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Home My WebLink About5842-zFORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .~.( ~....~..7'! .L.~..W, .~..7. e../~...bV~treet Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/~ ~ ~ 197~-~ pursuant to which Building Permit No..~.~r/~ ~-~ dated ....................... 19. as 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 ........................................................................ [qAI~'K f,4 t,VI L~EN5 1,4, The certificate is issued to . :. ..................................................... (owner, l~'~"~il~" of the aforesaid building. 2 5 S£P7 7~'_ - Suffolk County Department of Health Ap~ov~ ................ $'~'-;' I 1 'o t~ ........ UNDERWRITERS CERTIFICATE No. ~OUSE NU~ER ............. Str~ot .... b ¥," ~¢'ii'd d Z, ~ ................ Building Inspector I~OB~ NO. ~g TOWel OF ~ITHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. N°. BUILDING PER~IT (THIS PER~IT MUST BE KEPT ON THE PP.F~VtlSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .... ~..~.S..~..e.~ .......................................... ...... ~..Se~t~l~..~.$aa.~a~..l~ ................... to ...... .~ ~I,~L. ~;i,e~ · · c~,~e · ..£m~t...l~. · .~,'~e .~.~.~L.,"~.~ ................................................................................ at premises located at ......I~..~.~I-TI-~,~-~,~..J[~'& .......................................................................... ................................................. ~te~o~e ........... ~.~ ................................................................... pumuant-to application dated ............................~.~.~.:[.~.....~....., 19...~., and approved bythe Building Inspector. TOWN OF SOUTHOLD Building Depa~tment 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 fallowing; for new buildings or new use: ]. 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 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 Boa~d approval ~f_'~o~pleted site plan requirements where applicable. B. For existing buildings (prior to April 1957),~Non-conforming uses, or buildings and "pre-existing" land uses: ]. 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. Date g/2?/T2 New Building ..... ..X. ............ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ............. ~'~'./'~''~.'t~'~'~.~.~'~.'~'e''z''~'A.''v''e'~'e~?~'''~'~t'~?''~'''~'g1z"~.e' .......................................... Owner Or Owners Of Property ..~..~..~....~..~...DLq~...~..~..3...c,,e.,~..,~....~. ........................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. 584~,-Z Date Of Permit .................... Applicant H.ealth Dept, Approval ....... .?../..~...5./.~.~. .................... Labor Dept. Approval ................................................ Underwriters Approval ............ ~./..~)./.~..~. ................. Planning Board Approva! ........................................ Request For Temporary Certificate ........................................ Final Certificate ......... ..X.. ............................. e 5°00 Fee Submitt d $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ....... Sworn to before me this ..~ .~....,.. day of ...~'..~~~ ..... (stamp or seal) Notary Public ........~... County. ~ NOTARY PUlll, lC State of New YQ~ Ho. 52-884'1_100, Suffolk County .T~rm Expires March BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTflOLD, N. Y. Approved .............. · ~. ....................... , 19 ........ Pemit No.....~....~,...?...~T....~.~ .... Di~opprov~ o/¢ ............................................................... ^pplicotion No...?......~.....c~..?__, APPLICATION FOR BUILDING PERMIT · " ' ,' , . ", Dote ..... .... ;......~..............;~ ............ , INSTRUCTIONS - ~ a. This application must be completely filled in by typewriter or in ink and submitted Jn triplicate to the Building Inspector, with~ 3 sets of plans, accurate plot plan to $calb. Fe~ according to schedule. ' b. Plot plan showing location of lot and of buildings on premises, relationship'to adjoining premises or public streets' or areas, an~: giving a detailed description of layout of property must be drawn on diagram which is pert of this application. c. The We~k covered by this application may not be commenced before issuance of Building Permit. d. Upon al~roval of this application, the Building Inspector will issue a Building Permit tO the applicant. Such permit shall be kept one' '~he .~, m~i~e~ av~i ,l~ale for inspection throughout the werk ..... ., · ~. '~le buRdl'l~g .shall tie b~cupled or used ih whole Or in I~rt 'for'arypuq3°se whate~r'until a Certificate of Occupancy shall have 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, Suffotk County, New York, and other applicable Laws, Ordinances or Regulations, for the ~onstruction of buildings, addlfiom er alterations, or for re~oval or demolition, as herein described. The applicant agrees to comply with all applicable laws. ordinances 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) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ ............. ................................. : ............................ ......................................................... Name of owner of premises ...... /~J.~.,~.~.~. ...... ~!(1.,.....~.z..~...~...~:....~....~../..(._/ ............................................................... If applicant is'a corpora~te, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of lam:ron which proposed work will be done. Map No.: ........ ~ ...... Lot No. ~ Street and Number ...... ............................................ ,5 Ti CL. D. TCiL CU trC: .................................... ' ~ ~ ~ ¢.~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existyg use and occupancy ............. Z~..~)./.~...~ ................................................................................................ b. Intended use and occupancy ........ .~.~.~Z~..~...:....~..~...~.~..~./..~....~' ........................................................... ,~ 3. Nature of work (check which applicable): New Building ....;~. ........ Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ......., ................ Other Work .................................... (Description) ................................................................................................ 4. Estimated Cost ................... 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 eac~h 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 ......... ~....~. ........ Rear ........ .~.....~.. .......... Depth ..~....~ .~.........~. ........... Height ...................... ~, ......................... Number of Stories ..... ~ ..................................'"r ............................. 9. Size of lot: Front ...... ...7....c/.,..~..~..."-- ---- ......... Rear ...... ,~ _.A.~..~..~..~....~....... ......... Depth ..._~)_ _/.~...'/Z..x] .............................. Height Number of Stories ...................................... 10. Date of Purchase ....~, ./....Z:..~...,/~..~,~......- ---- Name of Former Owner~./~/~f.,~...~....'~.~'~/.'~/.~..~f.....,,~'J~'..(~../~..~.~...-- 11. Zone or use district-- --in which premises are situated ...... /~.~,,~./...~/.~,a~.//.4~.../,,, ...................................................../ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ,,~......O. .......................................... 13. Will lot be regreded ....... ~.Ph~.,~ ...... ' ........... Will excess fill bq removed frOm premises: [ ] Yes IX] No 14. Name of Owner of premisesZ~/~J:[[~/.[L~JA~LC~?J~.~:..L~q~`~Z~`~C~4.~.~[~f~..`~`~.~:/~5~"Z:~lr {Address) %/ {Phone No.) 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-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate Wheth- er interior or corner lot. STATE OF NEW Y(~K,j~T'-/./.* ) COUNTY Of ....... . .'~....C(....T~. (_ ./~. ....................... ) .......................................................................................................... being d. uly sworn, deposes and says that he is the applicant above named. (Name o/individual signing contract) ~ '~ He is the .... ................................. : ........................................................................................................................... i ............................................... (Contractor, agent, corporate officer, etc.} j: 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 ell statements contained in this application are true to the best of his knowledge-and belief; and that the ~tork will be performed in the manner set forth in the application filed therewith. RUOOLPH H. BRUE ........................................ 19 ..?.,..,.~.. a~.~.0~ssS~-sa.a~ Cae.tv · ~ .......... CutcLogue, L.I. ,,Ilo,cia. Ioe,,tioti: ~ Itase,nent ~- 1st FI. ,.,,,,,i~,~,~o,, SEPTEMBER 15, 1972 ~ECEPTACLiES] [ FIXTURES ~ 31 20 15 lC0 CB 1 2 .~.naces. Oil 1-1/8hp, 1-1/12hp ko%or/s: 1-thp George Zimlinghaus, 4 Park Place, Patchogue, L.I.. 11772 SUFFOLK COUNTY DEFARTHENT OF HEALTH H.D. ef e eno. o.g d-! l0 0 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE .DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: 1.Applican~/~i ·~:~ ~ /vi, ~< ~ lc~- ~ ~'/~' Phone' . i, , 6-Sub div ~ · Address / , ~'/, ~ ~ / '/~',. : / ~ ~ ~ ;',TfSection. 2-Detailed property locationl.~ ,./~ * ,/ //../~ ~: ~ · i "~"Lgt0N°' ~'/'~ Hamlet ~ ... ~ ./~ ,, ~ ~ ,,_ Town ' ~' r t~, /~.,,,~) '~2F~ate well? ~ 3.Public water supply name Distance to nearest main 4-Lot Size: WidthYc ~.~ft. Length2 , <'ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~] Two Family? ~ Y Cellar? /.Slab? ~_~ Crawl Space? / ~ 10-Proposed system: Septic tank ~YPrecast ~ /Cesspools / /Shallow pools ~ /Other/ / ii-SePtic tank inside dimensions: ¥olume .L/Gals.Length ft. Width~ft. Liquid depth ft. 12-Precast sections: /ZyNumber~ YSquare Ft. Cesspools: Block sizeL incs.D___ins.H ins. Total blocks below inlet.~ ~1 - ~2 $3__.__ PLOT PLAN apacity'~ '& Gals. G W.L. Indt Data Feet 0 2 4 6 8 10 12 18 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". Date Signed 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. Date *' v } ' ~7..,. Signed (10/6~ Revis.) S-15 SUPFOLff COUNTY NEAL?H DEPAR?~NT $ r ~ [j 5 1972 DA~E The sewage disposal ~d water [acllitles for the st~c~ure lc:'ated at have boon inspected by th~s Dep~tment ~d Chief of Gm:e~i E~ine~.lng g~ vl~