HomeMy WebLinkAbout6966-zTOWN OF $OUTHOLD
BUILDING DEPARTM~NT
Town Clerk's Ol~ice
$outhold, N. Y.
Certificnte Of Occupnncy
No..Z..~8~8 .... Date ............. ~,pl'$1....~.%..., 19..?~
THIS CERTIFIES that the building located at..~//S..-El.~.2ah~ ~ -Lan~ .... Street
La t
~----'~"~--~l~Iap No. ELijah ..... EB~ock No ........... Lot No...12 ...... l~atti~;uek.. ~,¥, .....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........... 0c~..~l..., 19.73 pursuant to which Building Permit No..69f~6z.
dated ............ Nc~... 2 .., 19. ~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~i~te. one. fairly. ~lwelLln~ .? ...................................
The certificate is issued to .. Iz~nd~ ~o~as. lr~.. O~ner. ..........................
(owner, lessee or tenant )
of the aforesaid building.
Suffolk County Department of Health Approval ,tlo~:El..~..~.~71~.. by. Ko..¥~..
UNDERWRITERS CERTIFICATE No.. 1~..1.~20(~ .... Apl'~,~, .~...%97~ .............
HOUSE NUMBER... 2~.~ ...... Street .. ~l~.~ah ! s. J~ane ........................
Building Inspector {
FOII~ 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)
N? 6966 z
Dote .............................. t~ O/g. ....... ~. ........ , 19.~4~..
Permission is hereby granted to:
~.~ea..Z~ .........................................
................ · Y~.t,t .1.tmek.....W .Y, ...........................
,o ~.u.~.l..~..~.V...~....~.~,..l~...~.~.~.~,~.~.n. g ......................................................................................
at premises located at
.............................. ~/. ~.......g.~,~..~ ~.....;~p..e. ........... ~.s;.~ ~.tu~ .................................. ~ ..................
pursuant to application dated .......................... ...0~..~....~ ............. , 19~.~...., and approved by the
Building Inspector.
Fee *:~.'.~. ...........
FOR~I NO. 6
TOWN OF SOUTHOLD
Building Departmen~
Town Clerks Office
Sou~hold, 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 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 Residences and similar buildings and
installations, o certificate of Code compliance from the Architect or Engineer responsible for
the buffding.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Nomconforming 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
New Building ....~ ...... Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property
Owner Or Owners Of Property ...In'l~m.~..~Q~.~S,...Z,~.¢.~ ........................................................................
Subdivision ...~'1 £,j.ah.!.s..~e...~..~.~..~..~..s .......... Lot No...~.2.. ..... Block No ............. House No.~6.~5..
Permit No..69~6Z ...... Date Of Permit .11/.~./..'~.3...Applicant ..I...n..1....~%~...d.....H...Q.m...e..s.~....~...n..c..?. .....................
Health Dept. Approval ._~4.5~.2'.~ .......................... Labor Dept. Approval ................................................
Underwriters Approval ..... .~..~./.7.~ .......................... Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ....~ .................................
Fee Submitted $ ..... -5,.00 .....................
Construction on above described building and permit meets all applicable codes and regulations.
App cant .I...n..1...a..n..d. .............................. ..H..omes Inc./ ~.~bert Hiltz
to before me this , ~'~'~(~."'f"~':"
Sworn
......... /.]... day of ..... .~....~....../..~..~./ (stamp or seal)
Notary Public .................................... County
THE~NEW YoRK ,u.r~ , ,~ ',.uNDERwRITERS
85 .K:)HN ~I'~ET, NEW YO~
THI~ ~E~IRIE~ TNAT
Xnl~nd Ho~el~ ~XX~h~8 L~e~ w/~Xde ~000~ ~/o R,R, ~oks) ~ob 201
15 15
[] ~,~ fi, Out, lide s~t~o,,
Wnd fo~td ~o '~ i~ cornpi~an~e with the ~quirernents oJ th~ Boa~L
Lot 12
$ E V I (: ·
°'~u~ApP, Feeders= 2-3t8, 1-2112 :
Water He~te~:
Motor/s: 'l-3/~hp
Eleo. ROom Heaters~ .1'3.0
George Zlmllnghaus
~Park Pl.
Patchogue, New York 11772
11
............ ~ ........................... , 19 ........ ,*~pp,dcm~on rxo.~,~ .........................
Approved .................... ~'. ........ ..~......., 19..2.~. Permit No....~.~......~...¥.....~.. ........... / ~/~/--~-t~ ~%
APPLICATION FOR BUILDING I~IU~IT
Date ...................................... , lY,.. ........
INSTRUCTIONS idi~?
a. This application must be completely filled in by typewriter o~, in ir~ and submitted in triplicate to the But
Inspector, with 3 set~ of pla~, accurate,plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on p~emises,~ relationship to adjo n ng prem ses or pub ic streets at
areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is pert of this application.
c. The work covered by this applicatioq may not be commenced before issuance of Building Permit.
d. U.p~n appm. val of this aPPlication, the Building Inspector will iSSue'a Building Permit to the applicant. Such permit
shall be Kept on the premises ava lable 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
_Bu.ld~r~.. Zon,e Or.chnanc, of t.h. T, .o~n of Southo.~., Suffolk Cou.n. ty~ New York, and other applicable Laws, Ordinances or
~egwan,o. ns, ?or the c.onstruct?n o.~. Du!!ding~ additions or alterations, or .for removal or demolition, as herein described.
