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Home My WebLink About7002-zFOII~I NO. 4 TOWN OF $OUTHO/~D BUILDING DEPAHTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~.7 ...... Date THIS CERTIFIES that the building located at ,701~ .(~l'e.~k. I)1'~,~ ......... Street Map No.~ermea0$t.. Block No ........... Lot No.. l~ ..... 8o~l~hoJ~.. }[,Y, ........ conforms substantially to the Application for Building P~rmit heretofore filed in this office dated ........... N.o.v... 26., 19..~' pursuant to which Building Permit No. ~0.02Z.. dated ......... I/O.V.... ~fi ...., l/F3.., 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 . P.r/[.v.a.~e. 011o./'~lllt, ly..~wel;ktJt~ ........~ .............................. The certificate is issued to . 1~ .&.}{ltS. E.,..l~.~ra:/ .... (dwner, lessee or tenant) of the aforesaid building, : Suffolk County Department of Health Approval .t48. Y.,..~l..~.~....bY .~?. ~..~.i. 1..a ...... UNDERWRITERS CERTIFICATE No. ~..~[~9~. ..... ;.}{aY...1.. 1.9~ .............. HOUSE NUMBER .... .tt2~'. .... Street . .I~Ol~ug .Cl'®t~k .Dri~re ..................... Building Inspector TOWN OF SOUTHOLDi BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TIlE PREMk COMPLETION OF THE WORK AUTHORIZED) ;ES UNTIL FULL Ne 7002 Z Permission is hereby granted to: ......... t~-~'"-~'~-: .............. ! ...... , ........... at premises located at .~...~ ...... .~G~tl~OG~-g..~ .......... :'- ....... , .................. i.ii .......................... ...................... ' .......... ~n~..~..~e ............. ~1~,~....t~.~.~., ............. pursuant to application dated .................. ~ ..........~.,.,,i_,~...,., 19.J~,, ~nd' approved by th~ Building Inspector. Fee ~,.~,~ ............. FOI~M NO. 6 TOWN OF SOUTHOLI: Building Department Town Clerks Office $outhold, 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 Inspector with the following; for new buildings or new bsa: l. 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 Jtesldences and similar buildings and installations, a certificate of Code compliance from t~e Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site pla0 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 build!ngs 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 $5.00 3. Copy of certificate of occupancy $1.00 Date .....~..~. .......... t ......................... New Building .....~... Addition ................ Old or Pre-existing B(~ilding ....... ......... Vacant Land .............. Location Of Property ................................................... , ............... y ........ ..~ .............................................. Owner Or Owners Of Property .~..~,. Subdivision .~.~...~..[.C.....O~....'[~.......[~:~.....?~....~.. ................ Lot No..l..~..i.... Block No ............. House No ............. .................... Permit No .~. ~)~" Date Of Permit ..... J .............. App ~ t .................................................................. Health Dept. Approval ..... ...~....~...~..'.~..~...~. ................. Labor Dept. ~pproval ................................................ Underwriters Approval ...... !...~..(~.~.~..~.. ..................... Planning B°~rd Approval ........................................ Request For Temporary Certificate ........................................ Finoi Certificate .......~ .......................... Fee Submitted $ ..~.... ......................... Construction on above described building and permit meets ell ~pplicable codes and regulations. Sworn to before me ~lti~s ~ ........ day ....... 2.%... Notary Public .................................... County (stamp or sea,) ~,~Z~ -~'~'ct/7 THE NEW YORK BOARD OF' i U DERWRITERS -- 85 JOHN STREET. NEW YORK~ NEW' ~ 1~38' THIS CE;IFIE$ THAT M.