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Home My WebLink About5962-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No....~!~..~ ...... Date ............. 00:~ .... & .... , 19.~. THIS CERTIFIES that the building located at ~ .1~1. ~. '3'-~t~. 0al~lw, ra. ~et Map No. ~1~ .......... Block No .... ~ .....Lot No... ~.. ~Ollt~l~Ol~i ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated .........~ll~e' · ~¶ · · ', 19 ~2. pursuant to which Building Permit No~91~.~... dated ........J~me. ~ ~-$ ...... , 19.~'~., 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 .PrSaraCe. ohs. fa. rally, dwe.',~...$ng ....................................... The certificate is issued to l~iw&r~- .Fl. yrm. ·. O~nsx- ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · Oo~. h- .;97£...b~'- t~, .¥1..1.t& ....... UNDERWRITERS CERTIFICATE No.. '~9 ........................................ ttOUSE NUMBER... ~.O ...... Street...~$'l'&~O. l~.OIMl-~. ~ ........................... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5962 Z Permission is hereby granted to: ~o ...~.x...a...~.~ ..~...~.a...a.~..~....a.~ ....x...x....~.. ................................................................................... at premises located at ......... ..~..~.....~.~..~..?..~...~..e.....~..O....t~......~. .............. .~..~......O....&~....]._~....I~......A..?~... .................... ......................................................... ~:O~at, ho~ ...... ~i~:~ ................................................................... pursuant to application dated .............................. ~'..l~.li[L....~..~ ....... , 19..~....., and approved by the Building Inspector. Fee $....~..~ ........ muilding InspectorI FORM NO. ~ TOWN OF SOUTHOLD Building Department Town Hall Suuthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, end submitted in duplicate to the Building Inspec- tor 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 ahd sewerage disposel-(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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. 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 Copy of ~:xisttng New Building......Z......OIdorPre-existingBuilding ............ Vacant Land .. .......... . Location of Property (No ~!). ~.~.~.e. ?.ec.k..~,o.a.d .& Oakla~'~ Avenue, Southold Hou.~ No. Street Ham/et Owner or Owners of Property Edward J..~.].,v~..~ ~ t(arie L. Fl:gnn . County Tax Map No. 1000 Section ...7.0. .......... Block ....0.6 .......... Lot..3.8. ............ Subdivision ................................. Filed Map No ........... Lot No .............. 5962Z Date of Permit 6./.2.~/.7.2 Applicant ' Permit No ................................................. Health Oept Approval .. Labor Dept. Approval ................ Underwriters Approval · Planning Board Approval ...... Request for Temporary Certificate ..................... Final Certificate C...O.: .~..z..~.87,.3..(.[.0./.6./.72. ).. Fee Submitted $ 1.00 described building and permit~eets all appl!ca, ble,co~les and regulations. / / - Applicant .... .~,~' .~ ................. · ~i~A. Wi~. as Attorney FORM NO. 6 TOWN OF SOUTHOLD Building Depaztment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submi~ed 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, N~ultiple 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 ....... U..../'... ..... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...... ?/...~'..~.....~..~ .~.~.......~...~...'~..~/ ......... .-~.........~.~...'~. .~'-..'''-~/~C~ ................. Owner Or Owners Of Property ..... ~.~:~.zg:~,.~...*~'...~.'~.~.....-..~/~.z~.../..~'. ....................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~.~.~..Z-... Date Of Permit~.u...~:....~.!t...l~...Applicant ~.~J~.~-..j~.(~ '~'''~''''~i~.~"''~''..l'' '~'-'0-' Health Dept. Approval ..... .t...O..~...~..~(~..~?.?..."~.. ........ Labor Dept. Approval ............. .~..I...~.. ......................... Underwriters Approval ........ ..CJ...l.!..~J..[..O[..']..'~.. ........... Planning Board Approval ...... ..~...t..~.. ........................ Request For Temporary Certificate ..~~ .......... Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and,p~ermit meets aU, applicable codes and regulations. ,~oplicant ......... Sworn to before me this ~ (j ~ ~-/~f-J~ '/"~ ...~. ........ doff ...(~.~---~C~.~..,.~..~.~.~~'. (stamp or seal) ~,2~/ Notary Public . · . aunty ~ TERR[ LEE EL,~ NOTARY PUBLIC, State of New York No. 52-6[68295 QuaBfied i~ S~ffo',k County ~ol~mis$ion Expiras March 30, 1~ SUFFOLK COQNTY DEPARTMENT OF HEALTH H.D.Reference N o ~-//J5 EASTERN DISTRICT, RIVERHEAD,N.Y. APFLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISFOSAL SYSTEMS Date ~/~ Approval tn construct said systsms is requested,Pertinent data he~ith: Address ~, ~ (~ ~ ~t,-~ ~¢ · 7-Section 2.Detailed property loc~tion ~.~.~.~ ~ ~+ ~A:--,~ ,~'~ 8-Lot No. Hamlet ~AJ Town ~~ · 9-Private well? 3.Public water supply n~me Distance to nearest main ~-Lot Size; Width ~ ft. Length ,~ ft. (also enter on center plot plan below:) ~-Dwellimg: Single Family ~ Two Family? L~Cellar? 'L~,Slab? ~ ICrawl Space? lO-Proposed system: Septic tank ~ ~preC%t Z_.~Cesspools ~ ~Shallow pools ii-Septic tank inside dimensions: Volu~.e ~Gals.Length ~ ~t. Width__~Lft. Liquid dePth, j, ~ ft. i2-Precast sections: ~ ~Number/ ~Sqtmre Ft,-Cesspools: Block si~.eL incs.D___ins. H . .ins. Total blocks below inlet: ~l ~2 ~3..~ PLOT PLAN Street Data ~eet I 0 ~ 2 lO 12 Ind] No d.L. The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health DePart~'nt~..' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal SyStems''. Date ~ Signed /~,. ~ ~ &~ '~Q, ~ ~ OWner ~ o~ Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adze and satisfactory Sewage Disposal System (10/65 Revis.) s-15 TOWN OF ~OUTHOLD~ ~ DEPARTMEN~//Tz_ ~- BUILDING TOWN CLERK'S OFFICE~ ~ ~UTH~D, N. Y. ~ ~ -- Examin~ .......... ~! ......... , 19~..~. Application No...~.~.~.~ ........... ........................................ . 1~ ....... , ~.mit No~Z.~..~..~ ........ :~ ~r~e~ ~i.p~ ~z~ ................................ .....~ ..... ~~ ~' ~_/~. ..................................................... ~~- .......................... 2> 7 ........ ~ ............... ~~~ - ................ ............... - ~ ~, O~lc.~. APPLICATION FOR BUILDING PE~IT --'y~ ~ate .....~ ....... ~.~ ................... , ]9.~.~ .... INSTRU~IONS a. This a~i~tion must ~ completely filled in by ~writer or in ink ~n~ submitted in ~ripli~ate to the Building Inspector, with 3 sets of plans, ~urate p~ot plan ~o scale. Fee according to schedule. b. Plot plan s~ing I~ation of lot and of buildin~ on premix, relationship to ~joining promises or public s~reets or givi~ a ~t~Jied ~s~H~fion of layout of pro~rW must ~ drawn off dJ~ram which is ~K of this ~li~fion. ~. T~ w~ ~r~ by this application may not ~ ¢ommen~d ~fore i~uan~ of Building Permit. d. U~n ~ ~ ~is appli~fion, ~he BuiJdJng Ins~or will issue a Building Permit to the applicant. ~u~h ~rmit shall be kept on t~ premim ~b for ins~Jon throughout the work. e. No ~il~ s~ll ~ ~oupied or u~d in whole or iff pa~ for anv pue~ whatever until a ~rtifi~te of O~u~ney shall have been ~n~ by t~ Building Ins~or. ~, APPLICATI~ IS HEREBY MADE to the Building DepaK~nt for the issuan~ of a Building Permit pursuant to the Building Zone Ordinan~ of t~ T~ of ~uthold, ~ffo~ CounW, New Yo~, and ot~r appli~ble L~s, Ordinan~s or Regulations, for t~ ~n~ru~ion of building, ~diti~s or alterations, or for removal or demolition, as herein de~ri~d. The appli~nt agrees to ~mply with all appli~ble laws. ordinan~s, building ~de, housing ~, and regulations, and to ~mit authorized ins~ctors on premiss and in buildings for ~ssary inactions. (Signatur~ of applicant, or name, if a'corporation) ....... (Add re;;. ~.;.~;~._...{~ ................. State whether applicant is owner, lessee, agent, arc~eer, general contractor, electrician, plumber or builder. ...................... ............................................................................................ If applicant is a c~qrporata, signa~t~'e of duly authorized officer. ............. ~ t i~'l~'~' ~ ~'1~:~'~' ~i~;i ..................... 1. Location of land on which prql~osed~vork will be done. Map No.: .................... Lot No ............ ........~ ......................... Street and Number ........ ,....:.! ......... ~..~..~..~.~'.~. ..... .~..~.'-;~.~.....~.....~.. ......... ~i ....... , ..... 2. State existing use end occupancy of premises and intended use and occupancy of proposed construction: ae Existing use and occupancy .................................... ~......._..~.~/..:._. ............................................................................... ~ Intended use and occupancy .............................. .~..~ ............................................. .z..-..., ....................... ~ = Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration...'.;.....~...; Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) Cost ................ ~ ...... ........................ 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 w th a terat one ~)r addit on~:~ F~Ont ...;.....' ................. Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. DimensionS.of entire new construction: Front ....... ,~../,. ........... Rear ........ .:,~..~ .............. Depth /* . ............. Stories ........................ ~. ................................................................ Height ...~...;, ........................................... Number of Stories ...................................................................................... 10. Date of PUrchase ............ ;:;...../~;;.../~.~, ...... 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. Will lot be~regraded ...-~;.~. ....................... Will ex,ss fill be removed from premises: [ ] Yes ['~J' No (Address) (Phone No.) Name of A~chitect ..................................................................................... · (Address) (Phone No.) (Address) (Phone No.) PLOT DIAGRAM Lo~te clearly and distinctly all building, whether existing or proposed, and indicate all set-beck dimensions from property lines. G|~/e street and block number or description according to deed, and show street names and indicate wheth- er interior or cbtner lot. -_ .. / i ,~ .*, ;, ::/ '* i: ~ ~ ~- STATE OF NEW YO~K, ~, / 1 )= / COUNTYOF .~ .~._....._........~...~..,~._...,,L__...i....,;.,{.~....;,~..._.... "~"'} ~ ~ ~ing duly sworn, de~s and says that he is the appli~nt above na~ed. (Na~ of individ~ si~ing con~acO Ha is the ...................................................................................... ~....~ ........ ;:....~: ................................................................................................... {Con~ctor, a~t, coyote o~r, etc.} of said owner or owners, and is duly a~horized to ~rform or have ~rformed the said work and to make and file this appli~tion; that all stamments ~ntained in this application are true to t~ ~st,~f hi~[e~ belief; and that the work will ~ ~or~ in the ~nner set fo~h in the application filed therewith. No 52-0344963 Su[[ork Count ' .............. ~.,~ .................... day of .~ ................... ~.~.~,~ ....... 19 ....~.,~ ,,! t DATE 2he sewage disposal faTlll~es for ~he S~ructuze FO~d %o be s~*~-~-