The URL can be used to link to this page

Home My WebLink About6012-zFO~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 2~bt97.~ ....... Date ......... .,Ia~ .....12 ....... , 19. THIS CERTIFIES that the building located at . PJ, r~O. kv.e ................. Street Map Nt/loos~ .~ay .~lock No ........... Lot No.. [L2,,8~[ ...... SQut, hold... It .Y,.. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ,Iuly... 1 .~., 19 .?2. pursuant to which Building Permit No. dated ........... July .... .~3, 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 . Pr~.~ate..one. ~.~m~ly..~h~ef.].~g ....................................... The certificate is issued to .~,'rs. Eugerm .t~erkh~n ....... 0~ner ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .J.a~. UNDERWRITERS CERTIFICATE No... Ii..6'l 83~.... DR(I HOUSE NUMBER...~.~ ....... Street ...... PA. ne. Ave ................................. FOB.~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 6012 Z ate ................................................... Permission is hereby granted to: pursuant to application dated .......................... ~:~.~.~. ....... .1.~. ........ , 19...~...., and approyec~, by the Building Inspector. Fee $~.. ~.~R .~... ............ ........ /.~:~.:~...~..'~......~ Building Inspector TOWN OF SOUTHOLD Building Delmr~ment Town Cle~.s Office Southold, N. Y. 11971 APPLICATION FOR CERTIFIC:ATE 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-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 cornpleted 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 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 ............................ Request For Temporary Certificate ........................................ Final Certificate ......... ~ .............................. Fee Submitted $ ........... ~.?..~. ............ Construction on above described building and perrn.~t~meets all ~pp~ codes and regulations. Sw:rn to..~.befaO, reofm, e tJ~ App;ci~ ~ ............... "~'"~";~ ........... .r.~..~.. ................... /~";"~":'~'i' ~~..~ Notory eub,ic .................................... cou.ty ~Jater heater: 1-4.5 kw .o.oro. 1-1/2 hpg Fiat. room heaters: 4-1.5, 2-1.25, 1-1.0, WJB. Ruland Mattituck, N.Y.' ' Per ' SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference EASTERN DISTRICT, RIVERHEAD, N. Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said systems is requested,pertinent data herewith: Date , 1-Applicant ~z~ /4Y~-~zc ~.~'~/.. ~Phone~4Z~6-Sub div Address ~,%--~ '~. /~.~f c',.~-~" .... ~ 7-Section 2-Detailed property locatzon t ~ ~ ~ ~ 8-Lot No. Hamlet ~-~ ~'~F ~-'~-~ Town c..., ~.... _/ 9-Private ~1~ 3-Public w~ter supply name ..... D~istance to nearest main 4-Lot S.tze: Wi.dth ~o ft. Length/~ ft. (also enter on.center plot plan below:) 5-Dwellmng: Szng'l~-~amily; ~ T~--~a~ily? ~_/;ellar? //~Slab? ; ~Srawl Space? 10-Proposed system: Septic tank ~ %/Precas .~.~ Cesspools ~ /Shallow pools 11-Septic tank inside dimensions: ~lume Gals. Length ft. Width ft. Liquid depth ft. 12-Precast sectxons. /~/Number~Square Ft. Cesspools: Block stzeL lncs. D tns. H ins. Total blocks below inlet: ~1 ~2 PLOT PLAN Data Feet ~ 0 ~ ' 2 8 ~ ~9 ~ Street ,.. ~ o Ind5 m ~ No The Undersign~ CERTIF~S: "Construction of authoriz~ installations will be in accordance with the Suffolk County Health De~tments' current Standa~s, ~lletins, a~ amendments thereto, covering Private Se~ge Dis~sal Systems". FOR ~ALTN DEPART~NT USE O~LY. Bas~ on the i~fo~ation ~resented here~th, it i~ the o~iuion of the Health De~tment, that an ad~uate and satisfacto~ Se~Ee Dis~sal System can be install~ on this ~ot. Approved ........................................ , TOWN OF SOUTHOLD '~'~:: BUILDING DEPARTMENT ~//Tz-- ~-/~z~->,~ ~ ~ ~ ~ TOWN CLERK'S OFFIC~ /~~ ~ ~x~ ~UTHOLD, N. Y. /-/~- 7~ ~// . ~ ....... .............. ......... Disapproved a/c .............................................................................. ................... L...Y... ...... ........................ (Building Inspector) I A..L,CAT,O. 'O...,LD,.G .'.M,T Dole .................... ~..~.~..~ .............. ,19 ........... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, withl~ 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 adjoining premises or public streets or areas, and 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 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 work. ~ e. No building shall be Occupied or used in Whole or in pert 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ........................... i~:~dress of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general ~contractor, electrician, plumber or builder. ................................................... ................................................................................................................... Name of owner of premises ....... ~'~f~..,....