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Home My WebLink About5905-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z .b,9.~l~ ...... Date ............ ,~anuar. y. 2~...., 19.7.3. THIS CERTIFIES that the building located at . .Lon~ .Creek .&. ~uth:L~l,.. Street Map No][ezmeco.tt. P~31ock No ........... Lot No.23 .... ,qouthold.. 1~ .Y, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... l~ay...26 .... , 19.73 pursuant to which Building Permit No..~90.~Z · dated ........ ~ay ..... 2(~ ..., 1973., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pr. iva.~e .one..£am~y. d~:Lling ....................................... The certificate is issued to .. ~.d.~rcl..~.. Car. cl. An~iers.ea .... O~ners ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~9.v..2.8...~.9.72....b.y.. ~.o..V.$..~.]..a. ...... UNDERWRITERS CERTIFICATE No .... .I~. ~7907. · l~ov.. ,29.. 19.72 ................... HOUSE NUMBER.. ~0.. ,Longgti~l~®k. D.I~ .......................................... 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) 5905 Z Permission is hereby granted to: .......... 1,~-'~9 .................................................. to ...~-~-.~e~..me ..te~n~l~ · 4~e:~i~ ................................................................................... at premises located at .......... ~l~"~I~ ......... ~¢lllllll~lCt~'t~"~l~l~ ........................................................ .............................................. /,e~..g~e~..~ .......... ~e~elm~l .................................................... pursuant to application dated ...................... ~'. ......~1~ ............. , 19....1~1~, and approved by the Building Inspector. Fee $..~*~.(~ ........ Buildin~'~lnspect~r FOBM NO. 6 TOWN OF SOUTHOLD Building Depofl'ment Town Clerks Office Southold, N. Y. 11971 APPLIC:ATIOH FOR CERTIFIC:ATE OF OCC:UP~NC:Y 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 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. Dote 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 ~ New Building ..... ..~.. ........... Old or Pre-existing Building ............................ Vacant land ............................ Locot,on Of Property .w~*~.~z`/4'~..~..~¢~.....4zm~`//~`..~.~.~¢~.h.`.~..~c~r....~.~...`z`.~.``~. .... / Owner Or Owners Of Property ....... ~.~4~:~.~-..~.......~'~ ...... ~....~-r.~./...../(..~........~...~.c.C..~.~.~/. ................ Subdivision .~....~.....~..~.C.~ ................ Lot No...~.~.... Block No ............. House No Permit No...~..~.~..~..~.~.....~'~' "" Date Of Permit ../;~/~.../.~.?~Applicant ...... G./x~zZ.~: .z~. ............................................ Health Dept. Approval ....-~.~...;.../..~..~.../. ................. Labor Dept. Approval ................................................ Underwriters Approval .~..:...~;..~.~...7. .................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ...~.'~....~... ..................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me thisc~ ~/'~Lc~-~ ~/~ . ~ /'~o-.~ .~.~. ......... d~f~......X~..~ ............ ,stamp or seal) ~ Z ~ ~ T[RRI L~[ E~K HBTRRY PUBLIC, State 0[ New York No, 52-616~295 Q~e~i~ied in Su[fc~k Oounly ~mi:~ Expi~e5 ~arch 30, 1~ FORM NO. 6 TOWN OF SOUTHOLD Building Depar~ment 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 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. S. 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 ;~/~ Dote .... New Building ......~.. ............ Old or Pre-existing Building ............................ vacant Land ............................ t _A C: Z · ocat,an Of Proper,,, ....... ....... Owner Or Owners O~ Property ...../'~.c~.V~..~.~...~......~.....~...~.~..~...o./ ....... .~..~.' ...... ~.~.~.~./...~..C./3 ........... Permit No. ~.~.~...D.~%~ ..'~/ ~'Date Of Permit ./.~..~../.~.~pplicant ..... ~.~.C,.~.. ........................................... / o- /.. L Health Dept. Approval ....~.. ........./.~ ........................ abor Dept. Approval ................................................ Underwriters Approval .... ./.~;....~:~2....~..~..~.. ............... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .~.~.~.., ...................... Construction on above described building ,a_n.~ermit meets a~/pplicable codes and regulations. Applicont...:;~.~.~..~......../....'~....~ .......................... Sworn to before me this ~ '~,/), ~ ...~....~...¢..'~.~.. dc~y~ ....~...c~....~.......X...~...~....~. ............ (stamp or seal) TERRt LEE [IJ¥~ ~ARY pUBLiC, Stat~ of No. 52.6168295 ~li~ied in SulioiK Co~nt~ ~ion Expires ~arch SUFFOLK COUNTY DEPARTHENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS. Date May 23 t 29?9 ~pproval to construct said systems is reques~%~$~'oUueg~_at~2~ewith: 1-Applicant Edward G. Andersen PhoneEXt.25 6-Sub div Map # Address Eox 1239~ ~orth, Road~ I'econic 7-Section 2-Detailed proper~y_ location ~/s ~or5 Creek Drive 8-Lot No. Hamlet Sout.~ol~ Town ~outnotl 9-Private well? no 43.~,~1~- ~+.-r sunnlv name C-reenuort Distance to nearest main .~[~ze"~.-~idth~5 ft. Length 2£( ft. (also enter on center plot plan below:) , . 5.Dwelling: Single Family ~ Two ~F~amily? ~_~,Cellar? ~X~S~l,ab? ~ ~Crawl Space? 10-Fro~$ed svste~: Septic tank ~ Y~Precast ~Cesspools ~<~/Shallow pools ll-Sep[~c tan~ inside d~mensions.: _~olume 90~$~-fs.Length. ft. Width,..ft. Liquid depth ft. 12-Precast sections: ~_/Number~Square Ft. Cesspools. Block sizeL incs.D ins.H ins. Total blocks below inlet: ~1 PLOT PLAN Street LOn~ Creek Drive Vacant Park Capacity Gals. --1 G.P.M. nnne Data Feet 0 LoCm 2 Sa~d Sand 12 16 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 Syst~s'~.