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Home My WebLink About5829-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold. N. Y. Certificate Of Occupancy No. Z. ~O~0 ...... Date ........... kia, r ..... 1. 5' , 1973 THIS CERTIFIES that the building located at ~qannLug .Ro~.d ....... Streut Map No, ~ ..... Block'No. ~ ..... Lot No .... ~...~9~, .8~P,~. ~.'~ 7 .... conforms substantially to the Application for Building Permit heretofore filed in this office '~ated ........ April. 19, 197~. pursuant to which Building Permit No, 'dated ........... Ap~l. 2~ , 197.8., 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 ?rSYa.~. 9g~. rgb;;7, d.~9¢~.~n$ ................................... The certificate is issued to . F~a~..aucke.1 ..... ~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval LrNI)I R%'RITt~RS Ct~Rq IFI('ATk~ No...H. IlOUSt.. NUMI~t.R 'IOQO ...... Street .....F.an.r~i.[~g..S9'q.d ............................. Building Inspector l~OR,i~ NO. e, TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 5829 Z Permission is hereby granted to: to ..... ]~.~, .-'~'~.. ~e....?~mJ,~...¢.~:e:~.~..£nq ................................................................................. at premises located at ....~/F~...,F, islr.~/t~...~o~. ................................................................................ .............................................................. 11e~...$.~.'$ ~.~ ........................................................................ pursuant to application dated ..........................,~,.~.]......~)~ ....... , 19...'~., and approved by the Building Inspector. -Building Inspector la'GuM ~TO, 6 TOWN OF SO~JTNOLD Building Deportment Town Clerks Office Southold, N, ¥. 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 t~e 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 $5.00 % 3. Copy of certificate of occupancy $1.00 . ...~x,..~...~ Date ...Z/.), .,,~. .................. New Building ..... .~,.. ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .....~..C~O.~.~.~....~-,LO.~D...) ....... ~.....~...~,-~..~--~...~....~.~.....~...:..~.: ........... Owner Or Owners Of Property ..... .__~...~.~(~..Y~....~....~L'~(~..~. J~..'C. ....... .~.L,~r~,.~.~, .......................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No....~....~....~....~...... Date Of Permit ....~.:..V~.~.Applicant ....~..'...J/~.~...~..~....?(-....~..~...~'.-~ ............. Health Dept. Approval ..... .~... .................................. Labor Dept. Approval ................................................ Underwriters Approval ........ ~ ................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....~ ................................. Fee Submitted $ .....~..'.....(~. .................. Construction on above described building,g,n~J permit meets all cipplicable codes and regulations. Applicantt~.~c....:r..~....~......~..,~~'~'; .......................................... Sworn td before me this //~t~/~/ ................ day of ............................................ (stamp or seal) Nota Pub,c .................................... cou y ?070 SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS. Approval tn construct said systems is requested,pertinent data herewith: 1-Applicant ~.~.~ ~__,__, Phone 6-Sub div Address pro~e y oca zo ' ~. .?-Section 2-Detailed 8-Lot No. Hamlet -'- 'l~wff'-~'_%~:-j_~li- '--~'~ 9-Private well? 3.Public ~a-{~r su---~]~"hame stance to nearest main 4-Lot Size~ Width~ft. Length_~.~_ft. (also enter on center plot plan below:) 5-Dwelling. Single-e~amily ~ T~m~amily? ] ! Cellar? ~.Slab? t t Crawl Space? 10-Proposed system: Septic tank ~ /Preca~s~ .~_~Cesspool§'~_/S.hallow pools / /Other / / Il-Septic tank inside dimensions: Volume~ Ggls.Length ft. Wzdth ft. Liquid depth ft. 12-Precast sections: /3;Number/ /Square Ft. Cesspools: Block sizeL incs. D ins. H ins. Total blocks below inlet: ~1~W3 ~2~._~3 PLOT PLAN Capacity ~b~als. H.D.Reference NO'~ ~-/~~'~ ~' ~U~__ Data Feet 0 2 4 6 8 10 12 i8 Street The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendmel~s lhereto, covering Pri~ate~e~age Disposal Systems". Date~l~ '! ~')}-- Signed ~'~.~-~J: Q-~(~I , ~ !~ 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 C --f~--- ~ (10/65 Revis.) S-15 G.P.M. ~ j~/, c~ TOWN OF ~oUTHoLD TOWN CL~K'S OFFICE .../_ ~.. SOUTH~D, N.Y. ~~ ...... ........ , Disapproved a/c .............................. APPLICATION FOR BUILDING PERMIT Date ~t1 19 19..~. ..... INSTRUCTIONS ~ o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty must be drown on the 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 Building Inspector will issue o Building Permit to the applicant. Such permit~:~ shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy~' shall hove 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 applicarit agrees to comply with all applicable laws, ordi nances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. ~ '~ (Name and title of corporate officer) C~) ~ Ma o Lot No ~ ~ Location of land on which proposed work will be done. p N .: ............................................................. ~ 1. _ ..... ~:J. la~ b~ I O o O' ~ .,.[~...~. ~=l~£e~ ~ ~treer ana mumDer ~....~;~....~'. ...................................................................................................................... Municipality ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................. b. Intended use and occupancy ......... .~..?.?...~...~...a~.....:~..~...~..[..[.....~. ................................................................ 3. Nature of work (check which applicable): New Building ...... ~ ......... Addition .................. Alteration ~'* Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...........~.~w~l~,.~.~ ......................... Fee .......................................................................................... (to be paid on filing 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 .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ s, o.,f Depth.....~.~. ............... 8. Dimension ~.'ntire new construction: Front ............. ..~1.~ ............... Rear ......... .~.Q .............. Height .................... Number of Stories ............................................................. ~j~ ............................................... $ 9. Size of lot: Front ..........~.e. ............ Rear .......... ~ ................... Depth ....... ...~...~ ........... 10. Date of Purchase ........................................................ Name of Former Owr~r .......~....~.~.~. ...................... 11. Zone or use district in which premises are situated ...... ..~..~l~.~l~. .................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~ ............................................ 13. Name of Owner of premises ..... .~.tL~..~.....~ress ............................................ Phone No ..................... Name of Architect ...................................................... A~clress ............................................ Phone No ..................... Name of Contractor .i~l/4~e..J~l~lt~?,~.~L.~ll...Acktress ...~1~..~t;~ .............. Phone No. 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 whether interior or comer lot. STATE OF NEW YORK, ~S S COUNTY Ot~ ...... ;.;'. .................... ~1' "'" ! . (Name of indi~dual signing applicatio~ above named. 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. Sworn to before me this ~'~ o, ..... ...................... , Notary Pub 'c, . ........................................................... County ' (SignOre of applicant) ..... J ,4 M.D, tZE LLY GU/~D. AINYEEiD T~ THE. Ttl-LI';: ~U, VEYED VAN TUYL*SON LICENSED LOA~ 5AND 7~ Z 0 WELL CESSPOOL, '[:]: TI TLE C.,O r-iO. 127~,555 TOW'h~ OF .?:OUTHOLD., IN,Y, A~E~: ZO, OI7 SQ. FT. r? The sewage dlsp6sal and water supply :f~t~'i*~es for this !o~nt. ion have been ,GU~, .P~NTEE. D TO THE. TI'FLF_ GUA1;?.AN"FEE COMPANY S£PT. II VAN T, UYL~,SON' LICENSED LAND 5UP~/EYOR5 -~- - WELL. 'o HEW 5UFFO~I~ Q:I~H PIPE ~: ~HUMEMT TI rLE~:~. 12735~. AgE A :~ Z ~0t7 ~Q. F~ UCXFL