~.T. Cons~.Corp,, Long C~eek D~tve, ~thlll Rd. E La~el AVe., Sou*hold, L.X. Job 123 ~ ~.~o. April ~ W~ ~flA~T FA~ ~R~ M~NKT ~. OF S E R V I C E ' COPY F . THIS OF ' BE : SUFFOLK COUNTY DEPARTMENT OF HEALTH Hqalth Department ,Re~erence Number APPLICATION FOR APPROVAL TQ CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY AddressApplicant ~ L,~'-~ (] a~ ,~,.~.??,:,~_~ Phone_ ~HFX$ Property Location _ ~ , Village ~,~,,~ ~ Township ~ ~ Public Wat~m~ahY ~N~ ~_:~~ ~ ~, Lot size: Width ) ~) fe6t ~' ~6ngth~ ~?et 10. Sewage Disposal System: ll. 5. Subdiv. ~(~l~OT1 6. Section 7. Lot Number 8. Private We~ 9. Public Wate~~b~'v-~o Distance to ~in (For H~alth Dept. Use) A, 900-gallon septic tank: Precast_ ~quival ent Block_ B, Leaching pools: Nu~er of pools Precast ~l ock ~pecial If private well, fill in the A. ~a~k capacity. .gallons C. Ydtal well depth, D. D6pth to gr~o~water. E. A~,~ount ~f~water in well Th?unders~ned CERTIFIES: "Construction of authorized installations will be in accordance w~th the S~folk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval in~dicated below and may be renewed if a current local Building Department Permit is in effecti:. Date ~%1~ ~ []) Signed '~~C~~ FOR HEALTH DEPARTMENT USE ONLY. Based on the informati6n presented herewith, it is the opinion of the Health Department that an adequate and sbtisfactory Sewage Disposal System and Water Supply can be installed on this plot. } APPROVAL DATE / SIGNED ' / ~ "' ~ Rev, 4/1/73 , "' BUILDING DEPARTMENT ~-,/~ ?~, ~ ~ ~,~, ~.~, TOWN CLERK'S OFFICE . Examined ~ ~ .~.. 19~ ................ , ....... .......... ...... ........................................ , ~ermit No.....~.~..~...~..~ ....... Di~ppr~ a/c ................................................ .................................. APPLICATI~ ~ BUI~NG PE~IT I ~. This a~licoti~ must ~ completely fill~ n by ~writer ~ in i~ a~ s~mi~ in triplicate ~ ~e Buildi~ Ink,tar; with 3 ~ of pl~s, aocumte plot plan to ~ale. F~ ~i~ to ~ule. b. Plot plan showing I~afion. Of lot Qnd of buildi~ ~ premiss, re at ~sMp to adjo ning premiss or public str~5 areas, and givi~ a detail~ d~ripti~ of I~o~ ofpr~ must be dra~ on the diag~m which is ~. ~e work c~er~ by th~ a~hcQti~ may n~ ~ c~me~ before i~uo~e of d. U~n Qpp~QI Of ~is applicati~, ~e BuiJdi~ Ins~tor will issue ~ Building Permit to the ~piicaflt. Such pa~it~ shall be kept on ~e premisK ~ail~le ~r in~ti~ ~g~ the work. e. No beildi~ s~oli be ~copi~ or u~ in w~ole or in part for any pu~o~ whatever until a Ce~ificate of ~cu~ncy shall have been gmnt~ by the Buildi~ Ink,tar.. APPLICATION IS HEREBY ~DE to the Bu di~ ~ment ~r ~ issua~e of a Buid ng Pe~it pum~nt to the Building Z~e O~inance of the Town of ~thold, ~olk ~un~, N~ Yo~, and other applic~le ~, O~J~ or Regul~ions, for the co~tr~ti~ of buildi~s, ~JtJ~s or al~mti~s, or for m~al or ~moliti~, ~ heroin ~ri~. ~e applicant agr~s to comply with all a~lic~le I~, o~i~, building c~, h~sJ~ c~e, a~ ~ulati~, a~ admit authoriz~ in~tom ~ premiss and in buildi~ ~ ~ i~ti~. (Signature of applicant, or name, if a corporation) ........ ................. (Address of applicant) ! I ~ ~"2..~ State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises l~,e~ I~-S. 1~ , If applicant is a corporate, signature of duly authorized officer. (Nar6e and tiflb of corporate officer) Builder's Liconse No ..................................................... Plumber's License No. ~ '} O Electriclon's License No ........ .?....~..C~,.....~ ............... Other Trade's License No ............................................... No Locotion of land on which proposed work will be done. Mop ...................................... L..IJ~Lv. No ......................... Street and NUmber ~ L~..