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Home My WebLink About6967-zFO~M NO. ~ TOWN OF SOUTHOLD BUIT.rlING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate O[ Occupancy No.Z~.Qt~3 ....... Date ...........August...22 .....,19. THIS CERTIFIES that the building located at . 14xmewata. Roa5 ...........Street Map No. Il. ass ,. 1~- ~lroc~No ........... Lot No..~l ..... Cutahogu~.. Ii,~o ...... conforms substantially to the Application for Building Permit heretofore fried in this office dated ............0e~;..l..., 19.?3. pursuant to which Building Permit No..6~7Z · dated ........~ov. · 2. ....... , 1973.., was issued, and conforms to ail of the require- ments of the applicable provisions of the !aw. The occupancy for which this certificate is issued is .. P~ivat~ .on~ .£am&.~v ..d~,~lli~g ...................................... The certificate is issued to . .John .&. ~ro~L .Seazxl~n ..... .V~mer. II (owner, lessee or tenant) of the aforesaid building. Suffolk County Depa~ment of Heaith Approvai . · Ju~y. · -~¶... ~ ~.. by. Rt. UNDERWRITERS CERTIFICATE No. App~ove~. b2. Jw..~baeki. · .~/23~ ....... HOUSE NUMBER ...~800 ...... Street .. b~aeweta. Road ........................ .... ............ Building Inspectdr TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6967 Z Date Ilaqg 2 1 9.?..~... Permission is hereby granted to: ........... .C:;.t ,~.of;~e ............................................... at premises located at ...... ~:....~.le.~ .......... ~41~..]~OL~t...]p~l~ ............................................... ............................................. e..~.~.....~,~ ......... .~.~t~g~e ..................... ~ ........................................ pursuant to application doted ...........................~ ......... .1 ............ 19~.~..., and approved by the Building Inspector. Fee $ 3,0~..,6~.~ ......... FORM NO. 6 TOWN OF SOUTHOLD 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 oll buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(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 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: 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 c~de 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 / Date ....~../.2~.~f/~...~....,. .............. -New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....~.`.`.~.....~...~..~../-..~..~....~....~.~...~...~...~...~..~...~.....~...~...`.~./.~.~.~.~....`~....~./.~..~:.. Owner Or Owners Of Property ...~..~.]/...~.....~....~.~../~..~..O.../-........../~...~....~.'1~.~...~.../.../~...... Subdivision · .~...P/~.~....~?.:..L~.~....~...~.?./.~.-~ ........... Lot No..~...~../..... [~lock No ............. House No ............. Permit No...~...~.~..Z..'~...... Date faf Permit°..../~'..0...~...~..:./.f..~.~pplicant ~..~.~....~...,~..~...~...? ........ ...... ....................... ...... ...................... Hea th Dep, Approva .7./: ././Z.~. Labor Dear A~roval .~..' Underwriters Approval .... -/-.7/..~...~/7..~.......~..~./..~:....Planning Board Approval. Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .~..~ ...................... SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference Ho 3 -J# '/~ EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: Address ~,~ L~.&... - £ ~,~0~o~ 7-Section 2_Detailed~p'r6~e~ty 106a-tion~;~ a/ .... ~ ~ S-Lot No. ,~ Hamlet ~'d~ n~ ~ ~,.~, ¢~J~,' Town ~ o~ m,o ~ ~ 9-Private well? ~ 3-~blic ~t~' supply name ' Distance to nearest main 4-Lot Size: Width~ ft. Length'kS' fF. (also enter on center plot plan below:) 5-~elling: Single Family ~uT~ Family? ~ /Cellar? ~ /Slab? / ~Crawl S~ce? / / 10-Pro~s~ system: Septic~=,,~ F~ /Precast A /Cesspools ~ /Shallow ~ols / /Other / / il-Septic ta~ inside dimensions: ~ol~e Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: /~ ;Number~Sq~re Ft. Cesspools: Block sizeL" incs. D ins. H ins.~ Total blocks below inlet: ~1__~2 ~3 ~T PLAN Indi e Nc 'th "Construction of authorized installations will be in The Undersigned CERTIFIES: Data Feet · o ; 2 ~_ 6 ~0 ~6 %als. accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date Signed ~ ~/~uilder 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 / ~' '0 '.>'~ Signed - - (10/65 Revis.) s-15 TN;: NEW YORK BOARD OF FIRE IJNDERWR1TERS ~UR~mU O~ eL~cTnlcrr~ -- /~'~ 85 JOHN ~RE~, NEW YOR~ NEW YORK ~038 ' "~ N 173297 THIS CE~IFIES THAT Cut~hogue~ ~XTU~ ~XTU~ RA~ ~o~s 0V~S ~ W~ERS EXHAUST SANS 26 ~7 35 36 I 2 F I DR~RS ~RNACE ~TORS ~ ~A~ ~ ~AL~. T~C~S M~ UNIT ~TE~ M~TI~ ~MMERS · ~ 3o 3t~llwate~ ~venue, COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BI ALTEREB iN, ANY ~ER. APPLICATION FOR BUILDING PERMIT~ INSTRUCTIONS a. This application must be completely filled in by typewriter aC in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and gi¥!ng o detailed description of layout of~pperty must be drawn on the diagram which is part 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 shal! be .accu~pJ.,ec~, or u. sed in whole or in part for any purpose whatever until a Certificate of Occupancy~ sna. nave ~een granted by the uuitaing mspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pe~nit pu~uant to theT ~Build!n.g. Zon,e O~inance of the Town of Southold, Suffolk County, New York, and Other appli.c, able Law~, Ordinances or .~.hegeUlah..ons, Tar the construction o.f buildings, additions or a!terations, o.r for remqv, al or demohtion, as herein descr bed · apphcant agrees to comply w,th all applicable laws, ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ,~(Signatu~_.~of ~'F~?:~'~',~ ~"~'~"~i~'~) ....... ,Y z. .. T" ....... (~;~ ;~f ~,cant} ...... I ~ ':~'~']':~ State whether applicant is owner, lessee, ag~ent, architect, engineer, general Contractd(, electrician, plumber or builder. - . , , Name of owner of premises ... ..................... :.; ........ .C~ ................ ~ ..................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer} Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ................................................ ~, ~ ~ .~ ~/~, 1. Locat on of land on which proposed work w be done /v~p No '/~V.,~,~'J~ '/.,~,,,,- --.. ,._--,~. ' N.'.LZq .' ............. 'r' ..... :,;-;-;.:;.-~'"~: ........ Street and Number ......... G~...~ ...... ..Z~..I~'..R~.~-....~.~[ ............ I~..r'~./~. .............................................. ~.~L'..¢~...~ ............. MuniCllT)olity 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 ......... r ................................................ ,..~,. ...................................................... / ~ 3. N ture of war Ii able): New d ... ..... Addition ................ r . ............... Repair .................. Removal .................. Demolition ............. ~..... Other Work ......................... :..!.....i ................... - '~ ~" '/,C (Des~iption) 4. Estimoted Cost ...... ..~.Qf..~ .......................... "..Fee :L.:,:;'i..il...O..~...:~ ......................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garnge, 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 some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories .............................. 8. Dimensions of entire new construction: Front ....~.~... ....................... Rear ...'.~.i~ ................... Depth ....~/..~.. ............. / Height ............. Number of Stories ..,Z.~./...~. ................................................................................ ~ .......... ~. ...... 9. Size of lot: Front ....~.~.4~./.~.. .................... i ............... -- Rear ../.~.~' .............................. Depth ...~..~...-......~...,~'.....~... 10. Date of Purchase ...~ ....................................... Native of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ .~.('...~../.~...~..%~....C:. ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~...: ................................... t3. Will lot be regroded' ........---~.; .................. Will excess fill be removed from premises: ( ) Yes (l~No 14. Name of Owner of premises .....~.~./~..~........~....'..~...C...~....L.~ddtess ................................ Ph°ne No ....................... Name of Architect ............ .'-r~; ...................... J .................... Address ................................ Phone No ....................... Name of Contractor .~.~.Z/./..'..~.....~...'...,J...../~....~..o...~...~... Address~..~!~..a...T..~..~-... .... 7,~'Y-...~'~'~/~' .................. mane Ho ..... , ................. PLOT DIAGRAM ~------~,'/"E ~/~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from · whetherProperty interiorlines' Giveor cornerStreetlot.and block number or description according to deed, and show street names and indicate STATE OF NEW Y~P~I~.~ ~ ~, couN .................. ~~...~...~:~Z.: ............... being duly sworn, d~o~s ~nd soys that he is the epplicom (Neme of individu~i~g controc~ above nom~. ~ ~ , / . He is the ................................ ~Z.~....~ ................................................................................................... (Contractor, agent, co,orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that oll statements contained in this application are true to the ~st of his knowledge and belief; and thaz the work will be performed Jn the manner set fo~h in the application fil~ therewith. Swam to b~me this , ~ ~ -- - ............--. ......... ...... ...................... Nota~ Public, Slate of New York Ne, 52-03~963 Suffolk Coun~~ ~mmi~ion ~pir~ March 30, I~ 2 2.0 ~JNAUTHORIZED AlTERATiON O1~ ADDITiON TO THIS SURYEy IS A ¥tOLAT/ON OF SECTfO~I 7209 OF TH~ NEW YORK STATE EDgCATION LAW ~ _ [~ I ~ ,,, ~ , . , ~.~,~ :~, ~ ~_ ~ ,,,,,,,,,....,, r ~ --- 1 ~ ---- ~ ~ "' ' ~:~'" ~ ~" ~/~,, ~~--~-:- ~-~-=~'---- ~-r-~'~ .... ' ~ .... ~ , /7 u --~ ~' ~ ~ - · ~'-~ I I .:: ~ ~ ........ , ..... :~: . ~ ~ -~. ~ _~ , , ~, ~, - ~ . ,I~ ~:~a~,, . ..... I:~" 2:~" _ ~" Fid' ~1~" ~. ~0" ~ --' ~'- ...... ~ ~ --:- I ~ ' ~ ~ J ~ J ~ '~ - . ~ _ . ., ~ .~.,, .................................. . "~ ~- ~ ~.~ - -~) ~-~'V~, ~ ~- :~ ~ · _ .... ...... ~- ~ %'~J,o ~ '~ ~/'~'~,' .~'~ ~ ., ~ ~ , , ~,*~ ~_~_~___ (~, ~ ~¢~ ~ ¢~ ~= ~ '~ ~ ._._~ ~,~8~ ..... ~%-~ ___~_'J ......... ~_~__: ~' -; - -I~ ~ ~/ ~ ~-~B~ Be~~B~~ =---~ ~¢'.~y -- ~----~ ~ ---~--- ---------~-- ~ ' ~ -~ ~~ w ~ ]-%' ~' , ,~-.- ,¢ .......... ~¢c~ T ~ ~ * ~--~/¢ , : ..... ~ %, ~ v ~/ -- I~ //~ ~// l, ~ ~ ~ ' ' /~:o" ~ /o:~" , . / ~"=/~;~'~ ~ ~'~ ...,o..o. 1950 / A Foil · L£/A ~'lOAd PRELIMINARY CHECKED APPROVED ,R I ~ hl T 1950 :)me hers, Inc. oP