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Home My WebLink About5747-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Occupancy No ....Z9852 ........ Date ... J. anuargr. 2~ ................. 1980. THIS CERTIFIES that the building ................................................ Location of Property/~ ~oqq~5. Sheporcl..Dri.v.e ..... ~t' ........ SOLLt~Aold~..N.¥/~/e~ County Tax Map No. 1000 Section ... CY78 ..... Block ..... 0.1 ........Lot ...... 02,2 ....... Subdivision. Mes~;. Creek .Eat, tea ........ Filed Map No. ~8/~8...Lot No....~T. ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated ·.. March..1.'~ ........ , I~'2. pursuant to which Building Permit No ..... 5.T./+TZ ........... dated ...Mar. ch..~./~ ............... 19 72, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ............. Pr£v. ate..C~ne. Eamil~r..Dwelling. .................................. The certificate is issued to .....0'ames. R.. and. .d'ud£~;h. W,..l~ood2~ull ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . 80-'! 0/~. · ·/~/.9/?.~ ..................... UNDERWRITERS CERTIFICATE NO ........ ; ~I .862~ ................................ Building Inspector Rev 4~9 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TEMPORARY Certificate Of Occupancy No. Z~0.8.~;~ ..... Date .......... Alar!l .... ~6 .... , 19 ?3. THIS CERTIFIES that the building located at ... Shepard..Dr ........... Street Map NoS~e. at. Ck .~3 sfc~lock No .......... Lot No...3? ..... $outhold.. N..X, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... l~ar.. ~13.., 1973.. pursuant to which Building Permit No. dated ......... t,~areh....t~.., 19.7.3., 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 . .Px'iva. te · one · family, d.we~ .1.i. ng. ..................................... The certificate is issued to . Jaraes. ~,loodkull.. .0w~ar ............................ of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) · Ap~...9..197.3..byR. ,Villa ..... UNDERWRITERS CERTIFICATE No...pending ....................................... [tOUSI! NUMB[!R.~'I ~ ......... Street.. She~O.l'.c~ .DJ' ................................... Building Inspector FOF,~I NO. ~ TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5747 z Permission is hereby granted to: at pr.,',,,s,,,ocot.,:' at .......... ..,ff~....3..Z.f ....... __"/-'t/'"~'"'"'~"~'Z":'"'r'~':=': ........................ pursuan¢ to application doted ..................................... /..;~..~/,~t,4~,~197~, and approved by the Building Inspector. ~.., ...... ~.....t~. ~ '3? .I I ~1 Il FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerk~ Office Southold, N. Y. 11971 APPLIGATION FOR GERTIFICATE 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 ]957), Non-conforming uses, or buildings and "pre-existing" land uses: ]. 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 Bull.ding ............................ Vacant, Land ............................ Location Of Property ..~,./,~.......~. ,~...~./~ .~.._.~....~..../..~......~.~..~.., ..~.~..~.]d. ..................................... Owner Or Owners Of Property .J~.~.,~...~.~....~.....d4~..~.~'./~.....~...~.~.~.~..~.Z..~..L{. .............. Subdivision ..~...~....~...~..~'.~..~......~-,~..~,~. ....... LOt NO. '~"'7-.-Block. No .............House No.~./...~.. Permit No.,,~...7...~..,,?,~. Dote Of Permit .~.~..~.../.~,o~pplican, .J~PP?P.~.-~....~..~...~../.~./Z .......... 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 permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County FOI/M NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR CERTIFICATE OF O~¢UPANG¥ Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the fallowing; 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. Permit No ..................... Date Of Permit .................... Applicant .................................................................. 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 permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference Date L~/~ A ~- APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Address /~,~ ~]. C'~4-c ~.~. 6J.~ , ¢193~-- ?-Sectzon.__ -- 2-Detailed property ~oqat~onJl~ ~= ~J,~,*~ ~ }~ ~+. 8-Lot No. Hamlet ~u~-~.o~c) ' Town gou %~\ ~ 9-Private well? 3. Public water supply name /~, ~, Distance to nearest main 4-Lot Size: Width;;~ ft. Leng{hp~; ft. (also enter on center plot plan below:) 5-Dwelling: Single Family ~Two Family? / yCellar? ;~'/~Slab? ; ~Crawl Space? 