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Home My WebLink About6519-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~;50l Date THIS CERTIFIES that the building located at Long .greek Drive Street Map No.~e.l~ec°1;t Pl~lock No. .Lot No. 9 Soltthold conforms substantially to the Application for Building Permit heretofore filed in this off~ce dated April 2bt , 19 73 pursuant to which Building Permit No..65197- dated ...... &p~'i~,.. 26, 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 Prtv. a.t¢ o..n.e .f..~. i,l.y..d..w.e.l. 1..l.n.g ............................... The certificate m issued to ~'oJan Y~ac~ck ... Owae~' .. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 8..ep.~ .. 2.6 . .1973....by..R. Villa. UND[RWRITURS CLRTIFICATE No Sept 2~.1973 by J. Kubaeki ItOUSI NUMBI:R 60~ Street I~,Bg ¢~..00~. Dl~,~rO ........... Btttldmg Inspector / FOt~M NO. 2 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°. 6519 Z Date ........................ ..~]~r..~..~.. ...... ..~..~.. ....... , 19~.~.... ~ermission is hereby granted to: ~.s..e.~....c.?.~ ~........,Z..c......~.o.~...~..a.~..~.~ ...... .3...~.......~.,...~..;L~y..e..~e...P.~.t~ ............................... .......... ,5~a ...................................................... to .~..~.e.~...o..~.e....~.~..~...~.e. ~.~ ~ ................................................................................... ~t premises located at ...~,~.~...~, ............ ~.e, iqD, et~.Q~,~...J~.~k ............................................................... ...................................... .Lo~g...C;r.e e.k.. ~A3?. ......... ~at,~o~ ........................................................... pursuant to applicatlon dated .................... _Ap~/~.]. ....... P_.~. ........... , 19.~.., and approved by the Building Inspector. Fee $..I...0..~.~.. ,,5'. .......... SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. ~SO'~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~ ' Phone Address~ ~ ~ . - 2. Property location" ~, . ~ -~ · / Village *~ F / / Township · / 3. Public Water Company name 4. Lot size: Width / feet''- Length. / ..5. Subdiv. ,~.~ / 6. Section z 7. Lot No. 8. Private well 9. Public water ,~ Distance to main feet (Enter on center plot below)- 10. Sewage Disposg~-~ystem: A. ~O0/gallon septic tank: Precast ~ Equivalent Block B. L~_gMching pools: Number_~Q---Preca's~/~Block. Special__ , /. If private well fil in blanks below: Tank capacity... Gal Pumpk, P ~ Amount of water in well Test Hole Data ]; Feet 0 I 4 J 6 J 8 J 12 ] 14 J 16 I 18 The undersigned CERTIFIES: "Construction of authorized installations wi~ be in accordance with the Suffolk County Department of Health's current stand ards thereto." Date Signed Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, is the opinion of the Health Department, that an adequate and satisfactory Se~ Disposal System can be installed on this plot. Date Signed .... - S-15 Revised ~/~/72 FO~ NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPMGATION 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 electncal installation from Board of Fire Underwriters. 4. Commercial buddings, 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 s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Nan-conforming uses, or buddings 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 inspectJon of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 $5.00 - 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certif,cate of occupancy $1.00 ~...~.. Date .............................. New Building .................... Old or ~re-exmting Building .......................... Vacant Land ............................ Loca, on Of Property ............................................................................... Owner Or Owners Of Property .~../~...~....~..~...~...~.,.~.~.....~_.~....~..X.~....../../.~...~.....~.i..~...~....O...?.~ ........................... Subdivision ....~4~.../~..'..~/A~...~:..~.../~...~- ..~.~...~..../..~'. ........... Lot No .... .~... ..... Block No ............. House No ............. Permit No...~.~.".~..~..... Date Of//Permit ....~..'..~..,~..~,.~..~.Applicant ...~...~.....~..~.,~.,.~...,~'..,,-~'......~,...d.[..~..~...~,...~.~.a[~.~ .,/.,~. Health Dept. Approval .......... ..~.... ............................ Labor Dept. Approval ................./~...t!..~....! .................. Underwriters Approval .......... ..~...... ............................ Planning Board Approval ......... .~...:i!~..~ .................. Request For Temporary Certificate ........................................ Final Certificate ......~ ................................ Fee Submitted $ ...... ..'-.~../..~...~.. ............... Ccnstruction on above described building and permit m~.~ts all applicable codes and regulations. App, icant .............../~~/7' ..~.....~.....:. ................. Sworn to before me this ? Notary Public .................................... County (stamp or seal) LONG NOTE- gOT NO~. P.E:FE~ TO"MAP OF YENHE'COTT ¢A~K~ FILED Iii T).I'E' 5UF'POLK COUNTY CLF..I~k;5 OFFICE I'OR31[ NO, 1 TOWN OF SOUTHOLD BUII.~IHG D~PARTMENT TOWN CLERIC'S OFFICE ~',,~¥/?