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Home My WebLink About5725-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. ~ ..... Date .......... Oc.~l~er. ~! .... , 19.73 THIS CERTIFIES that the building located at . ~].~pp~I. Laxm ............ Street Map No}Iai.box,. I~§ts Block No...~XX...Lot No.. 39- . · .qollt, h~l(l ................ Estates conforms substantially to the Application for Building Permit heretofore fried in this office dated ........ l~reh .3 t .... , 19.72. pursuant to which Building Permit No.. ~72~.Z dated ........ .l~r.~}! .3t ..... , 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 .... Pr~.v~te. or~e. f~lJ, J.y..dvel;I.:l~g .................................... The certificate is issued to ... P.,.I~. ~.o. }tt~l. dtmann ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... 0.~t.. J~.t. ]-9.7,~ .bY..R.,. ¥.]..~..a... UNDERWRITERS CERTIFICATE No .... ~e .~.:t'~g ...................................... [lOUSE NUMBER .... '1~0 ......Street .......(~'ltl~.l~er. I)~v~ ........................... ............................................ ........................... Btlilding Inspector FORM NO. 6 TOWN OF $OUTHOLD Building Deim~tment Town Clerlm 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 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 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. New Building .....~.. ............. Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property L~.o..'~. ....... ,~...c~. ........ .!.~. ~.~.~.c~j.~......L...L..~.~....~......~.....~...~...c...~..~.~..~.........~.. ........ Owner Or Owners Of Property .....~..L....~....~....~.........F~,....~T~.~.L~..'~....f~....~..~...~.. ............................................... Subdivision ............................ Lot mock No ............. House No ............. Permit No..~..-I.....~,....~.... Date Of Permit ...?.~......~l~,..q..~....Applicant ....C~.~....~..~....~........~:...~\~..~....~...m~......~....~....~....,~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....~.' .................................... Fee Submitted $ .................................... Construction on above described building and~ermit meets all applicable codes and regulations. ............... (stamp or seaD ,/~Z ~"~'~ ~ S-9 SCHD '73 OCT 15 ~,1 8: 3Z SUFFOLK COUNTY DEPARTMENT OF HEALTH Date f~ 5 IC~ ~o~, .idg. Fermit No. ~ ~ ~ ~ TO WHOM IT MAY at Log- ~3q CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by thia department and found to be satisfqlctory. Chief of Ger~eYal ~ ?' ~,~'~,~ Sot~] ~ TOWN OF SOUTHOLD 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? 5725 Z Dote .................... ~....~ ............... , 19~... Permission is hereby granted to: at premises located at .........~..-~.9 .........]~lk~..t'~..~'~ll~.....~..Z ................................. ................................... .~3~.e..~...~.~., .......... ~.~t,l~e~4.....~.~;~ ~ ...................................................... pursuar~t to application doted ................... ~ ........... ~ .............. , lC).~1~..., and approved by the Building Inspector. Fee $...~1~0. ........ PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT [)RIVEWAY CONRTRUCTION C'(~SP'2, OL CO; JSI RUCTION CELLAR CtUN~TRUCTION Building Inspector/ LOT 38 S.64"OS'IO"E. LOT 39 L / .,/'"'¢'~4,t,~ ~ ~.~ t~kS ,~:~J P..VE'Y'F__..D FEEU~I.9_"f2 ~ ~ VAN TUYL~'''¢''' LICENSED tJ~ND 5UiVEYOl;t5 · S.64'"OS'IO"F__. IN 6~°0= SUFFOLK COUNTY DEPARTMENT OF HEALTH HoD.Reference No ~-/JO ~J APPLICATION FOR APPRfrgAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval t~ construct said systems is requested,pertinent data herewith: Date 2-Detailed p~pe~y location ~ 8-Lot No. Hamlet ~ ~'~ o/~ ro~ ~ ~ ~/~ 9-Private well? 3-~blic ~ter ~pply name ~ Distance to nearest ~in 4-Lot Size: Width/~ ft. ~th~ft. ~a~o enter on,~center plot plan below:) 5-~elli~: Single Family ~T~ Family? ~ '~Cellar? /F~ Slab? ~ ~ Crawl S~ce? 10-Pro~s~ system: Septic tank ~ ~Precast ~Cess~ols ~ ~S~llow ~ols il-Septic ~ inside dimensions: Vol~e Gals.Lengt~ft. Width ft. Liquid depth ft. 12-Precast sections: ~Number/ YSq~re~. Cesspools: Block sizeL incs. D ins. H ins. Total blocks below inlet: ~1/~ ~2 ~ ~3. PLOT PLAN CI 'ran~l ~pacity (~ ~Gals. .P.M. ~' GW.L. Ind: ate Ni th Data ?eet 0 2 4 6 8 l0 12 14 18 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~a~ l, tqT)-~ Signed~l~u, ~'. ~ Owner or 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. Date '~//~-f'~ ':~"--'--~' ~ (10/65 Revis. ) s-15 Signed BUILDING DEPARTMENT o'/' --, ~ ,~ TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ~ Examined .... ..