10-Proposed system: Septic tank F~/Precast y /Cesspools /F/Shallow pools //Other Il.Septic tank inside dimensions: Volume~dO Gals.Length ~ ft. Width ~/ ft. Liquid depth_~_ft. 12-Precast sections: / /Number/ /Square Ft. Cesspools: Block sizeLl6incs. D %~ ins. H_~_ins. Total blocks below inlet: ~1 ~d%2 PLOT PLAN Street Indi No Capacity~2-Gals. G~P.M. ,'~0 rth Data Feet ~.5'o~1 ~"~i0 10 ~, 12 ~6 can be installed on this Plot. (10/65 Revis.) S-15 The Undersigned CERTIFIES: "Construction of authorized installation will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Syste~s"~ ~ ~ ' / ~' 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 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH APR 9 1973 Date TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ~/~:: (¢ive deed locatiou)~ at have been inspected by this department and found to be satisfactory. Chief of General Engineering Services APR g lg73 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 installa- tions, 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 peoperty 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 informa- tion required to prepare a certificate. 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 $5.00 Date../..-'..~. ~. ~ ............. New Building ............ Old or Pre-existing Building ............ Vacant Land ............. Location of Property... ~./.~. ~.~?,~..~[..~..~.. ~..~...~.o..~/..-~..~..~./.~.~.Z~ .~.. ..... ~/;r~/'e~ Hou$e No, Street Owner or Owners of Property .. J.~.~..~.:~.. County Tax Map No. 1000 Section ............... Block ............... Lot .... ~ ....... Subdivision..~.¢~.~...(~.~'.C,~I~....~..~.'/?~...Filed Map NO ........... Lot NO...~'.7. ....... Permit No.~.7./--/~..~, Date of Permit ~..--/~..--...~-Applicant..J~ .*:~, .~.$..~.,.. ~..~, .°J..~.~. II .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ~-~..'~ ~ · ' ' ' -I. I?~ = No....~3..~.7. ................... Al~rawd ...... ~ ................. ~ ............. , 19....~.. Pomit No .......5.7.~...~ ................ ........................................................................................................................ ~ ~.~. - ' ~',. *PPLI~TI~ FOR IUILDIHG PEmlT.~ ~~ ~. ~i~ ~i~tion mui~ ~ ~m~l~t~iV fill~ i~ bV ~ri~r ~r i~ i~ ~n~ i~ i tri~li~ .... ~. . · ~ . ~. PIo~ Dmn ~h~?o I~tion of lot and of bu~ldm~ on pr0m~, rolat~oh~h~p to adjommo D~m~ or Ow~ a ~il~ ~n~ion of I~out of ~o~ mu~ ~ dr~n on di~m whi~ i~ ~ of this ~li~tion. o. T~ ~ ~d ~ thil ~Dli~tion may no~ ~ ~m~n~ ~fo~ i~uan~ of Buildi~ ~rmit. d. O~ ~oval of thi~ a~li~i~, t~ Building Im~ will i~ a Building P~rmit to the aPDli~t. 5~ ~t ~all ~ k~t on ~ ~mi~ ~ail~o for In~ion throu~ou~ the work. o. ~ ~i~l~ ~ ~D~ or u~ i~ w~l~ o~ in ~'for a~y ~r~ ~ha~r until a ~ifi~ of ~ ~ ~ ~il~ In~or. - .A. PPLIcA. TI.0N_IS HE.R~EBY. MADE to the Building Demrtrnent for the i.uence of e Building Permit purluant to the Building i~m..n~me ? ~ Town ~ ~uthold, ~ffo~ ~un~, New Yo~, and ot~r ~pli~ble ~s O~in~n~ or R~l~i~, ~ildl~, ~m~l or II~rlti~i, or for m~val or ~lition, ~ ~min ~i~d. ~ a~li~nt ~s to ~ w~ iii I~~ o~inanm, ~lldi~ ~, ~sing ~, and regulations, and to admit authorized ina~ on ~mi~s and in ~lidin~ ~r , / m .............. ~ ~ o~r, I~, a~n~, a~hl~t, onoln~r, ~noral oon~or, Ol~tri~ian, plu~ur~buil~r. ........................ ~.~.~ .......................................................................................................................................... , ........... ~,~, o~ o~= o~ ~,~:~, ..'~....~....~.o~ ........................................................................................ If ~l~nt I,, co~rm, ,i~,~r, of duly au~=lz~ offl,r. ~ ..................... i~'A'A&'Aiiig'~'A~g~'A66Oi~6 ..................... ~ O ~ 0 ~B-ol 1. L~ion of lind on ~i~h prop~ ~rk will ~ dono. Map ~o.: .~.~.~.~...:... ~t No...~.~ ..................................... ~,.~ ~.~ ....~.h.~0.~&.....~.,.m. ......................................................................................... : ................ 2. S~ exl~ing u~ and ~u~ncy of pmmi~ a~ in~n~ u~ a~ ~u~ncy of pro~ con~ion: a. Exi~i~ um and ~u~ ...... ~.~ ................................................................................................................. ! 6. 10. 11. 12. 13. 14. ~ ' -~ ' ' ' ' ' g ....................... Add't'on ..................... Alteration.., ........... Nature ~of WOrK (check which applicable): New Bu d~n V/ i , ~ Repair ... ............ Remo al ......................... De litio Othe Wo .............. ........... v mo n ........................ r rE ...................... ( Description ) . Estimated Cost ......~..~..~..~....~. ......................... Fee .........~ ....................................................................... (,to be paid on filing this application) If dwelling, number of dwelling units ............ ,.. Number of dwelling units on each floor ...... ~ .............................. f 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 .....-m. ................... Depth ....:. ............................. Height ......... ~ ............................................ Number of Stories ............................................................................. Dimensions of same structure with alterations Or additions: Front ...... :....~[ .............. Rear ......................................... Depth .............. ~ ....................... Height ......................................... Number of Stories ......................................... Dimensions of entire new construction: Front .......~,0. ............. Rear .....~.0. .................. Depth ..~...~. ........................ Height ...... ~...~.1.................................... Number of Stories ........ ~.. ............................................................................. Size of lot: Front .;,....~.~......,.... .............. Rear ....... I.~.~ ........................... Depth ..... ~...J.~. ................................... Height ......... ~.~.t. ................... i ............... Number of Stories .....~.. ............................................................................ Date of Purchase ../.~.~.~ J../..T.J.- .............. Name of Former Owner .~.~.~t.q&~,.~,,J~O.[D.[X{.,.'~L~.[. J.~.~.~.~...".;.-- Zone or use district in-- ~which premises are situated ...'[~,~.~.~.~)J~.~.i.{L,[' ...................................................................-- J Does proposed construction violate any zoning law, ordinance or regulation: ,...~,,~..o., ................................................ Will lot be regraded . _ ~_.~q ...................... Will excese fill be removed from premises: [ ] Yes [~('j' No Name of Owner of premises ..~(~D3.i~S,...~;..~,/~..0.(~f~t~.[[ ......... ~,~,~.~.~U~..,.~:.~/, ............... ~.~t.~..:.~.~..~..~3~,.' (Address) ~ (PhOne No.) Name of Architect ............ ~ ........ O.1~.~. ...................................................................................................... (Address) (Phone No.) Name of Contractor ........ ~..O.13.~. ............................................................................................................................ (Address) (Phone No.) - er interior Or corner lot. COUNTY OF PLOT D lAG RAM 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 wheth- ................................. · ..~'.. ................................................................... being duly sworn, del~oses and says that he is the applicant above named. (Name of individual signing contract) He is the ................ ..~....~....~....E......~... ........................................................................................................................................................................ ~ {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 application; that all statements contained in this application are true to the best of his knowledge and I~i~f~d~l~a~E.~LL~Ork will be performed in the manner set forth in the application filed therewith. NOTARY PUBLIC, State o~ New York · No. 52-8125850. S~lk County '~' /'//t~ 77 Term Expires M , ........................... .~...'~......day of ...................................... :...~, 19 .....~.. -- ' , M~/~O,~f~ /~/~ ///~ Notary Publi _,~-~...,....__,.~ ~~'..... County . .......................... ~1 ~ -- / :.~ ~ {Signature of applicant) . . THE tab D.~e April 25, THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK. NEW YORK 10038 1973 A.p,ic.t,o. No...fl~ 609?48 N the electrical equipment as described below and inzroduced by the applicant named on thc above application number in the premises of ~,~,~/oU.,~.~o~.~..~ ~ ~.~o,.~.~ ~ ~rt. ~ ~.d r~. Outside s~t~o, mo~ ~ ~..,i,,od o. ';: Apri 1 2 3, 19 7 3 and found to be in compliance with the roquirements oJ this Board. FIXTURES RANGES :OOKING DECKS OVENS DISH WASHERS I EXHAUST FANS /\ l_