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Home My WebLink About6856-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z..(?. / Y~r Date THIS CERTIFIES that the building located at Map No. ~t,. ~""~loek No .......... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated / t ~-Fp7 19 7~{ pursuant to which Building Permit No. dated . .. ............ / ~ ~c 1~ P7 , 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 ...... .~. .... 0.N.~ .... .F.~../'.q..t.~)~ ...... . ../~.t~ .~..L.[7./.~.~.~..~z. ................. The certificate is issued to ............. ~ ................................... (owner, lessee or tenant) .of the aforesaid building. Suffolk County Department of Health Approval ..... ~..ff./.r. ~ ~ -.~.t]- [ .2./..- ~/~ ' t9 '!. .......................... uous~. ~U~B~.a../. q .5.... Street .ZL.~..~.C... ?.f.C.o..q.,~..??.~(....~..qp.~.. ............... ~-'/../.~g..~ ~ .. Building Inspector l~O~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT OH THE PREMISES UHTIL FULL COMPLETIOH OF THE WORE AUTHORIZED) 6856 Z Permission is hereby granted to: ..... ~/. . .~ ........ ~ .. . . .~ ~. ~.~. .:,: ....... .c.-. . . ~ ~. .~ ~ C U 'T-C i-~ o d ~ t'- pursuant to application doted ............................... ./..J......~.....~..~.7]...., 19.7. ~.~..., and approved by the Building Inspector. Building Inspector TOWN OF $OUTHOLD Building Deportment Town Clerks 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. Rnal 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 d~sposal--(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 ArcNtect 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" {and 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. 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 ..... .................. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Locat,on Of Property ..... ..L...t.~..~...¥~7. ..... .?.~..~...~.~ ..... ..~....1~...~......~., ..... ..~..~....~......~..?...~..'~.... ........... Owner Or Owners Of Property ......... ...~....;.....~....~....?~,....~...'~ ..... .¥~....~.~...~..~ ............................................... Subdivision ....~....~,~..S...~,.,b~...... ,~..,~.,I.~....~,,l~.,..~..,.~,,,,~, Lot No..,~....~,,,~,,. Block No ............. House No../.,,~',,J.,..% Permit No....~...~...~....~...~.. Date Of Permit .................... Applicant ......... .~....~?......C~......~...~.~?.j..~..~......~.? Health Dept. Approval .... ..~...-...~_.~...?..~..~T...! .............. Labor Dept. Approval ............................................... Underwriters Approval ..... .~.....~,.~...Ol..~.~...~C. ............. Planning Board Approval ........................................ Request For Temporary Ce~te ........................................ 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 ............................................ Notary Public .................................... County (stamp or seal) 'h"e fo.'Z 4 SIJFF~LK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT ~ ~. ~ ~,A PRIVATE~.r~ ,~,SEWAGE~ DISPOSAL- · v----~-- S~-~T~cM~-~e ~ATER SUPPLY 1. Applican~:~ lq~ . ~,~wc*~ ~ 5. Subdiv. Address ~~ ~o~ ~i <~ ~oo ~ ~. Section ~O~rtg~Loc~~~ ~ ~A~j~ Kg~ .. Lot ~umber Village Public Water Com'pa~me Lot size: Width feet Sew~ggisposal System: A. '-~3t~O-~on septic tank: Precast Equivalent lO. B. Leaching pools: Numbe~of pools ~recast Block ~pecial Block -~' I~' ~-~ 8. Private !.!ell !~e~t¥gp~ 9. Public Water i~,.! ~- Distance to n~in Length feet (For Health Dept. Us~ If private well, fill in the following blanks: ~l~ A. Tank capacity~'~ ~:~l~ B. Pump G.P.M. C. Total well depth D. Depth to ground water E. Amount of water in well II. ?he undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current lo.cal~/,~/'/Building Department Permit isj in ef~~~, ......., ,C.,~'~.~-.,' Date Si gned ZZ~-ZZZZZZZ.-ZZZZ~ZZZZZZZ.-ZZ~.