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Home My WebLink About5859-zFOP~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z.~.6. .~.~ ....... Date November 16, 19 73 THIS CERTIFIES that the building located at ...~/iv_ewet.~a .Road ........ Street Map No.. ~[~ ....... Block No..~ ....... Lot No. ~ ...... ~?~.~ ............ ~/~-~onforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~a~. ~., ........ , 19~.. pursuant to which BuildMg Permit No.. ~.~. dated ....... ~a~. 9., ......... , 19. ~2, was issued, and conforms to all of the requ~ ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is .... ~$v.a~e. 9.2,. f.~!~Y..4~?~.l~g .................................... The certificate is issued to Alfred ~e[er (owner, lessee or ten,t) of the ~ores~d buildMg. Suffolk County Dep~tment of Health Approval . D.~?~..~qY~..~. ................. 1973 by R. Villa UNDERWRITERS CERTIFICATE No .... ~.73~.qq .... q~?~ .~?k'..~.,. ?73. ...... HOUSE NUMBER ... ~Q~5 ...... Street ...~?~. ~ ..................... ......... Cutehogue ......... ............ ................ Building Inspector FORM NO. ~ 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) 5859 Z Permission is hereby granted to: at premises located at ........... .I~t;...'J.~IL...JJ~-.I:~...pJ'.IrLJ. ........................................................ ................................. ~sm~..i~.t~ ~ .&. ~i~et~ .3~1, ........... .CJtel~ .............................. pursuant to application dated ........................... ~&~ ......... ~ ......... , 19....~, and approved by the Building Insp~:tor. Fee $'~'i~ .......... Pz:t:r,,l'F INCI.UDES APPROVAL 70 ~EMOVE EXCESS F F?OM ABOVE PREMISES REG~L~DING LOT Di~O,fi%VA y CON'STRUCTION ....... L CONSIRUCTION CELLAR CDNSTRU,C]iON .... C;TitER FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Sonthold, N. ¥. 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, 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 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 oil 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. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .......................... ~ .............................. ~ .......... ...~.. ............. : ......................... Owner Or Owners Of Property ..... ..~.....~....~....~..~.....~.......-~.....~....~....~,. ,/....~..:......~.....~...~...~'.~.. ....................... Subdivision../~...~.,..~.,,'~?....~....~....~..?./t~--4~,.7'../~... ...................... Lot No ........... /.~.., .~... Block No ............. House No ............. Permit No..,~.,,4~.....~.~.. Date Of Permit ...~...~...~...-.....-'~. ,Applicant ,~.,,~, ~....-~,.....~.,..~....J-7....O..,t~'~...~....~...[ ................ Health Dept. Approval .~..~.~. ................................... Labor Dept. Approval ................................................ Underwriters Approval ..~...Z~..~..~..~...~...c~...~..~../...~?...~.. Planning Board Approval ........................................ Request For Tem~porary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .~.~. ............................. Construction on above described building and perm_it m~ets all applicable codes and regulations. Applicant Sworn to before me this .../....~......~.. day of ..~.~....~..Ze'~./~ J/ -~' (stamp or seal) Notar~h Public ........ ~--- County Notary public, State of New york No. 52-0344963 Suffolk Country4(.~ Commission ~xpJres Mmch 30, 19~c,-~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date NOV 15 lg73 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located deed' location) have been inspected by this department and found to be satisfactory. NOV .~ $1973 SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No$'~ ¥o?~~' APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date ~ '3°/7Z' Approval to construct said systems is requested,pertinent data herewith: 1-Applicant ~' ~r~-Q~ C~ Phone 6-Sub div~.~-~. ~.~ Address ~-~.2 I~'~ ' I~ ~'~ ~ 7-Section 2-Detailed property location ~ ~-~ 8-Lot No. Hamlet ~.~.~.~. ~ ~. w · Town 9-Private wel 1 ?_~'-:~.~..~ 3-Public water supp~ name ~.~-~-..~'~ Distance to nearest main ~-Lot Size: Width]~r~ ft. Length~.~ (also on ft. enter center plot plan below:) 5-Dwellin~: Single Family ;X; Two Family? / ~/Cellar? ;/~/.Slab? ~ ~Crawl Space? 10-Proposed system: Septic {ank ~ /Precast F /Cesspools ~/Shallow pools il-Septic tank inside dimensions: Volume 12-Precast sections: / /Number~_/Square Total blocks below inlet: ~1~6'~ ~2~3 PLOT PLAN / Gals. Length ft. Width ft. Liquid depth ft. Ft. Cesspools: Block sizeL~incs.D~ ins. H~' ins. Ta~ Capacity¥~ Gals. --1 G.P.M. ~' Street ~~~. The Undersigned CERTIFIES: "Construction of authorized installation~ Data Feet 3&, 0 A. 2 6 8 ~6 Indi No will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". ~ 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 ~//~J~ Signed (10/65 Revis.) ~ ~% S-15 ~ TOWN CLERK'S OFFICE ~ ' ~z,~'~. ~ ~///J.- , ~ ~ SOUTHOLD, N.Y. '"~"~"~"~"~"/~" ~' / ~ ; - -~// ..................... ...... ~pr~ed ~t ~' ~ ~7 ~ ........................................ , ~ ........ Pemit No ..................................... Disapproved a/c .............................................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS , a. This applicatic~h must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locatiOn of lot and of buildings on premises, relationship to ad oining premises or public streets or arees~an¢ giving a detailed description of layout of property must be drawn on diagram which is pert of this application. . c. The work covered by this application may not be commenced before issuance of Building Permit. · d. Upon approval of this appiicati°n, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept~on the premises available for inspect on throughout the work e. No buiiding shall be occupied or used in whole or in pert for any purpose whatever until a Certificate of Occupancy shall 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 South01d, 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 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. State whether applicant is owner, lessee, agent, architect, e~ngineer, general contractor, electrician, plumber or builder. '~:~'";~'~'~""-"71%'""""'"'"-"-'-"' Name of owner of premises ~~.....~ .................. If applicant is a corporate, signature of duly I~ flauthori~ded officer. [J .............. 1. Location of land on which proposed work will be done. Map No.: Lot No..../....~1~...~'7~. ......... ~,..;~ ......... Str,t and Num~r ~~...I~.~..,.~.~J..Z.~.~.=.~.~......~.~ ~ O ~ ~ ~ ~icipali~ / 2. State exi~ing u~ and o~upancy of premiss and intended use and occupancy of propo~d con,ruction: a. Exi~ing u~ and ~cupancy ..... .~..~ b. Inte~d~du~ando~u~a~c~...~..~...~..~.~~ ~ ............................................... 3. Nature of work (check which applicable): New Building ...... ,~....% ......... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... <~//.. ~ (Description) 4. .................... .... ...................... [ e pmo on ~ ~ng ~ms 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 ~r additions: Front .......................... Rear ......................................... Depth .......................... ; .................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new corj~tructlon: Frpnt ..... .~,~.....(7~.. ....... Rear ..... .,,~.....~.. ........... Depth ..~.....~.....(~. ........... ,.. Height ..D~..~....~-........o...~..~.!~. Number of Stories ....... ~ .......................................... ~ ................ ~ ...... g. Size of lot: Front ..... ~..~IJ.;.., .................. Rear ....... /......O2~.. ......................... Depth ..-~...u~...~... ...... ,~,..o..~...~.. Height ..................................... _ ............. Number of Stories ..................................................................................... _ 10. Date of Purchase .~..~..,/,~...../..~..~.~H~lame of Former Owner ....~...~v~....~..~~' ......... 11. Zqne or usa district in which premises are situated ....~.~ ....... ' ................... ?. ..................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~.....~.. ....................................... 13. Will lot be re~aded ~ .................. Will excess fill be removed from premisas: [ ] Yes [~No 14. Name of Owner of pram(see .~3:~1..;.~....~31~..~.~~.~,~,...~..7./.=...~.'ZZ,~,. ,,~/'~ ,,~ ~ ~ ~ -, ~, (AddressP~'~''-' /(Phone No.) · ~..~.,~, . I:~...~- _ ~-- L, s/, . ~ ~.¢..~=-.~2,/.~- Name of Arch,tact .............. ~...:.¢...3. ......... /-~/% ~/,~'~ /} .~ ~~'"~" ' ' --(~/~dre~s} / ~P~one No.) -~ Name of Contractor ..~~~ ......... ~..~..r..~......~.....,...~....~...~..=.~../a..~...~... ? -- (Addresso ~ / (Phone No.) PLO:r DIAGRAM L, ocete clearly aPd disfipctly ~11 buildings, whether'existing or prol~osad, and indicate all .set-back dimensions from property lines· Give street add'block n~mber or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) SS / .... ,..~....~.~..~.,:.~ ...................... ~ing dul~ sworn, de~s and says that h~ is the appli~nt above named. ., ;,,:..:.:. ............ : ........... :....' ................... :., ......................................... of said owner or owners, and is duly authorized to ~rform or have ~formed the said work and to make and file this application; that all sta~men~ ~ntained in this appli~tion are true to t~ ~st of his knowledge and ~lief; and that the work will ~ ~ormed in the ~nner ~t fo~h o the app caren f led therewith. ' '~ J~r~ 'r BOGEN ........................ o, ............... ,, ~ · .... ........................... ~ {~m~ o~pplicant} ii -'1