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Home My WebLink About5814-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~- .1[~1 .... Date ........... IlOV~bel~...~0. ·., 19.~2. THIS CERTIFIES that the building located at .. ~ .l)X*~.~ .......... Street Map No./*~®~*~. &e.Block No ........... Lot No. ~,. .... I~.O~O]~ .... .~.,~.* ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ &]l~*~... ~1.~ 19 .?2. pursuant to which Building Permit No.. dated .......... &llX*t,~..¶?.., 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 .. 1~*~1,~ .o~. ~ldl~..Sw~].].~ ...................................... The certificate is issued to ... B~I~. · .!~1.].®~ .~.~1~. ....... ~S ........ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~l~.¶ 0,..¶~..b~. B. UNDERWRITERS CERTIFICATE No...~. ~.~0~ .... ~..~....~.~. ~.~.~..~. ...................... HOUSE NUMBER.. ]~ ....... Street .....~I~'~1'~ .~.1~ ............................ Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..~...~.. ...... Date .... &~..]0 ............... , 19. .~ THIS CERTIFIES that the building located at ~al~.. ])~ .............. Street Map No. ~a~'~ &,~ck No ........... Lot No. ~..l[~[$,]~].d.. 1~0~0 ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ &pl'~l, .. J ~..., 19. ~. pursuant to which Building Permit No. ~¶~.. dated ............&p]~]....¶.?, 19. ~2, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . 1~.$~.~ .ORe .~.-~y-dwellinf ....................................... The certificate is issued to .P~cha~. & .Kat, hlool~ Wl~Lta~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · .&p~l. ~0 -%9~..b~/. C., .8ua$,h .... UNDERWRITERS CERTIFICATE No .... .p$1~ ..................................... HOUSE N UMBER. ~0~ ........ Street... ~.~1'~. ~' .................................. FOR~ ~qO. 2 TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5814 Z Permission is hereby granted to: ............ ..~..~.b.:?.T..~...~..~.a..~h~.e.e.~.... at premises located at .......... I,~t~.....~. ....... ~se~-,~z.'~l,..A-~'e8 ........................................................... .................................................. Z~r~..D~v.o .............. ~~ ...... I..~. ............................ pursuant to application dated ........................... .A..~..~.~%....~.~. ....... , 19..~......, and approved by the Building Inspector. Fee $...~....e....(~... .......... .......................... B;ilding I'r~'.~;'~;o r ........... PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE pREMISES BY REGRADING LOT DRIVEWAY CONSTRUCTION CESSPOOL CONSI RUCTION CELLAR CONSTRUCTION OTHER FOUM NO. 6 TOWN OF SOUTNOLD Building Depmtment 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. ^ccurate 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. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ................................................................................................................................ Owner Or Owners Of Property . .C .~5. . : ....... : ......................... .b. ' Subdivision ~'.~..~..~.'..~( .... .~..~..~...E. //./.~..~.... Lot No.....~......~/.. Block No ............. House No ............. Permit No....~.....~./...~...~.... Date Ofpermit ..~../././../Z..~...Applicant ..... ~..~....,~/..~.../~.. ....................................... Health Dept. Approval .~'.././~.~..~,~..~/~'.[/.?..~../~s~..¢../.(.Labor Dept. Approval ................................................ Underwriters Approval ........ .~.../.~...~../.7....L.. ................. Planning Board Approval ........................................ Request For Temporary Certificate /// Final Certificate Fee Submitted $ .................................... Construction on above described building and permit meets all applicoble~__~ and regulations. Swam to before me this Applicant .....</~/ / / ,~~.......~...:..~....~ ........................ ;. Nota,0, Public ....~.....~County Not~/ Public, Slate o~ New York No. $2- 034,~96@ (stamp or seal) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter Off ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final suwe¥ of prop?rW with accurate location of all buildings, property lines, streets, and unusual neturll or topograph ~c fca~u re~ 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 Undan, riter~ 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 6. 