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Home My WebLink About7040-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ............... Date ................ ~ ................ 19 ... THI~ CERTIHE$ that the buAd~ ................................................ ~cation of Prop~y ~ ~o: ........................................................ ~ 7 s~t ~ ~. I County Tax Map No. Z 000 ~cfion ............ Block ............... ~t . .' ............... Subdiv~stog ............................... FUed Map No ......... ~t No .............. confo~subst~t~y to ~e AppUcation for B~g Pe~it he~tofore Ffl~ ~ ~s offi~ dat~ ~t ~ 73 70 ~ 0 ~ ..................... ,19... puts~nt to w~cA B~ P~Jt dated ............................ 19..., w~ ~, ~d confo~to ~ of~e ~m~ts of thc applicable provisio~ of the law. ~e occup~ for w~ch t~s celeste ~ ~u~ ~ .... ~e ce~ificate is issued to ................................. (o~, I~~ ~nU ................... of the aforesaid budding. Suffolk County Depa~me~t of ~e~th Ap~ov~ ........ ~ ...... ) ..................... .... . ~ ~7~99g ~ERWRITERS ~RTIFICATE NO .................................................. B~dM~ Ins~tor Rw. 1/81 TOWN OF SOIFI~IOLD BUn.nING DEPARTMENT Town Clerk's OJ~ice Southola, N. ¥. Certific;~te Of Occupancy No. ''~ ~['~ ~ Date THIS CERTIFIES ~at ~e b~di~g locat~ at Msp No ............. Bl~k No ........... Lot No conforms substantially to the Application for Building Permit heretofore filed in ~hi~ office dated ...........~'..~..H.. ----.~...k~., 197.'!. pursuant to which Building Permit ~No. 7 0 dated ~ mI ]~ k-F__ 19.7..~. was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is issued is ~ 0 I,I,C The certificate is issued to ( owner, of the aforesaid building. ....................... ' Building I~spector FOBM NO. '~ 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) No. 70 10 Z Date ......................... ~)e~ ......... [;~ ......... , 19.~.~.. Permission is hereby granted to: · 'l>*~,'O*,~o*x ....... ~'~8' .............................................. ...... ,l~n~,tng~;o,~.....~].,.~.,......1.12~3, ................. to I~u~L~..~w...o~e..~3.;y..~we;l.~ .................................. .................................................... at premises located atN~.S..,,K.:~lg...L~.t.....f~l~A~z,.ow...[~,£v, ez*...~,d~ ..................................................... .......................................... ~l~n.t ............ 1~.,,¥.,, ................................................................................. pursuant to application dated ................... D~C .......... 2,L~ ............... , 19~..., and approved by the Building Inspector. pee $3~o.~;O ............ FO~ NO. 6 TOWN OF SOUTHOLD Building Depu~tment 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 DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of praperty 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--(5-9 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: ]. Accurate survey of property showing all praperty 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 perHnent 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 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property /~ YS' /~4 FFrr tlt,/ ~c~W£77 '-~1~/~ ~,~ c"27~;I ~ ~" T Owner Or OwnersOf Property ~L/~I]' kC '~L 0T~. Subdivision .............................................................. "TUu/D /: / Lot No ............. Block No ............. -- House No ............. erm,t No ..................... Date Of Permit ....Z.:...L. ...... App icant ....................................................... :. ......... Health Dept. ~pprovm ............. / ............................. .ooor Dept. Approval ............................ : ................... Underwriters Approval ~J 17 ~ 9 D ~) Planning Board Approval /J' xc~ - ,u st For Tempo,ary Certif,cote ........ rtif,cote ........................... Construction on obove described building"~..O,,~rmit meets all.~l.~bl~eodes end regulations. Sworn to before me this PPT ~J. .......... .2 ............. .Tdo of bC 7 / 9 7 ) THE NEW YORK BOARD OF FIRE UNDERWRITERS &~( BUREAU OF ELECTRICI~TY ~ 85 JOHN STREET, NEW YORK., NEW YORK 10038 ~,. August 5, 197~1 Ap.l~..o.~Vo.o.