HomeMy WebLinkAbout6848-zNO. ~
TO~VN OF SOUTHOLD
BIBT.BING DEPAR~RNT
Town Clerk's Office
Southold, BT. Y.
Certificate Of Occupancy
No.. ~,~13 ..... Date .............Dee ....28 .... ,
THIS CERTIFIES that the building located at... ~a3,ta-:Lre. Way. & .Set~l~
Map No.Sa~t. A~re. I~ck No ........... Lot No... 2 .....Eatt~,t~k..~.~ .....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ...........~ept...7..., 197.,:~. pursuant to which Building Permit No..
dated ..........6ept. · .7. .... , 19.73., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
The certificate is issued to . .E. :.S :.T. :..g.o.n.s.t..r.u.c.t..u.i.n..C..or.p ...... . .0~m..e..~..b..uS..1.d.e.r. ....
(owner, lessee or tenant )
of the aforesaid building.
Suffolk County Department of Health Approval ...Dec .. 2~... ~ 97~ .. by..1~,..V.{,l~.a..
UNDERWRITERS CERTIFICATE No...lt. ~21+19 ..... $~pt...~.1 ...~.973 ...........
HOUSE NUMBER ..... ~0 .... Street ....~qalLt, 4~{.re .kl&y ......................
vgo
Sound ¥2ew
· ............
· 'O~ NO. 2
TO~VN 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? 6848 Z
Date ............................ 2ett~&.....~. ........... , 1~..~ .....
Permission is hereby granted to:
· % ]Y~, · ~...T .... ~Jan~t~c ~zo_..~.o~.p ...........................
.... ~.%.~L. bu~k .....................................................
...................................................................................
at premises located at. l,~xt;..~...2....2ia2Ll~..Juiz,.e..~is.t~.t~a~ ..........................................................
................................. Ikmr~...~.i~w.,.Ave..&.. ~aLta.2~.e..,,~t~ ........... ~',a.tt &tuek ........................
pursuant to application dated ......................../L~I{~....-~ ................. , 19~.~..., and approved by the
Building Inspector.
Fee $.~8,,..~Q ...........
.... ~....~.,.,..., .................... ~. ........ ~ ....... ~.~ .....................
i
Building Inspector
SUFFOLK COUNTY DEPARTMENT OF HEALTH
H.D. Reference No. ~-~--//,
APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM
1. Applicant ~%~ (~'%~,g~¢'~-~,.) C~¢CPbone~J'~'f2~. Subdiv..~,~.C ~~f
Address ~, '~, ~~C~ ~ ~',~, 6, Section
2. Property location $~- ~'~q~ ~pJ~ ~%~ 7. Lot No. ~ %~
~% f~%%~L~ ~ 8. Private well ~
Village ~,%~OC.~_ ' T6wmship ~%%~ 9. Public water ~
3. Public Water Company name ~C ~ Distance to main
4. Lot size: Width, k~ feet Length'~.QO feet (Enter on center plot below)
10. Sewage Dispos~System:
A. (9D~ gallon septic tank: Precastt~quivalent. Block
B. ~aching pools: Number ~ Precas~ Block . Special
If private well fi
in blanks below:
Tank capacity
Pump G.P.M.
Total well depth.__
Depth to G.W.
Amount of water in
well
Test Hole
Data Feet
0
2
6
8
10
12
14
16
18
The undersigne~ CERTIFIES: "Construction of authori ed installations wtl
be in accordance with the Suffolk County Department of Health's current stand-
.
ards thereto~/ /
Date /'~ ~ '2'~ Signed ' Ow~z o u
lder
FOR HEALTH.~DEPARTMENT .USE ONLY. Based on the information presented herewith, i
is the opinion of the Health Department, that an adequate and satisfactory Sew
Disposal SystemiZe installed on th~ ~____._.~.~
S-15
Revised 4/~/72
TOWN OF SOUTHOLD
Building Department
Town Clerk~ Office
Southold, N. Y. 11971
APPLIGATION FOR CERTIFIGATE OF OGGUPANCY
Instructions
A. This apphcation must be filled in typewriter OR ink, and submitted ~n duplicate to the Building
~nspector with the following; for new buildings or new use:
I. Final survey of property with accurate Iocahon 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 ~nstallation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Mulhple Residences and similar buildings and
installations, a certificate of Code comphance from the Architect or Engineer responsible for
the building.
