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Home My WebLink About6389-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No..z~l+3.~; ..... Date ....... &~-,ll~g .6~ .......... , 19. '73 THIS CERTIFIES that the building located at . .tRgbt... Oelee. 1~..I~LII .I~F~treet Map No... XX ....... Block No...XI[, ..... Lot No.. ~X ..... 0l,:l,~n~;l. l~ew. Y. Ol'tr ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Pebo. 8~ ....... , 19.7~. pursuant to which Building Permit No. dated ..... bi~ah. 7t ......... , 19.73, 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 . Pr~¥ate .oRe..l~n~ .]..Ir. ~lltell.tJ~ ....................................... The certificate is issued to . .¢tgl'k. J.,--Otll'l~/ .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. AU&qlst. ~t' 19~'.~ ................. UNDERWRITERS CERTIFICATE No..~1111~912, ..... J:aly. 2~. ~L97] ............. HOUSE NUMBER ..-2660~ ..... Street ...R,0tdg, .Fm~n...Roe& .................... Building Inspector TOWN OF soo'mot.~ BUlLmHG DEF,,urrM-u~rr BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6389 Z Permission is hereby granted to: Dl~w..~ ....... .~.~..... ~n~ue~ae .. &~e ................... ....... ~ ~n'"~aT8'i'""~ ~ ........................... to ...~u.~& ..r~.. ~n~ ..£.a~. ~ .. d~v~ ~. ~ ................................................................................... at premi~ located at .JL,~e...O~'~..~,%..F,~r~..P~a~,..~,~,'G..~,~..I~) ............. .~ ......... pursu~r~t to application dated ........................ l~b,'"""e ................ 19~,~ ....and approved by the Buildl~,g Ir~or. FOB,Bi NO, 6 TOWN OF SOUTHOLD Building Del)ailment 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 following; 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1,00 $5.00 Date .~..?J ~'- ~° . ! C{ -~..~... New Building ....... .~. ..... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..... ~:...0...,......~.....,.;.....~..f.~........~......~......~.....~... ........... ~ ....... Underwrite. Approval ~..~..~.~:~l.......~/~..Planning Board ~proval ..~.:.~ ..................... Request For Tem~ra~ Ce~ificate ........................................ Final Ce~ificate ...... .~ ............................ Fee Submitted $ .~ Construction on above described building and permit meets all applicablq c~es and regulations. Sworn to before me this ........... b. ........ Nota~ Public .................................... Coun~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL 1. Applicant ~4~B~ ~ ~AI67' PhonJA~°;~5. Subdiv. Address 6. Section 2. Property location ~t~ o~f ~{,~ f%f/~]~ /~ 7. Lot No. O~/SN~- A,I ~,~, 8. Private well ~ Village Township j~A~ 9. Public water 3. Public Water Company name Distance to main 4. Lot size: Wid~ L~ feet Length ~O feet (Enter on center plot 10. Sewage Dispo~System: --- A. f/90~ gallon septic tank: Precast~ Equivalent Block B. ~aching pools: Number / Preca~lock Special TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM below) ~,0~ ' ,ZO ~,,~, O Street If private well fill in blanks below: Tank capacity~ Gals. Pump G.P.M. ~ ~,~q, Total well depth/~O Depth to G.W. Amount of water in well Test Hole Data Feet ~o/~. 0 8 ~ ~V~ ~' 1 o 12 16 18 The undersigned :ERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date F~. ~..~ ~_~ Signed 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 ~ ~ -- -~, ~. S-15 Revised 4/1/72 OF SOUTHOLD BUILDING DEPARTMEHT ,-..- ~:~ -~. ..., -- , -./. ,~..r..~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E om,ned ...... Approved .............. .4.~ ......... ..~... ....... , ! 9..7.