~l.726090 ' ' N 174998 THIS CERTIFIES THAT &. D.LOQiI;el;~;R '£tle Uo~'teF o1" Na~Pl',0w ttlver l~Q. & KIRg ~i~ . · 0~'lent Point s L.T. ;.tkefollmeingloc.tio.; [] B~semeat [] lstFI. ~ 2nd FI. outside ~ti~ ~mS/ ' FL~E~ ~ ~T. K.W. I ~T. K.W. MT. J K.W. 13. 26 19 13 ' 1 3.8 L 1.5 ~RVI~ m~ I NO. OF S E R V I C 1 OTHER ~A~TU~ ~o~/~: 1-1/2~p EXHAUST FANS DIMMERS OF NEUTRAL 332 Ha.esau Road, ~m~.~ll,~, ~ 61 Wear He.stead. L.I. ].1552 ~~ - I _ COPY FOR BUILDING DIEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERIED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applican~l~on~5. Subdiv. Address , · ' 6. Section 2. Property Location 7. Lot Number 8. Private Well Village (~)~--~(~,.~-~ Township~~\~:~ . 9. Public Water 3. Public Water Co~pany Name Distance to main 4. Lot size: Width~q~,.~m4mfeet Length~.~"to feet lO. Sewage Disposal System: ~) A. O~aly~n septic tank: Precasty Equivalent Block__ (Fpr Health Dept. Use) B. Leaching pools: Number of pools ~ Precas~(a Block Special ll. If private well, fill in the following blanks: A. Tank capacity B. C. D. E. ¥~-~gallons Pump G.P.M. -~ Total well depth Depth to ground water Amount of water in well The undersigned CERTIFIES: "Construction o~d installations will be.in accordance with the Suffolk County Department of Heal(h's current\Qtandarx~--bfl~o. This application will be valid for one year from the date ot~kapproval in~icate~ below an~may be renewed if a current local Building Department Permit ~in effect~ ~ ~ ....... :::::::::: ................. :=:::: ........................... . FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, ~t is the ~~ ~ ~ ~nt that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this pl~ot. S-15 Rev. 4/1/73 · '~P(SIt'M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE~-~-I ~UTHOLD, N; Y. //~, prov~ ........................................ , ly...~... ~-erm:r r~o ..................................... / - 7~"? . isapproved a/c ............................................... ~. ................................ ¢~. ~ ¢ ~ ~ .................................. I.~ ......... ~, ~ ~ - ~-t INSTRU~IONS a. This a~lication must be completely fill~d in by ~pewriter or in i~ and submitted in triplicate to the Inspector, with 3 sets of plans, accurate pl~ plan to ~ale. Fe~ acco~ing to b. Plot plan showing location, o¢ lot and of buildings on premise~, relationship to adjoining premi{es or public streets al areas, and giving a detail~ description of layout ofproper~ must be drawn on t~e diagram which is ~ of this application. c. The work covered by this application may not be 6ommenced hecate issuance of Building Pcmit. 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 ~cupied or u~d in whole or in pa~ Car any pu~ose whoever until a 6e~ific~tl of ~cu~ncy shall have been granted by the Building Inspector. APPLICATION IS HEREBY ~DE to the B~ilding Department ~or the issuance of a Building P~rmit pu~uant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable b~, Ordinances or Regulations, {or the construdion of buildings, additions or alterations, or for removal or d~molition, as heroin de~ribed. The applicant agrees to comply with all applicable laws, ordinances, building c~e, k~sing c~e, a~ ~ulations, an8 to ~dmit authorized inspectors on premises ~d in buildings for n~es~W i~tions. (Signature of applicant, or ~me, if a co~omtion) (Address bf applicant) State whether applicant is ow~g~lessee, ogent~ architect, en i~r, general contractor, electrician, plumber or builder. INt~ premises .~~'~~.~~~ ......................................................... I f ap~nt is~o~orate~ure~o~lul_y authorized~ off icer. (~,lame and title~f corporate officer) .... Builder's Ucense No ..................................................... ~"~-7 "~¢1 ¢/h ~ ~// ~ Plumber's License No ....... ..~...~..~.....t~....~...:[ ............ ~ /'7%c/~y) Electrician's License No. ~~....~¢~r~ -'-~-,~- o~--/ Other Trade's License No ............................................... 1. Location of land on which~or~oosed work will be done. Mop No.: ............... .._:.. ..................... Lg. LNo ......................... Street and Number ...... .~...~-....~.~......~-W~....~%. ........ ;.......~...~....~.~.0...~.. ....... ]../~..,.~..~.~..