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Home My WebLink About5796-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~..~.9~ ....... Date .............. ~o¥0~a. er.. a, 19.72. THIS CERTIFIES that the building located at . ~..~a .a_hWgo.~....IO~..e .......... Street Map No. l~;tJ;It¥OO~. Block No ........... Lot No. ~6 ...... $O. tl~XO~!.. 1~.,.~, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ..~... ;~819.7.2. pursuant to which Building Permit No.. dated ...........A~r~....~..., 19.72., 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_r:~V.~e. or~. ~ttl~r..¢lweJ;!_~_n_g ....................................... The certificate is issued to ...(iel~a~,~e...IA~;.t,l.o ....... 0~ne~. ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . I~0~'. ~ ~..197~..l~J'. R,. V;LLI. a ...... UNDERWRITERS CERTIEICATE No .... ~. ~l ] .~. .................................... ]lOUSE NUMBER..1~0 ........ Street ..... l]O&O~O.0, .l~,lX~ ............................ Bttilding Inspector ]~0~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPL£TION OF THE WORK AUTHORIZED) 5796 Z Permission is hereby granted to: ....... .e...,.~..,..n....~...~..~....~.~.,...~ .~.....~.~..~....m~. s~e ~ttze at premises located at ......... ...~..~..~.,~.....,~.~,,¢~. .......................................................................... .............................. ~.~.~A1~m~A..X.~tm .............. ~o~t~ole...li.Z. .................................................. pursuant to application dated ............ ~ ............ JJ~JJJ~.~,JJ....., 19eq~..., and approved by the Building Inspector. Fee $.~....~...~. ......... I~I~'M NO. 6 TOWN OF ~OUTHOLD Building Department Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFIGATE 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: I. Final survey of property with accurate location of all buildings, property lines, streets, end unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispcsal--(S-9 farm 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 opplioable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: !. Accurate survey o~ 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 $5.00 3. Copy of certificate of occupancy $1.00 V. New Building .................... Old or Pre-existing Building ............................ ¥ocant Land ............................ Location Of Property ..~,.~...~...~...~..,o~)......Jm~..~.....~..~........~¥.a..~..~..~...,.~.....~.. ............................ Owner Or Owners Of Property ~..~..~.~ ~./~'~. ~,.~/-..~:.. . Subdivision ............................. Lot mock No ............. ouse ............ Permit No~...~....~...~...~... Date Of Permit ..~./~./~......~'X~. pplicant .~.~..:..,~~,j.~-.. Health D~pt. Approval ............................................ Labor E~pt. Approval ................................................ Underwriters Approval . .~....~.~...~.,~.L2~ .........Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ ..................................... Fee Submitted $ ................... Construction on above described building and~ermit meet~~f~~ oil applic/ol, ec~es ~d.//~ J~'/'"~ regulations. ~plicant ..~~..~.~.~ ....................... Sworn to before me ~is ~ ~ · ..~ ....... day of .~~..L~]~ ..... (stamp or seal) ~ ~ Notary Public ~-~-~.~.....~S-~.. County TERRI LEE ELAK NOTARY PUBLIC, State of New York No. 52-6168295 Qualified in Suff01k County Commission Expires I~]srch S-9 SCHD SUFFOLK COUNTY DEPARTHEHT OF HEALTH Date NOV 1 19'/2 Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located have been inspected by this department and found to be satisfactory. ............. - ...... SUFFOLK COUNTY DEPARTMENT OF HEALTH Date 7-Section 8-Lot No. / g 9-Private well? 3-Public water supply name, , · i ~. ~ · Distance to nearest main ,! 4-Lot Size: Width ~ ~,ft. Length~ ~ft. (also enter on center plot plan below:) 5-Dweiling: SingYJ Family ~ Two Family? ! /Cellar? ~f~_fS~ab? ! /Crawl S~ce? / 10-Proposed system: Septic tank f~Precast ~Cesspools ~*/Shallow pools / /Other ii-Septic tank inside dimensions: Volume Gals. Length ft. Width ft. Liquid depth rS. 12-Precast sections: /~;Number/ /Square Ft. Cesspools: Block sizeL incs.D ins. H · ins. Total blocks below inlet: ~ ~2/~ ~3 PLOT PLAN ~ ~ No The Undersigned CERTIF~S: "Construction of authorized installation accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems".~ Own~ 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 Street g Data ~eet b,~zv ~ 2 8 lO 12 18 ~te ~h will be in EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herew~th: 1-Applicant · ~ ~, ~ ~-~ ~ ' · Phone Address 2-Detailed property location j , ,? Hamlet.- Town TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined .....~ ...................... , 19Z..