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HomeMy WebLinkAbout6551-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Zg~87 Oat 19 ., 1973 ----~.No ............ Date .................. ./' TI-II~o~[~T~oI~that the b~lding located at.. ~aCths.w~ ~e Street Map No.~9 ...... Block ~o ......... Lot ¢ ..... ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~t. y... 3 .... , 19 ?3 pursuant to which Building Permit No. 6~lZ. dated ...... .l~a.y... 8 .... , 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 . .PI'..~?,a.~.e. on.o...f..allli.~y..dWe.~.~.~,~ ......................... The certificate is issued to .~q .P~...~.~t. rl~.e~..X ........0wl3.e.r ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Oe~; 17 .197.3 ........ UNDERWRITERS CERTIFICATE No..R . 1 k~). ,6.~8 ..... .09.~ .].6..!973 ............. HOUSE NUMBER Street ... r:ia.thews. Lan~ ..................... -- Building 'InspectI FORM 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? 6551 Z Permission is hereby granted to: .... .,T...o...~A......x...,.....s.~,~ .,.~ .................... ~ ............. ............. 2O~....Ke~;La..A~ ................................ .................. /ht.v.~ rh~a~i ....... .t{..~X,, ...................... to ..~_.! 1,d..ne~...one..~ami~..~twalling .................................................................................. at premises located at ...... ,T.~t,...5. ........... ~OZ'.~I~.~O~. ..... .(llltBll~t'.~9.). ........................................... .................................. Y-~,thm~a..Lane ............... O.ut,~hoffue .......Ii.%, ......................................... pursuant to application dated ..................... ~,~. ........ ~ .............. , 19..~., and approved by the Building Inspector. Fee $.-(~.~rO ............ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES T~AT ~ exami~ on Oct 0 b O~ ~ 2, ~ 9 ? 3 a~found to be in comptia,ce with the requlreme, ts of th~ B~rd. ~lain Stree~, Yaphank, L.I. Per 11 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. APPLICATION FOR BUILDING PER~IT ~.[ _.....--'~.., 19...~,~.,...~ .......... ........ . / INSTRUCTIONS a. This application must be completely fililed in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 3 sets of plato, _~c__'-'rate 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, ar giving a detailed de~ription of layout of property mu~t be drawn on diagram which is pert of this application. c. The werk co,red by this al~dication may not be commenced before issuance of Building Permit. d. Upon ~al of' this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ,shall be kept c the premim a~aildete for i~ion throughout the work. a. No ~thMI be occupied or used in whole or in pert for any purpose whatever until a Ce.rtificate of Occupenev shall have b~ ~ by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the iuuanee of a Building Permit pursuant to the Building Zone Ordinan~ of the To~t ef Southold, Suffolk COunty, New York, and other igl:)licable baw~, Ordinanc~ or RegUlations, for the construction ef buildinw, additions or iltlrltions, or for removal or demolition, as herein delcrtbld, ~ II~lcaflt agre~ tO comply with all al~)li~lblt law~ ordinanm, building cede, housing code, and regulations, and to admit authorized inspector~ on premises and in buiklin~ for nece~ary inspections. Stat~ whether applicant is owner, lessee, agent, amhitact, engineer, general contractor, electrician, plumber Name of owner of premises ....~.~.~,~,)....E.)......~..~.~..b~./~/~.~ ................................................................................. If applicant is a corporate, signature of duly authorized officer. Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... F~,I Z J~ 1. Location of land on which proposed work will be done. Map No...