~... APPLICATION FOR iUlLDIN~ Plait INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot end of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which is Part of this epplication. ~ 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 permlt.shell be kep the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pert for any purpose whatever until a Certificate of Occupancy shall have granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pur~ to the Building Zon~ Ordinance of the Town of Southold~ Suffolk County, New York, and other applicable Laws, Ordinances or Re~Jlatiol~ for the co~truction q~ buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to compl~ MI alaplicable law~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildin~ ~eee~ary impeetion~: (Sig~re of appl' ........... ................ (Address of a~l~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ......................................................................................................................................................... Name of owner of premises ....,.~..~.,,~ .~..,.....¥~...~.~......~..~ .~...~'.,¥,. ...... ~.,&....~..~...~..~..1~ .~-~...~.~..a~.~.~.~.&~..~'....~...,~ 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 ..................................................... Other Trade's License No ................................................... No .. . ~L~ . - X I. Location of land on which proposed work will be dona. Map ........................................... LOt FIO ......................... . Street and Number ..'..~:..0...6a1...... .~..../~.~.~.&(~'....../~,~....: ............................................................... Municipality 2. Stete existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... A/....a.~.: ................................................................................................................. Intended use and occupancy ...... .~...~.~.:.....~...~/.~.~X~~ ~ ............................................................................ ~' ,.... ..... ~ 3; :, Nature of work (check which applicable): New Building ..... ,. ~. ............. Addi ion .; ................... Alteration .............. Repair ................. Removal .............: ....... ;... Dern~tion .............. ~,..:..... Other W6rk .................................... ........ / ~:~/~'.1 ~, * : (Description) ~, 4. · Estimated Cost'./:..~...~.~.~.~.z~. ................... Fee .......... , ....................... ; .................................... ; ........................ :~ ~- - {t~ be paid'on filing this application) 5. If dwelling, number of dwelling un ts ...~.. ......... Number of dwelling units on each f~oor ................ v ....................... If ga{age, number of. cars ............................................................................................. .~ ....................... : ..................... ' 6. If business, commercial or mi,xed occuoanc¥, specify na{ure and extent-of e~_h 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 ......................................... De th ........................ : ......... Height ......................................... Numbe~ of Stories ....................... ~ ............... 8. Dimensions of entire new constrUction: Front ..... ,~..~.. ............ Rear ..... ~.~?...~.. .............. Depth ....... Height ....... :2J~. ................................... ' ~ ' Number of, Stones .........; .................................................... , .......................... 9. Size of lot: Front ....... ~....4[~.. ....................... Rear ............ ..~.....~..~.. .................. ;' Depth .....¢~...~.~.!.~.~.. ........ ; .................... 10. Date.of Purchase ~Lk~.~r.f..../.~..3~..;.....'... Name of Forme~ Owner ...... ,~...~..~, ~.