~-- .~..~ .~..~- .~..07...?.~..~., Municipality 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. Nature of work (check which applicable): New Building .;~ ..... Addition .................. Alteration ............ .~ Repair .................. Removal .................. Demolition .................... Other Work ................................................... 0 (Description) 4. Estimated Cost .................... ~.~..~'~... ........................ Fee (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. D mensions of existing structures, if any: Front ..........~ ......... Rear ....... ~ ................ Depth ...~ ........ Height ...... ~1~ ..........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 ............ ~1~..~ .................. Rear ......... ..~..~ ............ Depth .....~...~ .......... Height ......~Z ....... Number of Stories ............... J...~'.~ .......................................................................................... 9. Size of. lot: Front ..............L~..?. ................................ Rear ................ .~..~.....~... ............. Depth ....~...~.......~..~:. .... 10. Date of Purchase ...................... "'. ................................ Nome of Former Owner .................................................... 11 Zone or use district in which premises are situated ....~...~..:.~i~.).~.~....~.~.l~. ....................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: " ~ ~ }3. Will lot be regraded ............ .~....~. ......... Will's. excess fil be removed from premises: ( ) Yes ( 14. N~e~ of Owner of premises .....~r..~,..~,~'.,..~.~eR~..~.... Address ...~tb~..~.~ Phone No..~..~...r.~..i...~...~..~' N*ame of Architect ........................................................... Address .............................. ;.' Phone No ....................... Name of Contractor ...._!~...~'......~.~.~..~...~ ........... Address .~,~...~.~.[ .......... Phone No...~..~....~.~.~.. PLOT DIAGRAM ~ ~'~ ~'"~' ! Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Gi~e street and block number or _description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, I.¢c COUNTY OF, ................................ . , d l sworn ................... · ~~ ............................ ~. ............... ~e'ng uW. ~. ~, depgses~on_d says that he is the applicant (Name of individual signing controct~ above named. He is the ............. .~~r~l~........~....~...~. ...................................................................................................................... (Contractor, agent, corporate officer, etc.) of. sa d owner. . or owners, and s duly authorized, . · to .perf°rm. or .th~s' apphcahon; that all statements contained m th~s, apphcaf~cef are-true to the best of h~s knowledg~ and behef; and~ that,the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this · . o of .............................. ......... ........ .................................................................................................................. ~ (Signat~of applicant) LO~ REVsoNS YO JNG &,YOUNG APR~I2,1974 400 OSTRAND£1~ AVENUE, ~IVERHEAD, NEW YORK ALDEN W. YOUNG } HOWARD W. YOUNG SURVEY FOR: ' EDWARD T. LEAVAY LOT NO. 1;5 "YENNECOTT PARK" AT SOUTHOLD TOWN o~ SOUTHOLd! su[[ocK co., u~ ~,- ~ .............. Chief of Ce~ez'al MONUMEnt S~O~BI~N MAP FI~O IN ~HE OFPI~ O~?H~C~BKO~MFFO~K COUNTY ON ,.'L / ;:" pA~'t;'c (. APPROVEE~ AS I~O~ED NOTIFY BUILDING DEPARTM_;,IT 765-2660 9AM TO 4PM FO& K~.QUIR- ED INSPECTIONS; 1. BEFORE BACKFILLING FCUI4DA.- TION OR S~'ART FRAMING 2. BEFORE COVERING piPELINE 3, FINAL WHEN JOB COMFLETED . _ & STEV'E CONSULT~N ~ T$ONTAKI5 IZ t 1 1 'F-