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Home My WebLink About5823-zNO. · TOWN OF SOUTHOLD BUH.DING DEPARTMENT Town Clerk's Office Southold, N. ¥. Certificate Of Occupancy No. Z6~0 ...... Date ............ April....ll~ .... , 19. ?~. THIS CERTIFIES that the building located at . Solmd. ¥~. Ave .......... Street Map No. ~:x ......... Block No~ ........ Lot No. xx....~oui;holt...1~ oY., ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 1.8 .Aplll., 19..72 pursuant to which Building Permit No. ~,~Z.. dated ...... Al~rlt~,.. 19. ..... , 19 .~.2., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which ~ certificate is issued is . l~.rivate, o~e. f~l~ilY..dweLling ............... ' ....................... The certificate is issued to . Rober.t .Jolmsoi~ ....... 0vnet ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · ~y...~ 2...~97~..b~. ~o. YJ. lla.. UNDERWRITERS CERTIFICATE No. ]~ .8607-7. .... Apr$~ .21~...~?~ ............. HOUSE NUMBER . .. t~.300 ...... Street .... 8ou~..V. tev. ,~ve ..................... ..... FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING P, ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5823 Z Date ........................ ~pl~...:.JI 4~ ......... , 19....~ Permission is hereby granted to: .............. &t~a~,.-* · -~. 'D~ .............................................. ..................... ~ae~,~.....l~.,~ ........................... ~%ld ~e~ ~e family. ~Walling at premises located at ........... IJ.~..~el~..~-~e~.-A-~ ..................................................................... ............................................... t~.Q~.l;¥~:~k ....~ ~., ................................................................................ pursuant to application doted .................. Aplr~.~......l~ ............... , 19~2,..., and approved by the Building Inspector. Fee ......... I ¥" Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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 duplicate 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, ~nd unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(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. §. 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. Swam 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 Date .......... ../...~.........?...U...L..~......~ .._.~.. New Building / Old or Pre-existing Building ............................ Vacant Land ~_~oo ~od~ ~j ~"IE~,/ t~v~~ Location Of Property ............................................................................................. ~/ ...................................... Owner Or Owners Of Property .................................................................................................................. ..~.. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.....~.....~....~...~... Date Of Permit ..~//..?/..7...'.¢~.....Applicant .../?-.....E..~....D.~.~./~~. ........ .L..!...I'~.,~....-F~....~ Health Dept. Approval .......... ./...~...~.~[..~......../...~../.~Labor Dept. Approval .................. ~. ............................. Underwriters Approval ............................................. Planning Board Approval ........................................ Request For Temporary Certificate........................................f Final Certificate .......................................... Fee Submitted $ .......... ~...~ ............ ~n~truct~n ~n ~b~ved~cr~bed bui~ding ~nd~/e~m~e~s ~. p~2~ c~- es ~nd//~~_ regulations. Applicant Sworn to before me this ..]~..~-....... day ~f ~.~,.~....~..~.~...~..~ ......... (stomp or seal) Notary Public .%-~-~.~-.'-...~...~ounty TERRI LEE ELAK NOTARY PUbLiC. State of New York FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi[icate O[ Occupancy THIS CERTIFIES that the building located at t~ ~.vq .50t,~.~..~f! ~.~.. f~ ~e Street Map No ............. Block No ........... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... !.~' ..... ~.~'.~.., 19~.~ pursuant to which Building Permit No. dated .........1.9....~.~.(~.., 19~.~., was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~ ~ ~ ~ ~ ~ ~ k y ~4/ ~ kk ~ ~, f~ The certificate is issued to ~ K 7 ~ 0 ~ ~ ~ ff N (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~ ~ ~ u ~ ', ~ ~ 5 UNDERWRITERS C~RTIFICATE No.. ~. ~.~. ~. ~'/ ................................... ItOUSE NUMBER. ~0~) .Street. ~OO~ ~l~l~ ~ Building Inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference Nolo -/~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS ~.../ Approval to construct said systems, is requested,pertinent data herewith: Date 1-Applicant ~.J~ ~ Z,.~,*~ ~one~r-r-~ ~-Sub div Address Z'~,~ /m~2 ~.z .,~.k/ /~"F 7-Section 2-Detailed'p.roPgr~oc_ation _C~..~/.7~.~ ~. , , · 8-Lot No. Hamlet ~,~,.///~'.~ ~.', Town ~.%~/~F 9-Private well? 3-Public wate~supply 'name Distance to nearest main 4-Lot Size: Width ~$ ft. Length F,~ ft. (also enter on center plot plan below:) 5-Dwelling: Single Family; %~ Two Family? ~Cellar? ~_~Slab? ; ICrawl Space? 10-Proposed system: Septic tahk ~ /Precast"~-~_~Cesspools ~_/Shallow pools il-Septic tank inside dimensions: Volume~ Gals.Length ft. Width' ft. Liquid depth ft. 12-Precast sections: ~_/Number/ YSquare Ft. Cesspools: Block sizeL incs~.D ins. H ins. Total blocks below inlet: ~1.