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Home My WebLink About6501-zFOF,~[ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~+.31 ...... Date ........... Se. pt...1.0 ...., 19.73. THIS CERTIFIES that the building located at . Ba .yy.i.ew...R.d..a..Lg.n. gy.i.e.~' Street Map No..T.~r~'y..lg.~.~l'~k No ........ Lot No..~ ..... .S. qu..'F.hqZ, d. ,..t! :.~: ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... /.,p.r.t. 1....2.Q., 19..~.3. pursuant to which Building Permit No. dated ....... April.. 20. , 19 73 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 ...Prl.v..~te..one. £amil.~: .dwelling .............................. The certificate is issued to . .Fou~..dflr. s..H. om..e.s..~.n..o ..... . .0~n..e.r. ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .S.?p.~... 1.0. 197.3 . b~. R, UNDERWRITERS CERTIFICATE No...N. 10.8.8.2D.. .A..ug .!.~...!973. ............ HOUSE NUMBER . .1.1380 ... Street ........ BaY..Vt~.~.Bf~d .................. 95 Longview La ...... ..... r ' ' ~l'di~g' Inspect°r ~0~ NO. ~ TO~N OF $OUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE - SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 6501 Z Date ..................... A~';~.....~. ............ , ~97..:~... Permission is hereby granted to: ...?.~.~?....~.?.~.'...x.E*.. ................................ (one floor - Hi-ranch) at premises located at ..,~...$...~. ....... .~..~.~,...~.~.~1~.~ ......................................................................... .................................... E~.t,.?.~.,,~..,~....z:..o.~,..v...t..e..w....~ ............... ,s..o..~?..z..~ .............................. pursuant to application dated ...................... ..~..~..1....,~.O. ........... , 1~.~....., and approved by the Building Inspector. Fee ~,.~,*..~.,~,. ............ Building Inspector FOR~ NO. $ TOWN OF $OUTHOLD Building Department Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY InsfrucHonl A. This application must be filled in typewriter OR ink, and submi~ed in duplicate to the Building Inspector with the following; for new buildings or new use: ~]. Final survey of property with accurate Iocat.on of all buildings, property lines, streets, aha unusual natural or topographic features. 2. Final approval of Health Dept of water supply and sewerage d~sposal--($-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple 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: 1. Accurate survey of property showing oll property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspechon 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 dwelhng or land use 3. Copy of certificate of occupancy $1.00 $5.00 Dote ......... New Building ..... .../... ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .~,/..~.....~..¢~../~.~...TJ~/~lJI.,~.~...~/.~...~...~...~t~..~....~ ........................................... Owner Or O'~vners Of Property ...?~..~..~..l~.~..l~.~-,.~. ...... ~'L?..{T3....~..~.......~ .~...~..; ....................................................... Subdivision ../~.Zt~/~.¥....../M.~.'~...~..A..~. ......................... Lot No..~?.~..~... Block No ............. House No ............ Permit No. ~...~..~.~.,../.-.~.... Date Of Permit .~.~./'.~/~,.~]..Applicant ~'~.wz~.~./~.~ ...... ~.....~'...~...~......~./~.....~..: ........ Health Dept. Approval ~..~.~.~...../.J,J~../..~.~._~ ............. Labor Dept. Approval ................................................ Underwriters Approval ~..~'..~,.../.¢...~.~.~.,~. ............ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .~ ................................. Fee Submitted $-,,~ ................................ Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this .......... ...... .... Notary Public .................................... County (stomp or seal) SOF OL COUNTY DEPArTmeNT OF APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~,)~l+ ~,~ ~ Phone~2~5. Subdiv. ~l.q,-~ ~,~ Address~ ~ ~,~,~.~ .~,~ ~,~,~ ,~ ¥ 6. Section 2. Property location ~ ~,~4~%~-.~-, ,~ .... ~ ,~ 7. Lot No. ~.,~.~.~ ~...~ ~,~,~ ~ ~ ~ 8. Private well Village ~..~m.~,~ Township, ~. ~T~,~ 9. Public water 3. Public Water Compan~ name ~. ~ Distance to main 4 Lot size: Width !~% feet Length ~C' feet (Enter on center plot below) 10. Sewage Disposa~ystem: A. ~00/gallon septic tank: Precast/ Eqgivalent Block B. 'L~.~ching pools: Number i Precast~0~. lock S'Pecial If private well fill in blanks below: Tank capacity~-Gals. Pump G.P.M. ~ Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet 0 6 10 12 14 16 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." ~' Owner 6r Buil'der FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewag= Disposal System can be installed on this plot. Date y/~[~ ~ Signed ~_._~ ~ S-15 Revised 4/]/72 FORM NO. 6 TOWN OF $OUTHOLD Building Del~tment Town Clerks Office Southold, N. ¥. 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, aha 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 F~re Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and simdar 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: 1. Accurate survey of property showing all property lines, streets, buddings 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-ex~st~ng dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building '~ Old or Pre-existing Building Vacant Land Location Of Property .~. ............. ~. ~.....~ .... t.¢ ........ ~...~.~...~....~ ...................................... ............. ~.~.k.~ ......... ~...~...) ..... ~l .............................................................. Owner Or ~ners Of Prope~y ~ ~ * ~ , C Su~ivision ..~;~.'.~,.,~.?. ..... ~.~.~;~,~. ......................... Lot No ....~}. .... Block No ............. House No ............. Permit No. ~,:~,~./,,~... Date Of Permit ~.t.~..~,~,.Applicant ~.~.~.~,.~.~..[ ...... ~.~,~,.,..f.~ .......... Health ~pt. Approval ,;,~.~J.,..,~:~,..~.~ ............ Labor ~pt. Approval ................................................ Underwritem Approval ~.~.~...,,~....(.~,~,~ ............. Planning Board Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Ce~fficate ,~ .................................. Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ..~:~v~v.~r~ ~:..~..... ~.~/ ......... ~. ........... ~.; ............. :.: .................... Sworn to before me this ............... day of ............................................ (stamp or seal) ~tary Public .................................... County /&AIN ~F(~_ NDEI2'S I-IO/AES, INC. SOUTI4OLD New YO~: SCALE ° 40',' i I^AP OF PEOPEETY FOUNDEIZS HO/Al:S, INC. SI TUAT, E AT NEW YOI~IC · NOTES: [.LO1' NU/ABEES $14OWN tEFE; ?O,"IAAP OF TEENY WAt'I.:D'$" FILED IN THE SUi=FOLK OFFICE AS/AAP N_= 7901 IcOuNT Y '3DATUIA ASSU/AED 19.6 ELEVATION AT ; NO2TI;EAST CO~NEiZ OF PEI:IMSB TEST 140LE UNAUTHORIZED, TO THIS SURVEY IS SECTION 7209 OF EDUCATION LAW. SCALE - 40'= I" E) = II[OH PiPE St = ~QNU/~ENT WELL CESSpooL. GUAEANTEED TO TI4E SOUTLIOLD SAVINGS BANK. 0 SUEVEYEO APEIL 17, 1973 EODERICK VAN TUYL, P.C. LICENSED LAND SU~VEY~ES GEEENPOET, NEW' YOI~K //~AIN AD.' ZO.O AEC "31.42 COI~ C.- I~L.~ 25 , ?t~'~._ ,,.oo bi. 6B' O0'30"\V. - 116.O -,..(j.,Fx- ,,~s' LOT 50 ' ,,' VACANT MAY' zg, I97~ O NOTES: PLOT NLIt^BE[Z$ $t-IOWN ~EFEI~ OF TE~2~ WA~gS" FILED IN T~E SU~F3Lk DF.,AT ROAD TEST ROLE bOA/~ 1'~'} 2K'2'. ,1'O ?Ht$ SECi'IO N 7209 ~IXJCATION LAW SCALE o 40'= 1" (D =IIZON PIPE 'iq -' IAONL)IAENT ..~= \VIE LL = CESSPOOL. GUARANTEED TO T~E SOUT~OLD SAVINGS BANIZ. O SUIZVEYffD APD:.;L ~,7, i973 20DERICK ~,N TUY' pr' ¢~, , /z~ . , ~ ,~ ,, J"',' ' ? ~JO'' Disapproved o/c .. ? ........ ~ ............ ~ ~ u di~ Ins~o ) ~te .~e.~.~......~.~. .................... 19.