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Home My WebLink About6988-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19976 Date JUNE 13~ 1991 THIS CERTIFIES that the building Location of Property 4365 WELLS ROAD House No. County Tax Map No. 1000 Section 86 Subdivision NEW DWELLING PECONIC~ N.Y. Street Block 2 Lot Filed Map No. Lot No. Hamlet 12.4 conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 15~ 1973 pursuant to which Building Permit No. 6988-Z dated NOVEMBER 15~ 1973 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWFJJ.ING The certificate is issued to SUSAN HALLOCK (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 3-S0-165 - MAY 8, 1974 UNDERWRITERS CERTIFICATE NO. N-164775 - JIF~E 12~ 1974 PLUMBERS CERTIFICATION DATED N/A /B~i~di~nspec%or - Rev. 1/81 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Of[ice Southold, N. Y. Certificate Of Occupancy No. ~590~. ..... Date .......... I/ay...1 ~ .......... , 197.bc.. THIS CERTIFIES that the building located at ..... '~4e.115./~oad ........... Street Map No. ::?c .......... Block No...xx ...... Lot No. xx, x... P. econl¢.. ,N. oY. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ l~ov ..... ~..., 19.73. pursuant to which Building Permit No. 6988g. dated .......... ..";ay...'~ ...., 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 .I,r.i~ate. one..f~mit.~ .dwe.tling ....................................... The certificate is issued to l~an~e~. Hallock .. ore, er .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~ay... 8~..1.97.~...by. R.. ¥illa .... UNDERWRITERS CERTIFICATE No...pencting ............. ~ .................... HOUSE NUMBER .... 1+~6.~ ..... Street ... ~ells..Road. .......................... ...... .... ~ Building Inspector ! lrOB,~ NO. ~ TOWN OF ~OUTHOLD BUILDIN~ DEPARTMBqT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMI~LETION OF THE WORK AUTHORIZED) ~ 6988 Z Dote NOT 11~. ~ 19.~..~... Permission is hereby granted to: ............... .gu~o&ue ............... : ........................... ~uila new one family, dwelli ~o ................................................................ ~..~ .................................................................................... located at 8~S ~ella Road .... at premises .......................................... pursuant to application dated .........................~.q~......l~. ............. , I~.~...., and approved by the Building Inspector. FORM NO. 6 TOWN OF $OUTHOLD Building Depor~ment Town Clerks Office Southeld, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY insfructions 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 end 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 ]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: ]. 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 New Building ................ Addition ................ Old or Pre-existing Building ................ Vooant land .............. Location Of Property ....... ......... ............. ............................................................. Owner Or Owners Of Property ....... ./.?.~.....~..//.~..~..5........~...Q...q../..¢..,/. ........ ~...q.../../.~...~...~... .................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~..~..~....~...2:..... Dote Of Permit ..././,/~,./.~./~..~...Applicant ....~.~..o.:.....~../.E.~..5...../~....~.!./..~.~..r....~..~....h~.'. ..... Health Dept. Approval ...O..~'...~.../..~....~.. ....................... Labor Dept. Approval Underwriters Approve1 .............................................. Planning Board Approval ........................................ Fee Submitted $ .......~...C~... .................. Construction on above described building ond~m~i~t mee~cable codes end regulations. Applicant ....... ~.....~:~....".(~ ............................................................... ~ ........... Sworn to before me this ~ ~ ....... /..~dayof....~.~......~.~/~ (stamp or sea,) ~~,~ Nota~ Public .................................... Coun~ ~ . Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY '~- This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S_9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains · less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a~ertificate of Code Compliance from archiuect or engineer responsible for the building. 6. Submi~ Planning Board Approval of completed site plan requirements. ~. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing ail property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. :. Fees I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00 Additions to accessory building $25.00. Businesses $50.00. ' 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 OVer 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 House No. Street Hamlet ...... nwer or Owners of ProDert,, .~0~ /~0-1/0~k ~unty Ta~ Map No ~000, ~ection ..... g.~ ...... Biuc~ .... & ......... ~ot.../~,.Y. ............ ~bdivision ..... .~ ?~82 .... ' .... ap .......ut .................. ....... Filed M L ~rmit No ............... Date Of Perm · .~ .... Applier .............. Underwriters Approval ....... arming Board Approval ......... . ..... quest for: Temporary Certificate ........... Final Certicate ........... e Submitted: $ ~.5~O.~ .. . ~'~"~ i~7~ ~ APPLICANT ............... [ ] FOIJNI)ATION I. IT [ ! ROI~.N PI.B~I. [ .1 F'OUNI)ATION ~ND [ ] INSU~TION [ ] FllAININ~ · F~FINAL, ~ : ~ ' ~THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELEC, TRIClT~ ~---~ 8. k t 85 JOHN STREET, NEW YORK, NEW YOF~K tO0~8 N 164775 THIS CE~IFIES THAT Dan/el ~lloek, s/s/de Well~ Rd., 1000' e/o Dead end, Peeonlc, in thef~l~ing I~at~n; ment ~ 1st H. ~ Fl. outside S~t~n Rl~k ~t ~exami~o~ ~e 6, ~97~ a~fou~incomplia~ewiththe~ulremenoofth~B~rd. ~ ~ ~t~em ~e ~T' K'W' ~KI~D"S[ 0~HS 'DISHWASHERS 1 FA; ~TsflX~ ~A~ SWIT~G m~E RXTURES ~ES ~T. K.W. I ~T. K.W. , ~*. K.W. ~HAUST~r. H, P, 27. 