~ -A'~'~-~-,,~ SOUTHOLD, N. Y. aom,ned ................... ^pp,catiOn No .............. i ................ , pp,o, ea ................................................................ ............................................................................ ~ ............ ~. ~,~ Date .... INSTRUCTIONS a.' Tl~is application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationsh p to adjo n ng prem ses or public streets or areas, and gJ~ing a detailed description of layout ofproperty must be drawn on the diagram which is pert of this application. c. ~ work covered by this application may not be Commenced before issuance of Building Permit. d. UPan apPr6val 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 progress of 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 been granted bythe Building Inspector. ' ,~PLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~ ~ B~flding Z~ne O~i~nce of the Town.of ~thold, S~olk C°un~, ~~r~ c~nstr~t[O, ~ bu~}di~a~itj~s or ~i~, ~ ~c~ ~ ~s to comp y w~m gll appl cable la~, omi nonces, -,. ........ ....... ............... .......... ~s,~..t.~ o~ .pp~ co.t. or ~m., ~ ~at~a~ ' u~aamss o? apphcont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem ses ...... ..~...~.../~.~ ........ ~/'......~r'...~.,.~.,~ .~,./~ If appli~corpora~tse,~gnature of duly authorized officer. ' ........................... ................ ............. (Iqame and title of corporate officer) . ~. ~at~on of ~ond on which pro~o~d work e, be done. Mop No..'~.~'..~.~..~..e/./f~..~u~ No.....~ .... Street and Number ...................... ~ ~ ~ ~ ' ."' ........... '~ "~"",'7"':":-";:: ........................................ / MunjcjpGjrity 2. State existing use and occupancy of premises and intended use and occupancy of propaSe~ ¢onstructiert: a. Exisiting use and occupancy ................. .../...~.~...,.:~, ~,~ ~,~ / b. Intended . and occupancy ~" .... ~7" ' , ............. use .................... ¢'./... ............ £~ .................................... / 3. Nature of work (check which applicable): New Building ......... Addition .................. Alteration .................. Rllpair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............... 3...~..4.~.....ff~... ....................... Fee ./...~...~:.~C ................................................................... (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 ............................ N~,~lber of Stories ............ ~ ............... 8. Dimensions of entire new construction: Front .......... ~l'..~ ................... Rear .....~..L ................. Depth ....'~....~.. .............. Height .......... *J~.~.... Number of Stories ...... ~. ........................................................................................................... 9. Size of lot: Front .......... J..?....~. ......... Rear ....~....~..~... ................... Depth ..~..~....~.. ................... i0. Date of Purchase ....~p~ ...... .~.~..?.~ ....................... Name of Former Owner .~....~..:..~..~..~..~..~.?... ........................ i 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does p~oposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ..~1~..~..~....4L~...~,~:[ ........ Address ...~....!,,~',~: ............................. Phone No.~.~..~..~.~... Name of Architect ...................................................... Address ............................................ Phone No ..................... ................... ~ ............. Phone No.'~,.. ,*~... ,~, ?.,.4~...-.... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~J:~:~:;k dimension~ from properly lines. Give street and block number or description according to deed, and shaw street n~me~ and indicate whether Interior or oomer lot. ?, -I STATE OF NEW YORK, ts $ COUNTY OF ................................ $ ' .................. .../.....'~...'1~.....~'..~.~.~'~.~....*~... ................................... being duly sworn deposes and says that he is the applicant (Name of individual~Jgning application) '-. above named. He is the .../~.,....~1~...~...~.~,~.~..~....~'... ........ ~'~..~..~..~....~.. ........ ~.~...~., .~.. .............................................................. (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 anti file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~.the work will be performed in the manner'set forth in the application filed therewith. Sworn to before me this , ,lotary Public, ..~....-,),~~ .......... County ......... 7 ........ iS~gnature of applicant) .... ........... TEIIRI LEI EI~,K ' ' ............................... NO~'I~Y PUBLIC, State of New York No. 52-6~.68295 ' ~ied n Suffolk County DESIGN ~1766 HOME PLANNERS, INC., DETROIT MASTER BED RM. 12o x 156 42'- 0" 22'-0" EATING KITCHEN 124 x 17& FAMILY RM. 214 x I~6 BED RM. ~,o ~ 12o BED' 14° x HEARTH BED RM. 164 x fO4 BED RM. 140 XlO4 LIVING RM. 19~ x '136 ENTRY DINING RM, 124 x II6 GARAGE 21.4 x 2tG SECOND FLOOR IO0~ SQ. FT. ROOF 16310 GRAND ome pi.ann RIVER AVENUE , inc. DETROIT 27. MICHIGAN ~' 0 /.1 tk/A 7' / Ad ,.o L. A M 'I ,= . 5'-9" :., ,Zz~,o'.. ......... /-- R 0 ,~".T 'E .z..£. v A T ,! 0 ~ NOT[~ .h ±1.r i · annerl, Ino...,~.o. ~. 7_-Z Z_-_-_-5--_-~-t T J