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Home My WebLink About5840-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ,Z.~0..~.. (Z5058) Date ............. .Apr;Ll..~, ...... , 19. ~3 THIS CERTIFIES that the building loqated at . 8alt~.$~e. ~y ............ Street Map No.. S, ttai*e. ~ck No ......... , .Lot No...37 ...... Ma~;tituel~ .. N.,.~, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... May .. 1 .... , 19 '72' pu~suai~t to which Building Permit No..~81~0Z.. dated ............ Ea-y.. 1....., 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 . Privat~.one..t. am~,t.y · ~lwet~tng ....................................... The certificate is issued to ... In~and. tleme~ .In~ ...... 0~nex' ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... Ja~. 16..$973.- .by. I~..V$l. la .... UNDERWRITERS CERTIFICATE No .... .N '66~t9'' ,X~.n · · '1'5.19?.3 .................... HOUSE NUMBER .... ~-50 ......Street ....~'1 t&il~.O .~:i&~. .............................. Building Inspecto [ ~FOI~I~ NO. ~ To N OUTSOLD BUILDING DEPARTMEHT! TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMIS~$ U~TIL FULL COMPLETION OF THE WORK AUTHORIZED) 5840 Z Permission is hereby granted to: ............ · Setd~n ............ ~:~'~'~ .............. ~ ................ L at premises located at ..... ................................................ l~.~.t& t:~ek ....... '~ ~Y"' ................. ?"i'" ........ "'""~ ................................ p~rsuant to application dated ~,~2~. ~...,¢.,.,~ 19 .... ............................... o,nd opproved by the Building Inspector. t~, ,~ ng '~ector>ectdF ~ , - Fee $.....~.9~60 ....... TOWN OF ~OUTHOLD Building Delm~tmen~ Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF ~)C~ :UPANCY Instructions A. This application must be filled in typewriter OR i~k, and su~mlited in tripffcate to the Building Inspector with the following; for new buildings or new us~: 1. Final survey of property with accurate location of all b~aildlngs, 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 Unq, er~,'riters. 4. Commercial buildings, Industrial buildings, Multiple :ReSidences and similar buildings and installations, a certificate of Code compliance from the ifArchitect 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 uces, i 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, OCrCUp;ancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings qr 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 usei i$5.00 3. Copy of certificate of occupancy $1.00 New Building ........< ........... Old or Pre-existing Building ....................... ~ ..... Vacant Land ............................ ~g/S Saltaire Way 100' ]x~fO W.~ve~res~i Location Of Property ........................................................................... ~ .................. Subdivision ~altaire ~3s-~.tes ~,~+ ~ 37 B!ock No; House No ............. Health Dept. Approval ..... ~.,/...~.6./..~.~ ....................... Labor Dept. J~ppr~va! ................................................ Underwriters Approval ...... .,~../...~.~/.~ ....................... Planning Boaid ~pproval ........................................ Request For Temporary Certificate ........................................ Finc Fee Submitted $ 5, aa Applicant ...~ Sworn to before me this ...:.~.-..~,...~. day of .....~..~.~..../..~.~.'.... I ICebtificate pli' hie cod and regulations. i (stamp or seal) [~OTARY P~LIC, State of TOWN OF $OUTNOLD Building D~pmtment Taw~ Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF CICCUPANCY 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: b~ddings, property streets, i. Final survey of property with accurate location of all ' ' lines, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerpgei d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Un~rw~iters. 4. Commercial buildings, Industria~ buildings, Multiple Re~'~de~ces and similar buildings and installations, a certificate of Code compliance fram the .Ar(hitect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan ~eq~iremenl~s where applicable. B. For existing buildings (prior to April 1957), Non-conforming u~es, or buildings and "pre-existing" land uses: ! . 1. Accurate survey of property showing all property lines, s~Fee~s, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, o~i:uNancy and condition of buildings. 