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Home My WebLink About5782-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 2~1~.99.1 ....... Date ........... Ja~ .... 30 ...... , 19. THIS CERTIFIES that the building located at . ~enni~gs. Road ........... Street Map No.. 0~k. ridge · ti~l]~l~ No ........... Lot No. 9 ' · · Southold. · l~.o~. ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Apr~.'~ '3 .... , 19.79. pursuant to which Building Permit No. dated ......... Apr~..3 .... , 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 . P~-$vate .one..$am~..1.y .~lw®~.lJ. ng ....................................... The certificate is issued to . .Joseph..~ol'J.a ..... 0m~®l, ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .,~al~ .. 19' '1'973'' .by. R.,VJ.l~.a ..... UNDERWRITERS CERTIFICATE No .... 'V '6~I~ ..... ~1811. ~ .19e];~ ..................... ItOUSE N UMBER .... ~']~ ...... Street... J'~r'tlll.llg$ .Ilo&d- .............................. 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 PI>,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5782 Z Permission is hereby granted to: ........ .q ,~ ..r~..L ....~.g~,~'"~. Im~.. ......... .......... ~,a, e4aape~.t .... ~ ~C, ................................. at premises located at ............. G,3~j~.t~e...~x.3l ....... .~0~..4~ .......................................................... x ............................................ ,/mm,~Sa...~m~, ............. 8~t,i~l.d ................................................... pursuant to application dated ...........................~.~J~.....~ ....... ~..., 19..-~.., and' approved by the; Building Inspector. / ! '~- -~uildin'g Inspector FORM NO, 6 TOWN OF SOUTHOLD Building Department 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. ,~:curate 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. Date J..~nuary 22. 1973 New Building X Old or Pre-existing Building Vacant Land Location Of Property S/S Jennings Road, Lo~ #90~kridge Hills Southold, N. Y. Owner Or Owners Of Property Joseph Laria Subdivision 0akrid~e Hill s -~+ 9 ................. ~. ............................................. -v. No ............. Block No ............. House No ............. Permit No..5.~..8..2....~ ...... Dote Of Permit .,~.-..~..-..7..~.....Applicant ......... Q, ~, ~.owell J~n. ]9~ 1973 Health Dept. Approval .... ~ ........ ;.-, ....... : .................. Luuur Dept. Approval ................................................ Jan 5, 1973 Underwriters Approvo~ ..................... [ ........................ Planning Board Approva~ ........................................ XvX Request For Temporary Certificate ........................................ Final Certificate .:.;n~ ................................... Fee Submitted $ ,~.:.[~.q ......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ~ ...1~......~).~..'.......~../.~.. ~. ,,, .~ ......... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference Data ~eet L~, 0 10 ~ 12 ?" : : ,.,,r,,/ ~ e The Undersigned CERTIFIES: "Construction of authorized installat 11 be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, ~ and amendments thereto, covering Private Sewage Disposal Systems". / / . Date · ' ~ ~ Signed ~ - ...... / ~'~,~ ~ " ~ Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewi~k~ it is the opinion of the Health Depa~ment, that an adequate and satisfactory Sewage~isposal System Ta: Ca pa city&~t__Gal s. can be installed on this Plot. (lo/65 Revis.) s-15 Signed +~ O o~ 0 I~o EASTERN DISTRICT, RIVERHEAD,N.Y. APPL~TION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Appel to 'construct said systems is requested,pertinent data herewith: Date 1-Applicant (~ ~' i~"ll PhoneT;~'oyw~6-Subdiv O/t~, Address ~',~d, V~,,, M ~i, ,x O- u ~ ,~ ~'/d/% ~ 'r ~ty 7-Section 2-Detailed property location J¢,/I/~tu{ ) .;~* O 8-Lot NO.' 