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Home My WebLink About5965-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .P?.t...P~.. ~d.~.~.~$a.~.~.~ .e.l-.[...Pal.. Street Map No.. ~ ....... Block No....:~.. ..... Lot No.....~. .... .S.o.u.t.h..o.l.d....N.,.Y.., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J'..~. ~.. ~ ?., 197..2.. pursuant to which Building Permit No...~.96..~.. dated ........... J..u~..e...22 .... , 197~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P.r.~.v..~ .t.?. o..~.~..f.~..~.i.l.~...d.~.~. 1. .1.~. g ....................................... The certificate is issued to St..~.n.l.~.Y..P.~.t. 9.r.s. ..... .0f~...~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~. Y....2.8....~ ~.7.~.. bY...R:..V.~.$.~.....(89) UNDERWRITERS CERTIFICATE No. , .N.~.7.1.8..0~ .... .J.%~..y.,, .2.~.,, .~.9..~. .............. HOUSE NUMBER . .~..2.~. ........ Street . .W.i. 1..1.i.a.m.s..b.e.~.g...R.o.a.d. .................... FOIJ.~ 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? 5965 Z Permission is hereby granted to: ~, O~lovlki A/~ ~ta~ley Peterl ............ .c..w.t...,.~..,~ .............................................. 8euthold li.¥. ~ae 1 pursuant to opplicetion deted ................................................ .~. ...... 19 .~....., and ~pproved by the Building Inspector. ........... Building InspeCt S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH ~ate i,~ ~ Eldg. Permit No. TO WHOH IT HAY CONCERN: The sewage disposal facilities for a structure located (Civ~deed Zocation> ' have been inspected by this department and found to be satisfactory. Chief of General Engineering Services I~AY 2 8 1974 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR CERTIFIGATE OF O¢CUPANG¥ Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE 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 dispasal--(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), No~-conforming uses, or buildings and "pre-existing" land uses: I. 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 .......... New Building ..... ~. ....... AdditiOn ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Prop~erty~.~....~../.~....~~..~...~,...~....~...~.~....~...~.~ ,,. ~-._n f) ~)r_ ~0...rJ ~ / Subdivision ................... ~ ....................................... Lot No......-m. ..... Block No.......~. ..... House No..~-~..~.~" Perm" No. Perm,t ........... .ealth E~pt. Approval .... ~ ............................ tabor I:~t. ApproVal Approval ........ g'.~.~....~ ...................... Planning Bo~rd Approval ~[~./r~....x ........................... Underwriters Request Far Temporary Certificoter ........................................ Final Certificate Fee Submitted $ .................................... Construction on above described building a~,~m, ~e it meets ~,)~pp~ codes and regulations. Applicant ...... ~'/~ ............. 21 .................................... Sworn to before me this ....... Z. y of ..zz...z.2' (stamp or seol) /~ FO~M NO, 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION ,./ -. ,: ~- -,,,: /,~ 19.../...? Date . ,~ ~...~;:.C ,~;./.~.Z A,;,~.,;~;~m ................ TO m,~..,., .. ~.. x'~'. ,e.,~, :..'~. ..... x,~ .,dJ['. .......... (owner or authored agent of o~er) (address of owner or ~thorized ogent of owner) PL~SE TAKE NOTICE there exists a violation of: Zoning Ordinance ~her Applicable La~, Ordinances or R~ulotions .......................................... ~t p~e~i,~, he~ei,~e~ a~,~ribea ,. th~., ~..~.,.....~~.~,~...~~ / (state character of violation) ....... (~tQte section YOU ~E ~HE~EFO~E DIRECTED AND ORDerED to comply with ~e I~ a~ to remedy the ~.~.o.~ ~o~ m~o.~ ~o.~w~th ~. or ~e~o~e the ........ ~7~../~ ....................................... ~ o~ .~.~.~r~:..~2.~ ............ ~.~ The premises to which this ORDER TO REMEDY VIOLATION refers are situated at ' '~ ' ~ ' ~ ' .~' ' , County of r.~'~.',~..' .~' ~¢/./',~,,~,~ :~/~'~"~... ~.,~.,~ ............ Suffolk, New York. Foilure to reme~ the conditions aforesaid and to comply with the applicable provisions of law may constitute an offense punishable by fine or imprison~or both. / SUFFOLK COUNTY DEPARTHENT OF HEALTH JUL 1. 197~. H. DoReference APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS ~ 3o/7 Approval to construct said systems is requested,pertinent data herewith: Date · 1-Applicant ~-~5~._. ~ ~ ~1.01. O~° 6-Sub div~~ Address ~,~L_'~--~ ~,~J. I~;tl~ 7-Sectio~ 2-Detailed ~P%~t~ locatzon i~J ~.~.'.~_._ ~ ~:__a 8-Lot No.' ._~ O ' Hamlet~L ~._.ll.l.m.~.~To~ ~j~A~' " 9-Private well? 4-~t Size% Wtdth~{. Leng{h~t. (also ~nter on center plot plan below:) 5-~elling: Single Family I~T~ Family? ~ /Cellar? ~ /Slab? ~ ~Crawl S~ce? ~0-~=o~,~ s~st~: Sept~o t~ { /~o.,t ~c.