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Home My WebLink About5707-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate Of Occupancy No..Z~..~.~.~. ...... Date ............... 0~$,...1~..., 19~. THIS CERTIFIES that the building located at . 8/~..Ix, kc. Drive .......... Street Map No.. XX ........ Block No... Xl~ ..... Lot No. ~'~... 8ottthol, d.. · 1t,¥, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Feb .... 3 ...., 19. ~.. pursuant to which Building Permit No. '~O~Z' · dated ......... Feb ..... lt. .... , 19~2.., 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. iv&t~ .one..£am~..ly. 0we.],ting ....................................... The certificate is issued to ... ga~es. P..lice ........ 0w~e~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~el~;. · .21 ,..~.9~2...by. R, .V~II& .... UNDERWRITERS CERTIFICATE No... I~. 36227 .... Xllg. ..1972 ................... HOUSE NUMBER.. 6~.~ ....... Street... L~¥,.O .Drl[.'~O .................................. Ce~ditions~ Band rail to basement be ila,,talle4 No heat. B--or oceupano, enl2. ...~j .%:'.~. /V / Building Inspector l~O~ NO. ~ TO~N O~ SOUTBOLD 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? 5707 Z Permission is hereby granted to: · ..Nl',r .qTl~e~..P,,.. lice ...................................... ............... l~.eel~l:~..-.ll,-~, ............................... at premises located at .........lll~..&ll~..~llil~lqR~ ................................................................................ pursuant to application dated ............................. ~ ...... J. ............. , 19.~.., and approved by the Building Inspector. Fee $'l!~b~ .......... Building In~oector / S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WItOM IT MAY CONCERN: The sewage disposal facilities for (Give/d~ed location) a structure located have been inspected by this department and found to be satisfactory. Chief of General E~g:[neerJ~g Services THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY r-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~,,.t~^u~ust :~o, :z~72~p,,i~,,io,..,o.,,,.r,,,S87008 N 3E;322 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application n~z rnber in the premises James Meg, s/s Lake Drive, Southold, L.I. (1000' w~o Kenneys Rd.) i. ,i,e.fouo.~i.~ lo,..tio,,~ ~ ~,,~,.~.i X~ ~' ~l. ~ ~-,,d Pl. outside Section Block was ext~,nined on ALlgus t 7 · 197 2 andfound to be in compli ...... with the requirements of this Board. FIXTURE OUTLETS DRYERS IIECEPTACLES 27 FIXTURES FURNACE MOTORS RANGES COOKING DECKS I OVENS FANS SYSTEMS NO. OF FEET OTHER APP/(RATUS: Water heater: 1-4.5kw E R V I PER ~ 1 A. W G NO OF HI-LEG OF CC COND 3/0 I C NO. OF NEUTRALS 1 AWG OF NEUTRAL 1/O SUFFOLX COUNT~ DEPARTMENT OF H~ALTH APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SEWAGE DISPOSAL AND WATER SUPPLY SYSTEMS Inspection for approval is requested, pertinent installation data herewith. N°'_--=-=__ - 2-N~e of Builde~,/~/~ ~ ~ ~/~ Phone~-Lot ~er~~ Address~L ~ ~ ~,AL/~ ~.~ 6-Bldg.Pemit No.~ 7-SewaEe System instated by ~//~. /~. /~~ Phone Address ~//~r~/ ~ ~/~ 8-(a)Daed location of~roperty Z~/~' ~/~' ~ g:'~/~//~.'~$ (c)Town~ (b)H~let or Village 9-Septic ~ank-Gal~o~ L ~ ,ft.W ~ .ft.Ligui4 Dept~ ~ f~ lO-Cesspools-(a)No.pools ~ (b)Blocks below inlet-l) 2) pool (c)Block size-L in.W in.H in.(d)Precast ~/(e)l~2 (f)H ft. in; Di~__ft.__in.(g)Finished grade to cover~ft. (h)Backfill Material ll-Water Supply: Public Syst~ ; Private Well If Private, the following questions are to be answered: Address~/~ ~ ~,~ //~ ~/~/~ ~'~ 13(a)-Total Depth of Well ~ (b)Depth to Static Water Level 14-Diameter of well pipe ~ in. 15-Name of Laboratory/~3~)~%.~ ~Q~,~F~/(~Method of Dlsinfection~C/{ 17-Date ready for inspection ~ ~3- ~'. /~~) /~ The undersigned CERTIFIES: Above syst~s have been constructed and are in compliance with the Suffolk County Health De~rtmen~'s curren~ndards, Bulletins and ~end~en~s thereto. . // /~_ _ ' ~ ~er - Builder 19-Insert sketch of location of Water & Sewerage Facilities with accurate dimensions. STREET FOR HEALTH/DEPARTMENT, US E ONLY Inspected by 4 ~- /~ - ' ~- ~Date ~d%d' Based upon the info~a{~d abovd, ~isfactor~ fuffctionins of above sys,~s can be expected ,i,h pr ope, maintenance and care.~p ~ ~ ~9~ ~ ~ ~' ~L~& Da~e ' Approved the H.D.Reference No~ /?/? Date · ~ Phone ~/5''f~3 6-Sub div ' , ~ ' - i~~ /~,/~a/~/ /~/~y~, , q-Section Address ~ ,. c- /~ ~ ?/ 2-Detaiied property lo'cationZ,/k~ z°,~>~' (/<f/_-U~'×~,~j/~ M~?.8-Lot No. <~,2 g ~ 9-Private well? Hamlet To~/~. ,~ ~/~ ~ ~ ~ · ~-~blic ~ter supply name ~ z~ Distance to nearest main ~*-Lot Size: Width z ~ ft. Length /g ~ ft. (also enter on center plot plan below:) 5-~elling: Single Family ~/~ T~o Family? ~ /Cellar? /~//~lab? / ~Crawl 5~?? iO-Pro~sed system: Septic tank ~/Precast / , /Cesspools ~ /Shallow pools /~/Other / ll-Seotic ta~ inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft. ~-Precaso sections: / /Number/ /Square Ft. Cesspools: Block sizeL incs. D ins. H ins. 7oral blocks below inlet: ~l ~2 PLOT PLAN Street 7he Undersigned ~F.~tT]F~:~~C°nstcuct~°n of authocized installations will be ~ - .~.~ ..... ffolk Count'~ '~ealth De~rtments' cuccent Standers, Julletins, _a~e, ~. , ~ ~er or Builder ;-~- ~w--~" ~-~'~ ~SE ONLY. Ba~n the /n/o~ation presented her~,th, ~t is the r~ Ab. , - . opinion of the Health De~rtment, th~an adequate and sat~sfacto~ Dis~sal y .... can be ~nstalled on this Plot. (tO!65 ~evis.) Capacity = ~_ s. q. P. M. Grade W.L. Ind] e NoPth Data ~eet 12 EASTERN DISTRICT, RIVERNEAD,N.Y. APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISBDSAL SYSTEMS Ap5roval to construct said sy$~tems is requested,pertinent data herewlth: FORM NO, 6 TOWN OF SOUTHOLD Building Department 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 dispcsal--(S-g 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 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 ............................Vacant Land ............................ Location Of Property .....~.i..~....,~.....~........~...~.~..././-.~.~ ................................................................................. Owner Or Owners Of Property ...____~__..~2 ....... ~__..... ....... .~. ,~.~'~.~/:?~'./.Z~Z~..~.. C~ Subdivision ................................................................ Lot No ............. Block No ............. House No.............'7 ~ Permit No.. ~..~....~../.~E)ote Of Permit ..~.~.L.i...'~...~.Applicont ...... .~.'.~.....J..~,..L..~ ......................... Dept. Approval£. ~'d -')~,~._....~..~,,...:....~.. .............. Lobor E~pt. Approval ........ [ ........ ~ ........................... Heolth Approvo ...... ........... Planning Boord Approvol Underwriters Request For Temporory Certificote ........................................ Finol Certificate ....... ~... ............... Fee Submitted $ .................................. Construction on above described building a~/~er~m, it meets al~_~p[~ c ,~l~es and regulations. Applicant .. ;.~.~.~/~.../..-~.........~. ~,~,~ .................................... Sworn to before me this ......... /...~. day of .............. .-C~..~.~%~.....'~.....!..~.i. 7 ~ (stamp or seal) Notary Public ..... TERRI LEE ELAK NOTARY PUBLIC, State of New YorR No, 52 6168295 (~ualified in Suffolk County Commission Expires ~,~arch 30, 191Ci j J S~NO S/.'RVE Y OF ,~T 30UTHOL O TO VIAl OF SOL/THO/ ~6'FFOLK ~06'~T~ Sco~e I : 5C IVOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ CLERK'S OFFICE /~ ~UTHOLD, N. Y. · .............. Examined ........ . .............. ~ .............. ~p~o~ ................... ~ .................. , z~ ~' ~No. Disopproved ~/c ........................................................ ............... .................. , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building~ Inspector. 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 layout ofproperty 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 Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of 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 hove 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 construction of buildings, additions or aJterations, or for removal or demo t on, as herein described.