The URL can be used to link to this page

Home My WebLink About5988-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. '" ... ~,ttflLlr .,.30 .... 1973. 533:& Date ...... ........... , THIS CERTIFIES that the building located at . ~l'&~,. ,A~'O...~ .......... Street Map No .... ;1~ ...... Block No. ~ ....... Lot No31~ll;i, . . I~ttLr~l .]g~][~ ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... J'tt~... 5 .., 19. ~ pursuant to whi6h Building Permit No..~958Z . dated ........ ~.'tLl.y ..... 5 ....., 197~., 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 ?~.iVa.~a. O1~..i'a~ai~y. ~lw.aIlir~g .......... , ............................. The certificate is issued to R.'[ehard. ~taglll ..... ~m~l~. ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~l'~...~.. ,~973. ,Dy. ~tl~. ~/;klZa .... UNDERWRITERS CI-:RTIFICATE No. ~..09~'9.~.8... ~.*,, J. 2 .... 1.9.73 .................. I lOUSk NUMBER .... 314..~ ..... Street.. ~y. A.V.,a ..................................... ! Building Inspector / FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT, TOWN CLERK'S OFFICE SOUTHOLD, Nm. Y. BUILDING PERMIT (THIS PERMIT MUST., BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5988 Z Permission is hereby granted to: ;':.~...;.:; ......... ~ ....................... ..'~_:.".:..':. .......................... ~ ~/>/C,~L~ ~'b MAG / L ............. ;.~':~ .......................................... ;.~ ................ pursuant to application dated ~ -JbT. ~: 1~...~ and approved by the Building Inspector. Fees 5/.~9 ~90 . Building Ihspector TOVIN OF SOIJTHOL~ Building Department Town Clerks Office Southold, N, Y. 11971 APPLICATION FOR CERTIFICATE OF ~ccUpANCY 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 sewerbge 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 comp lance from the ,~rchitect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan ~equirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming u~es, or buildings and "pre-existing" land uses: l. Accurate survey of property showing ail property lines, s!~eets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, o¢,cupancy al~d 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 .................. ~ 4f/- · .'~...t..~.'/.. ·/J. / New Buildin~ Jr/ Old or Pre-existing Building i . . Vacant Land Location Of Property ....~.,'/.~. .......... ~.~,J~..~..,...~.~,'~,., ...... '~-~.~,~..~,~.,~,~'"¢-.~,....'~"~'.;;."~/' ............ Owner Or Owners Of Property ............... .~. ~*.~. ............................................ - ....... ! ........................ Subdivision ............................................................... Lot No ............. Block No ............House No..~?...~.:/.~. Permit No.. ...~.... Date Of Permit. : .~.....Appllcant .... ~ ~.,.....~lt~..'tT..O..~. ...... .t~........~..'.~...~.'..~. Health Dept. Approval ............................................ Labor Dept. ~pproval ................................................ Underwriters Approval .............................................. Planning Boated Approva! ........................................ Request For Temporary Certificate ........................................ Final iCertificate ....... ~ ........................... Fee Submitted $ .~.'~..-~.....~..~. ............. Construction on above described building~ permit meets all a[ Applicant ........... ..~...,~.,..., Sworn to before me th(i~ ............ .0.. day of t .................... Notary Public ......... F./, ................... County ~a~e~ and regulations. (stamp:or seal)~ ,~ TOV/~ OF $OUTHOLD Building Depertmeflt Town Clerks Office Southold, N. Y, 11971 APPLICATION FOR CERTIFICATE OF JDCCUPANCY 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 usb: 1. Final survey of property with accurate location of all k~uildings, property lines, streets, and unusual naturol or topographic features. 2. Final approval of Health Dept. of water supply and seweCage disposal--(S*9 form or equal). 3. Approval of electrical installation from Board of Fire Undlerwriters. 