~. ..... I NSTRU~IONS ~. lhi~ a~¢limtion mu~t ~ ~mpletel~ fill~d in b~ t~writer or in ink and ~ubmitt~d in triplie~t~ to th~ 8uildin~ In~or, ~ith · b. ~lot ~l~,-~h~in~ location of lot and of buildin~ on~r~mi~*~, r~lation~hi~ to ~d~oinin~ ~i~in~ a d~t~i~ d~mH~tion of I~out of ~ro~rt~ mu*t ~ dr~wn on di~r~m ~hich i~ ~ o{ thi~ i~pli~tion. ~. T~ ~o~ ~r~d b~ thi~ ~p~ication m~ not ~ comm~n~ ~for~ i~u~n~ of 8uildin~ ~*rmit.. d. H~n i~o~*~ of thi* ~lie*tion, th~ 8uildin~ In*~ctor ~ill i**u~ i 8uildin~ ~rmit to th~ a~limnt. th~ ~r~mim* i~il~l~ for in*~etion throuflhout th~ work. ~. ~o buildi~ ~h~ll ~ ~copi~d or u~d in whol~ or in ~art for ~n~ ~ur~o~ what~er until a ~r~n~ b~ t~ Buildin~ In~etor. ~LIC~T~ 18 ~fi~ESY ~D~ to the Buildin~ D~a~m~nt ~or th~ i~*u~n~ of ~ 8uildin~ ~rmit ~ur~u~nt to th~ 8uild!n~ ~o~ buildi~, ~iti~ or ~lt*r~tlon~, or for r~mo~*l or d~molifion, a~ h~r~in d~*eri~d. Th* a~plimnt ordinan~*, ~ildin~ eod~, ~u~in~ cod~, ~nd r~Oul~tion~, ~nd to admit authorized in~ctor~ on Cr~mi~ (Signature of applieaflt, or nmi if a corporation) ..~..,~s~.~...e.v. ~.v.a- ~..-~..~..~0 ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... ........... ~.~....~ .~.~.c........c.~..?.~..~..~ ~ .-~....~.~.~ ~ .................................................................................. Name of owner of premises .~..o..~...~.p..~.~.....~...*...~...~....j.~.C~: ................................ ~ .......................................................... If a,~nt is a corp~rate,:signature Of d~ly authorized officer. ""'i~l'~'~e a~ title of ~'~';~:~'~¥~icer) ................. 1. Location of Jand on which proposed work wdl be done. Map No ............... ~...~: ........ .~.....1~.~.,,~ ...... Lot No. Street and Number ...~.~.l..~.....~.~.~'.,..~...~....:~'.....~.?...~..~..v..*.E-~-....t....'~...~....~.....?. .......... .~...~..%.-~'...~....L...~..., ..................... MunicipaliW 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 .....0.~.~.~....~.e.~-',~.~.~,..".(....~..W~...~..~..~.L~.~ ..................................................................... * · 3. Na~ture o~ work (check which applicable): New Building ..~.. ~ .......... Addition ..................... Alteration.~;-;..~......!. · Repair ......................... Removal ......................... Demolitlon ........................ Other Work ................ ,~ .................. ,~.~. /.4~~'- IDescription) 4. Estimated Cost ..... ~.~...o....o. ...................... ?,, 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 Stones ..~.. .................................................................................... ! 9. Size of lot: Front ....~./.4: ........................... Rear ..'././.~,../. ............................. Depth ...../.~:'...~....../......... ............. .............. 10. Date o~ Purchase ..~.~...~..[....J..~..?.~.., ....... ,... Name of Former Owner .J, .................... J.;..I....~ ....................................... 11. Zone or use district in which premises are situated ....: ................................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~'...~. ................................................... 13. Will lot be regraded ...... .~_..~. ...... ~ ................. Will excess fill be removed from premises: [ ] Yes [v~/No 14. Name of Owner of premises .~..~ ......... ~..~.. ...... ~.....~. ....... ~ ................................................. ~.. ............ ~. ...................... · ~-~ ·~ .~ (Address). ~ Phone· ~ No. Name of Architect ............................................................................................................... , ..................................... (Address) (Phone No.) Name of Contractor .................................................................................................................... .%J ........................... (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 delld, and show ~tr_.eet names and indicate wheth- er interior or corner lot. P/~iN D~¥b le, v..' KU · I1 ,t STATE OF NEW YOR}(~.~./~. ~ COUNTY OF ......... ~~.....) IlG ' being duly sworn, deposes and says that he is the applicant above named. (Name of individual~n~ lie is the .......................................... ~a~ ............................................................................................................................................................. {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 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. .............................. ....... ...................... Notery Public, ....;