~ Owner /or Bui er . FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion.of the Health Department, that an adequate and satisfact~o~-~w~ge Disposal System can be znstalled on this Plot. ~ · .... ~ ~/ FO~M NO. 1 F,,,. [ 6 5, a ~b TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... Approved ........................................ , 19 ........ Pemit No.. .~). ..~ ....... Disapproved a/c ...... ~ ...................... ~ ~ (Building Ifnspector) APPLICATION FOR BUILDING PERMIT I NSTRUCT!ONS Date l~[ay, 26 72 a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot pian to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and,~ giving a detailed description of lavout of property must be drawn on 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 a Building Permit to the applicant. Such permit shall be kept on~r~ the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever 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, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the ~:onstruction 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. ..... (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. ............................. .e..r.. .......................................................................................................................... Name of owner of premises ..... .................................................................... 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.:5.1~.T. ........... Lot No....~. ..................................... Street and Number ..... ~L~a~L~;~C~D~e~2~g~C~e~/~[~e~~ ................... ~_.~ 0 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy ...... .~...e.A~.e...~.~.~ ................................................................ ..,............. ...................... 3. Nature of work (check which applicable): New Building ..,.~,., ................ Addition ..................... Alteration ............... Repair ............. ............ Removal ......................... Demolition ........................ Other Work .................................... { Description) -~ , 4. Estimated Cost ....~..~.~..,.Q(~).,..(;£. ................... Fee ................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... [.C.. ...... Number of dwelling units on each floor ...~....~...~.~..~. ..................... If garage, number of cars ..... ..~..w....o. ............................................................................................................................... 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. Dimensio,s of entire new construction: Front ......................... Rear ............................ Depth ............................... Height ....... ~..?..!.[ ................................. Number of Stories ....?. ................................................................................... 9. Size of lot: Fro,t ....!.2.5..', ......................... Rear ....... 1.2.5. ........................... Depth ....2. Dp.; ....................................... Height .................................................... Number of Stories .................................................................................... . . 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated re s idenligt .................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ T~P ................................................ 13. Will lot be regraded ....... ~r,e...s, ................... Will excess fill be removed from premises: [x)~Yes [ ] No 14, Name of Owner of premises ~¥~a~.~.-.~G-.s-.-~4~.~-~--e~e...~q~.~..~.~..t~.~..`~.~..`~2~..~.g-~-~ ........................ (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 Int. STATE OF NEW YO~.K,__ COUNTY OF ........ ~.~. ..................... ) ...................................... ~...~..~........~..-...~'~... ~eing duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract} He is the ........................................................ ~ .......................................................................................................................... (Contractor, agent, corporate of]Tcer, 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 o~ ~bi$~lf~o~.~.e~ and belief; and that the work will be performed in the manner set forth in the application filed therewith. Nofery ~u[~lic, $ta~e o~ New Yor~( ...................................... day of ................ Notary Public, ....~.....~.....~~unty ........ ~..'~.~'~.~..~_~~.~...~.~.']~.~..~ ..................................... ~/ / (Signature of applicant) LONG TU?W;LL R~, C~EEK DRIVE .23' tu -4' ,!, ." ''xN/?' .~ El.. MOI4UMEklT / MAP OF PROPERTY ~;IJ g.'V EY ED FOI/. ED\VARD (4. AND,EP-,SOM AND CAROL M. ANDERSON 'SITUATE ,AT · SOUTNOLD TOWN OF SOU~I-I. OLO, N.Y. LOT NUMEE2.$ SHOWN ~FE~.TO "MAP OF ~/ENI',[ECOTH PAF. K" FILED [:-I, THF.. SUFFOLK C. OUNTY CLEIIK'$' OFFICE AS MAP N-~ SI~'/ GUAEANTEED TO THE TITLE GUAZANTEE COMFAHY AND TO 'THE NOIZTH FOR. I/. BAI'{14, AND T~.UST COMPANY · '~UEVEYED ' AUGUST VAN TUYL [ICE~EU ~EEENPOET, NEW ~0~ ..... NOV 28 lg7~ ~he sewage disposal and water supply facilit!es for this location have been inspected by this department and found C~tef of General Engineering Services LONG 1'0 -~TMILL ~D. CI~EEK DRIVE N.~,~'$1'O0"E.- 125.0 -23. MAP OF PROPERTY SUg. VEYEO FOF. ED\VARD d. ANDERSON AND CAROL M. ANDERSON $ITUATE AT 50UTNOLD TOWN OF $0UT~.0LD, N.Y. · NOTE: LOT NUMBE~.$ (;MOWN ~EFE[Z. TO "MAP OF YENMECOTT PAI~K.' FILED tN Tl-I£ SUFFOLK COUNTY CLEF..K'$ OFFtC_m'AS ~AP H_o 5($? GUARANTEED TO THE TITLE GUAIZ. ANTEE COMPANY AH0 TO'TNE NOET~ FO~.~4 BANK AND TEUST COMPANY $ ¢;UIZVEYED · AUGIJST ~,197Z VAN TUYL a ,.SON QE. EENPOET, NEW ~ILU~ .l ,/4) O0 0 JIIVJ/'Jg f' r. f'J~ fL ..S/./ //o[../ - ji · Gn-T /"l E' ?(41L ' -1 J~o~.cN son .1 #,4' 2 xio e.~OIST 16~ c/c. l¢m- I&"c/& FILL ,--'/&L aC J/ 12.* ; I~c. // 125' &l ~7 S~UTH*~) L. rt