~_~2~,~ ~3 /'(; ~ ~'J ~,~ k--~ ~ ~--~ Street Capacity~Gals. G.P.M. ~ ,~ ,ad~ , G .W.L. :ate 'th IndJ "Construction of authorized installations will be in accordance with the Suffolk County Health Depa/t~ent~' current~andards, Bulletins, and amendments thereto, covering Private Sew~e/Di$~tsal System'S'. ~. ~/ Owner -or 'Buil~[~ FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department!can be installed____on Date ~/~ ~/~i~ Signed , -~.~.~.~f (lo/~ ~evis.) The Undersigned CERTIFIES: Data ~eet 0 2 4 6 8 10 12 q6 18 ~ ~ TOWN CLERK'S OFFICE ' Exam ned.. ' / 19 2~ ~ .......... ...... .__. ~pra~ .................. ~ ................... , 1~ .... P.m,~ No ..................................... .... Di~pproved ~/~ ................~ ........................................................................... ........................................... ~ .......................... ~..~ ....... -- ' ~ ' ' [Uuilding Inspector) ' ,(./~_, ~ ~ .~.J, PFLICATION FOR BUILDING FERMIT ....... / iNSTRU~iONS L a. This o~licoti~ must be completely filled in by ~pewriter or in ink Ins~tor. b. Plot plon s~owing I~otion of lot and of buildi~s on premises, relationship to odjoining premises or public struts or ore~s, ond giving ~ detoil~ de~ription of layout ofpr~e~ must be drown on the diogram which is c. The Wo~ c~ered by this opplicotion m~ n~ be comme~ed before issuance of Building Permit. d. Upon opp~vol of this opplicotion, the Building Inserat will issue shqU be kept ~ the premises ovoiloble for insp~tion thr~ghout the p~ of the work. e. No ~uilding sholl be ~cupi~ or used in whole or in pa~ for ony pu~e whatever until sholl hove been granted by the Building In~ector. 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 applicabl· Laws, Ord nonces 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, ordi nances~// //--/~_z~bu?7/~' housi~bd/~ regulations. ~(-~"'/~1~ ~ ~ ~ ~/ J-Signature of opplicont, or name, ifa corporation, O~P~,ee..c~ , '~ y"' (Address of applicant) State whether applicant is OWner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... ~..~.~/~ ........................................................................................... n .......................................... ~. ,_/._ /.;1/ V/ -- ~ ~ .... Name of owner of premises..... ~' ~:'.~'~. .~. . . . l~. .'. . . ~'.: ~. ~. jj. .~'. I .~ ......................... l' oppIIca~t.:s a c°rp°iai~' s'gnatur~. °f .~'Y aut~°rized °fficer' ................. i~q;~;;';~;~'~'~';';F~'~o~'~; ~¥~i~;~i ........ ~, '- 1. Locotion of I~ on w~ic~ pr~o~d ~ork will be done. ~p No.: ........................................ ~ot No ......................... ~...~ ~.~ ~.~ ...a.~m~:~.~." --' .R~ ............................................ ~u~ici~l ~3~ o ~ "' 2. StYe ~isting ~e ond ~cy of premises ~ i~nded use ~nd ~upa~y Exisiting use and occupancy ........................................................................................................................... ; .... Intended use and occupancy .~.r4,t ~ ./.~i.~ ............... I'~ture of work (check which applicable): New 'Building ..... ~... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Estimated Cost ...... t..~.(~.O ..................................... Fee ............ :...~....O.. ................................................................. (to be paid on fiting 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, 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 ..... ..~....~.~ ..................... Re~or / .... ~..~ ................. Depth .....~..~ ............. Height ~.~.../. Number of Stories ~ ' 9. Size of lot: Front ..... .~...~../...~..~.... Rear ......... e~../.~..../.. ............ Depth ....... ..-~..../.~, ' 10. Date of Purchase ......... .~'/.~./. ................................... Name of Former Owner ..~;i;i;~.'Z..~..C.~/~../~... ............. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate ar~y zoning law, ordinance or regulation;~ ......... 13. Name of Owner of premises . .~.~.~.9.Z~.~...~.:.~/¢~/a.~..4..~ddress .~Z./.e?~.~.....?.~...c...o~...<.c. ..... Phone No..~..~...T.~...7..~? Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and blook number or description according to deed, and show street names and indicate whether interior or comer Io~. I ,/d?. STATE OF NEY/¥OP-~/, , / lc ~ COU~OF .~ ...... ~'~ ........ ~ ............................. bem~ duly ~wom, d~o*es ond (Name of individual signing~p/i~on) above named. He is the ...... (Contractor, ag~t, co~rate officer, etc.) of said ~ner or ~ners, and is duly authorized to perform or have pe~ormed the ~Jd work and to ~ke and file this application; that all stotements contained Jn this application are t~e t~he best of~is knowledge and belief; and that the work will be performed in the manner set forth in the applica~ fi~ therewith. / ~ . Swam to before me this . ~ ' . ...... ~..~..~...~..~ .................................... [Jota~ Pub}lc, State of New Na. 52-0344963 SuFFolk Cour~ ./., this dSpart~e~t~nd found o TEST !40LE' ;A-tr'F./ So~-~oz_z:~, Az, W.~ LINDAL CEDAR HOMES LTD. /\ LINDAL CEDAR HOMES