5. Submit Planning Board approval of completed s~te plan requirements where applicable.
B. For existing buildings (prior to April 1957), Nomconforming uses, or buildings and "pre-existing"
land uses:
]. Accurate survey of property showing all property lines, streets, buddings and unusual natural
or topographic features.
2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspechon of buddings 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 dwelhng or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date ...... .................
New Building ~ Old or Pre-existing Building Vacant Land
Location Of Property ..... .~...~.~.?...~.A.~...`~.~..~.~.~.~.~.~.~.~.:~.~...~.v...~.~z~..~..~..~...?...~..~.~~`~
Owner Or Owners Of Property ...... ...1~..~..'~'......~..~..~.~...(¢..?.~...~..~..~.......C..~..¢..?.. .............................................
Subdivision ...S.'.,~...~.,~..,?.~..~..,.~......~.~,.~..~,..~..~.~ ................ Lot No ..... ~ ....Block No ............. House No .............
Permit Ida...~....~..,.~...~.. ..... Date Of Permit .................... Applicant ..... .,~,..$.?....~.~...~...'¢.,..'~.....?..?~.~..~...,~... ...............
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval ..N.'..:."..~..~.~.~...~..~. ...................... Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate
Fee Submitted $..~...~ .................
..... . ..dayof ...... ...... ....
Notary Public .................................... County
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ~ ' ~~
(stamp or seal) ~ ~71~
MAP F/LEO/N 1"/~ OF~/¢~
CL~t~I~ OF SLIF~OLK ~OUIVI'Y ON
.Ews~o.s YOUNG & YOUNG
4oo OST,^,D£, ^V£NU£..,~V£,,£^O. ,EW YO,K
^-OEN w. ~ou.~ .ow^.o w. YOU.a
SURVEY FOR:
MST CONSTt~UCTION CORP.
LOTNO. 2,"SALTAIRE ESTATES"
AT MATTITUCK GUARI NTI :ED TI~ ~'~l ~"
TOW. OF SOUTHOLD
SUFFOLK CO., N.Y. e~'~.~,,/,~~
'~^~': ,": ~0'. I"~'': ~u,Y ~.,~ j.o.
UNAUTHORIZED ALTERATION OR ADDITION TO
THIS SURVEY I$ A VIOLATION OF SECTION
7209 OF THE NEW YORK STATE EDUCATION
LAW
THE LAN0 SURVEYOR"S INKED SEAL OR
COPIES OF T~IS SURVEY MAP NOT BEARING
.Ews,o.s YOUNG & YOUNG~_~~
ALDEN W. YOUNG
SURVEY FOR:
PA~ KNIG~,T a ~RY KNIGHT
LOTNO. 2, SALTAIRE ESTATES
MATTITUCK SO.HOLD S~0S BANK
,',, ~ ,~, ;: TOWN O[ SECURITY TITLE & GUARANTY CO.
~r~ '~-~ SOUTHOLD
~he se~aBe disposal and ente~ Supply
~aciltties tot this loeatlonlmve been
/nSpected by this department and ~ound
to be satZsfactory.
Se~vloes
MONUMENT
SUBDIVISION MAPFILEO IN T~ OFFICE
OF T~E CLENK OF SUFFOLK COUNTY ON
TOWN OF SOUTHOLD
BUILDIN~ DEPAIII'MENT
TOWN CLIE~K'$ OFFICE
SOUTHOLD, N. Y.
Examined ........... ~....~. ......... , 19..~..
Disapproved a/c
' .................. 2:: .................................
~ ~ ' . 'A.P. PLICATI UlL I G P[al~tel~ . .......~.....: .............
~ INSTRUCTIONS
a. This alaplication must be completely filled in by typewriter o~, in ink and submitted in triplicate to the Building
.I.nspector, with 3 sets of plans, accurate plot plan to scale, Fee according to schedule. '
' b.. Plot plan showing location of lot and of buddings on prenuses, retOtionshlp
areas, and giving a detailed description ef layout ofproperty must b~ ~dfawn'on the 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 on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in pa rt 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
Regul~io~s, 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 cede, and ragulotions, and to
admit auth~,rized inspectors on premJses~ and ir, buit~ngs'~r necessary inspections .....