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 suwe¥ of peopert¥ showing ali property lines, streets, buildings and unusual natural or topographic features. Id s · Sworn statement of owner or previous owner as to use, occupancy and condition of bui lng. 2. Date of any housing code or safety inspecuon of b~ldlngs or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / 2, Certificate of occupancy on pre-existing dwelling landuse--pre-gxiating C.O. $15.00 3. Copy of certificate of occupancy $1.00 Vacant land C.O. $ 5.00 June 28, 1984 Date .......................... COPY New Building ............. Old or Pre-existing Building .... X. ....... Vacant Land ............. Leeward Acres, S.quthold~ NY .......................... Location of Property ....................................... Hamlet HOUAI NO. Street Owner or Owners of Property .R~ch. ard O. whitney, and Kath].een M. Whitnev 1000S ction 79 ......... '. Lot ................ County Tax Map No. e ............... Block ..... 7 27 24 Subdivision ................................. Filed Map No. 5599 .Lot No ......... Richard & Kathleen Whitney Permit No Date of Permit ...... Applicant ........................ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporaw Certificate ..................... Final Certificate ...z. ................... Fee Submitted $ 1.00 App,icant .............. R~, 10-10-78 SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No ~d 'i~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said s_ys.tem~s, i§ rsquested,pertine, r~t~ data herewith: Date Address 74 ~//] --;~ ~C/. ,/)RF.'/~.'~, ~.t~. //7&~ ?-Section 2-Detailed ~roper%y 19cat~on ~ ~e~.d /J~,~ 8-Lot No. Z ~ Hamlet ~ ~ ~/'~/~ Town ~=~w/~/ 9-Private well? 3-Public water supply name..-- Distance to nearest main ~-Lot Size: WidthZoO ft. Len~th;-o$ ft. (also enter on center plot plan below:) ~-Dwelling: Single Family ~ Two Family? ~ /Cellar? ~(/Slab? / ~Crawl Space? / / 10-Proposed system: Septic tank / /Precast ~ /Cesspools ~ /Shallow pools / /Other ii-Septic tank inside dimensions: Volume ~e Gals. Length ft. Width ft. Liquid depth__ft. 12-Precast sections: /.~.Number/ /Square Ft. Cesspools: Block sizeL incs.D ins. H ins. Total blocks below inlet. ~1/~o ~2 /~3 PLOT PLAN 'ad~ Capacity~;'Gals. ~e Data Feet 0 2 6 8 i0 12 ~6 1¥ Ind~ ~te No ~h 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;'. 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. S-15 Examined ....~....../.. ...... , 19 ........ Approved ~' ~' " ~--~:/~/' ~ ' '..~..~-~/~ ........................................ , 19 ........ Pemit No ................................... Disapproved a/c ...................................................................................... (Building Inspector) ~ v v APPLICATION FOR BUILDING PERMIT TOWN OF $OUTHOLD _ ,-/~-,. ..... · ,~ BUILDING DEPARTMENT ~<"~'~'~'~'~ ~ TOW. CL:.K'S O Fm: SOUTHOLD, N.Y. /' '' ~ ~ Application Date ~Z April lO ~ ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Bud ng Inspector, witl%~. 3 sets of plans, accurate plot plan to scale. Fee accordJ~ng 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 I~,~out of property must be drawn on 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 Buitding inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises a.v.j~i[able for inspection throughout the work. r e. No buildihg sl~all bi o~cUpied or used in whole or in I~art for any purpose'~NhateverFuntil a Certificate of Occupancy shall have been-, granted by the Building Inspector. ' · APPLICATION IS~HEREBY MADE to the Building De~artme,nt~for the issuance of a Building Pe. rmit pursuant to the Building ZonejJ~ Ordinance of the To-wh of Southold, SuffoJ~ County, NeJv Y~rk, ani:l Other applicable La~vs, Ordinances or Regulations, for the construction o{Ir buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws. or,dinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections~ (Signature of applicant, or name, if a corporation) 7~ I~ 17th Street Deer Park, New York ~Address o~ applicentl State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~j~g~x~e~]~e~e~*~e~ ................................................................. If applicant is a corporate, signature of duly authorized officer. ~k (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ....,~,,~,,~ ....... Lot No ...... ,.,~1:,, ................................... Street and Number ............ T~.e...e..w...e,~C~..T~..:[.?.~.......~.,~C).o/~.-~. ............................ ~.Q~l.t~kO],l~, ..................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructJm~.· a. Existing useand Vacent occupancy ......................................................................................................... , .......................... b. Intended use and occupancy ..Re~.[l[eiZl~3~. ............................................................................................... .(~ ..... e Se 10. 11. 12. 13. 14. N~atur[ 0'f wor~k ichJk which applicable): New Building ......... ~, ........... Addition ................. .~', AireS, etlon..' ............. Repair ............. ............ Removal ......................... Demolition ........................ Other Work .................................... (Description) Estimated Cost.......3.~.0...O..0. ............ . . . . .............. Fee .. ........................................................................................... .. . . (to be paid on filing this application) If dwelling, number of dwelling units ....... ,3:, ........ Number of dwelling units on each floor ..... , ,~ ,'. =. ,', ,-, , ....................... c 2 If garage, number of ars ............................................................................................................................................ If business, commercial or mixed occupancy, specify nature end extent of each typo of use ........ '~,~,,',,',,', ................... Dimensions of existing structures, if any: Front .,~[i[~, Rear ........................... Depth ................................... Height ........................................................... Number of Storlem ............................................................................. Dimen=lons of some structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Storl# ........................................ Dimension= of entire new construction: Front ,,,7,~,,,,,),,~, ........ Rear ,?~,,~l,g ............... Depth ,,~,,,,,{~ ................... Height ,,' ....... ~,.6.~ ................................. Number of Storlel .......... ~,.,J~9~.~,) ............................................................... Slze of lot: Front ..... ?. , ,0. ,0, , 9. .0. ,~ ................... Roar ,,,~,Q0~,Q~.! ....................... Depth ,,,,~03~7.~ ................................ ~ Height .................................................... Number of $torle~ ...................................................................................... Dateof Purchase ~' ....~ = .....~ ......Leeward Acres at BaT~'iew~I[3Oe Zone or use dl,trlot In which premise, ere ,Ituated ........ ~,q,lA,~,~),,~ .......................................................................... Doe~ proposed construction violate any zoning law, ordinance er re0ulatlon= ~To Will lot bo regreded ..... .~.9 ........................... Will axle,, fill bo mmowd from I)rtmi~Mi b[] Ye, I ] Ne Name of Owner of -mmla=Rt°hard Oe~at;hlee~ ),i. W-h_~t;ne~ ~;16-~o7-hOO! Le.-'~er Oohea Room ?01 8W 3 Si;, ZE ~ .3 ~l ~ C Name of Architect ................................ ¢, .........r, ,,~ .~-~,, ......... r,,,,~,,.e.....~......~ .~ ~,,., NemeofContre~tor !. Clause, 3~0 Ne Bic. Pa~, Selden, N.Y. SE2-8755 I~I.OT or Intorio~ or oornor Iot~ , r ,,, ~m~ ~o~in~ in ~hi~.~ppli~ien ~ro ~ru~ ~o ~h~ ho~~d~~ ~!iof~ an~ ~ha~ the WOFk will be ~oFm~ in the ~nn~r · . ~ 7~ ~mi~ion c ~o 8uffotk ~ ~o~ SUFFOLK COU~iTY ~eA~TH DEPAI~?~EN? The s~o d~sposal ~d water facilities for the st~cture located at ~ve been inspected by this Department · fo~d to be satisfacto~. Chief of ~enera~ ~neer~ng ~ervices CODES STATE AND LOCA SEAL (. -I · ~ ~..o";,; 2'" ~o,vc. Fro-. ~ LI f FI/~J'T FZ 0 0 ,~ k }'' cc "47~ ? ii" [ J ~o/ec Fl q'- fi'", ) :t r- L L ! ti T ~' T ooL