-~ZZ~-~ZZ~-ZZZZZZZZZZZZZZZZZZZZZZZZZZZ.~ZZ~ZZZZZZZZZZZZ~Z~Z~ZZZ~ FOR HEALTH DEPARTMENT USE ONLY. Bas_=d on the information presenLed herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage DisFosal System and Water Supply can be ]~-r~talle~o~o this plot. ,,; ,/ ,.f/ APPROVAL DAJE S~ GNED S-15 Rev. 4/1/73 Lot $~/OD/V/$ON MAP F/LEO /N TH~ OFFI~ OF T~ CL*.rt~K OFSUFFOI /¢ COONTY O~ YOUNG & YOUNG 400 OSTRANDER AVENUE, RiVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: WILLIAM BARRY EVERETT LOT NO. 422 ~.<r -:'"' -"~-~-...-~.. "NASSAU POINT CLUB PROPERTI E S~I~,~, SE'e?IO,~," : .,., ,. -', lam NASSAU POINT ~/ i~:. }./.:, ~ TOW. O, iSOUTHOLD ~~L¢~ /~, '0 SUBO/It/$ON MAPFI£EO IN TH~ OFFICE OFTbI£ CL~I~K OFSUFFOL~ COUNTY ON ~t Lot 415 .q ~OAD GUARANTEES INDICATED ~EREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE REViSiONS YOUNG & YOUNG APR Z, 1974 400 OSTRANDER AVENUE, RIVERHEAD, NI~W YORK dULY :5t, 1974 SEPT. It,1974 ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: WILLIAM BARRY EVERETT LOT NO, 422 "NASSAU POINTCLUB PROPERTIE~ AT NASSAU POINT GUAi TOW. O~ SOUTHOLD ~'o~o' ,~ sc~: I"= 40' IDATE= AUG. 2,1973 ~3-~3 THE 'NEW YORK BOARD OF FIRE~ UNDERWRITERS ak BUREAU OF ELECTR!CITY . ~ 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CERTIFIEB THAT only the eiectri~d equipmen~ as described below and introduced bY the q~ldicant named o~ t~e ~ application number in the ~remlses of H.S.T. Constr., Little ?etonic R~., Nasaau ?oln~, ~utchogue, L.£. March 18, 1971 and/ound to b~ in compllan~e with the requirements of thls Soard, [COOKING DECKS I OVENS J DISH WASHERS TIMECLOCKS BELL tUHITHEATERS MULTI-OUTLET C OF HI.LEG EXHAUST FANS ,~T. ,.~.F DIMMERS NEUTRALS OF NEUTRAL 1-. 5kw Ronald R. Ennis, P.O.Box 20~ Middle Island, L.I.1195~ Per ~ i COPY FOR BUILDING D~ARTMENT. THIS COPY OF CERTIFICA~ ~, ~T BE ALTERED ~ AN? MANNER, BUILDING DEPARTMENT///e'~/~'4' T~N ~E~'S ~FI~ ~- ~H~D, N.Y. ~ ........................................ 19 ........ Pe~it No ..................................... (~uilJi~ I~tor) ~ APPLICATI~ FOR BUILDING PE~T ~/~ ~ ~: Date .................. ~. ..... ~..-.., 10.. In~ctor, ~ith ~ ~t~ o~ pl~*, ~ccumt~ plot pl~ ~ ~l~. F~ ~o~in~ ~o ~h~ul~. b. Plot plan sho~infl I~,tion of lot ~nd of buildi~, ~ premises, relationship to ~re~, ~nd ~ivi~ ~ det~il~ d~ripti~ o{ I~ut o{p~ mu~t b~ dm~n on t~ d c. lh~ work cowr~ by thi* a~licetion m~ n~ ~ cemm~ b,fora i~ o{ 8~ld~ ~. d. ~ opp~l of/hi~ ~pplicati~, th~ 8uildinfl In~Ior will i~u* ~ 8uildi~ P~rmit ~o ~ ~licent. $~h ~i~ ~h~ll b~ ~t on th~ pr~mi~ ~voil~bl, ~r in~ti~ thr~h~t ~ ~rk. ~. ~o buildin0 ~h~l~ b~ ~cupi~ or u~ in whol~ or in p~ rt {or ~n~ pu~ wh~t~r until ~holl h~ve b~n ~mnt~ ~ th. 8uildinfl In~tor. ~ui~oinfl ~on~ ~rainance ot th~ Town of ~old, Suffolk Count, ~ York ~d ~r ~Oul~ti~, for th~ co~tructlon of building, ~iti~ or ~lt~mfi~, or {or ~1 or .................. .................................................... Stot~ w~th~r.~licont i* ~n~r, I~, ~*nt, ~hit~t, ~n~in~r, ~en~ral c~tmctor, ~l~trici~n, plu~r or ~uil~r. Name of owner of premises If .... nt is a corporate,~signature of duly authorize,ed officer. .........· (Name and title of corporate officer) ! d Pluml:~r's License No ................................................. Electrician's License No..t..~.......~ ........:.:.i: ................ ~ ~'~ -- ~her Tmde's Lic~ No ............................................... ~ationofla~on~ichp~workwill~d~e. MapNo.: V~.-~ ' ~ i~ LotNo ............ J.q ......... St~t and Numar State ~isting u~ and ~c~ncy of promises and intend~ use and ~cu~y of p~ c~: a. Disiting use a~ ~cupa~y ~'/ bo Intended use and occupancy ~) ~1/: I , ~ ~'~' , / '/ I'x i, ' J' ; / I N) ~=* ' ~ ..................................................... : .................. =.: ........................................... ,. ...... iii 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteratio~ ................ Repair .................. Removal .................. Demolition .................... Other Work .................................. ~ ....... .~ .... (Description) ' (to be p~id on filing this application) 5. If dwelling, number of dwelling units ........... ./. ............... Number of dwelling units on each floor ............................ If garage, number of c~rs ................................................... ..~ ...................................................................................... ~business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ ~ensi0ns of~ existing structures, if any: Front ............................ Roar__ ................................ Depth .................... ' ~r..~eight ........................ Number of Stories ................................................................................................................ Dimensions aT some structure with alterations or additions: Front ........................ ~ ............ Rear ............................ Depth ................................ Height ............................ Nu~m~ber~,~: of Stories .............. ~e~-~' ................. 8. Dimensions of entire new construction: Front ............. ./~......~... ........... Rear ....... .;~....~ ...... Depth ....~.'...~...~. ........... Height .................... Number of Storms ....~ ............................... /./...(.: ~ ': Rear l ./......~..f ' ~'/~' 9. Size of lot: Front .................. ......... ................. ................ .............. Depth~.,..j~...~.;.~ ........... I0. Date of Purchase ................................. ...'~..:. ................ Name of Former Owner 1 ! Zone or use district in which premises are situated ............................ .?..~.~.~...,~.:...~. .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .................. .~...:...F.~ ........................... 13, Will lot be regraded.... ........................ Will excess fill be removed from premises: ( ) Yes 14, Name of Owner of premises ../..~.~.-..m~...:..,~,..!/..Z... ......'.......~/, ......... Address .C!.Ji,~,..~..L~..:..(..~.~./~ Phone No ....................... ~a~ of ^rch~tect ..... .~. .......... Z .......................................... Address ....~.~..~.~i.....~.~...~;;Phor~ Name of Contractor /~ ? ~ Address ..,..~..'?.l......~.--i...~;:..~..~.'~Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~b~ck dimensions from property lines. Give street and block number or description according to deed, xond show street names and indicate whether inter or or corne, r lot. - ~:~,.~ ,,/~0 '~'\~ ~x~ '~' 21~ ~t~ L~. STATE OF NEW YORK, ~ c ~ COUNTY OF ................................ ~'~'~ .................. : .............................................................................. being duly sworn, deposes and soys that he is the opplicam (Nome aT individual signing contractO above ndmed. He is the ..................... ,,~,,.~.~./.~.'...f.../..:...,./J.....(-7.,...7..~.../....;.~. ...................................................... /. .......................... ~ ................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rrmke and file this application; that all statements contained in this opplicotiorkel'~t~ue to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the app3icatic~ filed therewith. Sworn to before me this t f , . ~,,'f- r"/ ,,, / ~ ! .~-? /, ~ .....r-~ ................. :......~ay ot ...,~.........._~.~......,z: .............. , ..... ,' I ~ ,._/ 7-7.,/./,,,~/..r'> , p~otory r u o d c2<;~.,'I.. 4,,/. df... ~.. ,..~ .z?7..~h,:,d[., ....... t, ou~y ....................................................... ;.,...~ .................................. -~ -'-"~"-'~ (Signature of applicant) JUDtTH T, I~OKEN Nofory Public, Sfofe of New York 52 034-4963 Suffolk County APPROVED A.S NOTED · EFORE BACKFILLING FOUNDA 1'9o