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Home My WebLink About5780-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. 5:0hi+ ..... Date .......... .l~..~. ..... 1.9. ......., 19~'~. THIS CERTIFIES that the building located at l~ortl~ .Drl.~ .............. Street Map No. ~hore. &ere~lock No ........... Lot No...Plot..1~. &. Il .. l~t~;$t~lOk.. ~.,.Yo conforms substantially to the Application for Building Permit heretofore fried in this office dated ............ liar,. 26., 19. ?~ pursuant to which Building Permit No. ~.80Z... dated ........... 14a~... ~t.., 1972., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... Prl.'g.a..t.e...one.. ~ .s~..$~y..d..w.e~.l.i.n.g .................................... The certificate is issued to . LOts. P.,..Lesn~.kowsk~. ...... Oletlel*. .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. Jal~. ~..~9']~..by. 1~, .¥Y~I,i& ..... UNDERWRITERS CERTIFICATE No...~.. ~[9.9.~.2....D.e.c.. J.~....~ ~}.~.~ ..................... tlOUSE NUMBER...600 ....... Street... liortl~ .ill~,~ ................................. Building Inspector FOF~ NO. ~ TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. N? BUILDING PERMIT {THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL CC~MPLE"FION OF THE WORK AUTHORIZED) ~,so z Dote .............. ...-Y...L ............ , ,9..?.....z.- Permission is hereby granted re: _ !. ............................. ~~......~. ............. ..~.......~: ....... z~../.. ..... pursuo.t ,..~,,¢.,,o. ,.,ed ..................... ~-~...~.~. Building Inspector. ~.. ,..ZZ.~ ..... Building Inspector SCHD SUFFOLK COUNTY DEPAETHENT OF HEALTH JAN 2 6 1973 Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage,disposal facilities for a etructure located (Give deed locattod) have been inspected by this department and found to be satisfactory. Chief of General Engineering Services District Engineer JAN 96 1973 FOGM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF O~CUPANCY 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. D~te Feb. 1, 1973 Addition to Residence tg~z~i .................... Old ar Pre-existing Buildin9 ............................ Vacant Land ............................ Locat an Of Prope ......... Owner Or Owners Of Property ...... L.,o..i..s.....~..,.,...I~....s.p..i...k.,o,w.s...k...i. ................................................................... Subdivision Shore Acres · .................................................. ~ ............ Lot No...~... Block No ............. House No ............. Permit No...~.?...~.0....~.... Date Of Permit ..3../..3..~./..?..2...Applicant .... .~..e..~.~...e.~.~....~.......~.e..u..?.~.~ ................... Health Dept. Approval .... .]../...2..6./.,7.3. ........................ Labor Dept. Approval ................................................ 12 11 72 Underwriters Approval .......... /...../. .......................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........x. ................................. Fee Submitted $ ....~.0.~. ....................... Construction on above described building and pe~~ and regulations. Applicant ............................................................'~--~~~'~/ H.D. Reference No-~~~3 EASTERE DISTRICT, RIVERHEAD,N.y. AP'FLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS D t ~ Approval tn construct said systems is requested,pertinent data herewith: a e ~ ' i/7~-- Address /~z~_~-p.o~ Z~ ~~r //F~ 7-Section 2-Detail~ pmpert~location~.4j/~ ~F/~D~ 8-Lot No. ~ ~, ~ Hamlet ~/:~/~ -' To~ ~o~D 9-Private well? 3-~blic ~ter supply ~me Distance to nearest main ~-~t Size: Wldt~o ft. Length~77 ft. (also enter on center plot plan below:) 5-~elli~: Single Family ~ T~ Family? ~Cellar? ~lab? / / Crawl S~ce7 / / IO-P~s~ ~st~: Septic tank I /Precast ~ess~ols ~ha]low pools ~ /Other / Ii-Septic ~ inside dimensions: Volvo Gals.Length ft. Width ft. Liquid depth' ft. 12-Precast sections:~umber/ /Sq~re Ft. Cesspools: Block sizeL incs. D ins. U ins. Total blocks below inlet: PBST PLAN Capacity Gals. G.P.X. The Undersigned CERTIFIES: Indi ~te th Data ~eet $ 10 12 16 - "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletias, and amendments thereto, covering Private Sewage ~isposa/ Systems". ' Owner or ~uilder - FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactor~AeW~ge Disposal System can be installed on this Plot. Date (10/65 Revis.) S-15 TOWN OF SOUTHOLD 7~ . ~ ~ BUILDING DEPARTMENT ~/7~ ~ TOWN CLERK'S OFFICE ~ ~ ~~ - ~UTHOLD, N.Y. ~ '~ ~/~ ExGmine~ ..~...~.~.' 19..~.~ ~pplicGtiofi ............ Approved ~ ~ 19....~.. Pemit No ~ ~ ~ ~ .................. · ........ ~ ~ ;~., APPLICATION FOR BUILDING PERMIT o. This opplic~tion must bo completel~ fill~ in by ~pewriter or in ink ond *ubmitted in duplicate to I nsp~ctor. b. ~lot pl*n showino I~otion of lot ond o{ buildings on premises, relationship to odloinino premi~* or public Stre*t~ or~ oreas, ~nd ~ivin~ a d~t~iled description of I~out o{prop~r~ must be drown on the di~orom which is ~ o{ thi~ ~plicotion.