~ ............. .(~.~..~ ....... ~ --~O ,o~/% Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ' Approved ................. Z~. ....... ~.! ........... , ]9.~i!~_ Permit TOWN OF $OU~HOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y~ Application No..i~.(~..~[..,¢~i;! .............. Disapproved a/c FOR BUll )lNG PERMIT Date NSTRUCTIONS a This application must be comptetdy filled in by typewriter or' in ink and submitted in triplicate to the Bui d ng~i inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of iot and of buildings on p;emises, relationship to adjoining premis, es or public streets o~ areas, and giving a detailed description of layout ofproperty mu*:t be drawn on the diagram which is p~rt 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 part for any purpose whatever until o Certificate of acc shall have been granted by the Building inspector. ';. APPLICATION lS 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 Regulations, 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 code and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature oF applicant, or name, if a corporation) (Address bf applicant) / f 7 Sto!e w~ether applicant is lessee, ager architect, en~.general con,rector, electrician, plumber or builder. f icer. (Name and titl~ corporate officer) Builder's License No ..................................................... Plumbers License No ............ ::e..,~,..,v....:.v,,,j Electrician's License No ..... Other Trade's License No ............................................... 1. Location of land on which~oraposed work will be done. ; Mop No.: ............. :'z'> ~ ....................... Lot No..; ...................... 2. ~tate existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting use and occupancy ....................................................................... Intended use and occupancy . · / · 'Nature of work (check which applicable): New Building ; ................. ~/' Addition .................. Alteration .............. ,Re[mir ................... Removal .................. Demolition .................... Other Work ..................................... · .......... ~ .... 4. Estimated Cost ....................................................... Fee ........................................................................................ ....~ (to b· 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. Jf 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 ............................ Depth ....~.....~..~...! ......... Height .................... Number of Stories ..................................... : ................................................ t'"~"~'""--" .............. 9. Size of lot: Front ............ ..~..~..~.,......~.. ..................... Rear ...... ..~....~.,..'~..~. ......... Depth .....'~...~..~.~.....~.. ....... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. V~ill lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name 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. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW)I'Q,%K..~,,'~ COUNTY OF~ ....... ......... ; ........... '. ........................................................................... being dul~ sworn, d~es and ~ys t~t he is the appli~ (Nome of i~ivid~l signing contr~ ~ve name. He is the .............. ' ................................................................ ~ ........................ ;~ ........................................... (Contractor, ag~t, ~orate officer, ~c.) of said ~ner or °W~em, and is duly authorized to perfor~ or h~e perform~ t~k and to ~ke and file this application; that all statements contained in this appli~tion are tree to ~e ~st of his ~nowledge and belief; and tha~ t~ work will be performed in the manner set fo~h in the~pl~ation file~ther~h. Swam t~ me this ~ ......... Notaw Publi~.:~.~n~ · ..................... · ') wou.'no, o~ ,~.¥. TR. ALI~ ~' V'~.:.4 ~"r .to ~..,s su~w.,. ,s ^~,)u¢^?,o, ,.,.w. ~ .! ,~A ,~ / ~ ~ lis ~,.-~.~ , ~ . . ~ / · . ,, J. . .:. I o ~ ~v~ ' - .I ,t~ ~1. -, 4 ~ , ~'1~ ~ r . ~~ ~ ~ . ..~,. ~"' '" . . .. ~~ ~ ~-~ ~ ~ ~, · - I~o~ ~p~ . m [ ~,IOT~: ALL ~lM~t-i'~lO~ SHOWN Ii -- i 4 \ / / ~voo,f EXTERIO~ DO0,~ ~ETAIZ " D£ T,41L, ¸Iv /C/cC/x/ k