The URL can be used to link to this page

Home My WebLink About6375-zFORM NO. 4 TOWN OF SOUTHOLD BUH.BING DEPARTMENT Town Clerk's Office $outhold, N. Y. Cerlificate Of Occupancy Bio. 7.~628 ..... . Date .............. ~OVe.. THIS CERT ~I~IES that the building located at . ~//5' B~ghwood · Road ...... SMeet Map No..H~ · Block No ........... Lot No.. ~ .... ~o~. · ~,Y, ......... co~o~s su~t~ti'~y to the AppHca~on for B~g Pemit heretofore f~ ~ ~ office dated .......... ~b .... ~.., 19..7~ p~t dated .........Fab ..... 26..., 19.7~, was ~sued, ~d co~o~s to ments of ~e appHcable pro~sio~ of the law. ~e occup~ for wM~ thi; ce~ica~ issued ~ ..p~a~. ~' T~11~ 'd~l~g' ' ~{~' f~r- ~ The certifica~ ~ ~su~ te 'Robert .D~g ~,. ~t-fe .... ~er~ .................. (o~er, lessee or ten.t) of ~e ~ores~d,b~l~g. S~olk Co~ty ~ep~ent of He~ Approv~ -' U~ERWRIT~S CERTIFICATE No. -~t' '3~ ~9~. · ~ .N. ~8~.~-.. ~0/~3 .~ HOUSE ~ER . ~ ......... Strut ... H$~oe- ~a~ ....................... Building InspectI TOWN OF SOUTHOLD BUILDING DEPARTMENT APPLICATION FOR BUILDING PERMIT Date ~" '-' '~'~ ............................................................ , .... INSTRUCTIONS a. T~Is aPplication must be completely filled in by typewriter or in ink und submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of bu.ildings on premises, relationship to adjoining Premlse~ or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram whlch Is part of ~is al~llcation. c. The work covered bY this application may not be commenced before issuance of Building Permit. d.. Upon approval of this application, the Building Ir~pector will Issue a Building Permit rathe applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall he occupied or used In whole or In part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. B,,~P~PLICATION_.._. IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the d ng Zone Ordinance of the Town of Southold, Suffolk County, New York, end other applicable Laws, Ordinances or R.egulatlons, for the construction of buildings, additions or alterations, or for removal or demo t on, a~ hem n deKr bed · ne applicant agrees to comply with all appllcoble~laws, ordinances, building cad.e, housing code, and regulations. ........ (Signature of applicant, or name, If a corparotlon) ...... ....... (Address of applicant) State whether applicant Is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar builder~o~ ............................... .C-,-.~.~.&......~,,~'. ~,~,e~-~.,~ ........................................................................................... Name of owner of premlse~ .................................................. ~ ,~..~ ...-,e.~ ,~.e,~.--~-' ..~,.,,,,~...~.o~.. ......................................................... If appllcant?~ a corpo~rote, slg~nature of duly authorized officer. (Name and title of corporate officer)' -- Location of land on wh ch pr~osed work w be done Mai> No,' ...~..~.K~.'"/~../~&'~ ~77 ......... Lnt st~ a~ ................................................................................................................ ~...~..~ ......... 2. State exl~Ing u~ and ~cu~n~ of pmmM~ and Intend use and occupancy of p~ ~1~: a. ~lstlng u~ a~ ~cupan~ ................ ~ ............................................................................................................. b. Intend~ u~ and ~u~an-,. ........... ~-~..~~ property lines. Give street and block whether interior or corner lot. 3. Nature of wink (check which applicable): New Building ....~... Addition .................. Alteration .................. Repair ............. ~j., Removal ..................Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..~.'.~./.)~..~..~...l~..;....~?...t~... ..................... Fee ................ : ....................................................... , ................ (to be paid on fi'.ing this application) 5. If dwelling, number of dwelling units ................; ........... Number of dwelling units on each floor ............................ If garage, number of cars ...... ~,...~.~...~..~....._:::~...~..~.~..~....~...t. ........................................ 6. If business, commercial or mixed cccupancy, specify nature end extent of each type of use ............................ 7. Dimen~,Jt.L~j'structures, if any: Front ...~.. .................. Rear ................................ Depth .................... Height ..~ ..... Nu,,b~, ,~;~,~ba't~",~ ........................................................................ Dimensi,?~~olterations or additions: Front .................................... Rear ............................ De th ~;.~u~ ~ · P .... ~ ............ H';.-'~?. .................... Number of Storms ........................... 8. Dimensions of entire new construction: Front ..... ~J.....~ .............. Rear ~.~..,,,..~.. ............ Depth .~ ............... Height .~-.[..'.~.~ ...... Number of Stories ....~.~..ve~......~....~..,.../'/~,.:~ .................................. 9; Size of lot: Front .......~...~...:. ......... Rear ..... .~...7....~.. .................... Depth ..... ./...~....C~.. ................. ' ........ 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~ ]3. Name of Owner of ~es .~..,...,~...o.~f..~..?. ............... Address ~...~.....~-~..~.~...~../.~....~'...~:......~one~o.~___~,~.,~,4~, Name of Architect ...................................................... Address ..~ ......... "~'"'""ZZ ................. Phone No ..................... Nome of Contractor ~J .~.. ~ ~..~...~f...~..., Address ~.~ ne ............ ;~/t~ ~.~ ~ No..~..~-~.ZZ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from number or description according to deed, and show street names and indicate STATE OF NEW YORK, tS,. ............................. ~./~'-?'~ ...... ..~....~.....~::..~ ................ being duly sworn, deposes and says t~t he is the applicant (Name of individual signing application) a~ve n~med. He is the .................. ~~~- (ContractOr, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfo~ed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his ~owledge and belief; and 'that the work will be performed in the manner set fo~h in the application filed therewith. Swam to before me ~is day ' ......... L'ORM TOWN OF SOt~140LD BUILmN~ DEPARTMENT TOWN Ct,ZRK'S SOUTHOLD, I~. Y. BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) °. 6'3'75 Z Pem~ission is hereby granted to: And~aw..l~,~.:L~.....ge~.~..4Joeg.....k/g-....IJee'~. ~ & ~ ,JebeJ, t · .nt...2.~,A.--.., ......................................................... .............. Jf~.:L:LeT...~&e~e ..................................... to ..:l~uJ.3A..~e~..e~..~.e~a~..l.~,.~lwe.~.:~ ................................................................................... at .premiSes located at -...Lef~...~ ............ H~:Jhwo'Od"E~'~.'l~lI ......................................................... ........................... ¥/J..l~ j~veod...J~Omt ...... 'll'~t~]r~r~Y~'"" ll~t~iJll .................................... pursuant to application dated . ................... ~1t~13 .......... ~ .............. 19~...., and approved by the Buildin~ In,~:tor. FORM NO. 8 TOWbi OF ~OUTHOLD Building Department Town Clerks Office Southold, bi. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, in triplicate to the Building 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 3. Copy of certificate of occupancy $I.00 $5.00 Date ........ ~'. ~....'~...?..~/. Z...