~ c. The work covered by this ~pplicotion m~y not bo comme~d bofore issuance of Buildin~ d. Hpon opprovol o{ this opplic~tion, th~ 8uildin~ In~p~tor will issuo o Buildinfl ~rmit to th~ ~licont. ~ch p~rmi~[ shall bo kopt on the premi~s ~voil~bl* {or inspection throughout the p~re*~ o{ th~ work. e. ~o buildin~ ,h~ll bo ~cupied or u*~d in whol~ or in po~ for ~ny pu~o~ whatever until ~ sh~ll h~ve beon Omnt~d by the Buildin~ I~p~ctor. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances bui,~i_ / od,eng c ,~ousing code, a~d regulations. (Signature of applicant, or name, if a corporation) ,. l /,Z r // 7z. / ' (Address of applicant) State whether applicant is owner, lessee, agent, architect, en{~eer general contractor, electrician, plumber or builder. ...................................................................................... ....................... ........... ............................................. Nome of owner of premise~ ..................................................................................................................... r .............................. If opplicont ~ o corporate, signature of duly outhorized officer. - (l~3me end title of corporote officer) 1. Location of land on whic/~ ~ro~w~oj~il!..b~ ~one. Map No.: ............. ~.~.~....~.....~.L.~, ..N.o...~......~.....~.....~....~ Street and Number ...¢.~..~..;.~....-..~..,~.~..~...-r:~. ................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .... ~.~..../~...~'...,~,. ........................................................................................ b. Intended use and occupancy ..... ~.'~.~/Z~_.~..~.....~'...~:::. ........................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition ...Z~ ......... Alteration .................. Repair .................. R,~moval .................. Demolition .................. Other Work (Describe) ........................................ 4. Est mated 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, speci,fy/nature and extent o~/each type of use ............ ~. .............. 7. D mens ons of ex st ng Structures, f any Front .,~7.. ............. Rear ....L..~.. ..................... Depth ..~... ........... Height ...... ..~. .............. Number of Stories ..... ./. ............................... D,mens~ons of same structure w,th alterahons or addihons: Front ....... ~..~ ...................... Rear ....~....G'.../. ............... Depth .~...~. He ght ./..~...~.~..~ ....... Number of Stories .~' .~.'~....~...~. .......... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories .................................................................................................. 9. Size of lot: Front .....2..../.~..'../.~.. ......... Rear ...... ~'...~....:..~....~... ............ Depth ......~...~...~.:./.~ ......... 10. Date of Purchase .~'.~.~../. .......................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..,~--~-~'/,~-~'.~....~..~.. ........................ 12. Does proposed construction v~iolate any zoning aw, oral nanoe or regulation? .....'~..~.. .......... ~. .................. ............ ........................ Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, ond indicate all set-back dimensions from properb/ lines. Give street and block number or description according to deed, and show street nomes and indicate whether interior or corner lot. STATE OF NEW_YORK . COUNTY OF- :.~..~ .-~.- ',/~.' .~..~ ......... ~' ~"' . .............................................................................. ~ duly ~m, d~es and says t~ he is the applicant (Nome of individual signing ~lication) above named· He is the .~.~~. .......................................................................................................................... (Contractor, agar, co~rate officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke ~d file this application; that all statements cont~in~ in this applic~ion am tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h n the ~pl c~i~. ~ the~ith Swam to befg~ me this ~ ~ ~ ~ / ' .................... ~J ........................ ~..~ ............... , lY~.~ ~ (7 ' / ......................................................... N~a~ Public, ~~.~.~oun~ (Si nature of aDulicantl ....................... ~ . ~U~ITH T. BO~EN g ~ ' Nota~ Public, State of New York No. 52-0344963 Suffolk Coun~ Commi~ion ExpJm~ March 30, ]9~ 0 ¢ % N 89" 42' IO*'W. ~ Lot N ................... _A_r_e a _-:. 2 ..760_Acres Lot M , 5p0.15' r L Lot L e4o.:re' SURVE, Y FOR LOIS PATRICIA LESNIKOWSKI LOTS M P, N ~ "SHORE ACRES", eUARAN~EOTO: MATTITUC K HOME TITLE DIVISION OF CNICAql TITLE INSURANCE CO. TOWN OF SOUTHOLD 0 VIEW Lot I DRIVE BAY · = ~NUMENT FOUND ' O · PIPE FOUND ~ LOI'S'RI~]~I TO NAP OF 8HORE~G~I~i FLED IN YOUNG & YOUNG ' " 400 OSTRANDER AVENUE, RIVERHEAD, NEW y ~Cil~ AUXIN w. YOUNG HOWARD W. YOUNG SURVEY FOR LOIS PATRICIA LESNIKOWS~ SHORE ACRES .o TOW. o~ so.~.o~' '~~~ ~,~: ,,,= ~, .o~. ,~. JAN. 8, 1973 PROF~SS~ L~ND SURV~YOR,N.~.UC.K. RIVERHEAD N.Y. Lof S-88°1 '$0"£. I;)3,06 17'4.45' o,-- $80.15' . Lot N Area = 2.760 Acres , I - Lot M SURVEY FOR LOIS PATRICIA LESNIK( LOTS M & N "SHORE ACRES" GUARANTEED TO: TOWN OF SOUTHOLD ~SUR~C~ CO. · · ~NUMENT ~UND SCALE: I" = 40' o =PIPE ~ NOV. IZ, 1968 RIVERHEAD~ N.Y,