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Home My WebLink About7042-zFORM NO. 4 TOWN OF SOUTHOLD BUII.IHNG DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z~9~.3 ...... Date ..........J.'~e...3 ......... ,19 .~. THIS CERTIFIES that the building located at .1~/I1 .~,.l~iN..lgt~ ........ Street Map No. I~,t;. ~.~.. ~ck No ........... Lot No .... .~¶ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ D. ae.. ~., 19.73 pursuant to which Building Permit No. ?0~.. dated ....... Ilse. · .~ ....... , 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 p~'.~¥.a.t.e..o..ll.e..f. ,a~..l.l.y...d.w.e.l!.i.l!.g ........................................ The certificate is issued to .Had. ry. Zh®r~l .&. b/igc ...... O~llt~.~ ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. Jxl~®...~...l.~...by. P~ .~ll~,a.. UNDERWRITERS CERTIFICATE No][. :L~9.¶?.~ .... ll~...l.~...¶9~. ................ HOUSE NUMBER ... 80~ ....... Street ~alt. il~. ~/ay .......................... ..... ~:,-.%~.~. ~.. ~.~... ~.~ r../../.'~. ~ ......... ' Building Inspector RD, ~Y. (THIS PERMIT MUST BE KEPT ON THE PI~MI~ Ut~TIL FULL COMPLETION QF THE WORK AUTHORIZED) 7(}42 Z FORM NO. ~ 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 DUPLICATE to the Building inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil 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: 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 $5.00 3. Copy of certificate of occupancy $1.00 / / e B ' Dote .....~..~,.i...~. ./....~......~. ........ N w u' ding ./~.... Addition ....... .~....~.. Old or Pre-existing Building ................ Vacant Land ..........~,.. Owner Or Owners Of Property Subdivision ................................................................ Lot No....~.J..... BIo~k No ............. House No.~.~.~.... Permit No..~.~,.. Dote Of Permit ...~,.~..;~,.~.Appl,cont .... Health Dept. Approval .... .~,/-,~..~.....Lobor Dept. Approval ................................................ Underwriters Approval ........ ~,~....../..o~..~./~7.~. ........ Planning Board Approval .......... ...._~- .............. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $'"' Sworn to before me this .../.._~...~. ....... · ~ ..... day of ........ ~.. ......... ~ .................... Notary Public .................................... County (stamp or seal) ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC~ i '~ *'' J-- EW 85 JOHN STREET, NEW YORK, NEW YORK'100~8. THIS CERTIFIES THAT only th~ electrical ~quipment as d~scrib~d bdo~ m~d introduemi by th~ ~uliea~t named on th~ ~bo~ apldication number in th~ premis~s of Harry Sheren, e/s Saltalre Way, 575' s/o Soundvlew Ave., Mattituck, L.] was exarnined on May 9, 197~1 and found to be tn cornpliance with the requireme.ts oy thls Bo~rd. FIXTURE ~EFI'A I S~IT H I RXTURES I 19 |38 23 19 DRYERS FURNACE MOTORS FUTURE AF%~IANCE F~EDERS A,~T. ' K.W, O~L H.P, GAS H.P. ANAT. NO. A. W, G. . RANOES 1 3¢ SERVICE INS~ONN~CT I NO. OF I S E 1 125 f x 1 *Fur~&¢es: 1-1/Shp, 2-1/15hp CC. COND. 2 COOKIHG DC-~KS OVENS DISH WA.q,IERS TIME CLOCKS ~L ~ MULTI:QUILET SYSTEMS V I C EXHAUST FANS 1 F DIMMERS NOrth Country Rd. -- , CO~Y FOR BUILDING DeART SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department ~_~d~-/~2 Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~Phone $~'~.~=)~),4. 5. Subd,v.~ Address I 0 ~0~6. Section 2. Rroperty Location 7. Lot Num~ ~)~)~O~I)V~ A~/~... ~ 8. Private Well Village ~ ~' ~.