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Home My WebLink About6610-zFO~ ~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O~ice $outhold, N, Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...E/.~. ~.e.W., .8.~..ff.o..1~.,..P~.,..(?~thre~t Map No. XX Block No. x~ Lot No, X~x New $1zt'folk N.Y, conforms substantially to the Application for Building Permit heretofore filed in this office 6609Z dated ......... .1~. y.....2.9...., 1§~.~. pursuant to which Building Permit No. dated ...... .M.~.~.....L~...., 19.~.3., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupsncy for which this certificate is The certificate is issued to /~dre~..E, ~od~],~ ....... .Ow4le~. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~.~..~..~...1.~.?$...b.~f..R.;..?~.~.~[a.... UNDERWRITERS CERTIFICATE No.1~,396~.... ~'~ .~. j.c~,~(~ ..................... HOUSE NUMBER .... 6t ~.~. .... Street....N.e.w...~.U~..S.?.~.. ?..0~..5....(.~..~...8.t.). ....... ............................................. ~..e.v..s..~..z.o..~.,. ~:.~: ............... B~ilding Inspector i ~0~,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE K~EPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o z ~o,~ ........ i~ .............. ~.....~,~.~...., Permission is hereby granted to: ..... ~ ......... ~.~...°.2.~..*....~.:. ................................. at premises located at ............................. ,./~',,,.E,-~..,/~',.. ..... ..~.,.?.,~{~..~..,z:.,,~, ........ ..,~....~..,~,..~,, .............................. .................................................................................. .'.~.~:.~ ......... ~.~.,~.~.:.~ ............................. pursuant to application dated ..........................~....~. ........ ..~.~.,~:., 19..7.~.., and approved by the Building Inspector. Fee $.../..0....0~.... .......... Building Inspector I~0~ NO. ~ TOWN OF SOUTHOLD Building Deportment 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 fallowing; for new buildings or new use: 1. Final survey of property with accurate location of all buddings, property lines, streets, and unusual natural or topographm features. 2. Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form ar equal). 3. Approval of electrical installahon from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple Residences and similar buildings and installations, a cerhficate 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), Non-conforming uses, or buildings and "pre-existing" land uses: l. 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 inspechon 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 certif,cate of occupancyv/ $1.00 Date~.~ca~La~ i..~...~.. ~....~.ii~..~.i ~ , ~ ::~::.~'~--~/::. New Building .................... Old or Pre-existing Building ............................ Location Of Property ...... .~..~...-~..,~ ........ ..~,..~h~.,.....~.~..~.,.~,.~'..,~,~.'~....,~,.~l,...[~.,~. ..~.~..1~ Owner Or O~ners Of Property ..... ~.'.~.~.~.~J~:,.-'~.~'......~'.~ ..... ..~..~.(J~.~......'~.~. .................................... Subdivision (~ .............................................................. Lot No ............. Black No ............. House No ............. Permit No.[~.,(P,~..~...'-~,,.. Date Of Permit ..~, .l~l.~.~,.Applicant ..~,L~.~.,~.,~?.%.....~c'~?~,.~,~..f;~,,. .................... Health Dept, Approva~,.,.~....~..~.~..,~..?',...~......Labor Dept, Approval ................................................ Underwriters Approval ...~tx ~J '.......~.t....~...~..'~...~,..Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ ....~..~. ......................... Construction on above described building an~it meets all ap~ ~o~,e~ ~nd regulotlons. Applicant ................... ~., ........ ""~ '~'~"~' "~ ' ' '~ '~' '_.~-i .................... Sworn to before me t~ ~ ~ ~ ~ ~ ...... ~ y .~ .......... ~ ......... ,stamp or seal~ , _~ SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant .~, P~hone~5. Subdiv. Address ~, 6. Section 2. Property Location ~ 7. Lot Number 8. Private Well Village ~J ~v~F~-~, Towpship ~ko~) 9. Public Water 3. Public Wa'~r 'Company Name ~ ~ . Distance t9 main 4. Lot size: Width~,%~feet L~ng~h ~,~ 'feet ~ 10. Sewage Disposal System: (For Health Dept. Use) 11. A. 900-gallon septic tank: Precast ~ Equivalent Block B. Lea~ing pools: :~ Nu~er of pools ~.~ ~ecast~Block Special If pri~Jte well, fill in the follow%ng blanks: A. Tank~apacity ~), gallons B. Pump G.P.M. ~k~ C. Total well depth D. Depth to ground water E. Amount of water in well The undersigned CERTIFIE~: "Construction of authorized installations will be in a~cordance with the Suffolk County 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 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 D~sposa~System and Water Supply can be installed on this plot. APPROVAL DATE , SIGNE S-15 Rev. 4/1/73 SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Departn~nt Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~i~)~l~J ,~:. ~,~oOb&~P~hone'~[-~'~O 5. Subdiv. Address ' ~' ~l~.'~Ll~c. ~g&'D " 6. Section 2. Property Location. ~(~Ft~) ~u~g~K, &J~uJ~t.~ lt~'&7. Lot Number : ' 8. Private Well Village '~ ~'~-~ Township__~'~u~k~) 9. Public Water 3. Public Water Company Name Distance to main 4. Lot size: Width~,~'feet Length__~_~,'~ feet ~ 10. Sewage Disposal System: ll. (For Health Dept. Use) A. 900-gallon septic tank: Precast ) Equivalent .... Block. .. B. Lea~gning pools: ' Nu~b~er of pools ~ Precas~.