-~.. ......... New Building .................... Old or Pre-existing Building ................. .;. ........ Vacant Land ............................ Owner Or Owners Of Property ...~..~...?:T...~'~ ...... ~/'~.~.~'~./.~......~.~.~/...~...~... .............................. Subdivision ~.~~...~...~..~.~...~...Lot No.......~...... Block No ...... ..'T~..... House No......-w~... Permit No..~,~.7~..~ .~.. Date Of Permit'/~//.~.~../~...~./.~l~pplicant ~.,.J/~.~.~../~.~;;~...~'~;~'~.~~.......~)~'~' Health Dept. Approval ........... .~..~/ ~/ Labor Dept. Approval .............. ~......~ ........................... Underwriters Approval ............ .~.~ ..................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .....~...~...~....~... .................. Construction on above described building and permit meets all applicable codes and r..~.q.ulations. Applicant ....~~z~.....~.~ .............................../'/'~'~ ........ Sworn to before me this ~'~///~' /fT.~ ................ yof ................. ~......~.?. ~'--~ Notary Pu~/.~--__~, Conuniadon Expires ~larch (stomp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICfr¥ ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT only t~ e~t~ ~u~ment ~ ~scdb~ ~ and int~ by t~ applier ~ on the a~ applicat~n numar in t~ p~mi~s of wo~ex.mi.~do. October 29, 1973 and found to be in compliance with the requirements of this Board. RANGES '~ACI~~v ~T. K.W. 1 10. FIXTURE ]-7 ' FLioXc T' ~U:EENST OUTLETS RECEPTACLES SWITCHES 17 ~o 2,"%~ ~.7 I°'', 'uT~c' Tj°RS"'~' ~'u2," SERVICE DISCONNECT NO. OF S E ] O0 ~B METER. 1 ,. i 2 OTHER A~ARATU$: I COOKING DECKS OVENS DISH WASHERS I --. T'I I I --' I I I I:. I~'~ TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET NO. OF FEET , V I C NO. OF HI-LEG OF HI-LEG Lot EXHAUST FANS 2 DIMMERS E NOC)F NEUTRALS A-W. G. OF NEUTRAL ~urnaces: Oil ]-l/Shp, 1-1/12bp ~tor/s: 1-1bp Rocky Point Elec.ConstoCo. Inc., PR #' 1S Box 197, King Rd., Rocky Point, L.I. ll778 Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. r SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No.~O'-I~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: Date _ - 1-Applicant I. :' ' J i)~'~'~'~ Phone~'-~ ~..~a 6-Sub div ~1~,t~ ~,, Address 7 ~..Q~.~."~:'~ ~"~c_~'~* ~"F , ?-Section. 2-Detailed property location ~/~ /~/fvH~/~co /?f' ~ /W/~f,//~be{ No. Hamlet /.~ z /,~ ~-~ -- Town n or,,~ ~-/,~ -- 9-Private well~ ~-Public w~ter supply name ------ Distance to nearest main ~f~r,¢ ~' ~-Lot S~ze: Width/7d ft. Length ~5-ft. (also enter on ce~r plot plan below:) ~-~elllng: Singl~ Family ~ Family? ~ /Cellar? ~ab? ~ ~Crawl S~ce? 10-Pro~s~ syst~. Septic tank ~ >~rec%~t ~ess~ols / /Shallow ~o1~ ~Other il-Septic ~ inside dimensio~ ~e'/~Gals.nem~-~idth ..... iu. ~i~pth ~t. Total .bJ_oek~,be~ow in.~e_t.:~_~ ,,~?~.. ~3 PLOT PLAN Street Capacity:i: '!Gals. G.P.M. ~ I The Undersigned CERTIFIES: ;ate ~th Data Feet o ~' 10 (T' 12 ~6 Indi No "Construction of authorized installations will be in cc rd nc mth h ~ ff lk C un H th D m ' a o a e w' t e ou o o ty eal epa~t eDts. purp~nt Standards, Bulletins, and amendments/thereto, covering Private~ Date -ZI~/7~ Sig~ed,~~~~ / / ' 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 (10/65 Revis.) S-l~ Signed DI£TZGEN 135 11846 NOTE: · -- MONUMENT SUBOIVI$10N MAP FI£ ED IN THE OFFICE OF THE ~LER'K OFSUFFOLff ~OUN~Y ON REV,S*ONS YOUNG & YOUNG 4,f4~..~,/,e7.J 400 OSTRANDER AVENUE, RIV£RHEAD, NEW YORK ~c7~. /o~,/~73 ALDEN W. YOUNG HOWARD W, YOUNG SURVEY FOR: ROBERT DOERING 6 JOANNE DOERIN~ AT GL ~R NTEE row. OF SOUTHOLD IN ~j.~j / / SCALE: : 40' IDATE: NOV. 2, 972~946 AIOt~ 7-H t~O~D SU~O/VI$10N AK4P FIL ED IN 7~ OFFICE YOUNG & YOUNG 400 O$'[R*,NDER AVENUE, .IVERHEAD. NEW YORK HOWARD W, Ye SURYE~ FO~: ROBERT DOERING ~ JOANNE DOERING LOT ~, 3," MAP OF HIGH~ . SOUTHOLD I L~ --4] [, :1