~ne app,canr agrees to comply wire att ap~icable laws, ordinances, bulldtng code, housing code, and regulations, and to
admit authorized inspectors on premises and in, buildings for necessary inspections
: .- / (Signat~r~ of applicant, or name, if a corporation)
].X7~ '~ ~.~uak, N~Y,
' ~ (,~ldress of ~o~iWant)
State wheti~r applicant i~ner, lessee, agent, architect, e~ineer, general cantroctar, electrician, plumber ar builder.
General
Name of owner of premises .I..n...1...a~....d. Hero,es, 1~,
If applicant is a corporat~,~ .si~g,nature of duly authorized officer.
Kenneth We ~hu~ Vp ~
(Name and title of corparote officer)
Builder's License No .....................................................
Plumber's License No .................................................
Electrician's License No.
Other Trade's License No.
1. Location of land on which proposed work Will be done. ~4ap No.: .................................
Street and Number W/S ~ B.l'l~Iahs LAUte ~.~ Ii~d~ ,~~os~...~..:.~..,.,..,.,t..~_..
Municipality
2. 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 One fam:Lly ~elling
3. Nature of work (check which applicable): New Building .,J..~... ........ Addition .................. Alteration ................
Repair .................. Removal .................. Demolition .............. ~ ..... Other Work ....................................................
4. Estimated Cost ..... ~ ............................... Fee ~'~' ~" (Description)
(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 ...4~ ..................................... Rear ..... ~...~.. ....................... Depth ..~....~.... ..............
10. Date of Purchase ...... ~. ........ ;.!.. .................................... Name of Former Owner ....................................................
1 1. Zone or use district in which premises ore situated ....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................
13. Will lot be regraded ......~IIB ..............Will excess fill be removed from premises: ( ) Yes ( ~
14. Name of Owner of premises ....~1~..~..~...... Addres~lls?...~~hone No .......................
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor ...~il~..~...~ .............. A~ross .......t~111~.. Phone No. ~...
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram
pi'0perty lines. Give street and black number or description according to deed, and shaw street names and indicate
whethe~ interior or corner lot.
duty sworn, deposes and says that he is the applicant
above named.
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 and fi!e
this application; that all statements contained in this application are true to the best of his knowledge and belief; and
thar the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
-~. d of . ,~ , 19'-~/~ -- -- ~
Commission Expires March 30, ]9 ~/'~;>
pAI~CEL IS PROt;OSED LOTNO 13 OFREALTY
SU~DIVIS/ON &f~P TO BF~N~IT~O "MAP
OF ~C~/ON / ' ~LIUAH~ LANE ES~A~F~ .
ANO rO ~FF/LFO IN YHF SUFFOLK COU~Y
Ct ~R~ OFFIC~
.-v,s,o,,,s YOUNG & YOUNG
400 OSTRANDER AVENUE. RIVERHEAD. NEW YORK
ALDE:N W. YOUNG HOWARD W. YOUNG
SURVEY FOR:
INLAND HOMES INC.
AT
MATTITUCK
TOW. o~ SOUTHOLD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
H.D.Reference No
APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date
Approval to construct said systems is requested,pertinent data herewith:
t-Applican Y~ ~ ~, Phone~98-9~6-Sub div ~
Address ,e? . . ! ~%$~ ?-Section
2-Detailed p~~tion $/' $~ ~ 8-Lot No.
Hamlet Town~ 9-Private well?
~-Publlc water sup. Dl~ name ~ Distance to nearest main
4-Lot Size: Width A~%~ ft. Length~ ft. (also enter on center plot plan below:)
5-Dwelling: Singl.e Family ~ Two. Family? ~__~Cellar? /X/Slab? ! /Crawl Space?
,yst . Septic tank . . Pre j Cess ols / /Shallow ols ! /Other / /
il-Septic tank inside~mensions. V_olum~e~_~als. Length ft. Width f.t. Liquid depth ft.
12-Precast sections: ~/Number~quare"Tt. Cesspools: Block sizeL mncs. D ins. H ins.
Total blocks below inlet: ~1 ~2 _~3
PLOT PLAN CapacitT~als'
Street
?Data ~et
0
2
4
6
8
10
12
~6
18
Ind:
Nc
The Undersigned CERTIFIES: "Construction of authorized installations will be in
accordance with the Suffolk County Health Departments' current Standards, Bulletins,
and amendments thereto, covering Private Sewage Disposal Systems".
/ / ~Owner or Builder
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
can be installed on this Plot.
Date tW/~7
(10/65 Revis.)
S-15
Signed
I
COUNTY HF_ALTH D~.PARTMY2{~
~he se~age ~tsposal ~d ~ter supply
faoitlties for this location have been
inspected by this department and. found
Chief of General Eng Services
~0~
TH~ tOCATION OF WELLS AND CESSPOOLS
SHOWN HEREIN ARE F~OM FIELD OBSERVATIO~
JIHD/OR FROM DATA OBTAIIgED r~OM OTHE~
= MONUME~
SUBDIVISION MAP ~0 IN TH~ OF~I~
OF TH~ ~LERK ~SUF~OAK ~UNTY ON
~B. I4~ 19Y4 AS ~1~,606~
.£V,S,ONS YOUNG & YOUNG
MAR 7,1974 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
APR 2, 1974
ALDEN W YOUNG HOWARD W. YOUNG
SURVEY FOR: AT~
INLAND HOMES INC.
LOT NO.12," ELIdAH'S LANE EST
TOWN or SOUTHOLD
t
APPROVED AS ~OTED
,/
AP~R~:VED AS ["~O~ED
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