~.... .............. , 19.~....2~ Application No. ~ >~--~ ~prav~ ................. ': ....... ~ ............. , ~...?.~ ~m~ No. ~..Z..~.~....~... ~ Disapproved a/c ......... ~ ~....,~ ........ ~...~..~. ..... (Building Ins~tor) APPLICATIOH FOR BUILDING FERMIT ~ ......... ............... 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 diogram 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 have been granted by the Building Inspector. APPLICATION IS HEREBY M,~DE 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, Ordinanc.e.s or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. ~ ,(S'gnature of applicant, or name, if a corporation) ..... ~'"'~ ~(~'~ ~t~ (Adclressofapplican,) -- Name of owner of premises ....~....~....~'t.~...l~......~........~'.:.....~.L~,,~.l.~..~.....(~....~.....~...1~... ............................................................... If applicant is a corporate, signature of duly authorized officer. ... ................. (i;;~;;;";;;"~i~',;";;F~;;,;;;~';;';;~ii~';;i ......... 1 L t fl h h M · oca ion o and on w ic proposed work will be done. ap No.:~..~...... ~ Lot No ....... .8..9 Street and Number ..........~'" --(~..!J.~..~,.,,~.,~,.....,~.OL,'i3,.~, ............................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy 3. J~ature~of work (check which applicable): New Building .................. Addition .................. Alteration ................... Repair .................. Removal .................. Demolition ........ ,w'~'"' Other Work (Describe) ........................................ 4. Estimated Cost ............................................................ Fee ...?....~...,...{,...0......~... ............................................................ (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, 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 .............. ~'.~. ............... Rear ...... ..~....o. ............... Depth ....~..,~,..--...!..o..... Height ...!...'~.~..T...°..~.~... Number of Stories ......... J. ........................................................................................................... 9. Size of lot: Front .......~...~...~...~. ......... Rear ........ .I....t....O...~. .............. Depth ...... ~...~...~....~ ............. 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 ow, ordnance or regu at on? . ~....~'....~ ............................... ~ ' ~en~.f~¢~_. ~ ~ o '"' 13. Name of Owner of premise~...~..~..~...M......~....~..~...~..'[~.,'~dress ..~'..~..~..~..~...~..~...~..~ .................. Phone N~ .3.....~.....~...~....~..~ r hit /~ Do ~oAZ 7'/~ /°/~.'f~.'-c r ,~ Name of A c ect .......................... ~.....: ..................... Add ess ......................................... phn No ..................... Name of Contractor~-~./b~.~.~.er.~[~.~J~..~..Address ..~..!'(~'~' ~g.~..*~.~....~...~....~..~.~. c~o~ne No.-[.~..'..~...~..~..~..(· 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, , ! S S COUNTY OF_.~..~.~..E:~..~. ....... ~ · _ . ................... ..~..~.J~'~.......~.......~...EJ.~..~..~'J~.~.... ...... being duly sworn, deposes and says that he is the applicant (Nome of individual signing applicatioD~, above named. He is the .......... ...(~...~j~.~..~ ................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~'authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ,. ........ of .......... . Notaj~' Public, . .................. ~~ ............ '~;..~: County (Signature of applicant) ~/~ ~t -% -- REN,~ELAER G. TERRY, JR. - ,~ l~ Re~ding in Suffolk Coun~ No. 52-3954850 My ~mi~ion ~pims March 30, 1973 ,! .,,, , .,, £ 5s I II