~--~.~/.~__...,.~.~-~'~,~ ................................................................ If appmi~pora~ re of d~.l~thorized, officer. ................. ii~'~i~'~i~il;"~F~;~;F~';~i~'i~¥ii~i ....... ............. ~ 1. Location of land on which proposed work will be dona. Map No.: ....~.~....~..~...... Lot No.~,.~?~e~..~ .~..~,~.~.. ....... Number ~ ~ ~ z ~ Street and ............................... ~4:~.....~.~ ................................................... ~ ~._ ..~. ~ ................ ~ , MUnlolpallW 2. S~ exi~ing u~ and o~u~ncy of premiss and in~nd~ use and occupancy of propo~ con.ruction: a. Exi~ing u~ and occupancy ..... ~~' ........................................................................................................ b. In~nded u~ and o~upancy .......... ~.~ ............................... ~....~ ..................................................... ~ Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... { Description) 4. Estimated Cost ...... ..,~...~../....~.._~..~ :. ~..o. ............... Fee ................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ......................................... If garage, ndmber of cars ......................................................................................................................................... 6. If bu~inesa, commercial or mixed occupancy, specify nature and extent of each type of usa ..................................... 7. Dime~sions 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 i~w ~onstruction: Front ....... .~..~ ............. Rear ...... ............... Depth ..... .................... /4 r Height ..................................... ,~ ......... Number of Stories ..~ ..................................................................................... 9. Size of lot: Front .......... ...~...~.~.:.~.....~.. .......... Rear ..... ~..~.. ..." .. ... , .................. Depth ..../.?~....c.~..-...., .............................. Height .................................................... Number of Stories ........................................................................... , .......... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposad construction violate any zoning law, ordinance or regulation: ........ ...Z/...O. ........................................... 13. Will lot be re~'aded .... ~_c~_.......~ ............. ..~.. Will excess fillbe removed from pre_.~isas: [ ] Yes, ,~] No . 14. Name of Owner of pram,sas ........... ; ...... :...~. ........................ ! ................................................. , .................. ~.. ........ ~ (Address) (Phone No.) Name of Architect ...................................................................................................................................................... ~ //~z ~ ., . Address) . //, (Phor~J~o.) Name oT ~;on[re~or ....... .~ ............................................................................................... ./.. .......................... , ........ (Address) (Phone No.) PLOT DIAGRAM Locate clearly end distinctly ell buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street end block number__o_r_de_s~r~ i~tion according to deed, end show street names and indicate wbeth- er in~lor or corner lot. b'TATE OF NEW ¥01~:~? ,.~i~/J~ COUNTRY OF ................ C::=~'~r/a""r ~C--'""~=..~ ........................... ) ........ .~. .......~ ........ ' .............................. being duly sworn, deooses and says that he is the apl)lieant above named. He is the .................................. /'"~; .............,., ._...,, '/":¢;',;'"~';*'~;;;'*'"~'~'~"~;'"'*""o~,*;';';",;.'; ..................................................................... of said owner or owners, end Is duly authorized to perform or have performed the said work and to make end file this eppll~ation; that ell statements contained in this epplleetion ere true to the best of his knowledge and belief; end that the work will be performed in the manner set forth in the eppli~tion filed therewith._ ... :. l..3........d.yo, ............. ......... ......... U-'";r ............ ...................................................................... ........... .............................................. ?? 4