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Home My WebLink About6616-zTO~N OF $OUTIlOLD BUILDI~G DEPARTMENT Town C]~rk% O~iee , $outhold, N. Y. Certificate Of Occupancy No..z.790.o. ..... Date ............. B.e. pl;. RO ...... ,197~.. THIS CERTIFIES that the building located at .E/.S...N.a.s.s.a..u..P. ql..n.t..R.d. ..... Street Prop Map No. N.a$~..P.t.... Blo~ No ........... Lot No. ~2 .....Qutchclg~e~..I~ rY.. ........ conforms substantially to the Application for Building Permit heretofore filed in t_h!s office dated .............l~a~..2~.., 19.7.~. pursuant to which Building Permit No. ~616z. dated .........}!aY.. 23 ..... , 19.73., was issued, and conforms to all of th~ require- ments of the applicable provisions of the law. The occupancy for which this certifl~te is ~ued is .. ?r.~.v.~.t.e..o..n.e.f.~.mily.. ~.~.e.~. l~n.g ...................................... The certificate ~ issued to .~.~rle.~. ~.~ll.e.r.. ~ .... .v~. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Jan .8. ~ .97t~.. by. R,..!/ill~ ...... UNDERWRITERS CERTIFICATE No p~lu~l.irlg ..... HOUSE NUMBER .... 7~ ..... Strut .. N~s s a~..Point. Road .....Cutnhogua.. NO~EI..~einapec.ted. and .up..date..G/0. #..Z790~.. Se.pt. 2~1.197~. .............. ..... .... .......... Building T.spector FOILM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . Nassau .Pt. Ro&d ..........Street Map No.N.a$~&.U .P~.. Block No ........... Lot No. l~.e.s.u.b.. ~...19.t' .~"~....~..t.a.h.o.~. ?, conforms substantially to the Application for Building Permit heretofore filed in this office dated .............gay.... 25 19.7.3. pursuant to which Building Permit No..6.~.] $.Z.. dated ........... .~.2...2.3 .... , 19. ?3., was issued, and conforms to all of the require- ments of the applicable provisions o£ the law. The occupancy for which this certificate is issued is .P..r.iy.a.t..e..o.n. 9' .f.a.m..i.ly..d..w9.1.1..l~A. g ....................................... The certificate is issued to .C.h.a..r.l.e.s.. ~..u~.l..1.e.r. ....... . .0~n..e.l,. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .J..a~....8....~.9.~.~...~.y .R.,..V..i.l.l.a. ..... UNDERWRITERS CERTIFICATE No, .Pending ................................... HOUSE NUMBER . .7.~.~.~ ........ Street ....N.a..s.s.a.u...P.o.i.~..t..R.o.a..~ .................. FORM NO, ~ 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) 6616 Z Date ...................... . ..~Y. ....... 3.0. .............. , 19.23... Permission is hereby granted to: ...... ~..~O.....e,o~...L,e ............................................... · .. 4~U,t,o ho g-~e ....... .1~.~.~ ...................................... to .~..u..i..~..d....~.~.~...9.na..fam,.tlY...d.~ze~,.lin& .................................................................................... at premises located ot ..... ,1,Q.~.....~ .......... ]~as..~u..~.o~1.r~t..~:~le~llk .................................... ........................................... .~/..,~..~.~.~,~ ~,u.. 2off, t,.. Zloa,d .............. ~teh~ue .............................. pursuant to application dated ................................ .1, ia7 ....... ~...., 19.~.., and approved by the Building Inspector. Fee $. J.22.,,.~. ........ FORM NO, $ TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 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 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 Underwriters. 4. Commercial buildings, Industrial buildings, Multiple 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 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 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 dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ~/./~/.~...~... Date ......................... New Building .......... Old or Pre-existing Building ............................ Vacant Land ............................ L~tion Of Property ....... .~~....~. ~/.~...~.. ........ ~.~.~.~ .......... Ow er Or Owners Of Property ...~.~.,~..~../~.~..~.~ ........................................... Subdivision. ermit No. ~:~,~ ./.~..'~ Date Of Permit ...~.~./~..~.Z'.~ppl cant ~ ~~.~ ........... Health Dept. Approval ...~..~...~......-~.~.~.... ........... Labor Dept. Approval ................................................ Underwriters Approval .... ~L~..~ ........... Planning Board Approval Request For Temporary Certificate ........................................ ~/ Final Certificate ......~ .......................... Fee Submitted $ Construction on above described building an/~cljpermit meets all/ap, p, plicable codes and regulations. Sworn to before me~is ........ t.I. o, .. Notary Public .................................... County (stomp sea,) or SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No ,?-.~ ~ EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS e~~ ~ /~ Approval to construct said systems is requested,pertinent data herewith: Dat 1-Applicant ~'1.~'~ f'.~.