~.. Approved . ~ , ~ / 19 ........ Permit No..~....?...~.....~...~ Application No. /C'-2 x~ ~ Disapproved a/c ................................................... .~ APPLICATION FOR BUILDING PERMrI' Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und submitted in duplicate to the Building~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to ad olning premises or public streets or~' areas, and giving o detailed description of layout of property must be drawn an the diagram which II pert of thio application.~ c. The work covered by this application may not be commenced before issuance of Building Permit. S~ d Upon approval of this application, the Building InspeCtor will issue a Buildtng Permit to the applicant. Such permit'''~ shall be kept on the premises available for inspection throughout the pr~ress of the work. ~ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc~.~ shall have been granted by the Building Inspectoc APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pureuant to the Building Zone Ordinance of the Town of Southold Suffolk County, New York, and other applicable Lawl, Ordinances or Regulations, for the construction of bui dings, additions or alterations, or for remova or demo ition, al herein described. The applicant agrees to comply with all applicable laws, ordinances, building cod~)housing code, and regulations. (~fgnature cf applicant, or name, if a corporation) State whether applicant ts owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. I~y. pli~:~duly authorized officer. ~ ~_1 ~ ~'% .... ............. (Name and title 'of corporate officer) ~_~.._~ ~' ~- ( ~ ( ~ ' A. Location of land on which propo'~ed work will be dane. Mop No.: ........................................ Lot No.: ..]..~ ............... Street and Number ~'.~c'.~.X~.~.. ~..~ .i~...~....L.~:..d~.]..~,~ ................................................................................ 0~)3 Municipality 2. State existing use a~d occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~/.~...~.~..~...~........~,.~..~..~:l ........................................................................... b. Intended use ond occupon:', ........................................................................................ 3. Nature of work (check which applicable): New Building ~...~... ....... Addition ................ Alteration ....... .". .... Repair ............. ::~. Removal .................. Demolition .................. Other Work (Describe) ................................... 4. Estimated Cost ..... ~...~...~ ................................ Fee ........................................................................ (to be paid on fi!lng 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, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, Jf any: Front ....~ .......... Rear .....~ ............ Depth ...'ff~' ....... ~ Height ..-/J~...~ ....... 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 ...~..~,~.~.~..~ ................. Rear ...~..~...~.~...~.. ....... Depth ../J~....~. ............ Height ../.~...~..~..... Number of Stories ..... ~ ................................................................................................ .:.. 9. Size of lot: Front ..J..~l',~..,~'..z~.. ...... Rear ....... ~..~..~..~7,.z: ......... Depth ...e~..O..~....~..~'.. ........ 10. Date of Purchase,,- .................................................... Nome of Former Owner ................................................ 11. Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning ~w, ordinance or.~.~u),a~i,oj:l~/_u:._ _/~..~..~ ............................................ 13. Name of Owner of pram ses~.~..~..Address ' ............ Phone No ..................... Name of Architect .................................................... Address Phone No .................... Nome of Contractor~,4/,.~.~l~...l("..,~.....Address ~::::::::::: Phone No.~..~,5..~.~.~..~..~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block, number or description according to deed, and show street names and indicate ,~hether interior or carrier Jot. ~ STATE OF NEW YORK, lee COUNTY OF ................................ $ '""~' ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He s the .................................................................... ~C/......~ ................................................................ (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. Swam to _b~f.or~ me this .... .................. j." . ....... ............................................................. hlotor! Public~; .~.....~Counh, (Signature of applicant) ..... * . ~ ' MJ~,lTit T. BGKEN . , ~ofaty ['ublic, Skate otc Ne~v York No. 52.0344963 Suffolk Coun~ ~nmmissJon Expires March 30, T~6T ~40LD 50UTHOLD El :~