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Home My WebLink About6040-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...~..$.~. ..... Date ............ l~me~. · ~. ·., 19. THIS CERTIFIES that the building located at . R~,~rs' Ro~d .......... Street Map No.. 8~) ....... Block No ........... Lot No.. -~9... t~;ahogt~e .... I{,~. ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ A~ -.-2.., 19.72. pursuant to which Building Permit No. dated ............. ~tg.. 2..., 19.7~, 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 . l~i~;e..o~e. ~.a~[.l~..SM~,l~ ....................................... The certificate is issued to ... Ikt~l~l~ ./~t.tle ....... .(~r~e~. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .l~'..~0,..]-9~2. - .by. R., .Vik. -l~. .... UNDERWRITERS CERTIFICATE No... 1[ .~[.~ .... llO~'.. 20. · '1972 .................. HOUSE NUMBER.. ~ ...... Street ..... l~J[~,,~, l~ ........................... Building Inspector FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N~ Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 60~0 Z Permission is hereby granted to: .......... &t..z~ ...... ~.~e~..~ ......................... ........ aee~ ..l~/~r ..L~I.,..~ ~Z., .................. ~o~...~..,...~....t..~..S..~....d..-...*...Z.~.~ ....................................................................................... at premises Io~ated at ........~l~r,..~,'~l~ ......... ~ll~&l&..~ll~:~..]~ll~ ................................................ ....................................... ~t~..aeml ............. C~eae~e ......... ~,Z., .................................. Building Inspector. pursuant to application dated .................... ~l~r ............. ~- .......... , 19..I~., and approved by the ; IleT~ ~k, eek ave~ale ~etl~ae~ et ethe~ ~well ,!apt ~ ~aae u o ng inspe~tor~ FOBM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southoid, N. ¥. 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. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 19§7), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey oW 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ..~,~;l~,lT.?, ................................ New Building ....... ..X. .......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..~E,~..~.OAD. ........................................................................................................ Owner Or Owners Of Property ...... [~1~,..~..l[¢x~.,..~.~.[m,,.~....~ .............................................................. Subdivision .N..A..S..S..A..U...~.O..Z..N.~ ........................................ Lot No..,~.~ .....Block No...~. ........ House No...::. ........ Permit No. ~40.~. .........Date Of Permit ..~/~L/.7.2......Applicant ..Bi~D~,~,..C;Qi~L~[ZC~3;Qt~..CQ~P~I~ ..... Health Dept. Approval .... Ar~ACF~ ....................... Labor Dept. Approval ................................................ Underwriters Approval ...... P~.~,C~I~D. ....................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ..5...0J0..~.# .................. Construction on above described building~and I~lrmit meets all applicable codes and regulations. Applicant .~ ................................ Sworn to before me this ]~OAD~Ar~'~S COb/$~'ROC~TO[~ CO~. ~ ( N~a~ H.D.Reference APF~iCATION FOR APPR(Y~AL TO CONSTRUCT PRIVATE S, ,EWAGE DISPOSAL SYSTEMS Dat Approval to construct said systems is requested,pertinent data here*d, th: 1-Applicant I ~h~ ~uD~a ~t,~ Phone ~'Oq~S-Sub div ~ Address ~o9 ~rn~ ~6~ltu ~g~ 7-Section 2-Detailed'~roperty location ~/~ ~rg~z ~O 8-Lot No. Hamlet ~uT~ ~o~ To~ ~O~1~ 9-Private well~ 3-~blic mter s~pply name ~//~ Distance to nearest ~-Lot Size: Widthla* ft. Length~O ft. (also enter on center plot plan below:) 5-~elling: Single Family I~] T~ Family? / ]Cellar? [ /~lab? / ]Crawl S~ce? 20-Pressed system: Septic tank ~Precast / /Cess~ols / /Shallow ~ols [~-Septic ta~ inside dimensions. Vol~e~ Gals. Length ft. Width ft. Liquid depth f~. 12-Precast sections: / /Number~0~Sq~re Ft. Cesspools: Block sizeL incs. D ~s.H Total block~ below inlet: ~1 ~2 ~OT PLAN Ca~city~als. G.P.M. ~ W.L. ~ m Street ~ ~ ~ Ind5 ate ~ Nc th The Undersign~ CERTIF~S: "Constmction of authorized installations will be accordance with the Suffolk County Health De~rtments' current Standa~s, Bulletins, a~ amendments thereto, covering Private Semge Dis~sal Systems". FOR ~ALTH DEPART~NT USE ONLY. Based on the infomation presented here~h, it i~ the opinion of the H~lth De~ment, that an adequate and satisfacto~ Se~ge Dis~sal System Data ~eet 0 2 4 6 8 10 12 can be installed on this Plot. Date ~./~-- '~.~/'~5 Revls.) ~-£5 Signed BUILDING DEPARTMENT .~,,__ A ~ ,;f-~.~k-, ~'~;~ ~ TOWN CLERK'S OFFICE ~//~ ~ V~' U~ (~ ~UT"~, N.Y. ~'-' ~ ~ ~1~ ~ ................................ ~amined .................... ~ ................. , Application No. ~0 ~ ~ Approved ............... ~.). ............ :.1. ...... , 19~..[~... PemitNo ....... ~.g...~].~..~.t....ll/~f/?~ ~ ~' ~ ~ Di~pproved a/c ............................................................................. i ~d~ ill n I '~1~ ' I /1~1~ . U ................................. .......... .............. , ........................... ................. Date .......................... ~ ................... , 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, w~ 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, giving a detailed description of layout of proper~y 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 or 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 ~ ~ertificate of Occupancy shall have been granted by the Building inspector. APPLICATION I$ HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zon .e~ 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 necassar¥ inspections. (Signature of applicant, or name, if a corporation) ............... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~,.,Ii,,"~,,,,L,,,~ .................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Street and Number ....~.~[t. UJ~Je.~t..~,L~:.....~O.~ ............... O,,..~J..~J~.~.t,J.~,,~ ......................................... Municipality 2. State existing use and occupancy of prgmises and intended us~ and occupancy of proposed construction: a Existing use and occupancy ...... ..~...~ j~.~t~......L....~....~... . b. I n te n ded -u se a n d occu pa n cy ....~....t.~.~..~..~. [e.?...l~.. il~...1.'..L ..l~..i~.....~['.1_....~..1~..~,...(,~... ............................. ~.,~, .................... 3. Nature of work (check which applicable): New Building ................. .~.... Addition ..................... Alteration ............... Repair ............. . ............ Removal ............. . .~......... Demolition ........................ Other Work .................................... { Description) 4. Estimated Cost ............................................... Fee ....~..(~.,g:~ ........................................................................... (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 .......... L ............................................................................................................................... 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 ......... v ......... v ................... Number qf Stories .................... ... .................. , ....-, aL/ 8. Dimensions of entire new construction: Front ....J~..~.~. ........... Rear ........... {0 .............. Depth ........ .,...)1~ ...................... .! Height ....... L[0.....~ ............................. .Number of Stories ~. .............................................................................. C~~ / O . 9. Size of lot: Front ..~·..~.......~ .................... Rear ~t~) ......................... Depth ...l ....... .~.. ................. .......... 10. Date of Purchase ..................................... Name of Former Owner ................................... : ........................................ 11. Zone or usa district in Which premises are situated ........ .~.'d~:. .................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~J..(~). ........ , ..................................... 13. Will I°t be regraded --~'"~·'q'~ . ~ ,,,~ ,. i - i ,--_ ................... ,. Will excess fill be removed from Premises: [I/~Yes [] No 14. Name of Owner of premises ..~-~.JL~,~.J:-)JI..~.J~)...),,.)..~/~..I,.~. ........... (Address) (Phone No,) Name of Architect ........................................................................................................ , ....... ......= ............... (Add ) (E e. mo. Name of Contractor ~....~.4J~.~J[J~.J~t:~r~J~.'.~ ............. ,..g.~....-~.....~..~......~.~..l~.~.~%~.~.g~l.~'..~ .............. ·" {Address) JPhone r~o.i PLOT DIAGRAM I.ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-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 lot. STATE OF NEW/ORI~ ~ .,/ ) ,.~ ' COUNTY 0 ~.......~.. ......... ) ~ .- .. .I.~ ................................. ~i~g duly sworn de~,s and says that he is the appli,nt above na~d. . ~Na~ of in.vidal si~ing ~n~t) ' ~ r. ' ~ ....... ................................................................ .......... { Con~ctor, a~nt, co~mte officer, etc.} of said ownar or owners, and is duly authorizsd to~o~ ha~s ~rfor~d the said work and to make and fils this a~lication; that all statsme.~ con~insd i~ this ao~liaation ara tru~g~o~a~ aha ~i~ aha that tbe work will ~ ,t forth in the appl~ation fil~ therewit~°'~ P~'?~3~'~s,f~o~k Co~t~ ................ , . SUPPoL~ COU~Ty MEALT~t DATE~ ' d"~P°Sal and water SUppl~ ~ac~'[ities For this location inSPeCted by this have beea to be ~at~sf ...... department and found Ci:ioC o2 General S'r~.KG Lcd1' LAND WM.. G,~ ~ L V~ ~''' "- Narc: TEST MOLE