~/~ _Ph~on~e~3~/-$~6-Sub.div Address ~-~ ~ ~ ~, ~/~C ~ ~ 7-Section ~ 2-Detailed ~rope~ location ~~ ~ ~ 8-Lot No. ~ ~ Hamlet ~ ~f'~ To~~~ 9-Private well? 3-~blic ~ter suppl~name Distance to nearest ~in 4-Lot Size: Widt~t. Lengt~ (also enter on center plot plan ~elow:) 5-~elling: Single Family ~ T~y? ~ Cellar? ~ Slab? / ~ Crawl o~ce? lO-Pro~sed system: Septic tank ~Precast y ~Cess~ols ~ /Shallow ~ols ll-Septlc ta~ inside dimensions: yol~ Gals. Length ft. Width ft. Liquid. depth i2-Precast sections: ~Number~Sq~re Ft. Cesspools: Block sizeL incs. D ins. H Total blocks below inlet: ~1~2 ~3, ~OT PLAN Street .Grade O ,W.L. ~o~ ~o ~ ~ Ind~ ;ate ~ ~ Nc ~th The Undersigned CERTIF~S: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Owner ~or Builder ! ins. Capacit~Gals. 7~· 'I Data ?eet 0 2 4 6 8 10 12 14 ~6 18 FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. Date Signed (10/65 Revis.) ~ (]VO~I INlOd nVS$VN Jnau~oriz~ ~lterotlon or addition to this su~ey is o ~otl~ of ~ction 7209 bf ,~e New York State Education Law. AV~ 31NO33d SURVEY ~OR REFE~E~GE: C H A R L ES M U EL L ER ~ /o SECTION a NASSAU eOINT CL UB PROPERTIES, INC. FIL ED OCT. 4,191~- FILE NO. AMENDED MAP A OFSEC~ B NASSAU~INT CLUB PROP- AT N~ S 3A U POINT ERTIES, INC. FIL ED OCT. 12,1920-FILE N~ TOWN OF SOUTHGLD eUARANTEED SUFFOLK COUNTY, N.Y. SCALE: 1":50' MAY lO, 1973 NO~ 5, 1973 LAND IURVEYOR RIVERHEAD~ N.Y. . [N lOd nWSVN uthorized altemtlon or addlt~ ~ thls ~ ~ a ~on 7209 of ~e New Yo~ State Education L~. ~ m'~ ies ~ this su~ey map not bearing the land su~eyo~s or embosse~~ seal shall not be considered ~ be a valid copy. , t,lications indicated hereon shall run only to the ~ ,, the ~urvey ~s prepare, and on his ~half to the on, and to the assignees of the lending Institution. :ertificafions are not trans~mb~e to addlflon~ ~l~ SURVEY FOR M/O 8ECTION B NASSAU POINT CCUB P~ES, I~. AMENDED ~P A ~ S~ A T NASSAU POINT E~IES, INC. FILED OC~ I~, 19~- ~LE NG ~. TOWN ~ SOUTHOLD ~ARANT~D TO~ SUFFOLK COUNTY~ N.Y MAY I0~ LASD 8URV~OR RIV~RN~AD~ 1~0uM NO?I TOWN OF SOIJTHOLD BUILDING Df. PARTMENT TOWN CLERK'S ,OFFICE SOUTHOU), N. Y. .............. ........................................ . ......... Disapproved o/c ....................................................... ~ ....... ~ ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~ e. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witl~ 3 sets of plans, accurate 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, an~l giving a detailed description of layout of property must be drawn on diagram which is pert of this application. ' f c. The work covered by this application may not be commenced before issuance of Building Permit; d. Upon approval 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 work. ('~ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall havebed~ granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuenca of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations; or for removal or demolition, as herein described. The applicant agrees to comply with all eDpllcable laws. ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~.~,,....{?~....~v,~~ .......................................................................... If applicant is a corporate, signature of duly authorized officer. ......... ..................... (Name and title o corporate o icerl 1. Location of land on which proposed work will be done. Map No.: .~.. ............................................... Lot No..~ .... Street and Number .~.~.Z~(-.....~.~...~...~ ........... ~'~'"~"~"l~l~i~i~;"ii~ .......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~,~.,C.{~;~,,, ......................................................................................... i ........... b. Intended use and occupancy ,..J~...~.~.~ ............................................................................................ 3. Nature of work (check which applicable): New Building ..... ~ ...........Addition .......... Alteration ............... Repair ......................... Removal ......................... DemolitiOn ........................ Other Work .................................... Fee ../.. ............................................................................................ 4. Estimated Cost ...... .~.~..,~.m~,~.~ ./:~... ......... ~.~., 0 ~ iDescription) (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 ~ach type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ..... i .............................. L ........................................ Dimensions of same structure with alterations or additions: Front ...f .......... Rear ....... ~ .......... i ............ Depth .............. : .............................. Height ..~,. ................................ Number of Stories ...../. ................................. 8. Dimensions of entire new construction: Front .....~......~.. ............ Rear ........ ~.....~.. ........... Depth ..~...., ................... Height ..... J~.~ ...................................... Number of Stories ...,/. ...................................... i ............................................ 9. Size of lot: Front ...~..J~....'..~.~../. .............. Rear ....... /..~.,.../..~.../. ............... Depth ...F..~....~...;...~..~..../. ........................ 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'-~.~.. ......................................... i ...... 13. Will lot be regreded ~. .......... , ............... Will excass_fill be ~e~. 0ved from premiss: [ ] Y.e.s, _ [~&,No Name of Owner of premises (Address) (Phone No.) Name of Architect ................................................................................. .. ................................... ":'::"~'e"::'"' ............... ~. ( dress) ~r'no .I . .... '~"~'"' '(Address) Name of Contractor~ ~ ....... ~..~......~.a~d~e...~...C...Z~....~ ........ ~..,~.e..~.~.. (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from street names and indicate wheth- property lines. Give street and block number or description according to deed, and show er interior or corner lot. ) COUNTY OF ........~; ............... ) SS .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of ~ndividual sisning contract} 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 and to maka 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 flied therewith. ........... .......... APPROVED A8 NOTED : "" ' HOIIFY BUILDING DEPARTMENT' AT 7GS-266U 9AM TO 4PM FOR REQUIR-' - : ' 3, fINAL WHEN JOB ICOMPLE~ED ' ' · ' :' , ,. ~~ . , < WA7~A~ ~,,rz ~ t4,0 5L t?~