~J...~/..~..'L ........................... Lot No ................. · ~.,'. "" , .............. ........ Street and Number ../...[~./:~..'T.,~,~-.~[~ ~......~!~,~[ ~ ................................. ,, Muhicipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... ,; _,/ P~q l~ ) ~ .. . ..~ b. Intended use and occupancy .4....~.~J~/~,.~.~'....;~,.~..ff~.~-~ ........-.,..,..,:..,.-...,.-. ...................................... ~' ............ 3. Nature of work (check which applicable): New Building ................ Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ~..~.~, (~)..~..~. ........................ Fee ~ ~ ~ ..... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ i ........ Number of dwelling units on each floor ...... ¢. ...... If garage, number of cars ..../.C.J~'~ ........................................................................................................................ 6. If business, commercial or mixed occupanCY, specify nature and extent Of each type of usa ..................................... 7. Dimensions of existing structures, if any: Front ..~.,~.'.~.?,-,.. Rear ...~.~,~..'~..~ .......... Depth ..,~.~.~,~, ................... Height ........ ~'~.,.~. ................................... Number of Stories ...... ...... .i.;...~ ....................... ?...;...;.;~ ....................... Dimensions of same structure with alterations or additions: Front ..~/.~.:.;~2..C .......... Rear ...~J..~....~..;.~.. ...................... Depth ......... ~..k~.Z. ..................... Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... ~..~./. ......... Rear .....~..~. .............. Depth . Height ............. ~..~ .............................. Number of Stories ..~ ............................................................................... 9. Size of lot: Front ........,~.~.~i./, .................. Rear ...... ,/~/.~.~.~.~."' ' ................... ' Depth ..../.J.~...~." ............................. 10. Date of Purchase ..~f,,...~/.~...~. .......... Name of Former Owner ..~.,..~-~//],4,/,(J~,~ ........................................... 11. Zone or use district inwhich premises are situated .....~.-..~/. ..................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~ ............................................... 13. Will lot be re,reded -~-~J~,~ ................... Will excess fill be,.remove~ from pre, mises.~[ ] Yes [~1o _ 14. Name of Owner of premises ...~'~./v.~[..g,,,~;~J.~/.~L~,~ ....... .,~.~..~.[J.~.~..,.~.£...,(~J.v.E£t;'~,t~...¥,~.'"~..'..~.~,. ..... .~ ~ (Address) -. (Phone No.) Name of Architect ......... ' ...... (Address) [Phone Name of Contractor ..~..~..,.J~.U.~.?~.[.~.,..."~Jt~.~,~.t~ .... j~.~.~..~i~.(.J~...~..U'.~;~,....~ No.) "~' "~"?' ~(Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and india-ate wheth- er interior or corner lot. STATE OF NEW YORK, ) COUNTY OF ............ ~ ...................... ) ~ ~ ~ , ~%,, 030 .................................. ~..~.~ .............. being duly swo;~ ~ and says that he is the applicant above named. (Na~ of indi~i~l si~ing con~act) He is the ................... ;~ .................................................................................. (Contractor, a~nt, cor~rate officer, etc.) of said owner or owners, and is duly authorized to ~r~orm or have performed the said work and to make and file this apolication; that all statements contained in this application are true to the ~st of his knowledge and belief; and that the work will be ~rformed in the ~noer set forth in the application filed therewith. SUFFOLK COUNTY DEPARTMENT OF HEALTH HealthReference Department Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant /iD/..~c, ui) .~ra~;.-~ , PhoneX~_/-)..; ,q.