~oo~ ~s~no. ~o~ Il-Septic ~ inside dimensions. Vol~e GAls.Length ft. Width ft. Liquid depth ft. 12-~ecast sections: ~Number/ /Sq~re Ft. Cesspools: Block sizeL ~ ~. incs.D ~ ins. H ~ ins. Total blocks below inlet: ~T PLAN Indi No Capacity~OGals. G.P.M. ~' ;ate ~th Data F~et ~ 0 £4 ~,,,s ~ 6 ~6 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". r Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactorv~ge Disposal System canDate be installed on this Plot. Signed (~o/65 Hevis.) i TOW. OF OUT"OL BUILDING DEPARTMENT ' ~ 11~ -- ' ~ ~ TOWN CLERKS OFF~ ~p~ed ........... ;,. , ............................................... D~ roved a/c .... '.. ........ ................ INSTRU~IONS q-~-7~ a. This application mu,t ~ comp ete,, ed ~ by 'W~wr ter or ~~itted ~-~m~.~.,~' '-~with~ 3 sets of plans, ~corate plot plan to scale. Fee a~ordi~ to scb~ule. - ...... b. Plot plan showing Iocati~.of~(¢[.~.~,~dings on premiss, relationship to ad oining premises or public streets or areas, a~ giving a d~tailed d~ription of layout of pro~rty m~st c. The work ~vered by this application may not d. U~n apFoval of this application, 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 Occul~ncy shall have been granted by the Buildin~g Inspector. ~ ~' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to ~ Building Zone Ordinance of (he TOwn 'of Southold, Suffoih CounW, 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 al3~licable 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 eOrporation) '~ dd S'Of - : State whether applicant is owner,~arc~al contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. ' ~ 1. Location of land o~ whic'~hh ~: "se~d work will be done. Map N~o.~.~/~ ~ ' 0^~. ~.: ..... Street and Number ......~....~......~..~'~.~.~}~r~t;~:.~. · ~ ~0 ] MunicipaliW 2. State exi,ing u, and ~cupancy of pmmi,s and ~n~, and ~cupancy of propo~ con,~ction: a. Exi~ing u~ and ~u~ncy ...... ~.....~...... ...............................~ ...................................................... b. nten~d u, and o~upancy ......... ~..~~;~.~~ ........................................... ~ 3.: ~'~lature of work (check which applicable): New Building ....... .LZ% .......... Addition ..................... Alteration ........ ~,'.... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) .... ..................... ................. ............................................................................ 4. Estimated Cost I ~ .- -- ,~ ~-~, ~1 -- (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 ........... .ir--. ............ Depth Height ......... /..~....~ ...................... Number of Stories ....... ~ ............ ; ...................................................... 9. Size of lot: Front ...... .~....L~... ..................... Rear ........ /...~..../... ...................... Depth ./.~..~.....~.../...~....~ ................. Height .................................................... Number of Stories ..................................................................................... 10. Date of Purchase ....... .~. ...... ;. ................... Name of Former Owqer ~.....~ ....................... 12. Do~a proposed construction violete any zoning law, ordinance or re§ulation: ...... ~....~ ...................................... regraded~ ~t,v~ ............. Will ~xcess fill be removed from premises: [1 Yes j~No 13. Will lot 14. Name of Owner of premises ..~.i'.~....~L.~:....O....'~...?.~..~2~...:..~...:.~..L.~..~.~..,. Name of Architect ..................................................................................................................... .:......~...~.~...~.. ......... (Phone No.) ~ ^ __ (Add[ess) . Name of Contractor ~.~.~. ........... ~2~..~...:..~.....':7....,..2..~....~...-;..G.....~....~..,~... (Addres~ / (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 YO.R~_, COUNTY OF ...... ~ ................ ) · ~....·.~..~...,.~ ................................... being duly sworn, deposes and says that he is the applicant above named. He is the ........................................................... i ............. ; ........... ~ ..................................................................................... ( Contrac¥or, agent, corporate officer, etc.) of said owner or owners, and is dulYjL~trl~Ol~iz~Kl~Nperform or have performed the said work and to make and file this application; that all statements contained in this apR§~i(FOb~. St~-~'t~-I~ i~r~ of his knowledge and belief; and that the work will be performed in the manner set forth in the application filel~tl~963 Suffolk Count~ ............... ...... : ....... ,, (~. off_applicant} MAP OF PlZOPEiZTY · ~ OUTHOLD, 14. Y. '1 fi. THE NEW YORK BOARD OF FIRE UNDERWRITERS "UR'=^U O~= ,'U=CTR,Cr~' [-- July 23,197[-= JOHN STREET, NEW YORK, NEW ¥ORKIOO38 THIS CERTIFIES THAT w~.o,.i,~ o,~ July 15, 19 7/* and found ~o~e in compliance with the requirements of this Board. RXTURE RXTURES RANGES OVENS DISH WASHER! EXHAUST FANS SERVICE DISCONNECT NO. OF S E R V I C E METER Not;ogs s 1-&hp.- Ele¢. reo~ heatmrs: 2-2.0, 3-1.5, 3-1.25, 4'1.0, 2.75, 2-.5k~.-- COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY t