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Home My WebLink About5777-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 .itJ.~...~,...~1.~.. &~ ........... Street Map No. ~ ....... Block No. ~ ....... Lot N .o~.. .... .P'a. ~;~i~_~.. !1.*~? ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............N~I~..~1, 19.72. pursuant to which Building Permit No. ~'/~.. dated .........Pal' ..... ~10..., 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 . l~t'.!'~t~..0.~...f..~i...1~... 4.~..~.1...ll~. ...................................... The certificate is issued to .At,,l~at;ie. I1~8..i/l~..~tl~. & .~,/..~tt~...0%m~.l's... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department Of Health Approval ~l~tl'...~. · .$9?3. · .by. Ro .~'lll~ .... UNDERWRITERS CERTIFICATE No..Il..l}018~ .... .~..1~.,..~]...,. !9~,~ ................... ItOUSE NUMBER. ~.~.()0 ....... Street...~l~'~lkl. &~l~ ..................................... Buildillg' · O~ ~O. 2 TO~N OF SO~THOLD BUILDING DEFARTM£NT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5777 Z Permission is hereby granted to: at premises located at ....~i~,..G~d..J~e..&..~,r~...]3~..~L~ .......... ~"~l'~'"]:~':llt~"~il~)e ............................................. Ilat, t~,tu~k.....~ .~, ............................ -~ ................................ : ................. ................................................................................................... ~ ........ 'i .................................. : ................ pursuant to application dated ............................. J~J~ ......... g~O, 19,..~l~, and approved by the Building Inspector. Fee $'"'"J'~'e'~ ...... PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADtNG LOT DRIVEWAY CO N:,TRU,,..TiON CESSPOOL CONS ~ RUCTION CELLAR CONSTRUCTION OTHER Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and 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 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 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. B. 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 featu res. 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. 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 ........ C~.~..a~..~..~. ,~7~.~. g.e~..l~,a~.~..u.(3.~.,.. ~, ~ ........................ House No. Street Ham/et Owner or Owners of Property .....D'~'.~.g~.~..~..~.s.t.~..q .m ........................................ County Tax Map No. 1000 Section . .~..07 .......... Block . .2 ............. Lot...~,~ ........... Subdivision ................................. Filed Map No .......... ~-ot No .............. Permit No ........... Date of Permit .......... Applicant ...~o.];)..e~.~ .(~.h~'.J,s. ~:;J..a~3~. Op ........ Health Dept. Approval ........................ Labor Dept. Approval ..................... Underwriters Approval Planning Board Approval .................................... :' " Request for Temporary Certificate Final Certificate . ~ ............................... Fee Submitted,. ;L,.Q0 ....................... ~ n on bove descr~ e I ~ n r II hc ble codes and re ulat~on Construct'o a 'bdbuid'nga,dpe~3~t~tsall~'a g ' s. Applicant....."~...~...~ ................. Rudolph H. Br%~e~, Attorney for Robert Rev. 10-10-78 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, H. ¥. 11971 APPLIGATION FOR GERTIFICATE OF OC:¢UPANC:Y 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), No~-conformJng 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 Date .......... .~...,~.. 4. L..~..~... ·~ Owner Or Owners Of Property ..~......~...~..~'/I/~ ........................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...'~....~....~...~....?. Date Of Permit .............. .(..;.Applicant .................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and p,~rmiJ' /eet~/alJ,/pj~plicable codes and regulations. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of OcCupancy THIS CERTIFIES that the building located at ~'~/~J k~ ~ ~ V L~- Street Map No .... ~ ....... Block No ..... .~. .... Lot No...~. .... ..~.. ~.'~ .?/..?.~/.(-. ~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ~ ~ ~ 50 19..?.~-~pursuant to which Building Permit No. ~'~ ~ 7 ,~ dated ~/~ ~ ~ d 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....~..~. ! .~..~. ?./-.'--..O..If..~.-..~.~.~.../,~..,.C..~'. .... .~..~...k..~.~../..~/....~'. .............. The certificate is issued to .. ~?.~. ~ ?.~. ~..C'....~.0..~..~.~..~..f. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . .~../~..g-..~..0. J. ?..).~. .... .~. ~./'..~.~.../~./..~../_.,~ UNDERWRITERS CERTIFICATE No...jf~t,~ .~:.~.. HOUSE NUMBER..~...'~.~.0 ..... Street...~" .~..~..~/.'~..../t4T. ~ ~ .......................... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a str~c[ure located (Give deed location) / # have been inspected by this department and found to be satisfactory. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No ~,~- i~(~ ~ APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DIS~ Approval to construct said systems is requested,pertinent data herewith: Date PLOT PLAN Street G.P.M. ~ Ind~ Nc Data ~eet ~m 0 g,,~l 2 q' 6 ~ 8 ~d lO 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". O~mer 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 ~/~I~ ~--- Signed (10/6~ Revis.) l-ApplicantP.~T~.~-'~.~ Phone_~.6-Sub div Address 35~ )./~.~.--- ~W. ~.