&;. Address ~,~"~q~/L~ ~'~'' ~]vz~,~-.~ ;,~- Vi'llag~ r ~.~ ~,~F- Township ~. ,~,~,~ 3. Public Wa~Y C~y~ame ~,~0 ~u- .... 4. Lot size: Width ~ feet Length ~9~. feet 10. Sewage pisposal System: A. /~O-~allon septic tank: Pre~/~Equivalentl~/ Block 5. Subdiv.~)Ot'"ihl~u~ 6. Section 7. Lot Number ~ 8. Private Well 9. Public Water Distance to main (For Health Dept. Use) 11. B. Leaching pools: Number of pools Precast_~ock Special If private well, fill in the following blanks: A. Tank capacity B. C. D. E. gallons Pump G.P.M. Total well depth,~ Depth to ground water .~/ ! Amount of water in well The undersigned CERTIFIES: "Construction of~stallaLlu,.> will be-~f.n~.r~ance with the Suffolk County Department of Health's current standards thereto. This applica-t~'Fon will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. 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 and Water Supply can be installed on this pl,ot. APPROVAL DATE I"/~,~,7 SIGNED S-15 Rev. 4/1/73 k N 67° ~? 20 E 5 68°02'40'W GUARANTEED TO RIVERHEAD SAVING5 BANg, ~63 86 - LO; 5 $2 O' I? 0' GAR - 0 Unauthorized aherahon or add,lion to this survey is a vio~at|on sect,on 7209 of the New York State Education Law. Cop,es of th,s survey map not beonng the land surveyor's ,nked seal or embossed seal shall not be considered to be a vahd copy Guarantees or cert,hcahons ~ndicated hereon shall run only to the person for whom the survey ,s prepared, and on his behali~ to the htle company, governmental agency and lend~ng ,nshtuhon listed hereon, and to the ass,gnees of the lending inst,tuhon Guarantees SUPVEY OF LOT 5 M,4P OF NONTHWOODS F/led Moy ~'/, 1970 F'~/e I~o 546~ AT CUTCHOGUE TOWN OF SOUTHO&D SUFFOLK COUNT~ N Y W~LLIAM G MEIER Wading R~ver, N Lond Surveyor N Y State t_~cense No 21656 Surveyed 5-t 73 Sca~e f' $0' MaD No 7553. ~N 67° ~7'20"E SZl /'5' fo L~de COX LANE~-S 68o02'40"W GUARANTEED TO RIVERHEAD SAVINGS B~K HOME TITLE DIVISION -C.T I CO £ O T/ .P FR HOUSE CESSPOOL LAN REBATED 6-1- 73 ~ " 7- 2-73 under can, t I0- t2- 73 hnal WELL- ~EPT TK -CESSPOOL ~$ PER OWNE~t now WELL 109 6-/ or formerly JUL/US SKIt~O£ R=50 00' L=40 Unauthonzed aherat;on or add,ban ~'o th~s survey is a violahon c~ secho~ 7209 of lhe New Yorlc Stole Educahon Law ~e~son for whom d,e ~,.,r.ey is pr~p.~reJ. ~r~d on h,s behalf to the SUHVEY OF 10T 5 MAP OF NORTHWOODS Flied May 21, 1970 File No AT' CUTCI4OGUE TOWN OF SOUTHOI D SUFFOLK COUNTY~ N Y 5469 WILLIAM G MEtER Wadmg River, N Y Land Surveyor N Y State L~cense No 21656 Surveyed 5-1-73 Scale I" M<3p No 7.'55387 now or former 'y JULILI.C; $~1/;'01 L~N 67° 68°02 40'W GUARANTEED TO RI v E.~HEAD SAviNGS LOT 5 ~ PROPOSED ,30 "~ ~09 67?'e -- o;O~ R=DO 2OO5. __J~ L:40 / Unauthorized alteratio~ or addition to this survey Is a vlolatlo~ oF section 7209 of the New Yodc State Educahon Law. Copras of th~s sun~ey map not bearing the land surveyor's inked seal or embossed seal shall not be considered to he a valid copy. Guarantees or cerhhcatlons ~nd~cated hereon shall run only to the person for whom the survey ~s prepared, and on his behalf to the tdle company, governmental agency and lending inshlution li~ted hereon, and to the assignees of the lee&rig inshtution. C-uarantee~ or cerhhcalions am not transferable to additional institutions o~ SUPV£Y OF LOT 5 MAP OF NORTHVYOODS F~led May ~1, I~YO 4T CUTCHOGUE TOWN OF SOU THai D SUFFOLH COUNTY, ,'1/ W,LLtAM G ME~ER Wading River, N Y Lo'~d Surveyor N ~ State L,cense No 21656 Ma;) No T3~537 · APPROVED AS NOTED ED INSPECTIONS: 1. BEFORE BACKFILLING FOUNDA. TION OR START FRAMING * ,,:' ~ 2. BEFORE COVERING PIPELINE 3. FINAL WHEN JOB COMPLETED · DONALD A. DENIS, A, I.-A, ~.*~:, RIVERilEAD, !~, Y/ 11901 DONALD A. DENIS, .A. !. A. IM MEADOW L~~'': RIVERHEAD, N, Y, 11901 ~-L~WT ~h: D©~AL~ A. DEMOS, A. I. A. I,l LA. 'oeu~