3. Date of any housing code or safety nspection of buildings dr 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 ................................................ New Building ;~ .... Old or Pre-existing Building ................. ~'""i""' Vacant Land ............................ Location Of Property ...................................................................... ?"L' .............. Owner Or Owners Of Property ....................................... ~..,..~ ........... ~ .......................................... Subdivision ...~...~..~..~?~.~ ...................... Lot No. ~ ~ Biock Nol House No ............. Permit No. ~' Date Of Permit ....~../...~../...?..~.. ....~..~.- '"~'"' ..Applicant~ ..~1~ ...'.~.~...~. ~ .................... Health Dept. Approval ..... ...................... Labor Dept. ~pprbval ................................................ Underwriters Approval ,.~...~/~ ..................... Plannng Boaid Approvarl ........................................ Request Far Temporary Certificate ........................................ Final ?e?fflcate .......................................... Fee Submitted $ Construction on above descr bed bud ng and~permit mee,~ts~ all appli~a~le codes and regulations. Sworn to before me this ~/~ f~ '7~ dayof ................................. ": ...... i.:. ! (stamp or seal) Notary Public .................................... County ~' -- bk BUREAU OF ELECTRICITY ~'$anuary 15~ 1973 A~'~li~¢°"'¥°'°'d';;~'605236 N ~r*F'¢1~, ~ Sa!taire, Wavecrest Lane~ Mattituck~ N.Y. Job 160 X · ~.,i~.~o~. January 10, 1973 outside Section Block NO OF CC CONg. C i i 100 *Furnaces: ~"'Future Eotors. 1~1./8, & 1~-1/12 bps appliance feeders: 1-2 #12, 1-1 1/2 hps & 1--3 #8 awgs Park Place 7r V 11772 APH~ICATION FOR. ,.~,~PPROPz~I~ ~. TO CONSTRUCT. PRiVATE SEWAGE DIS~S_~AL Sy_sTE¥~ Approval -oo cono~uc~ said systems is requested~pertinen~ data here~th: Date '~ "Y~ .... ' 2 i~(~ Phone 7~32~2t776-Sub div ~' ~'~ 1-Applicant --~ ....: ~ .... ' ' ....... ~ ~ '~' 7-Section 2-Detailed proporuy location ;~~ ~e ~o~ , 8-Lot No. ~ ~ __ ..o~,.~o ..... 9-Private well? ~....,, }-P~blie wa%er supply name Dis%a'no~ 6o neares% main 4-Lo6 Size: Wid6h .~.u_}f%. Lsngt~PO" ft~ '(also en%e~ on ~enter plo% plan below:[ 5-~{elting: Single 'Family [,X~ Two Family? ~ 7Cellar? ~Slab? ~Crawl S~ce? lO-Propsed sys%em: Sep%io '{a'nk ~Preeas% > /Ossspo61s ~[/$hallow pools ~Other 1l-Sep%io tank inside dimensions: Vol~e Oals.Length~r%. Wid%h ft. Liquid deptk__ft~ i2-Preoast sections: / 7Number~Square~. Cesspool~: Blook sizeL %6ines.D~ins.H~ins. Total blooks below inls%: PLOT PLAN .7 il! Capaczty~Gals. ~;gde ~m ~ iW.L. -- " ~ ~ Indi The Undersigned CERTIF~S: "Construction of authorize~ installations will be in accordance with the Suffolk County Health De~rtments' current $tanda~s, Bulletins, and amendments thereto, covering Pri~ate Se~ge Disposal $ysbems". Dao~q./,..l[/~E Signed II.h~,~ ~ lO~X or Builder FOR t!gAL'Nt 'DfiPAkTMENT USE ONLY. Based on tho info~sation or, in'ion of the lfoalth Dofx~rbmenb, that an adequate and satis~'actory Sowag~ can be installed on this Plot. Date ~P~ ~'~ / ~ ~ Signed ,, ~<~/~ .... / ,. ~ ,, ~ v .. :- ~ ,~ ,~ ~' i~'' ,:~ , ~ ~ z~? 'A',I'~,V:',~, p~ ~'~ ~'~ ~ ~tllL~ , ppvaved .............. ,19 Permit No...~. ~...~/..0 - ............. ~/~/~ ~ .~' ...... : .... : ......... : .................. i..~_~. ....... . .... ..... ....... .... ............. ~PLICA~ FOR BUILDING Date ....................... ~ ...... INSTRU(;riONs a. This application must be completely filled in by typeWriter or in ink and submitted in duplicate to the Building Inspecixn-. b. Pl, ot plan showing location of lot and of buildings o n ~uremises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn 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 In spe~tor will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the pregrese of th~ work. e. No building shall be occupied or used in whole o~ in part f~r any purpose whatever until a~Ck~rtfficate Occupancy shah have been granted by the Building l. nspecllor, . APPLICATION IS I-II~.I~Y MADE to the Building Department for the issuance of a Building Pormlt pursuant to the Building ~one Ordinance of the Town of South01d, Suffolk Oounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for rem/)val or demo- lition, as herein described. The applicant agrees to corn ply' with all applicable laws, ordinances, building code, housing code, and regulations. .. ~...