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Home My WebLink About5787-zFORM NO. 4 ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z1~957. ...... Date ............ ,Tan.. 2/~ ....... , lg. ~3 THIS CERTIFIES that the building located at Dlippar. Dr,.ye ............ Street Map No. tiaa. bot. 3~.g!~ck No ...........Lot No .... 38 .... God, old ............... conforms substantially to the Application for Buildin~ Permit heretofore fil~ in th~ office dat~ ...........Apt. il....~, 19.7~ p~su~t to which B~ld~g Permit No..~8~ · dated ..........Apr~l ·. ·..., 19.7.2, was issued, ~d conforms to all of ~e require ments of the applicable pro~sio~ of the law. ~e occup~cy for which ~is ce~ificate is issued is . ~lW$~.. ~n~..i~Z~. ~a155~I ....................................... The certificate is issu~ to ... ~eph~ .~. ;,:ar~.l~e. Dl~a ....... ~er~ ......... (owner, lessee or tenant) of the afores~d b~M~g. Suffolk Co~ty Dep~tment of Health Approval .~an..2~..1.973...b~. ~ .~i1~.... .... ........ HOUS~ NUMBER ...... ~0 .... Street .... ~pp~r .Dr ................................. ~ ~chor L~e Buildin~ Inspector FORM 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? 5787 Z Date ..................... ~,~:j .......J~ ................ 19..~,. Permission is hereby granted to: ..... ~.1; ~;~i~,~...~... ~ ~z,]~x ~t, .~.. ~. ;t~,.~ .............. ................... ~ ~u~o.l.~l.. tt.,.'. · ~ ............................. tO ......... J, ........... Z.'. ....... J. .......... : ....... ~. ........... ;.:;.,....~ ............................................................................... at premises located at .......10~...~ .......}h'~rl~...l~,6}~tS.....~-'4~ ................................................... ............................................. O~ppe r ..&.'~ne.h~r -'Lc ................. J~itll~Td"Jl';~'~ ..................... pursuant to application dated ......................J~.~.~-~, ........................ , ~. ....... , and approved by the Building Inspector. Fee $.9.1.., ~'.~ ........... t g sp tor~ FO~M NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Sonthold, N. ¥. 11971 APPLIGATION 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. 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 $5,00 ......... New Building....................~ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property Clipper Drive & Anchor Lane Owner Or Owners Of Property ..~..t..e.~..h..~,n ........................................................................................ & Mar~tie Diz~a .... 1 Harbor Lights Subdivision ................................................................ Lot No..-~.~. ...... Block No ............. House No ........ ~O. Permit No..~.?..8.?..~.. ....... Date Of Permit ..~.P.~.".....bC....~..~pplicant ..... .~.......~.e.~..~...o.~.~.......-.....~..~...:i...1.~..e.~. ....... Health Dept. Approval ...~.$~.....~.....J.~.~.~ .......... Labor Dept. Approval ........... ~.*...~..*. ........................... Underwriters Approval ..~.~.c~r.~. ....... ~).q~....'l..1...~.Planning Board Approval ...... ~..*.~.? ......................... Request For Temporary Certificate ........................................ Final Certificate .......... ~ ........................ Fee Submitted $ ,~. ?. .0. . .0. .......................... Anchor Clipper Construction on above described building and permit meets all opplicable~)des and regulations. Sworn to before me this ......... ~.6... day of ..... r-T..a..~..g~..~...J.C~ .......... No~ry Public ........... ~ County (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTH ,, , ~ H.D.Reference No APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to ~o.nst~ruct said system, s is bequ,~ed~i~n~n_~ ~t~6h~ .Date ~ 1 Applic~ f ~~ ' - - 'z n~¢ ~ ~ Address ~,~D /71-~,~. ~,~J. ~~ , ?-Sec~'o ~mlet~ ~ To~_~ 9-Private well? ~ 3-~bli~ ~ter supply ~me Distance to nearest ~in ~ . $-~t Size: Width ~ ~O ft. Length~ft. (also 'enter on center plot plan below.) 5-~elling: Single Family ;~T~ Family? ;~]Cellar? ~ /Slab? ~ ~Crawl S~ce7 ~ / 10-Pro~s~ syst~: Septic %a~k ~ /Precast'~'/Cesspools ~Shallow ~ols / /Other / / il-Septic ta~ inside dimensions: Vol~e Gals. Length~t. Width ft. Liquid depth ft. 12-~ecast sections: / ~umber/ /Square Ft. Cesspools: Block size~incs.D ~s.H ins. Total blocks below inlet: ~llfO~2lfo ~3 ~T PLAN Ca.city v~als. G.P.M. rade moe ~ o z ~ .rote ~th Data ~eet 0 2 6 8 10 12 Street ~ ~ ~ Ind~ ~ ~ No The Undersi~n~ CERTIF~S: "Const~ction of authorized installations will be in acco~ance with the Suffolk County Health De~ments' current Standa~s, Bulletins, a~ amendments thereto, covering Private ~ S ~ge D?~sa~ Systems". Date S~gn~ FOR ~LTH D~P~RT~T ~S~ O~LY, Ba~ on gh~ 5nfomagSon p,osong~d h~ro~h~ op~nSon of ~he H~lgh D~m,ng~ ~ha~ an adoq~ and ,a~Ssfaego~ can b~ ~nsgall,d on ghS~ Date ~/~-- SiEn~ ~ --~ (10/65 Revis.) S-15 TOWN OF SOUTHOLD /~'/ TOWN CLERK'S OFFIG~ ~0THOLD, N. Y. "omined ..... ~......~ ........... , 19.~.~ Application No ...... ~ ...... * ............ ~pr~ ~ 19 ........ Pemit No. ~ e Di~ppr~ed a/c ' ~/~' ...... .............................. .................. ........ ...................... ~ ~ - (Buil'~C~t) ~/'/~"~ ~'~J/ APPLICATION FOR'BUILDING PERMIT L~l Date April $ 72 · ................................................ , 19 ............ INSTRUCTIONS ~ ~ e~This ~ppli~fion must ~ completely filled in by ~writer or in ink ~nd submitted in tripli~te to the Building Inspe~or, w~ ~ 3 ~ts of plans, accurate plot plan to scale. Fee a~ordiflg to schedule. ~ b. Plot plan showing location of lot and of buildings on premiss, relationship to adjoining premises or public streets or areas, and giving a ~taiied description of layout of pro~rty must ~ drawn on diagram which is ~of this application. c. T~ wo~ covered by this application may not ~ commen~d ~fore issuance of Bui~di~ Permit. ~ d. U~n a~roval of this application, ~be Building Ins~or will issue a Building Permit to the applicant. Such ~rmit shaft be ke~ ~e ~mim available for ins~ion throughout the work· e. No ~iMi~ shell ~ occupied or u~d in whole or in part for any purpo~ whatever ~nfil a Certificate of O~U~n~ shell have ~n~ ~an~ by t~ Building Ins~or. ~ 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, Suffotk 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 building~for necessary inspections. Julius Zebroski (Signature of applicant, or name, if a corpOration) S outhold N .Y. (Address of applicant) State whether, applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. Contractor - & Agent owner of premises .... S..be~,he~..&....~.[..a:~.~..~.?..~.e......?.~.~, ............................................................................ Name of 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.: ...~l~;~...~t,B Lot No ............... 3.~ .......................... Street and Number ................ C.~..i~pe.r...~z~ ........... ,$~z~o.I~.....N~.~ ................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Vacant ..................................... a. Existing use and occupancy ............................................................................................... b. Intended use and occupancy ........ ,...oz~e..,f. ami;L.~..d~e&[~a~: ~/~.g ~J _~:~' ........... ~'~'~: ............. · 3. Nature of work (check which applicable): New Building ....... ~ ........ Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ................ $..~.~...QQ(~....+. .....Fee ..... .~.?.,.,..6...5'. ............................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... (~z&e.... 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 ...~(~! ...... 1~.... Rear ........ ~'~!.,,.1~3 ...... Depth ...~,~.D~...~,~.0. two Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ........... ,..1...1:~). ................ Rear ............ .1..1...0. ....................... Depth ........ .1.,.8.2".. .................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ........... ~.~3: ..................................................... 11. Zone or use district in which premises are situated n . .............. ~. ....... d. ts.t ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .............. n~ ......................................... 13. W'll lot be regreded ., yes ....................W~ll excess fill be removed from premises: [ ] Yes [3J No D inka 14. Name of Owner of premises ...6.~...&.~ ............................................................................................................. ; ....... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ..aT.,...Z..fJ~,l:'.g~;L ................................................... ..~..q.~,.~ .~.g.~..~. ............................................... (Address) (Phone No.) PLOT DIAG RAM Locate clearly end distinctly all buildings, whether existing or proposed, end indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names end indicate wheth- er interior or corner lot. See filed plans STATEOF NEWYORK, ) S~ COUNTYOF .............. ~m~ .................... ) ........................................................ ~12~$...~.~'.Q~.~;;L ........ being duly sworn, deposes and says that he is the appli~nt abo~ named. (Na~ of in~vi~l ~l~t~ con~t)~ Ha ia tha ................................. ~ae.~=..~.~ge~ .............................................................................................................................. {~n~ctor, ~t, coyote o~, e~.} of said owner or owners, and i~ duly authorized to ~Horm or ha~ ~rfor~d the acid work and to make and file this appli~tion; that all ~te~n~ con~in~ in this appli~tion are true to t~ ~st of his ~owled~ and ~lief; and that the work will ~ ~Hor~ in ~e manor JUDITH T. BOKEN ~t fo~h in the ap~ication fil~ t~rewith, No/a~ Public, Stele of New Y~ ....................... , ....... =....day o~ ....................... ~.~.~,1~.]9~ - ~' 4 , ~ ~ .... ............................ ............... D --- /Aol'J, UiA~klT ~OUT~ LF2 LGT 6.5 75 9O IO 'WINDOw SCHEDULE ~GT VENT CODE LGT Z V 0 UC ~4 ~ ZG 460 U9 172 8 5 VW 4764 ' t56 EL 6 5 ~6 J F LEFT ¢IDE ELEV. IW DATE NATIoN,AL FfOMEs COf~p ,7 ,-.. LE T ON NW No i FAMILY ROOM1 GARAGE,.. DINETT 'i N ,IAL HOMES TCHEN 'x . .'~L~',i V i NG ~'I 0~;~ A~'D "Pd0 CAR ~APJ~GES NOTE; I, AIl interior d]n~nslons ere taken to stud Ilne,~ All Interior partitions a~e 3 5/8" unless noted otherwise'. TOTAL · STOR~,GE INSIDE __ TOTAL ~J~ODEL' RH FLOOR SE'CON D FLO,)~ 2x4 IN PA RTl q-ION.5 NAT, IONAL, ' HOMES ' EXTENSIONS NOT AVAILABLE DATE G/ . DATE REVISION $ '[~O :,t.'fff USE 'FOR R~UNDATIO~ ,.' iC0~,.. ,,x. 10N- SEE FOU~AT ON PLAI~