~ 7-Section 2-Detail~ ~roPe~%ocation ~ ~/~ ,~,~, ~-Lot No. Hamlet ~~ - To~ ,.~.~ rr9-Private well? ~ 3-~blic ~ter ~pply ~me Distance to nearest ~in ~ 4-Lot Size: Width ~ft. Length ~7 ft. (also enter on center plot plan below:) 5-~elling: Single Family~T~ F~ly? ~Cellar? ~lab? ~ ~ Crawl S~ce? ~ ~ lO-Pro~s~ syst~: Septic tank ~ lPrecast ~ yCess~ols~Shallow ~ols ~ lOther / / il-Septic ~ inside dimensions: Vol~e Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: ~ lNumber/ /Sq~re~. Cesspools: Block sizeL~incs. D~s.H~ins. Total blocks below inlet: ~1~2~$3 INSTI~JC'I'IQNS.._,~'~-', ~ ",~'~ C.b. .,~ .... a. This application must be completely filled in by typewr mr or in ink and bubmitted in triplicate to the Building Inspector with.( 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on promises, relationship to adjoining premises or public streets or areas, and giving a deteiled description of layout of property must be drawn on diagram which is pert 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 shell be kept on~ the premises available for inspection throughout the work. e. No building shell 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 tl~e Building Zone Ordinance ~f *th~ 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. (Signature of applicant, or name, if e corporation) ...............................................(Address of applicant)~'%''~*~'~' ''~('' State whether applican/t%is owner, lessee, agent, emhitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~-~~.......~..~...'. ........................................................................... i f app,==~n,~t i~ ~,.o,~j~orat~r,~ignature of duly authorized officer' ---'% ~i L (l~ame and title of corporate officer) 1. Location of land on Wi~l~Lh.proposed work will be done. Map No.:. ot No....../~.l~ ................ Street and Number .....: .................... ~.'.:.-,~ .......... '...., ............................................................... ~ ........ . c:~.~ C) Municipality 2. Statee~istingu~e and occupancy of premises and intended use and occupancy o~ proposed construction: i'a.' E ~x!~ing use and occupancy .......................... ~..~.~ ........................................................................ :. ~;.' ;~tlmded use and occupancy ........................ ~ ................................. ~.~.~.... ,~, · Nature of work (check which applicable): New Buil~ng~.;~. ................... Addition ..................... AItera'tion..~.~:. ........ Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ...0'~1,~... 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 aitereti0ns or additions: Fr6nt .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ....................................... 8. Dimensions of entire new construction: Front ....... .~..,==' ............ Rear ....... ~ .............. Depth ................................. Height .............. L.~.... ........................... Number of Stories ........... ~ .......................................................... 11. Zone or use district in which premises are situated ......... .'..~....'. ......... .~...~...x. ......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ' ~ 14. Name of Owner of prem,ses ...~.~..~..~ ................ .~ .............................................................................. Neme o~ Archit~t Name of Contractor ~~ ~J ",~- ~ "- t l (Address) (Phone No.) PLOT DIAG RAM Locate clearly apd distinctly all buildings, whether existing or proposed, and indicate all set~oack dimensions from property lines. Give street and'block numbe~ or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW~ ) ........ ................................ ) /! ............................ ~')~'~'~.~'J~'~'~'~;*~'~J~'~'t~'~ .................... being duly s~rn, de~.s and ~ys th~ he is the, abo~ n~med. ( ~n~ctor, ~h co~=t~ o[~. etc. ) of said ow~r or owners, and is duly authoriz~ to ~Horm or ha~ ~Hor~d t~ ~id ~rk and to make and file this appli~tion; that all s~n~ ~ntained in this application are true to t~ ~st o~,~d~ and ~lief; a~ that t~ work will ~ ~Hor~ in t~ ~r ~u~rH T. BOKEN .............................. ~OCf°~ SoliDt~'' NO rE*' · = MONUMENT REVISIONS YOUNG & YOUNG 400 OSTRANDER AV£NUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG ~ HOWARD W. YOUNG AT MATTI TUCK sEl:u IJT.Y ~ * G~AhlNTY CO. so~ ~cG s,v~ ~os ~,. ~ ~OWN o~ SOUTHOLD~ ~~ SUFFOLK C0., N.Y. ~Y ~ I" = 50' ~DATE:~uLY 27~ 1972 NO. 72-585 NO E~DENCE T)F WELL OR CESSPOOLS Areo 40,326 sq fl. 319 95' Area -- 42,231 sq ft 278 4" ,. 40 07 18293' VACANT FARM LAND 497 93 .- --., $ §6°45'00"W --- - / / 180.00' Areo = 60,129 sq. ft. 2Z5.00' " 0 Paul Surer ~o.¢ Franklin Born // A~Jred Grossenbach Constontine Vloutely / , RESIDENCE- / _, RESIDENCE - / RESIDENCE- ~OLJTH OF pROPERTY L~NE ' 2~0'-~ SOUTH OF r~OPERTY LINE ~ 3OO't SOUTH OF pROPERTY LINE// --7 FINISHED FLOW SIDE WALL AREA CHING POOL GROUND .... WATER SEWAGE blSPOSAL SYSTEIW FINISHED GRACE WATER SUPPLY SYSTEIW GROUND WATER 0.0 14.0 TEST TOP SOIL LOAM & GRAVEL COARSE SAND COARSE SAND GRAVEL HOLE NOTE · = MONUMENT FOUND ARE REPERENCED TO AN ASSUMED DATUM YOUNG & YOUNG 4S00STRAND£R AVENUE, RIVESHEAD, NEW YORK SURVEY FOR: ATLANTIC HOMES OF SUFFOLK, OF "MINOR ;SUBDIVISION" INC. GUARANTEED TO: AT MATTITUCK SEC~JPJTY T]TLE & GUARANTY CO. TOWN OF SOUTHOLD . - ISLAND ABSTRACT CORE .... SUFFOLK CO., N.Y. SCALE: I "= 50' DATE: DEC. 16~ 1971 71- 758