~...0~..s.,...x..~.., ./!,.....~tt.....l:....~.t.,. ..... (Signature of applicant, or, name ff a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ~l~l~ Name of owner of premises ................ ~[. J[~IBOA~*. ~1~, ........................................ If applicant is a corporate, signature of duly authorize d officer, f-/7~/a ~ ~ (Name a_nd title of corporate officer) 1. Location of land on which proposed work will be done. 1V~ap No..1~...~.~..~..1~....~.~.~Lot No...~.? ......... Street and Number .... ~.l~. ~./..~.~$]~...._.~-O ' '~'' ~'~'~' .~.0...l~W.~.~pi~.~Municipality '~'~ '' 2. State eXisting use and occupancy ,of premises and intended use and occupancy of proposed construction. a Existing use and occupancy - P&B~I~' DMolllns b. Intended use And occupancy ................... ~. .................................. 10. 11. 12. 13. Nature of work (check which applicable): New Building .. ~ .... AddRion ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Work (Describe) ...................... Estimated Cast .... ~.~.(~, .Q.Q0...(~0 .............. Fee ................................................ (to be paid ~n filing this applicati,on) If ,dwel]ing, number of dwelling units ...~ ...... Number .of dwelling units on each floox- .... .~ ....... If ~arage, number o.f cars If business, commercial or mixed occupancy, specify nature and extent of each type of use ....... , ..... Dimensi,ons of existing structures, if any: Front .............. Rear ............. Depth ............ ttdight ................ Number of Stories ................................................. ; ...... Dimensions of same structure with alterations or additions: Front .............. Rear ....... ~ ....... Depth ................ Height ................ Numbe~- of S~o.ries ..................... Dimensions .of entire new construction: Front ..... .6.0. ......... Rear .... .6.0 ....... Depth ...~. ...... Height .... ],~.~. ....Number ,cfi S~ories ......... ], .................................................. Size of I, ot: Front ..... J~O0 ....... Rear .... ~l, 00. ...... Depth .... ~,@0 ....... Date of Purchase...,.~/~.i~/'L~ .................. Name <yl~ Former Owner .... ~...A......I~.~.~. ............ Zone ,m' use district in which premises are situated .............................................. , ...... Does proposed construction vi.elate any ~ning law, .ordinance. or regulation? ........... .}t.O. ............. Name .of Owner,of premises .~.It.l..~..ll.d...IE.O.~..o.~. .... A, ddress . .~.e..l..d..e.tl.,.. Name of Architect . ~.~.~.8.~.~...~.~..~1.~.~. I~..~.~.*.... A~ddress . .~.~.~..ri.,. ~ .J. l TO.~ Phone No. ?.]~,~.~.7.~. Name .of Contracl~or .~.~.].. gn~....~.~..~1.~.8. ,..I..1'1.~,~.... Address...8..~.l,~.9.rl.~.. ~ ]...~.~.8.~ Phrme No. ?.~,~.~-7.~. PLOT DIAGRAM Locate clearly and distinctly all buildings, wheth~ existing .or I~roposed, and indicate all set-back dimensions from p~operty lines. Give street and block number ,or description according to deed, and show street na~es and indicate wheCher interior ,or co~ner 1,ot. STATt~ OF NEW YORK, )S.S. COUNTY OF ' . ) .................................................... being duly sworn, deposes and says that he is the appli- (Name ,of individual signing applicati, on) cant above named. He is the .................................................................... ~ ....... (Contractor, agent, eorp.orate officer, otc0 of said owner .or ,owners, and is duly authorized ~o peff,~rm or have per~o.rmed the said work and to. make and file this application; that all statements eontainod in this application a~e, true to the bes{ of his knowledge and belief; and that the w,srk will be performed in the mann er set ~orth' in the application filed therewith. Sworn 'to before me this Lot 36 REVlS,ONS YOUNG & YOUNG SEPT. JI,I972 400 0STRANDER AVENUE. RIVERHEAD, NEW YORK '0CT 5, 1972 ALDI~N W. YOUNG HOWARD W. YOUNG INLAND HOMES, INC. ToW~ o~ S OUTHOLD ~ ,.. ~,~/ , _____SuFFOLK CO,, N:Y,__ aY ' ~ ' SCAL~ 1,, = 40' M~.3~1972 72--144 o~ .[ II i oJ "1 ,0 ol