50 23 2~ 1 1.5 DRYm I m~A~ ~T~ ~W ~aN~ .E~RS ~ ~'~ TIM' ~KS [ ~ [~IT HEATE~ MULTI~UT~ ~MMERS . , , 1 ~ml~°°1 C~lI I ~ I I~ I Wate~ hea~e~ 1-q. 5~ W.B. Ruland Elec., Mattttuck, L.I. 11 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BEALTERED ~ - ~ o~TOWN OF ~THOLD ~. BUILDING ~PA:TMENT TOWN CLERK'S OFFICE ~ ~UTH~D, N. Y. ] ~ ........ . pp ~o ................................. .......... ~ ............................ ~ ,,,,, ' ,.,, ................. ~ ........... . . ~. ~ ~ ~ . ............................. ..................................................... ...... : )~-~ ~ . 3 _ (Buildi~ Ins~tor) , . ,,, ~ ~ APPLICATION FOR BUILDING PERMI~ This ~pRIm~tlo~ must~m~etely filled m by ty~wriTer or m m~ an~ submitted in tr~ph~te'to The Braiding Inspe~or, with~ 3 sets 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 giving a detailed description of layout of property must be drawn on 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 shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have bee granted by the Building Inspector. APPLICATION IS 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 buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all app cab eaws, 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 of applicant) w ii:a~i...w. ;~ .e.t..h.i~.' :.~.~i~~ .:.~ ~~ .g~..;.t.:..:..~ .h. ,. .,. . .7 t.,..e.;.g.i..; .e~..r.,.....g~..~ .e..ra:...; .o..n.t..r.: .; t..~ .r:...;,..e.: .,.r.,..c:.: .;:...p.l..u...m....be.r....o.r....b.;: :.d..: o ow er of premises...~..~.~ ,~...~.....,.,,~_~,~.¢~.~ ....................................................................... If applicant is a co ure of duly authorized officer, · ................ 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. Street and Number ...... ~......~'_~I~....~.. ........... .~..~....~.~ ................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~...~.. (~ b. Intended use and occupancy ....... ...~....~~~. .................................................................................... ~Nature of work (check which applicable): New Budding .............. Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ................................. (Description) Estimated Cost ....~...~.j..v...~..=. ................... Fee ..... ~:_~._: .................................................................................. (to be paid on filing this application) If dwelling, number of dwelling units ..... ~. ......... Number of dwelling units on each floor ......................................... If garage, number of cars ..... ~.~..~ .................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 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 ...1~..~..../.. ................... Height ..... ~./.~. ...................................... Number of Stories ...........~.~....~...Y.. ............................................................ 9. Size of lot: Front ......... ~...~.....~....~ ............ Rear ~ 0 4 / Depth .~::....~..,..~.. / . Height .................................................... Number of Stories .......................................................................... 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: ~'~.~. ............. : ................................... /No 13. Will lot be regreded ....... ~GX~_~ ...............Will exces~ fill b~ remo~ved from pr~mi~es: [ ] Yes , _ 14. Name of Owner of premises .~..~.~..t..~:J~..~~,et~..~..~.~:~J~.:.~t'.~.~ .............. (Address) ~/ (Phod~ NoJ Name of Archi~t ............... ~ ..................................................................................................................................... ~ ~ / (A~r~ss). (Phone No.) Name of ~ntra~or ~~~....~~..,..~~".~.~/~~~ ~ ~~----~ 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 wheth- er interior or corner lot. STATE OF NEW YOR~/~ .......................................................................................................... ~m~ dul~ ~rn, d~ and *~* that h~ i~ tbe ap~limnt ~bo~ n~m~d. (Na~ of individ~ si~ing con~acO He ia ~h~ ................................................................................................................................................................................................................. {~nt~ctor, ~nt, coyote offi~r, etc.} of said owner or owners, and is duly authorized to ~orm or have ~or~d t~ said work and to make and file this a~li~tion; ~at all statements contained in this application are true to t~ ~st of his knowled~ and ~lief; and that the work will ~ ~or~ in the ~n~r set forth in the ap~i~tion filed t~rewith. ~ ~ ~ ..................................... day of ...-~~a.. Suffolk County ~ P .o,a ........................ ........ ........................... ~ (S~ o/app~tJ SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~ , , , Phone 2. Property Lo~atlon ,/ ~ · ~ Village-~_ ~ ~ ~::~:,/cTownship 3. Public Water Company Name 4. Lot size: Width feet Length. feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to n~in./ 10. Sewage Di sposal.~-JSy~tem: _: (For Health Dept. Use) A. 900-gallon septic tank: Precast ~quivalent Block B. Leaching pools: Number of pools Precast Block ~pecial ::., T~k capacity B. Pump G.P.M. ~ ~ C. ~-~tal well depth D. ~;pth to ground water E. ~liount of water in well?... / 11~_ If p)~vate well. fill in the ~:- foll~w, ing blanks: gallons The undersigned CERTIFIES: "Con~c~ion 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 may be renewed if a current local Building Department Pemit is in effect. Date /~ ,,//'~ Signed :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: FOR HEALTH DEPA~MENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfacto~ S~age Disposal System and Water Supply can be installed on this p~ot. _ _ /} APPROVAL DATE //~3 ~ )~ SIGNED S-15 Rev. 4/1/73 ¸ri, ~0~I~ OOL~¥ HF.~ ~he sewage disposal and w~ '~u~l'~ ~lef of G~nb'r~ C,-,,_,: CF ~:UfLDfNG INS?ECl'oR ~- .,:o,~cr.a Agency, per law ef- fCCbve Sc?L ~, y, ' Cc'~,~'L~ PR'" '1 .I; -/