~ Township~9: Public Wate~~ 3. Public Water Company Name D~stance to ma~n 4. Lot size: Width ~0~) feet Length. ~ feet 10. Sewa~Disposal System: . A.~-gallon.septic ~ank. Prec~st~/Equ~valent Block B. Leaching pools: Number of pools / Precast~::'~Block ~pecial ll.~f pri~)~tewell, fill in the ~ll°~ng~ blanks: ~ T~ capacity~gallons i,-~B. P~B~p G.P.M. ~, C. Total well depth D. ~eepth to ground water~)~ E. Amount of water in well m~'~ (For Health Dept. Use) WA,/ The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk Coun~ Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and ~y be ~newed if a current local Building Department Pemit is in effect. Date~__~_~ Signed~~~ 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 and Water Supply can be installed on this p)ot. APPROVAL DATE /~j/x~ SIGNED ~ ~ '~ S-15 Rev. 4/1/73 TOWN OFSO~TH~LD ~. _ ~--- ~ ,v TO~ ~ ~ / ' _ _ ~xamined ~ ~.~ ............ , 19~ ' ~ ~ '4-- ' ~~ ~ ............................... ~ I ~ ,~ ~lic~ ~ ~{~.:.....?.~ .... " " " Di~pp~ed .. ...................................................................... ~.:~: ...... · ~ ~---A ADPLICATI' FOR BUILDI~"'IT/~' -~ ~' ........ I , ~1 fill mb ~wr,t~r o~ ,n ,~ ~ ~ml~ tr~li~, o. Thi~ication m~b~ comp~t ~ ' ~ ' y ~ ' . .... ~' ' ' Ins~tor, with $ ~ of_~l~s, accum~ pl~ plan ~ ~le. F~ acco~i~ to ~h~ule. , ' ' b. PI~ pl~.. sKowi~-'l~ation.. .of.l°t ~nd o~ buildings on pr~mises, relationship to. ~ioining, premiss, or p~lic, street. . ar~s, and g~w~ a d~tad~ d~cnphon of I~out ofpr~e~ must ~ drawn on the dmgmm wh~h ~s ~ of ~hls ~hcah~. c. ~e work ~c~ered by ~h~ a~lication may no~ ~ comme~d before i~ua~e of Duilding Permit. - d. Upon app~val of this application, ~e Buildi~ tnsp~tor will issue a Duilding Permit to the ~plica~. ~ch parm shall ~ ~pt en the premis~ available for in~ti~ thr~ghout the work. e. No~uildi~ shall be ~c~i~ or us~ in whole or in pa~ for any pu~ose whoever until a C~ifi~ o~cu~ncy shall h~e b~n granted by the Duilding In~ctor. APPLI~T~N IS HE~EDY ~DE to the Duilding Depa~ment for the issuance of a Duildi~ Pe~i~ Building Zone O~inance of th. ~own of ~uthold, Suffolk Count, N~w York, and other applic~le ~, ~ncm or R~gulations, for ~e constru~ion of buildings, addifi~s or al~rations, or for removal or de~lifi~, ~ ~ The applicant agrees to comply wi~h all a~licable laws, ordinates, buildi~ c~, h~si~ c~, a~ ~, admit authoriz~ ink,tom ~ pmmlses ~d i~ buildin~ for n~es~ i~fions. ~ ........... ~noture of applicont, or ~m~, i{o (Address of applicant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, ~iUmber or builder. ......................................................................................................................................... · %.,:..~ ............... '., ............................... Nome of owner o, remises.J..~. A..~..~'~-'' L.. ~ H ~ ~ ~'--/~ ~ ~,~"~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .......... .~. ................. .°...T'..~.f Electrician's License No. ~....B.~F.~LJ, ................... ~"/ Other Trade's License No ............................................... ,. Location of land on which pxoposed work will be done, Map No.: ..~..~..~.l..../.~.t....r~...~...,~.~..J... Lot No...~.J. ................ Street and Number ..~../..~......~..~ .~..~..A.J ~.~. ~ ~...~. J~'~'-"~'J T'u c./c_. ......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...r....'..~. ........ ,:...