'f Hamlet _L, ,-, D~, c ~ Town ~: ,/r-~ ~. o 9-Private well? ,~'~-~ 3-Public water suppl~y name ,'~/. ~& Distance to nearest main 4-Lot Size: Width l~d ft. Len, gth ~¥~ ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~ Two Family? ~ ~Cellar? L~Slab? LJcrawl Space? 10-Proposed system: septic tank ~ ~Precast ~ ~Cesspools ~Q~Shallow pools il-Septic tank inside dimensions: Volu~,e~Gals. Length.__ft. Width ft. Liquid depth ft. 12-Precast sections: ~JNumber~Square Ft. Cesspools: Block si.zeL__incs.D ins. H--ins. Total blocks below inlet: ~1 ~2 ~3 .:, , r~. ~ . ~ ';' f · PLOT PLAN ~ ..... ~ (, l) -c -' ' ': ".--~ Approved ................. !,~ ..................... , 19.:.t, .... Pemit No...,~...?...,~,,,.~...~ ........ Disapproved a/c ..,,~..~ ...................................................... l~Ol~I NO. ! BUILDING DEPARTMENT ~~/7~ TOWN CLERK'S OFFICE . , , ,,, ,, SOUTHOLD, N. Y. .... APPLICATION FOR BUILDING PERMIT Date .......... ~1~, ~,.~....~ ...................... , ] 9.?_~,~ ..... an This application must be completely filled in by ~pewriter or in ' d submitted in duplicate to the B Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part 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 shall be kept on the premises available for inspection throughout the progress of 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 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, 6r name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................... .,..z. ................................................................................................................................................ Name of owner of premises ....... ~.e..~l..e.~..b...~..a~T..~.~. .............................................................................................. If applicant is a corporate, signature of duly authorized officer. ........................................................................................ ,/£ (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ......~.~.~ ......... Lot No ......... Street and Number ..J..?~....~..i...a.t~'..s..R..?..~.~ ,~.o¢~%hol.;l, ,~, Ye ................ "~/ ........... '""'"'"'"'"'"'"'"'"'"'"'"'"'"'"'"'"'""'""Municipality ........ '"'"'"'"'""'"'"'"'""'"" 2. State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: a. Exisiting use and occupancy Bu:itclltlsg T~ot, b. Intended use and occupancy Restdea%i&l dvelll~.g . BUILDING DEPARTMENT ~'~,/'Z'~-. TO~ CLERK~ OFFICE/~/~,/.~ ~UTH~D, H.Y. ~ .... ............ ........ .............. ................. ,: ..................... , .... ........ Oisappr~ a/c .................... : .............. : ..... ~;;;~ ................................. APPLICATION FOR BUILDING PERMIT ~at, ......... ~.~..~ ...................... , ' I NSTRU~IONS o. Thi~ application mu,t be completely fill~ in by ~writ~r or in ink and ~ubmitt~ in ~li~at~ In~tor. b. Plot plan showing I~ation of lot and of buildings ~ premises, relationship to adjoining premises or public stre~ ar~s, and giving a detailed de~ription of layout ofpr~e~ must be drawn an the diagram which is c. ~e work cover~ by this a~lication may not be comme~ed before i~nce of Building Permit. d. Upon approval of this application, ~e Building Inspector will issue a Building Pe~it to the ~licant. Such shall ~ kept ~ the premises ~ailable for insp~ti~ ~r~gh~t the p~re~'of the work. e. No building shall be ~cupied or u~d in whole or in pa~ for any pu~e wh~er until a Ce~ifkate of ~cupancy shall h~e been gmnt~ by the Building Ink,tar. · 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 Southolc~, 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, ordinaqces, building code, housing code, and regulations, .......... i..?~ ,,?, ~..... C..:., ~..~ .~..,. ~ ................................. (Sighoture of opphcont~ 6r name. if a corporotian) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................... ~.~3.~ .................................................................................................................................................. Name of owner of premises ....... ~..e..IEg~..~eR~. ......................................................... : .................................................. .,~ If applicant is a co~orate, signature of duly authorized officer. ~ .................. ~..~..~;.~..~.~.~.,~.~ ......... ~ ~g ~ 1. L~atJ~ of la~ on which pr~o~d work will be done. Mop No.: ~ Lot No. ~ Strut and Number ..~.....~ ....................................................................... ,....~ .............................................. ~nici~li~ ~ 2. State existing u~ a~ ~cu~y of premiss a~ intended u~ and ~cu~ncy*~f p~ c~stmction: ~ a. ~isiting ~ a~ ~cupancy .... ~.~ ~ .... ~ b. Intended u~ o~d ~cu~Ky ...... ~ ...................................................................................................... 3. Nature of work (check which applicable): New Building .... ~ ...... Addition :' 'x .................. Alterotmn .: ................ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..~lJ~Jl.~ ........................................... Fee .......................................................................................... (to be paid on filing this applicatiOn) §. If dwelling, number of dwelling units ....... ~ ............. Number of dwelling units on each floor .11¢t,~. ................... 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 ...~,~L.gl" .................. Rear ............................ Depth ..~.? ............... Height ..~.I. ........... Number of Stories ...... .¢1~. ................ ~ 9. Size of lot: Front .~...~. .................... Rear ..~1~ ........................... Depth ..~.~.~..e...~. ................ ~ 10. Data'of Purchase ........................................................ Name of Former Owner ........................................... ; ............ 1 1. Zone or use district Jn which premises are situated ..~'U~4¢1~,%~, ................................................... '!. 12. DOes proposed construction violate any zoning law, ordinance or regulation? ....milt ...................................... 13. Name of Owner of premises ~..~..~...1~....~..~. ........... Address .}l~..~e~lE ....................... Phone No.~.~...~. Name of Architect ..................................................... Address li,~ll' ~,gt~'k Phone No.~.~.~....~. Locate clearly a~ :1 distinCtly all hud nn~ whnth~, o~;~*:-; ..... ;---~, '~nd ind cate all set ...... . : -- r .... oder, almens ons Tram property lines. Give treet and block number or descriptipn according to ~e~, and shew street names and indicate whether interior or co ~er lot. / -~ "~° ~ ~-.-__* / STATE OF NEW YORK, ! c c COUNTY OF ....................... ,,',,.....$'~ ~ n ............. ~....L~'~ ............................... being duly sworn, deposes and says that he is the applicant (Name of individual Signing application) above named. He is the ........................... ~l~ ............................................................ (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 thework will be performed in the manner set forth in the application filed therewith. Swam to~(or~ me this ~ ~ ~ 4 Notary Publi .. County (Signature of applicant) JUDITH T. BOK1EN Notary Public, State of New York Ne. 52-0344963 Suffolk Count~y/~ Commission Expires March 30, ~9~/_.~ : ../ ~T ENh, IINGS ROAD iO.O Lot. · T0 0 verton V,,,,,, -Fu,~L ,~ So. 0 Iq. h'~' ~.5'00~ E. 4 T'"'- ~tELL 9 ~o.o AS SUP. YEYED ~ , I~ ~opEpjc~ v^N TUYk~. DEPARTHEHT OF HEALTH RIVERHEAD. N.¥. JAN 19 AH 3: rio RO~,D Lo t, G ~o,0 J'OSEPH $OU~.~OLD (D Su~Foi.~ C, .u~'r¥, N.Y. J ENNi 50.0 ~ OUTHOLD FP-.o N4T E L t~ V4,,T I o I'q I' "ME g- k/IP...5 ..,~¢,SEP~ 1::7E r5" ,. LEFT 51DE ELEVATION .R, Idtd"r' ~IDE ELEVA, TIOt'q 9t7'' ',,s~ BED~.OO kd LiVI N.IC5 'P.O o ~'-4 FIP-.STFLOOP, PLAI'q 7L 0" FOL)~ D~TI Cflt'-4 PLaN 19- TO FOUUOATION u~1 ~/~'~I~,"L~' ~'/Z"I~ ¢o~JCi~£TE F~L[EO LA[L)' ~'o[u~4~45 ALUH OuTIEg &:LEAD£~-S . ~P. 055 ' PLOT