......... ;~.. ~.........~.. %..~....;:..~,..: ................... ;. ...................... ~ ........
t31gnarure o'r oppllcanT,' or namei Jr a corporot on/
......................... .................................... .} ............... b ..........
(Address of applicantT
State: whether app~licont is owner, lessee, agenti architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of p .... ; .................... , ........................ ............................................................................................
If appl~e, signature of duly authorized officer.
Builder's License No .....................................................
Plumber's License No .................................................
Electrician's License No .............................................
Other Trode's License No ...............................................
1. Location of land on which proEo, sed work will be done. Map No...'~.....~..'?...~..I....1~...~.,.~ Lot No.....'~...:...'~... ........
. ' '" ' "
Street and Number ........ ,,~.1~....~.....~....... ..................... ,.....~..~...~... ........ '.~../. ..................
Munfcipality
2. State existing use and occupancy of premises and intended use and ocCUl~ancy, of-prc~posed construction:
.~,
a. Exisiting use and occupancy .................. ...1~...~ ....... ,~..,~.~.. ...... ~..~....~..~.~......~..~......~....l~l..~.~..~...
b. Intended use ond occupancy ................................................................................................................................
~ -N'-a~ure of work (check which appl bio): New Building .4 ............... Add~ .................. Alterahon ........
Repair .................. Removal .................. Demolition ........ ~ ............ Other Work ................................................ ~ .....
..~..~. (Description)
4. Estimated Cost ...... ~ ............................... Fee .,..~...~.~....~... ...................................................................
r (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 c~rs .................. J ..........................................................................................................................
6. If business, commercial or mixed occupancy, specify n~ture and extent of each type ~f use ....... ..1~...[....~.. ........
7. Dimensions of existing structures, if any: Front .........~...~.,.~J~.. Rear ................................ Depth ....................
Height ........................ Number of Stories ..................................................................................................................
Dimensions of same structure with alterations or additionS: Front .................................... Rear ............................
Depth ................................ Height ............................ Nu_~b~r of Stories .................... ~ ..........
8. Dimensions of entire new construction: Front ........... ~ ................Rear ....... ..~....~... .......... Depth .......~.....~.. .........
Height ..... J.~...! ...... Number of Stories .................... .~....i ....... .'~...J...~.....~..~. ............. ~:. .........................................
Size of lot: Front ............[..~... ................................... ReOr ............. .[...~ .................. Depth .~.....~o
Date of Purchase ........................................................ Name of Former Owner ....J.~....~.......~..1~....~.".¢~......~-~?. .....
Zone or use district in which premises are situated ........... ! ........ .~....~.......~....~....~.~.~..~....1~... .......................
Does proposed construction violate any zoning law, ordinance or regulation: ............. [~..~......'~.. .........................
Will lot 6e regradec~ ....~.~'~....." ...... Will excess fill be ~emoved from premises: ( ) Yes (t~o
Name of Owner of remis ....~.....~..T....~...~....~..I~I~....~...C...~..!?....~.. Add~ ... Phone No.~.-....~.....~...~..
Name of ^rch,te ; ..... ,o .......................
10.
11.
12.
14.
Name of Contractor ............................................................ Address ................................ Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate.al set-back d mens OhS from
property lines. Give street and block number or description dccording to deed, and show street names and ~ndicote
whether interior or corner lot.
1 DO
STATE OF NEW YORK, Jc S · ·
COUNTY OF ................ ..~.~:,.:..:.~.J'~,~ ,,
.............. ~..,.,.~,. ......... ~4.~.........., ...'~'.,.... .,~.being cl,~y~ says that he is the applicam
(l~an~e' of i~d~ual sigr~ing'contract~
above named.
He. is the ....................... ~~.~~ .........................................................................
~ (~=ee~l~;tor, agent, corpdrate 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 applicatibn are true to the best of his knowledge and belief; and
thor the work will be performed in the manner set forth in the application filed therewith.
Swam to before me this
........................ day of ............................................ , 19 ........
Notary Public, .................................................... County ..................................................................................................
(Signature of applicant)
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