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Home My WebLink About5989-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z' '~01~I ..... Date .......... [laX' ...... ¶ ~. ..... , 19 '73' THIS CERTIFIES that the building located at .I,am~el. l~ood. De .&. woodst,~i~tet Map No.i~wtlre~wood. Block No ........... Lot No. 43 .... I~ -ul~l.- · - .IloY~, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... i/ttly .... ~.., 197~. pursuant to which Building Permit No. ~989g' · dated ......... ,/miT... ~ .... , 19.72., 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 .Priv~e.. ~. rally' d~eel'~lng ...................................... The certificate is issued to . John- .Rome. ~I ....... O~neI ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · Iai.. 9'197'~' 'bit. .R.. ¥&.llm ...... UNDERWRITERS CERTIFICATE No .... 1~' ~t~9'~ .... POD-. 23' '~'9~3 .................... [tOUSF~ NUMBER... ~[~05 ..... Street..-l~tlll*~l~Oo~l..DI~.~'O ........................... ................... 105. ........... ~.o.o¢~.~e..l,~.e ............................... Building Inspector FOEI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT ('rillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5989 Z Permission is hereby grented to: ....~..(7.~;~,~ .............. '...:~;~ ...... ~.....~-~...~ .............. ..... d/.e_ ......... ~:~.~ ....... ~,.L.~ .............. ...................................................................... ~.~ ........ ~.~.~..,2.~:./,,, .................................................. ............................................... ~.. ......................... .~ ....... ;...).~,~ ......... ~.~..~...7...~. .'~ ..... pursuant to application doted ........................................................ , 19/..e~., and approved by the Building Inspector. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructiofls 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 end "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 3. Copy of certificate of occupancy $1.00 $5.00 / . Date .. ~/]...~./:~.,~. ...................... New Building ...... .'X ....... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .... L.L~..~.~.~'..~-.?..O.~'~-~ ........ .~.~.~.~...).....'.~..~.~..~-~-~...~.....~...~...~.t ....... Owner Or Owners Of Property ......~.....~..~.~.1....~......~...~.~,.~[*~"~...~.. ........ ~.~.~....~. · .................................. Subdivision ....~.....~j~.J~.~.i._.kk!.C2. D?~. ...................... Lot No..k'~..... Block No ............. House No ............. , Permit No.....ff...~ ................ Date Of Permit ,.'l~..Applicant ..~.~..'....~.~...~.'.'..(.&./..t' ' ' .............................. '~'~ ~ Health Dept. Approval ...... '.~... ................................. Labor Dept. Approval ................................................ Underwriters Approval .......... ~ ................................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....~ ................................. Fee Submitted $ ...~.7~.~.--'~. .................. Construction on above described building a,~:l permit meets all apglicabJe codes and regulations.. ~pplicant .....~¢J~.....; .......... ~.~ ................ ~...l..r:~..a.~ ..................................... Sworn to before me this ~(~-',- ! ~/f) ................ day of ............................................ (stamp or seal) ~V~ Nota~ Public .................................... County ~ c~ ?O SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No ~[?- t/? ~, EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date ~', Approval tn construct said systems is requested,pertinent data herewith: ' ' "' 1-Applicant ' :'~ " Phone 6-Sub div L. ~ Address /~ ' ·. ~ 7-Section 2-Detailed property location 8-Lot No. ;" Hamlet '. .... ~' ~ ,-. Town . 9-Private well? 3-P~blic water supply name Distance to nearest main 4-Lot Size: WidthI~ ft. Length . ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~l Two Family? ~ /Cellar? ~ /.Slab? J JCrawl Space? lO-Proposed system: Septic tank ~-/Prec~st ~ /Cesspools ,~__~Shallow pools il-Septic tank inside dimensions: Vplume ~"~ Gals.Length ft. Width ft. Liquid depth i2-Precast sections: / ~Number~_~Square Ft. Cesspools: Block sizeL incs.D ins. H Total blocks below inlet: ~1__~2 PLOT PLAN Street .trade G ,W.L. I e No~th / ins. Capacit~/~Gals. G.P.M. ~ Data ?eet 0 2 4 6 8 10 12 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 Systems". Date ' ~ Signed '' ~ '~ ' ~' ~ Owner ~ 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. ~ ~ ~ __ ~/1t7/ Date ~ oioned -- ~-____. ~1/~ t (10/65 Revis.) s-15 NOTE - LOT' NO'S, SI.-IOV¢ N E5 TATE,~",ON FILE N~.~6.48./~,yOOD .S~ DF£ ...,.6b ~0 ,O ,,V. . 