4. Commercial buildings, Industrial buildings, Multiple ReSidences and similar buildings and installations, a certificate of Code compliance fram the:Architect or Engineer responsible for the building. $. 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 alt property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, o~cupancy and condition of buildings. 3. Dote 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 uss $5.00 / 3. Copy o[ certificate of occupancy $1.00 ~'7/ Date .....~.j.. .... r../~...,..~. ............... New Building ................... .~?ld or Pre-existing Building ................ i ........... Vacant Land ............................ Locat,on of Property .........¢,, ,, _. -- ...... ............. Owner Or Owners Of Property ,.,.~.,-;~.C..~,,.,~, .~..~,,,.,~.,~..-.~. ,~,,~-?*-,~*.j~ ....... '~'"~'..,,C~....C,,h--~.'.~,..,Lm. ..................... Subdivision ................................................................ Lot No ............. Block NO ............. House N~.,~..~...~..~ PermitNo ..~...C~,~(~z DateOf Permit.7./~.E;'/.~'..~.. App cant ~ ~T~i~.~.'~.~..O 't~ Health Dept. Approval V~ .. Labor Dept. ,~pproval Underwriters Approval .............................................. Planning BoaI:d Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........................................ Fee Submitted $ .~T.~.....~?.'...~.. ............. Construction on above described buildin~ar~l permit meets all al Applicant ........................ Sworn to before me this ................ day of ............................................ Notary Public .................................... County i~)l~co~es and regulations. ................................. (stamp or seal) f N,ro9 I$ ~0 E, SUFFOLK COUNTy HEALTH DEFART~,~NT DA:~;JUL'"- ~'? 1973 i~o The sewage disposal aud ?,'a~,or f:upply fact.]iii, es for this loea[io,~ have been inspected by /his departmo~t aud found Chief of General Engineering So-~riccs C) UCE ~SE.D LAND SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Referenoe No. ? EASTERN DISTRICT, RIVERHEAD,N.y. APPLICATION FOR APPROYAL TO CONSTRU~.T PRi~.ATE SEWAGE DISPOSAL SYSTEMS Approval t~ vonstruct said systems ~$ requested','pertinent data 'herewith: Date Address ,i 2-Detailed property Hamlet X ~ 3-Pablic water supply name Phon~j, ~-,,cf,6-Sub div ?-Section 8-Lot No. ~9-Private well? Distance to nearest main 4-Lot Size: Width/~o ft. LengtH~;~j ft. (also enter on center plot plan below:) 5-Dwelling: Single Family lO-Proposed system: Septic ~ank ~/'yPrecast~__~Cesspools~_/Shallow pools 11-Septic tank inside di~nsions~i Volume~o Gals. Length ft. Width ft. Liquid depth ft. 12-Precast sections: ~umber[~_~Square--~. Cesspools.7~Block sizeL'" incs.D ins. H ins. Total blocks below inlet. PL~T PLAN Ca pa cit~/~l,~6als. G.P.M. ~ Street Indi No "~onstruction of authorized installation rth Data 'eet 0 2 4 ,6 10 12 14 ~6 The Undersigned CERTIFIES: will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private (~w~.~ge Disposal System~". ; · Owuer ~? Builder FOR ~ALTH DEPART~NT USE O~LY. Bas~ed on the info~ation presented herewith,' 'it opinion of the Health De~ment, t~at an adequate and satisfacto~ Sewage Disposal System Date ~g/~ ~ gne (10/65 Revis.) ~'~1~ TOWN OF SOUTHOLD ', / ~ ~' ~ BUILDING DEFARTMENT ~/'?~/.?> ~'~ .v~: <, . - ~) TOWN CLERK'S OFFICE ~ '~ ' ~ ~ ~ - ~ ~ ~0~,~,~ .................... ~...~.. ,~...~~ · ~.~.o~ ~o....~.....~_.._ .... Approved ..................... ~.~~.. Pemit No...5......~.....: ...... I . ,,,op~o~od 0~, ...... ' .............. ~..~ , ........... ~ ~h: ~ ~ ~ ~. ...................................... · ., .................................... ................. ......................... ~ ...~. ~.~ ..... (Bui~g Ins~r) '"~ D,~, ........... .~.~ .......................... , ~.~. I~STRU~IONS -- ~ ,. This applic,tion must bo completoly fill~d in b~ ~powriter or in ink and submitted in duplic~t~ to th~ Buildin~ Inspector. b. Plot plan showin0 Ioc~tion o{ lot ond of buildings on pr~mise*, rel~tlomhip to ~djoinino premise~ or public str~t~ or ~ oreo*, ond oivino a d~tail~ description o{ layout ofpropo~ mu~t be drawn on the dioorom which i~ ~ o{ thi* ~pplication. ~- c. lbo work covered by this opplic~tion moy not bo comm~ed b~fore, i~*uance of Buildino P~rmit. ~ d. ~po~ opprovol o{ thi~ opplication, ~ Buildin~ Imp~tor w' issu* o Bui d'n0 P~rmit to th~ ~plic~nt. Such p~rm~t ! sh~ll be kept on the promise, ov~ilabl~ for inspection throughout th~ pr~re~ of th~ work. e. ~o buildino *h~ll b~ ~cupi~d or used in whol~ or in port {or ony pu~os~ wh*t~v~v until a ~*di{ic~t~ o{ ~cup~ncy sh~ll h~ve b~n ~rantod by the Buildin0 Imp~ctor. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 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. (Signature of applicant, or name, if a corPOration) .~.~......~..o..,~~,.....~: ......................... (Address of applica~I' .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... .~...~.~o.~ ................................... ' ...................................................................................................... Nome of owner of premises ......~..~..~...')~...~..~..J~ ........ ~).~..t...~....~.. ................................................................................... ,~...~...i.~...':~.........~. .~'~i : ° corporot,,o~t.~.r~..of du'y outhor,zod off,cer. ~11- ~ (Ncl~e and title of corporate officer) Location of land on which proposed work will be done. Mop No.: ........................................Lot No ...................... Street and Number .....~....~.........~.~.~..... .................................... ['~.~..'~..~...qw~... ...... ; ........................... 3 ~/5~- MUniciPality State existing use and occupancy of' premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .~. 14~.~..T.,. ~?;. ......................................... use ~. t"~ ,~,,.~lk(~ .~..~.,' .~.. c'-3..~..~:~..~. b. Intended and occupancy ............................. ~ ...........................~ ...................................... 3. Nature of work (check which apPlicable): New Building .................. Addition .................. Alteraeion .................. Repair .................. Removal .................. Demo t o~ . .. Otl~r Work (Describe) . .. 4. Est mated Cost O~..~T..,~ ...t¢'~'~... , .~q~. Fee .~...~.....~.....t~....~.. ~, O .... ii'i i' 'i ......................... (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 each type of use ............................ 7. Dimensions of existing structures, jf 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 ....... .~.~..~. .................... R · ear ...... .~..~. ............... Depth ..~.. ~ ............... Height ...../..~. ......... Number of Stories ........ /.. ........................................ .. 9. Size of lot: Front .......Z.~....~.. .......... Rear ....... /.......0. .................... Depth ....... /.~.~... ............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... J~..~. ........................................... 13. Name of Owner of premises ~.~'J~eJ~:.~....JJ.~/.~,~.J~,~J.~..Address ...... ~_wlk. Q~.,~?,,, ............. Phone No.')...~-.~...-...~...~...o...~" Name of Architect ...................................................... Address ............................................ Phone No. Name of Contractor .~..~..L4..t~JJ~L..~.~.o~...~' ......... Address ..~...~d. tR...~...~Ar,, .........Phone No.q.~.~..~n.~'.~.T.~ 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 whether interior or comer lot. STATE OF NEW YORK, ~¢ ¢ · COU NTY,,-OF ................................ .f"'"~ / ............--'~"" ' '~' 'J~"~-'~J~J .......... ~~ .............................. ~ing duly ~om, d~s and says t~t he is the applicant (Name of individual signing a~lication) ' above n~ed. He is the .... . ............................ (COntractor, ag~t, co~orote officer, etc.) of said owner or owners, and is duly authorized to perform or h~e performed the ~id work and to ~ke and file this application; that all statements contoined in this applic~ion am tm~ to the best of his knowledge and belief; and that the work will be performed in the manner ~t fo~h in the ~plic~im. fil~ ther~ith. Sworn to ~fore me this .......... 'Nota- Public . · '" . ......... Pu~Jic, Stale oJ New York .0344963 Suffolk Coun~ Commission Expires March 30, 12. L ~'0 f-3 -F '7 ALL "n ~r~r~ L I