO. a SOU~OLD SAV1NG5 ~p~.z, ~Tu~ o.o m~N W~TE~ ~scoN~c sAY (~f~-- { ~J~' - ~E~DED 5g~r. Z~, 197Z ~RBENPOR~, NEW Examined ...... .~..L ........... 19.?....LT.. Approved ........................................ ('//' ~ , 19..~.... Pemit No...~....~....~.....~...~ ........ BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICE ~ ' ~/~ ~UTHOLD, N. Y. ~pplication No, ..~.~..~ ....... Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with[,q 3 sets of plans, accurate plot plan to scale. Fee according to schedule. -~ b. Pint plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, andca, 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. ,T~ d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept onl~l 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 been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building ZoneL.~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of J 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. (Signatdre 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. ............................................... ...................................................................................................................... owner of /'~ ~'~'"'e' .~.~.,~','f'Z.~:~' ~} ~ ,..'~'.~... · · Name of premises ............. a~..~.~.....-..7..~ ........ .......................................................................... / If applicant is a,.corporate, signature of duly au, t~orized officer. (Nam~Jand title of corporate officer) 1. Location of land on which proposed work will be d, one.__.., /'~ / ---,-~.---~-,----,-~ ~f-/Map No,: .......... ./../. ...... Lot No......~..~.. ...... ~.-.~..~.. ............ Street and Number ...... ;......~...~.~..~'.~/..~...~,~.......~./.~'.~....~.~.~.~..~.~.~..~.~.~....~..~~~ 2, State exi~ing u~ and occupancy of Premiss and intended use and occupancy of propo~d co~ruction: a, Exi~ing use and ~cupancy .......................................................... ,,~ ..................................................................... Intended u~ and occupancy .......................... ~'.~....~4~..:~ ......................... ~.-..-.~ ......................... ' b. 3...~ Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ....... : ....... Repair ............. ............ Removal ......................... Demolition ........................ Other Work .................................... { Description) 4. Estimated Cost ......~..~....~..?..~.~..~....q...~. ........ Fee ................................................................................................. (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 ........ ~.....~5~'.. ........... Depth .....~.~.. .................... Height .................. ~...~.......~...0....'.. Number of Stories ................... c~...i~.. .......................................................... 9. Size of lot: Front ........ ; ...... ~...~... .............. Rear ................ ,~....~'..~.. ................ Depth ....... /....~..;~.~.. .............................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ............. /...~'..~....,2: ........ 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. Willlot beregraded ...~...z?. ............. Will excess fill be removed from premises: [ ] Yes CX] No 14. Name of Owner of premises ...... ~ ................ ~.~.. ....... J~'../...~.~/~.~..~...~.Z ........ .~,/~...~.......~....~......~E.g~.. (Address) " ' (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor..~.. -'..~ ..~ .~'~...~.a/~r~..r,¢~.¢'.....~ ....... ~ ................... .~..~......~.~...~....-~..~.../..~... (Address) / ~ (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from properW lines: Give street and block nUmber'or description according to deed, and show street names and indicate wheth- er interior or corner lot. %/) .............. ~.'. .............. : ...................... : .............. being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is 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 statements 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 therev~ith.~J^.- ~JUDITH T. BOKEN -- ~ t~'~'fu~'~U~lc, ~e.~f New Yor~ 96 .............................. .~...,.day of ....... ~o~i,.i...~. ]§ ?~..~..-.. k ar¥ Public, . .~.~:m~y ................. ................. : .................... ~i ........ & ...................................... (Signature of applicant} WESTERN DISTRICT, COMMACK, N. Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRYCATE S~AGE DISFOSAL SYSTEL'S Approval to constr~aet said systems is requested,pertinent data ho~'th: Dat'.~ 1 ' -Applicant Grace T. Bancroft d .... --~ Phon~ ? 7- 0 9 9 9 6_Sub divPoco~ J c A.arc~G~ll Pond Road, Greenpozt, N.Y. 2-Detailed propor{y location~aYShore Rd.,Wic}~nam Park8 ~+ Ham]et Outside Greenport To~ Southold 9-Private 3-Public ~=ter supply name G~ort D{~tance to nearest main g-Lot Size: Width 75 ft. Length .125~t. (also ~nter on center D]n~ 5-~elling: Single Family ~ T~ Family? ~ellar? ~ Slab? ~YCrac'l 10-Proposed system: Septic tank ~ /Precast d %/CessDools ~Shallo~i il-Septic ta~ inside dimensions: Volume 9gt~Ga~s. Len=th l~-~necnst sections: ~'{/Number~.~/~wf ~ . s. ft. Width ft~ ~ ~"X ........ esopoo~s: Block sizs~inc~.D Total block~ bc!ow inlet: ,{1 ,~o ....... ~OT PLAN ~- SHORE ROAD The Undersigned CE2?IF~S: "Const:'uction of authorized instal/.*tion: accordance with the Suffolk County Health Dep~rtmants' current ot~na...c., and amendments thoreto, covering Private Sc%mge Disposal ~ - + ..... Dater,S____ Sip. ned__,/ UC.C~ -- O. ..... , ~ .... ~cr or Bui ~'der ~OR ~E~u.~ DzPARP~,S,:.i USE ONLY. Based on the info~ation presented l~cwith, opinion of the Health De~rtment, that an adequate and satisfacto~ Sewage can be installed on this Plot. ' .... S-15W +'~BAVSI-IORE .~ '"'ROAD '~ / cD, 0-4 25.0 50.0 N. 44' !7'40" ~1. - 75.0 MAP OF PROPERTY SURVEYED FOR T. BANCROFT SITUATE AT "A RS Pi A.M OMO(;;} U ~" "" ~ ' ~.k~,.~ 30'= , = IRON PlP~ = MONUMENT ~iO~N aiFaa TO "AMENDED ' MAP A * PECONIC 6AY ESTATES" FILED IN THE ~DFFgL~ COUI4TY CLEAK'5 OFFICEA~ MAP Nell2~ DATUM ' O.0 ¢iIGN IVATEA PE~0NiC BAY eSUaVEY~D; MAY ~ VAN TUYL & SON t: