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Home My WebLink About5795-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z..~0.~.~. ..... Date ........... .l~a;k~h .....? ..... , 1973.. THIS CERTIFIES that the building located at . ilbo. D.l.i~'e ............... Street Map No..XX ........ Block No. x,~ ....... Lot No... :x~...La~ral.. N.,Y, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Apl' ....~ ...., 19.72. pursuant to which Building Permit No.5~.9~Z. · · dated ......... A~l.il ... ~..., 19. ?2, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~sued is . i~l.~vat®..one. ~l.y .d¥~.ling ....................................... '~'~. The certificate is issued to .~/ill:l~. B~ock, ........ oYner .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Dee.. '$3' 1922 .... .by. It,..Villa .... UNDERWRITERS CERTIFICATE No .... .pSl~lll~ ..................................... HOUSE NUMBER ..... ~ ..... Street .....~klb~. ])I~-V~ ................................ Building Inspector ( FOBM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N.. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 5795 Z Permission is hereby granted to: at premises located at ..... ,~1~.~1~ ..................................................................................................... .......................................................... · amm~,....I,~.o ......................................................................... pursuant to application doted ......................... ~spll~.....~ ........... , 1 .~......., ond opprov~ by the Building Ink.tar. Fee ~...~..e.~..~. ............. Builaing Inspector FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerk~ 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 ar 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 Dote ......... ./:?./!. ~'... J. ~....'~¢.. ............... New Building ....... .~.....e~...... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....~......~...~ ...... ..~..~./..~....~.. ....... ..~....~..~..~....~-...~'..../....~...'...~..' ................................................... Owner Or Owners Of Property ..~~.....,~.....~..~ ........ ..~...'...~....~.~ ............................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..?..~..~....'~.. ...... Date Of Permit .................... Applicant ~,.~:.~:~.]~D~.~L....~..~.~......~.~;~.~:.~; ~ f/,/'c. Health Dept. Approval ......?...e.~.~. ............................ Labor Dept. Approval ................................................ Underwriters Approval .ff.~.4.....;.~...~..~..~..~..~ .......... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .... ..¥'...~:...~ ............................ Fee Submitted $ .;.~.....~..~ ...................... Construction on above described building and~,permit meets~;all applicabl.~d~e~nd regulations. Sworn to before me this ~x'~(~. ....~..,~. ....... day of Notary Public~%.~..'~..-~ .....'~'~Z-County TERR1 LEE ELAK NOTARY PUBL C, S[a~e of New Y0r~ (stamp or seal) SUFFOLK COUNTY DEPARTHENT OF HEALTH H.D.Reference No ~ ~ ' ~ ' / · /OO . APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1-Applicant ~ i%~h;~ '~ ~C¢1~ Pho~ne~5'~.~6-Sub div. 2-Detailedproperty location ~flt ~¢ /~C.~¥]~c,W |~;~k~$-Lot No. Hamletk~9~i Town ~OcT~i~ ' 9-Private well? 3-Public water Supply name Distance to nearest main 4-Lot Size: Width~O ft. Length3-~O ft. (also enter on center plot plan below:) 5-Dwelling: Singl.e Family ~V'~ Two Family? ~ /Cellar? ~'/.Slab? ~_~Crawl Sp?ce? 10-Proposed system. Septic tank ~ /Preca,st ~Cesspools / /Shallow pools !/Other / il-Septic tank inside dimensions: Volume~~ Gals.Length ft. Width ft. Liquid depth . .~t. 12-Precast sections: /L5/Number/~]~Square Ft. Cesspools: Block sizeL incs.D ins. H mns. Total blocks below inlet: PLOT PLAN Capacity ~ ~als Data ~eet 0 2 6 8 lO 12 ~th ~ ~ Indi ~ '~ No 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". Date Signed ~, ~ ~-~ ~ Owner 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 Signed .-- (10/65 Revis.) S-15 TOWN OF SOUTHOLD BUILDING DEPARTMENT 7/ ~L~;~ TOWN CLiIK'S OFFICE ~, ~ ~UTHOLD, N. Y. ~"~"~ .... ~..~.~ ............. ~ ............... , ~..~ .....~ ~ ~ .~ ~¢~.,o, No....~,, . ~..~ ............ ~r~ ........................................ , ~9 ........ PemitN~ ....... : ...................... ~* ~ .... ................................... .- . , ,..,.._ '"'Y'z. "t APPLICATION FOR IUILDING PI~MIT .~~' ] Date ..................... .%;..,..;, .......... ,19 ............ INSTRUCTIONS l'- a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~l~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. 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 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 Pern~it. ' ~ 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 work. e. No building shall be occupied or used in whole or in pert 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, and to admit authorized inspectors on premises and in buildings for necassery inspections. (Signature of applicant, or name, if a corpbration) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises ........ v~ ....... z ................... ,~.; ...................... ,, ........... ~ ..................................................... If applicant is a corporate, signature of duly authorizod offi~r. (Name and title of corporate officer) 1. Location of land on which prop(~d work will be done. Mao No.: .................... Lot No .............................................. Street and Number ..~..'. JJ'- !...~.....~... ....~.....~.. J ..~.....~...'~.... Munici~li~ 2. S~ exi~ing um and ~upancy of premi~ and in~nd~ u~ and ~cupancy of propomd con~mction: a. Exi~ing u~ and ~upancy .................................................................................................................................... b. Inten~du~and~upancy .... ' , '~ ~ ,/ ~., f~ 3.':~l~eture of work (check which applicable): New Building .........;;.~ .......... Addition ..................... Alteration.....;..;.~;"... Repair ......................... Removal ......................... Demolition ........................ Other Work ....... .................... . ........ : (Description) /o {to be paid on filing this application) 5. If dwelling, number of dwelling units ..~.. Number of dwe~ij~g un~l;s on each floor ......................................... . If garage, number of cars ................ · .~......, ........................ ~'.~.. .............................................................. 6. If business, commercial or mixed occupancy, specify nature end extant 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 ......................................... Nu tuber of Stories ........................................ 8. Dimensions of entire new construction: Fr°nt ......... '~'*~.~....'../.. ..... Rear .............. "-'"'~..../.. ..... Depth ........ ".~....~ ............ Height ............................................ "... Number of Stories ....~.:'..i ............................................................... 9. Size of lot: Front .......... ~(..:.¥...% ................ Rear ....... ~...~....¥.. ...................... Depth ....... ¢..../.... .......... /......; ................. Height ........................................ , ........... Number of Stories ................ ~..~..~.....~l..~r ........................................ 10. ,Date of Pumhase .......... 0..:....;........~. ........ Name of Former Owner ............................................................................ 11. Zone or use district in which premises are s~tueted ........... ./3.. ............ :...'~..;; ....... :, ......................................................... 12. Does proposed construction violate any zoning law. ordinance or regulation: ......... ../...V....?.. ....................................... 13. Will lot be regreded .......... ~.. ........... Will excasa flll be removed from premises: [ ] Yes [J~o 14. Name of Owner of promises ..... ......; ...................... .................................... . ................................................................ (Address) (Phone No.) Name of Arch,tact ..................................................................................................................................................... ~ ( d ) P~..~Oue No.) Name of Contractor ................................. ; .................................... : .......... ; .............................. ;....~.{ ....... ; .................. (Address) , (Phone No.) PLOT DIAGRAM Locate clearly and distinctly ell buildings, whether existing or proposed, and indicate all sat-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or comer lot. STAT~ O~ .~W ¥o~4/, ~ . i cou. ............. i ............. !~.: Ii...~..L.~.../..: ............... :.ii..~..../.i~......~.. ......... ' .................... bain · ' " (Name o£indivldual signing coh~t) ~ ne~d He is the ................................................................................................................................................................................................................. (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 the work will be performed in the manner set forth in the application filed therewith. JUDITH T. BOKEN ~ ~,~ Nota~y~ublic, Store of New. York ~ de of .................................. y ............................ ,......~ ..... ~,~ · · ~'.~.~Comr~io~ Expi~s Marcn ou, ~y,.~-, . __j,~ , //..~.J-/ ~~ /~/~( C~ '7-'/~ ~- ................... ....... : .......... ................................... 'OS '3^ ,, i,..Hi~ . ~~,, 46.O ~P 5UIZVE-YE.D WILLIA T.... 51TU~,Te OF P'Ol2. /~AT Ti TUCK '[OWN OF- 50UTI..IOLD, N.y. SC, ALE, ~= llZON IN = ~ONUI~ENT ~ '= WELL All ~ Ck$~POOL V~ki TU~/L ~ this d .... ' ...... ave been ~-.'..~ s~.~'o~ ~r:~nt and foun~ 5~ALE, ~0'- ~ COPIES OF THIS SUeVE¥ ~O'~. 1'~ LA~o SU -~ ~,P Nor I-I LL JL_ RIGHT SIDE ELEVATION ~C,.~/..E .* ,~" -- ('--0" · FRONT ELEVATION L SECTION REAR I I ELEVATION -I LEFT SIDE ELEVATION R- 1 8 7' PLAN- I SHEET- I DESIGN- B REVERSE TOTAL-$ , __5 RANGE I~ REF'G. WALL '~t:o" SINK WALL GENERAL NOTES _ 4~//~ ~ rDTM . ~'-I"~ ~oo~ 7~,. ~' JJ BATH ~ ~ ~ ~ 'o "- _ , _ ~ , , , ,, ~ ~ ~ ,~ - -- - X ,' ~ ~( 'g ~ / ]I ~ f-b'~ 7-~ bo~b~el~ 'J~J J ~ ~, ~l / s ~ ~r~' ~,J.I s~" ~'-roi" ] ~ ~ ~ ~ ': I[~ IP " I FLOOR PLAN s'c,~ ~ ' 7.~ -o" JR-187' PLAN-I ISHEET- a DESIGN - B REVERSE ITOTAL- $ 'I t~ 2 "x 4-" - {; "o.C. GARAGE ROOF DETAIL ;: "w ¥ " / MAIN WALL SECTION STAIR CoxJe. A-r '~. DETAIL ~'~ l '-~" 7'"u.F F$.3 PORCH PLO' PLAN CORN ICE D E,TAI L .5c4~-~- ,. ~ "-- ( '~o" $d/~%'4./G u,/e~ R-187 DESIGN-B PLAN - I [SHEET- REVERSE ITOTAL- $ ~ 'b.C. {"x ~." !"x [o" Cdr' ~,%,~,,