~--~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ........................... ............ ^ ess o, .... ?":F' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, ........................................ ~.~.~.' .~.....~. ....................................................................... Name of owner of premises .......~...,~./~....~,~'.....~...........~,......../....~....~....Cj~.. .............................. If applicant is a corporate, signature of duly authorized officer. ~'~ .................. iKi~;;~"~i"~i~'l;"~F;~';~;~';;~;"~¥~i~';;~ ......... ~;~ ~.~ 1. Location of land on wh ch proposed work ~ be done Mop No' Lot I~n Street and Number~.. ~,~./~'....~.T ..~..,~'/~ ~.~..~...~'.../~.. ~.,~....,~...~'.~...~. ~ Z-~r,~ x~ / -- ~ ~b~ ' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy...... .~.~...~....~../V~-'. ..................... ......................................................................................... b. Intended use and occupancy ..... ...~...~..../~....-~.....7-...~...~.Z~... ~.. ...~..~/,,.C~' 3. Nature of work (check which applicable): New BUilding .................. Addition .................. Alteration .................. Repair .............. ~' ,~"/r Removal .................. Demolitior ........ ~......: Other Work (~Descri_~be) ........................................ 4. Estimated Cost ~...,~,~/.~."O'..l~.. .................................... Fee ~....~....~......~...: ................................................... (to be paid on filing this application) .5. If dwelling, number of dwelling units ....~.,~.,~. ......... Number of dwelling units on each floor ...~./~.4~' .......... If garage, number of cars ....i~.~..4~. .......................................................................................................................... 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 ...~...~...n.~. ................ Rear ...,~.~..~..~.. ............ Depth ...~......~'...-....C~.. ...... Height ~.~'..~ ....... Number of Stories ..... ~.~...~... .................................................................................................. 9. Size of lot: Front ..../..~..~.. .............. Rear ....... /..O...~.. ................... Depth .L.~...~...~.....°....~.[...?...J/..~ ~('io~ /~.2 10. Date of Purchase .../~'..~......:/.~...~./.. ........................ Name of Former Owner ..~..~.~..~,....~..~'~.~'~.'.~.~'~/' 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construct on v o ate any zon ng law, ord nonce or regulation.;> ..,~.~:~ .............. - 13. Nome of Owner of premises~.r..~.../~'~...~.~.. .............Address .~...~...~...~....~.i~i....~'.....~.~hone ~'c~.,~.~.~.-~.~'.. Name of Architect ..............[ ................... .: ................ Address ............................................ Phone No ................. L.. ,, - . ,, Narr~ of Contractor ..................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locote clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block number or description occording to d~cl, and show street nem~s and indicote whether interior or corner lot. I0 STATE OF NE'W YORK, ~ c ~ ' COUNTY .OF . ........ ; ................ ._,.,,....f ~'"" · , .............. ,....~...~..../N~...~..~........~....~.~..~. ........................ being duly sworn, d~o~s and soys t~t he is the applicant (Name of individual signing application) above named. He is the .................... ~ ......................................................................................... (~mmctor, ~ c~~) of said owner or owners, and is duly authorized to peHorm or h~e perfo~ed the said work and to ~:ke and file this application; that all statements contoin~ in this appJicati~ am tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the ~plicati~ filed therewith. Swam ~fore me th~s , ~? .... ................ .................. , Nota~ Public, . ........ (.~..~ ............. ~. ....... >'"'"v.. Coun~ / / (Signature of applicant) ....... / -' / /1 0 . · ~INI~ ExpIr~ M~rch ~, le,~ I lit --I!- T ;'3.) 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