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Home My WebLink About5855-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy THIS CERTIFIES that the building located at 8/~I..P. eecmic, tla7. l~.lrd. & Map No..~ ......... Block No.. ~ ..... Lot No..~.. ~eZ...~,~, ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated : ......... ~a~ .... ~.., 'i9.~. pursuant to which Building Permit No.. ~.~. dated ........... }~Y...5 .... , 19.7~., 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 .. Private..one. 2a~i~ .d~elllng ...................................... The certificate is issued to ...gV.~.the~. P~o ....... ~er ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health ApprovM ...Sep~..12..1.972...by. R, .~a.. UNDERWRITERS CERTIFICATE No...~iobe~. ~.3. $ ~.~2. DY. ~ba~ki ................ HOUSE NUMBER.. ~-90 ...... Street .... Pe~o~iC. ~y. ~d.. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5855 Z Date ............................ .~.]J~ ......... S......, 19....JI~ Permission is hereby granted to: pursuant to application dated ..........................JJ~,jp....;....~....., ..... 19..~j~., and approved by the Building Inspector. Fee $..~I,e.~L ......... PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE P£*EMISES BY REGRADING LOT DRiVFWAy CONSTRUCTION CESSPOOL CC, i','S~'Rt BCTION CELLAR CONSTRLu I ~Orq OTHER FORM NO. $ TOWN OF SOUTHOLD Building Depor~ment Town Clerks Office Southold, N. Y. 11971 APPUGATION FOR CERTIFIC:ATE OF OCCUPANGY Instructionl 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 disposol--(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. 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 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 $1.00 Date .......1.0~/.$.9/.2.2 ............... ' ....... New Building ..... X. ............ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~/.~..~.e~,QzLir'....L~.~...]~L~rl ...... Lallz..e.]..,....~.,~ .............................................. Owner Or Owners Of Property ....... ..~........~...8:..o..: ............................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. 5/5/72 · , A. Reilly and Sons, Inc. Permit No. 5855Z Date Of Permit .................... ^ppdcant 912 12 Health Dept. Approval ..... /....../.'.~ ........................... Labor Dept. Approval ................................................ Underwriters Apprava~ ...!..Q./.1.3~.~2, ........................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....,,5.~..0...0. ...................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ... ~.?.....R..e..~ .1...Z. ~....a..~.CTL. · · .S. · .0..~. · .~. x · · .~ ~ ~.t ........................................... l~ .A. ~{eilly. Sworn to before me this .... 1..~....'~.... day of ....~...~.~.~....~....~ ........ .\~.?..2~ (stamp or seal) TERRI LEE E~AK NOTARY PUBLIC, State of New Yo~k No. 52-616~295 SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No '~}~//~7 %APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date ~/i"/~ ~ ~Approval to construct said systems is requested,pertinent data herewith: ~ 1-Applicant ~'~'~Af~O~;~ ,~( Phone 2.~-9~gl~-Sub div Address F%~T~T ~(-~ A- ! ?-Section ~-Detailed property location ~/~ ~c~¢ ~F ~A~-Lot No. J%1 Hamlet ,"~a~,~v,~ 'Town ~,~~l~-Privat~ well? m~--~ ~ ~ll-Public water supplyname ~,'~ . Distance ~o nearest main. .-Lot Size~ Width ~ft. Length ~ft. (also enter on center plot plan below:) ,~ 5-Dwelling. Singl~Family~_~Two Family? ~ /Cellar? ~ ~',Slab? ~__~ Crawl Space? / / lO-Proposed system. Septic tank f /Preca~ /Cesspools/ /Shallow pools / /Other / / ~l-Septic tank inside dimensions. Volume~4~als. Length ft. Width ft. Liquid depth ft. ~ 12-Precast sections: /~FNumber/ /Square~. Cesspools: Block sizeL incs.D ins. H ins. Total blocks below inlet: ~ /~$2 ~3 PLOT PLAN Capacity ? ~als. --1 G.P.M. Data ~eet 6 8 10 ~6 18 ~c Street ~i' ~P~ ~C '~/ Ind'i ~ate Nc 'th The Undersign~ CERTIF~S: "Const~ction of authorized installations wi~ b~ in accordance with the Suffolk County Health De~rtments' current Standa~s, Bulletins, and amendments thereto, covering Private Se~ge Dis~sal Systems". ' ~e~ o~ ~lder FOR HEALTH DEPART~NT 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 (10/65 Revts.) S-15 BUILDING DEPARTMENT~.,~'t~ -,~ TOWN CLERK'S OFFICE ~'/,~(~'~- I,o,~ ~-~, - SOUTHOLD, N. Y.~.J~' ~'~'~'~' ~ ~/~ Approved ~" 19...'..[.. '~" ~' <'~'- '~-' "~/7/? Z...- ........................................ , Pemit No ..................................... ~ ~-'/~ Disapproved a/c ................................................................. ~~ ~ ~~ ..................................................................... ............................................... .......... ..... .....................APPLICATIoN(Building Inspector~FOR BUILDIN~~ ~~0"7~'~ ~ Dote ............. .......... ..... , ...... a. This a~lication must bo completel~ filled in b~ Wpewrit~r or in ink and submittod in triplicate to the Buildin~ Ins~ector~ with 3 sets of plan~, accurate plot plan to *calo. F*o accordin~ to schedule. b. ~lot ~lan showin~ location of lot and of buildings on ~remises~ relationshi~ to ad oinin~ premises or public ~tm~t* or areas, and ~i~in~ a d~ta ed description of la,out of pro~rt~ mu~t b~ drawn on diagram which is ~art of thi~ application. c. Th~ work covered ~ this a~lication ma~ not be commoncod bofore issuane~ of Buil~in~ P~rmit. d. ~on a~pro~al of t~is a~plication, the ~uildin~ Inspector will is*uo a Bu[Idin~ ~ormit to the a~licant. Such ~ermit ~hall be k~t on th~ ~remi**~ available for in~ction throughout the work. ~. ~o buildin~ shall B~ occu~i*d or u*~d in whole or in part for an~ purpose whate~er until a C~rtificate of Occu~ancg ~h~ll havo beon ~r~nt~d b~ the Buildinfl In~ctor. ~P~[IG~TIO~ IS H~fi~Y M~Dfi to th~ Buildin~ Do~artment for th~ issuance of a Buildin~ Permit ~ursuant to th* 8uildin~ Zono Ordinanc~ of th~ Town of Southold, Suffot~ Gount% ~w York, and othor a¢~licable kaws, Ordinance* or ~ulation*, for th~ construction of~ buildings, additions or alterations, or for r~moval or demolition~ as herein d~scribed. Th~ apOlicant ~rees to com~l~ with ~11 a~lieab}o laws, ordinances, buildin~ code~ housin~ codo, and re~ulations~ and to admit authorized inspectors on ~remi~es and in buildings for n~m~r~ inspection,. A.Reilly & Sons Inc (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................................... .c...o. .................................................................................................................. Name of owner of premises .... ~'~,~,~.t~..~o .................................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .....~.. ............. Lot No ................. ~ ...................... Street and Number .................. .S./...~...~.~.Q.~,~,~..~y...~'I ~ .............. ~,~], .......................................................... _~ ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...y..~..c...~.~. ................................................................................................................... b. Intended use and occupancy .............. ~Tze...[.~.~.'l.},..<~¥/~.~.~.l. lQ~. ......................................... ,qc~._..b._.~.._ ........ 3. NaCre of work (check which applicable): New Building ........... ~ ......... Add.t.on ..................... AIterat~,or~ ............ Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) ~---. 28.000 + Fee ..... ~.l..,.~.g. ................................................................................ 4. Estimated ..u~t ................ · ............................ (to be paid on filing this application} 5. If dwelling, number of dwelling units ...QT~ ........ Number of dwelling units on each floor ......................................... If garage, number of cars ...QT~ ................................................................................................................................... 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 ....... ,~6.,~ ........ Rear ............. ~6,~ ..... Depth ......... ]+.9 ................... Height ................................................. Number of Stories ...... 1..~-. .............................................................................. 9. Size of lot: Front ........$.1~..,~, .................. Rear ........ ~.~..~. ........................ Depth .....1...~......+..../....2...0.~......+. ............... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ...... ~.~..~..~.~...~j,.s.~. ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~ .................................................. 13. Will lot be regraded _.~,~ ........................ Will excess fill be removed from premises: ~] Yes [ ] No 14. Name of Owner of premises ....~a.t.t,~e~/...~,,a,o ................... ~.:l;.t,~.~.~.c~ ................................................................ (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ....~.,....,'q,9~.3.~..~..~.~T~...I~C ............~,~;~.~,~Ok .............................................................. (AddreSs) (Phone No.) P10t 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. See filed plan STATE OF NEWYORK~ ~ ) COUNTY OF .................. ~.~...]~... ................... ) SS ........................................... ~Q:~lq..,~i.~.'[~ ........................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) Ha is the ................................................................ ~)~,.t.Z?&~ :~3'. ..................................................................................................................... (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. JUDITH T, Ncder./ PubJlc, Slate of ~',~w Yc;rk ............................... : ..... Y ...............~,~t'u~n. ~l~' .triarch ~o,· Notary Public, ,~~..~~0unty ..~~.~.,.,,~,,,J,~ ........ ~ .............................. ~/ {Signature of applicant) ~, ~,L~~'~ . ..~ ~ COPIES OF THIS SURVEY ~P NOT ~A~ SUFFOLK COUSTY Fea?.TH DEPA~?MENT The sewage disposal ~d ~ter supply facilities for the st~cture located at have been inspected b~hl~Depar~en~ ~d fouud ~ be ~isfac~o~. .,,,,, Chief of General ~g~me~rih~' ' Servi~ .