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Home My WebLink About6511-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z6 .~.. ...... Date .............. .J..~%. ~ .... ?..., THIS CERTIFIES that the building located at l~e~.' s. Lanq~ .............. Street Map No.P. ec On;i,g. ~]~lock No .......... Lot No. 12 .... Pe c.c~ni¢...It, ~., ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... April . .25 197~. pursuant to which Building Permit No. dated ......... AD-ii.. 2~.., 19.7.~., was issued, and conforms to all of the req~ire- ments of the apRlicable provisions of the law. The occupancy for which this certificate is issued is P.:~iYa.~e. o~e. family. ~we3 ling ................................... The certificate is issued to P&IL%. &..V.$o;l,~t. P4~ch .... .~waer. s ..................... (owner, lessee or tenant) of the aforesaid building. Su~olk County Department of Health Approval . ;%.~.r..~.1....2~...~.~?~. ............... LrNDERWRITERS CERTIFICATE No. ~.~333.~ .1 .... ~TpD9.3.0....~ ~;.~.~ ................ HOUSE NUMBER .... %39~- .... Street .... ~nry.'~ .%an~ ....................... ...... ..... B,,ilding Inspector ~ FOR:M' NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT C~HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COA4PLETION OF THE WORK AUTHORIZED) N.o 6511 Z Permission is hereby granted to: _ ......... l~ml· "&' 'Vi'o~e ~' 'Re;[~ ......................... ........... · 2?~'---4) t&"~"'~fs~"~ ...................... ................ t~e~ea~ .......................................... ' to ..e~.ec.La~L_~_oin~a!~:..one..r~,mi~y...d~-eLlin~..Cmohil~..h~e) ..... ~.l..s...o.....a..o.g..e.s. sory ................ ~with.. f~ont...cano~]~)...~ NO~E~.. ~heck..a~e/-~e.. ~e.tba~k.. f~.om..edg~..of m premises ~cted ot .Lo~..~2 ......... R~onie..~tome$ ................................................................... ............................................ B~n~...~...La~.e. ........... P.e.c ~nic ....... K ~.... .................................... ~uant to o~.~o~io~ dated ....................... Building Inspector. Fee 10,00 Acc~' bldg Building lr~j3ector I~:)]L~[ ~O. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OGGUPANCY Instructions A. This application must be felled in typewriter OR ink, and submitted in duplicate to the Building Inspector with the following; for new buildings or new use: ]. 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 Underwnters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code comphance 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: ]. 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-existing dwelhng or land use $5.00 3. Copy of certihcate of occupancy $1.00 Date ...'~../ I c:~ 7..~' New Building ...... . .~...... .... Old or Pre-existing Building ............................ Vocant Land ............................ Location Of Property ..............,~....~....?....~........~.....~...~....~...~....~'.......~....~....~...~... ....................................................... Owner Or Owners Of Property ..... ...4~...."~.....~....~--.......~'.....~..../...~:.....J'~'.. ....................................................................... Subdivision ..... ;.,.L~..~'../ ............................................ Lot No...[.~..... Block No ............. House No.../.~..~..v4- Permit No....~.....O'.././....'~... Date Of Permit ................ Z;~Applicant .................................................................. Health Dept. Approval ..~...~...,~...?..?...?...~.. ............... Labor Dept. Approval .... ~....././.4~.~..: ......................... Underwriters Approval ...~.......~....~...~...~..../..{ ................. Planning Board Approval ..~/..~.,./..~.~. .................. Request For Tempor Certificate Final Certificate Construction on above described building and permj, t, meets all applicable codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference NO, ~ ~ ~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address '~77 ~ CLDG~'TT~%0 t~iVi-~°~b~C--r'~fO 6. Section '~1~ 2. Property location p~~ ~~ 7. Lot No. ~ ~g~ ~ '/~/,~"~0 ~V,~ V~,~U~'~. Private well y~ Village'~~ Township~~~ 9 Public water ~Q 3. Public Water Company name Distance to main 4. Lot size: Width ~ feet Length ~ feet (Enter on center plot below) 10. Sewage Dispos~ystem: A. ~0~gallon septic tank: Precast ~E~uivalent Block B. Z~aching pools: Number m~ Precast~lock Special N If priv?~e well fil in blank'~ belq~: Tank c ~ c i t ~_~l~a 1 Pump G.C~.M. Total Ell d~th Depth.~o Amount~of water in well Test Hole Data I Feet 0 2 6 B 10 12 16 18 The undersigned CERTIFIES: "Construction of authorized installations wil] be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date ' ~.~--, 7° ~ Signed _ ~ / Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information p~esent~d~ he~e~ithTi~ is the opinion of the Health Department, that an adequate and satisfactory Sew~ Disposal System can be installed on this plot. Date ~/~ ~7.~ Signed C_~ "~ S-15 Revised 4/]/72 "l,~&p 0 F 'Pfc~m I C i-~O~F_~ - SECT. ~' LO'I'll MAP o1= 1~C wc~ - SECT. T~'" N U I ' ''{ "~,, ,, THE,, NEW ,YOrk BOARD OF FIRE UNDERWRITERS ~ [' ~ I' ,I ,ihl,i ~;' ;~:,ll?~q~llhlflg lhI~.~] ' 85'JOHN STREET. NEW York. NEW YOrk 10038 I ~ 'o~ly th~ el~tHcal equipment '~ ~sc;ibed b;lo~ and introduced by tho applicant ~med on rt~e above application number in the premises ~ ~. '. % Paul~Reich-I'Henr.' y's Lane n/o Middle Rd., Peconic, ..L'I' ,, Moro/rs. l-3/4hp. ~:~ ,,~ .~, '~ ,, 11935 Th~s certificc~te~ must ,not bel (~ tered in any manner; return to the 'office of the SOUTNOLD, N. Y. ~-;3q-"1¥ m .ed ...... ............ , .o. .... ............................................................................................................ ........... '/~ APP~TI~ ~ BUILDING PE~~ INSTRUCTIONS~ a. This application mu~t be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 3 sets of plans, accurate plot pla~ to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or I~i~.' ~tmets or areas, ant~ giving a detailed detcflption of layout of property must be drawn on diagram which is pert of this ap~l!eetlon. c. The work co~ered by this application may not he commencad before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue e Building Permit to the applicant. ~ the premises available for inspection throughout the work. ;~hall be kept a. No building shall be occupied or u~cl in whole or in pert for 8n¥ purpose whatever until a Ce.rtificate of O~ ~all have grlntad by the Building Inspector. APPLICATION IS HEREBY MADE to the Buildin0 Dapartment for the issuaflca of e Building Permit puauant to the Buildlr~ Zone~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for Ots buildings, additions or sltaretions, o} for removal or demolition, es herein described. The Ilffialrcilnt agrees to comply with ill aPl)liclble ~ ordinances, building code, housing code, end regulations, and to admit authorized inspectors on premises and in buildings for nee~ry insl~Ctlo~'~ ............. ................... (Signature of applicant, or name, if a corporation) ............ (Address of eppncant) State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... .~...~.K~...../~...(~r:.~....~'~.......~'./..~.......~.;.~.....~.....',.~.C-- (c= ........................... If applicant is a corporate, signature of duly authorized officer. tName and title of corporate officer) ~- ,~' 0 o ~ &, Builder's License No .................... ~ ...................................... ~ Plumber's License No ......................................................... (~ Electrician's LiCense No ..................................................... Other Trade's License No ................................................... c~./--' 1. Location of land on which proposed work will be done· Map No ............. ~...~. .......................... Lot No. J.~ ............ Streetand Number .........,,~,.,,~,.,.k~.,..~T,,~..,/,~., ~,.~,.,~.,...~: . ..................................... ?.~..~.:../~..~..:'~.../.'~; ...... ............................. MmiiOpali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construCtion: · g USe ana occupancy ........ ~?.~,...;~.;.~..,~.~.....~ ............. ~.1".'5.~; ....... ~ .................................................................. b. Intended use and occupancy ....................................... ~ ........................................................... ~o Repair ......................... Removal ......................... Demolition ........................ Other Work ....~....~:.~.~../~/.....E~.-.-~....?. .... _~/ ~ ~ ._~ (Description) *~-'~e~-~.. Fee .~..~ '/"/,T) ...................... 4. Estimated Cost .............. /.. ...................................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~.. ......... Number of dwelling units on each floor ........... I. ............................ If garage, number of cars ............ ,.~......~.,{9~Z-~[- .................................................................................................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use ................ , .................... · . ! . / , 7. Dimensions of ex~st~ng structures, f any Front .....~..~ ......... Rear ..... .~..~.. .............. Del3th .../....')c'.. ........................ Height ...~.~....~.~ ............................................ Number of Stories ....~.. ..................................................................... Dimensions of same structure with alterations o[ additions: Front .....~..~7...../. ......... Rear ......~.~17.../'. ........................ Depth ....... I..~..../. ............................ Height ....~'~.../.. ......................... Number of Stories ................................. 8. Dimensions of entire new construction: Front .....~,~.~.~...../. ........ Rear ....~...~..../.~i .......... Depth ..~...~....~ ................... Height ........ ./.~...../.. ................. .) .......... Number of Stories ...7.../. .............................................. ~ ............................. 9. Size of lot: Front ........ ~..~.~..~'~ ................ Rear ....... L~.~..i. ..................... Depth ....~..~.~. ................................. 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: ....... X~ .............................................. 13. Will lot be regraded ~.~..~...~., ............. :_Will exc. ess fill be removed from premises: [.~'~Yes [ ] No 14. Name of Owner of premises ..... ~..~../. ............................................... ~ ....... ,.~...._.~.?.,.....,....~.: ........................... '--~.~"?'? ~ ~.L~C~'/'f~.¢/ ~ (Address) /'eLl ~--fT.~t~ ~u'* ~ (Phone No.) Name of Architect .......'~.. ............................................................................................................................................ (Address) (Phone No.) Name of Contractor .......... E~U~-~~-~c~?~T~*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 deed, and show street names and indicate wheth- er interior or corner lot. I ~,~'cr-ftA~>~- L,OT S,A, COUNTY OF ........ · ..'..~ ............................................... being duly sworn, deposes and says that he is the applicant above namad. He iS t~e ............................... .~ ......................................................................................................................................................... (Contractor, ~e~t, corporate o[~cer, etc.) of said owner or owners, and is duly authorized to ~rform or have ~rformed the said work and to make and file this application; that all statements contained in this application are true to t~ best of his knowledge and belief; a? that ~he work will be ~rformed in the ~nner set forth in the application filed therewith. . // ~ ;~, ~' .............. ................ o, ............... N t ' ..... ....... ......... ........ .................................. .. {Si~ture oj appEcanu