~.. ....................................................................................................... ..... ...................................................... b. ntended use and o cu ncy ....... . 3. Nature of work (check which Roplicable): New Building ..'.; ........ Addition .................. Alteration Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (Description) 4. Estimated Cast ........ ..~...?Z....~..?..?......~'~... ...................... 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. 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 ...... ~ .............................................................................................. 9. Size of lot: Front ........... .................................... Rear ........................... Depth ......~.~T....u....u.. ............... 10. Date of ,urcho. P.. ........................................................ ame of Former Owner ........................................................ 11. Zone or use district in which premises are situated [ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ..~......O.. ....................................... 13. V~ill lot be regraded .......~'"~.'~',~ ,-~ ~.~Will excess fill be.removed from,,~ npremises: ( ) Yes (~ No . 14. Name of Owner of prerlNses .~.....~...~....(~.... Address ....~.~.. Phone No ....................... Name of Architect ..~...Y..~.~..~ ............. 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 fram 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 NEV~YO~J(,, ~/' ~ ¢ c ~ being duly sworn, deposes and says that he is the applicant ""'"'"'""~"~'"'""'( ~a 'r;l~'~o "i~vic~ual'"" ' ' ' signing'"'""'"'"'"'"'"'"'"'"'"'"'contraclO He is the .............................. ~- ......................................................................................................................... (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 end file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ~,~ ................ of ........ Notary Publi~ .......... ~ ty ................................................................................................ ~' ' _ ..... (Signature of applicant) JUDITH T. Notaef Fub~ic, State of Ne~' ¥orJ( Suffolk'- County 52.0344963 No. March 30, Commission Lot ,n-¥ BDIL[~NG DEPARTMENT AT ~'--;~' ~AM i'O 4PM FOR REQUIR- ~ L~. f~ONS: -~' -~:: ~ACKFILLING FOUNDA. '; * ~,~ .~IAKT FRA~ING u ~- C~V~RING PIP:LINE -. h L V~HL~ JOB COMFLETED ~ o, RESPONSIBLE FOR DESIGN OR cON- NOTE: · -' MONUMENT SUBDIVISION MAP F/LED IN THE OFFICE REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: HARRY SHE~EN 8~ GRACE SHEREN LOT NO. 31,' SALTAIRE ESTATES" T°WN °v SOUTHOLD ~t, ~:' l sclc: I" : 40' DATE: DEC. 4,19~ General ~eer~ 9osit~ R,cl~Orge NOTE: · -' MONUMENT $OOMVI$/ON ~ F/LED IN THE OFFICE OF THE CL~;~ OF SUFFO~ K CO~N r Y ON .EV,S,ONS YOUNG & YOUNG FEB. II,Ig'/'4 400 OSTRANDER AV£NUF', RIV£RHFAD, NEW YORK APRI~ ~5,1974 ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: AT ~TTITUC~ ~ I '~ ~ TOWN OF SOUTHOLD °[~i~~ SUFFOLK CO., N.Y. ~~~.e -' "'.. ,-,~ {JNNJTHORIZIED ALTERATION OR ADDITION TO THIS SURVEY I~1 A VIOLATION OF SECTION ?209 CF THE N~W yORK ~TATE EDUCATION LAW THE* LAND SURVEYOR*S INKED SEAL OR APPROVED AS NO)ED ED INSPECTIONS: APPROVED AS NOTED INSPECTIONS: BEFORE BACKFILLING FOUNDA- BEFORE COVERING PIPELINE FINAL WHEN JOB COMPLETED ALL STRUCTUR~,L LUMBER SP~NS TO COMPLY !P~2~ ST~7~' AND LOCAL COD~ II =1 f 3