297.08 Ld " SCAL~- 50 : ,' Chief of ~c~ ~ ~' eevln~' Examined ........................ x~,Z..i:..~'., 19 ........ ,.--~, ,,--,-~ --~ Approved ...................... ~ 19 ........ Pemit No ............................. ~ ....... D~sapproved a/c ~ (Building Inspector) TOWN OF soUTHoLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Applicotion No ................................. APPLICATION FOR BUILDING PERMIT Date ......... 2 ............................ , 19..'). INSTRUCTIONS a. This application must be completely filled in by t~/pewriter or in ink and submitted in duplicate to the Buildi Inspector. ' b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproPerty must be drawn on the d ogram wh ch s part of this appl cat or~ c, The work covered by this application may n.ot be commenced before issuance of Building Permit. d. Upon approval of this application, the Buildmg Inspector will issue a Building Permit to the applicant. Such permit[t 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 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 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 cede, housing code, and regulations. (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. ................ C.~.~...~.~ ...~i..'~.. ~ ............. .......................................................................................................................... Name of owner of premises .....~.~.L"~i~...:.."....~.,~.I~. ................................................................................................... authorized I~p~licant is a co,orate, signature of duly officer. ,~ ~ ] koc~t~on of I- d on wh ch pr~osed work w,II bo done Mop ~o ~ ~o . · ' _· . .: ............. ................ , .............. stt.~t .~ ~.U~.r ..~.~..~ ......... .~.~U.~ ................... ~ ...... - ...................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ .~...~.~ .......... ...~....~k.] .................................................................... b. Intended use and occupancy .....~..J~.~t.,....."..~..~e~,~.~/ ................. ?,~..~..~....~...~...~.l~..C~j ........................... 10. 11. 12. 13. Nature of work (check which applicable): New BuJidi .............. A~dition .................. Alteration .................. Repair .................. Removal .................. Demolition.....~ ........Other Work (Describe) ........................................ Est mated Cost .............. ..~....~..).~..:...~... ................... Fe~.....ZZT......~.....~... ............................................................. (to be paid on filing this application) / If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ..../, ...................... If garage, number of cars ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................. .......... 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 ................................ 6," - ' " ' Dimensions of entire new construction: Front ................................ Rear .....~...~.......~.. ........ Depth ....~.....~.. ............. Height .................... Number of Stories ...... w~.....: ......................... ; ............................................................................ Size of lot: Front ..... .~.~.~ ..........Rear .......... J,.~..~.~ ............... Depth'....~..~..~...~ ............. Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated ..... .~..~.L..~..~/~.~).~ ............................................................ Does proposed constructiOn violate any zoning law, ordinance or regulation.> ........ ~....~.. .................................... Name of Owner of premises ..~:~....~3.......~...~ ....... Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~,~...~.l~.l..'JT~......~...~..~.. ........... Address ........ ~.~.....~'R..~.....~....Irm... Phone No..').3~.':./~..~.~..e~'' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Givq street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, ~ c e COU N'T'~%OF ................................ $ '~'"' , ...... ,....t.~.~..~.~ '-- ' ....... .~...-......,~~ .........................being duly swam, deposes and says that he is the applicant (Name of individual signing application) ~, above named He is the ..... .~....°..C.~... ~..~...~.....~... ~ ....~..~.~...~... ....................................................................... (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 ~opplicatian; that oil statements cantoined in this application am-true tb the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. . . ...... ~ ' hlalaly PubJic, State o~ New yolk No. 52-0344963 SuffoJk Count~J~ Commission Expires March 30, 19..,~../