~Block Special If pri~ce well, fill in the fol low~n~g blanks: A. Tan~apacity. ¢~ gallons B. Pump G.P.M. ~J,~ Total well depth D. Depth to ground water E. Amount of water in well The undersigned CERTIFIE~: "Construction of authorized installations wilt be in a~cordanc with the Suffolk County Department of Health's current standards thereto. This applicatio 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. ......... -_z .... )~ .......................................................................... 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 Dispa~a~System and Water Supply can be installed on this plot. S-15 ~eu. 4/l/73 1-¢ st Mo$¢ ~ ................. .df........: ................................. 7L ....................... (~uilding Inspector) APPLICATION FOR BUILDING PERMIT Date .J~.~..~.k.....~.,..C;(... .................. , 19T~..~.;.,.~, INSTRUCTIONS a. This a~licati~ must be c~pletely fill~ in ~ ~writer ~ in ink a~ ~mi~ in triplicate ~ ~e Bui~i~ In~r, w~h 3 ~ of pl~s, ~cumte pl~ pl~ ~ ~le. F~ ~o~i~ ~ ~h~ule. b. Plot plan shying I~ation of lot and of buildi~s ~ premises, relationship to ~joining premiss or public str~ ar~s, and givi~ a detu!~ ~ripti~ of I~ ofp~ must ~ drown on the diagram ~ich is ~ ~ ~is c. ~e work c~er~ by ~is a~licati~ m~ n~ be c~me~ before i~nce of Buildi~ Pe~it. d. U~n appeal of ~is ~licati~, ~e Buildi~ In--tar will iss~ a Building Pe~it to the a~lica~. ~h permff~ shall ~ ~t ~ ~e premi~ ~ailable for in~ti~ ~t ~e ~rk. e. No buildi~ shall be ~cupi~ or u~ in ~ole or in ~ for any pu~e what~r ~til a Ce~ific~ of ~cu~ shall have ~en grant~ ~ the Buildi~ In~or. B APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit t~rsuant to the uilding Zone Ordinance of the Town of Southol.d., Suffolk County, New York, and other applicable ~L.~clinanaes or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, c~.~l~ein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and~latlons, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~,gnarure at appucant, or name, ir a co~ooration) ............ ............ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ~ ~).L,~.L~.J.L. ......................................................................................................................................................... Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. ................................................ Electrician's License No..~..~.k;~.~....L.~....../L,....~.~;~ Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ..~,.~,..~...~.....~..~.;L~,J....~. ~.t~L.~.,...b~/~.,.....t(~..e,.l~.l~?....&,l~,Gej.,.~/.t~.~:.:~. -- ~u~i~li~ State existing use and ~cu~ncy of promises and intend~ use and ~cu~ncy of pr~ c~mcti~: a. ~isJting u~ a~ ~cupancy ....~.~.~.~.....~.~:.~.~..~ ............................... ~.~]].. ................ ~ ............. b. Intended u~ a~ ~cu~ncy ...... k~U.,~ ....... ~ka-G..l..,......~...b..&.~.,..~A~-A.k.~.....~:.e.~k~.~ .... Nature of work (check which applicable): New Buildi~j-~ .... Addition .................. Alteration Repair .................. Removal Demolition .................... Other Work .................... - (Description) (to be paid on filing this application) 5. If dwelling, number of dwellin~l units ............................ Number of dwelling units on each floor ........................... ga age, umber o cars ................. .4 ............................................................................................ 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 ................................ Depl .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear Depth ................................ Height ............................ Npmber, of Stories .................... ~...: ....... 8. D~mens~ons of entire new construct on: Front, .~ · . . Rear ............................ Dep th .................. He aht ...... ~..'~ ....... Number,,of Star es . ............................................................... j .......... [.,.,~. ....... Zone or use district in which premises are situated ............................................... ~T~'O'"; ............... ~ ............................ Does proposed construction violate any zoning law, ordinance or regulation: Will lot be regroded ............. ..~....~.... W t excess fill be removed from premises: ( ) Yes I ( Name of Contractor ............................................................ Address ................................ Phone iNo ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bec ~, dimensions from property lines.. Give street and block number or description according to deed, and show street ames and indicate whether Interior or comer lot. 10. 11. 12. 13. 14. STATE OF NEW y,~)RK- ,~ , I. c ,c COUNTY OF ...... f '"'" ............ ....... · .k~'T~..~..~...~..~..~ ................. being duly sworn, deposes and soys tha (Name of individual signing contracf) above named. He is the ....~ .......................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfOrmed the said work om this application; that all statements contained in this application are true to the best of his knowl that the work will be performed in t~ manner set forth in the application fil~d therewith. Swam to before me this he is the applicant :1 to make and file ;dge and belief; and .................... 4ay of ................... ..~ ..................... , 19 ........ F'~ -- ~ n n , Notary Pub c. .:: .~...,...~.........~.. ;x~<~ County .... : (Signature of applicant) TF~RI LEE ~- .NOTARY pUBLIC, State e~.~ew ymk No. 52-616~2~ (~mlffie~ in Suffolk ~)mml~io~ Expires March 30, RIGHT SIDE FRAMING RIGHT SIDE ELEVATION ,/ ~NDREW ~. ~OODAL! RAKE DETAIL "~''~ LEFT SIDE REAR FRAMING FRAMING REAR ELEVATION ,_~ LEFT SIDE ELEVATION_ ~ ~ ~-~'~'~"~'i :=.~ -~ .... HEAD ,~ ~3 ::,~:.,~ ~------ JAMB GARAGE DOOR ~:, o _ DETAIL I : WALL SECTION .~'L e" ~-'~,,~' ,.-r; L___J _FRONT FRAMING ELEVATION