~-.,,'. ............................................. 11. Zone or usa district in wh!ch premises are situated ........ ~.=..../~....~.& ......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ./~... ..................................... : * ' 13. Will lot he regraded .... /~.~. ......................... Will ex_oe_ss fill be removed from p,mmises: [ ] ~Y'es ~[~q~.~ No 14. Name of Owner of p~;emisas ~.~...~.ff~..~.~.~.~.....~:....u~/~..~..../...~.~'~..~... ~ ..$.~,.~ .~.-.j.Z~..~.,. .................. (Phone No.) · ' ,- (Address) Name of:Arch,tact ....,~.~"A.~JE~.4~Z[...~.~A4~. ....... ~.~.~ .Z'~4~:,Z~t~:.....:;... ........................... ~= ....... :,:...,.....:; ........ , ' (Address) ~.. . . ,, ~ o'hone ' '. $, · 7. Name of Contractor ...~.~t~'.~........~..~ ........ ~..~.~....~......~.~...:.:.'../~...~..,..../~X~.,.~.../~...~.,~..~.~.....:=. ....... :.....: ............... ~ t~aaress! [rnone ~o.! PLOT DIAGRAM Locate c ear ¥ and d~st~nctly all buddings, whether ex~st~ng or proposed, and ~nd~cat;e all set-back d~mensions properW lines. G ve street and bock number or description according to deed and show street names and ~ndlcate er interior, or corner lot. 111..<- / STATE OF NEW YORK. CO U NT~({~c/'- '(Y ~'"'; .......... I1O ' ............................... ,,~ ................................................................ being duly sworn, deposes and says that he is the applicant above named. He is the ................................... ~ ............................................................ :r,~ ............................................................................................................. {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 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 mamler set forth in the a/pplication filed therewith. ............................ · ........... ............ Notary Pubhc ........ ~ ............................................... County ..................... ~ ..................................... ~.. ................ (Signature of applicant) Chief of General E~Eineering C · sq. "F+ '%. [.ALL DIMENSIONS INDIC. ATE 1~73L 4J/4" ',~ 8t ~' I ILl IS/4'' ~' '1 STUD TO'STUD DIMENSION, ~0 ~ ~A~H ~EDROOM UTILITy ~ (~ ,/~A/ -- u UPPE~ LEVEL FLOOR PLAN " ' ~ 15 '~ ~' 5Vi 15 ~" ~ i~ **. ~, ,, .' * ' ~' g~o,/." ll~*o~ ¢'%~W' ~d' sv~' 15s4~'' =~,, '~ ,: I I'-~ ~/4" 5 7c~'/~" A" I 1~4" ~' [~IW' PROW ~ ~ ~ ~ 4¢~¢ . 4~D¢ ~oS.I~L' I' ~ , ,,+ i~ . . ,, ., ,_ , ., . .. . .¢ LOWER LEVEL FLOOR PLAN ~ ~ b ~ ' ' ~ .' ~ C~ ~Z~ ~.~' ~- o~7 ~ zaz ¢ 2 ~ I . ' ' , ~ ///, // APPROVED AS I . I . , , ~ 765-2660 9AM TO 4PM FOR 0 e a a ~' - ~ 2~"¢~¢ ~ ~ L ~ ~ ~ i z ' , wHm J CO~Tm . __ - t , // ~3~u~To~, ' , ~ ___ ~ , . ~ ~ .1 _ , ~ ~, ,, ~" i~ ,' ~0" BUILDIN~ LINE t L 'I '- I L ¢ 7- ~CAL.~.-' I/4" = I".-O" ' Z L I ~ ~ ~ .... ~ ~ , - . ~ ~ i ~---' -- L ' ' ~ ~ ~ ' ~ ~/' ~! ~ .''S ~ ;% ~~ - ' -- , " ' ...... ~ ~ ~. . ~ . .. -~ ~ ~ ~ · , , ~ X~ ~. ' . ' ~ .I ' , . ~ , c~,~ , , L~/~,,~ 6// ~zf ' ' I ' - - '- c~t~o~ ' ' ~ / l,l~ ~/Z - ' . I ~ I' ~ ~ ,~ .. . . , . ~ I- ~ ~' ~ ' , t ' I :~ I ~ I , ~ x , ,, ,,, ,~, WAIL PANEL. L CON'FEMI~. d,A H'IT-D H AN DILA I L WA,,L/ PA N E~L ~V~'x, '~V¢." K ~.d/'~" p4:~'T POSt .I --~/2."~ ANCHO~ I~DLT~~Y AGG, UM ~P - t2"~ CONCRE'rI~ FILLED 50NOTU ~.e. Fc:~Ti ~ Ir' ALUM~c~Iw .y · WALL ~E ~NIL- ?~,2 .xl .,4 c, . W4:/',14 ~"~' b^u.>F (.c~ ,- WALL P~NKL I~IICI(I NI3 , V -,j 'i ~' f I J-L --- TI' II Tr V,t-"~.n'. R*~,=L.· I I II li~OUe, H OPeN IN(~ ~/4" i N T. PAt',JE L ~ N d FIR NANI~.II. NeJ.$ K II~I'I~,OAI~D' IHT. PANEl. / J J / / / / / / / / / -- I/4" iNT. PANEL. , ?ARTITION II ]1 ,Ii II II -- IX~ FII~ CAP STOl NG P~I~S P L.ANI fi' - I'-0" G F-.CTI ON I" = ~ECTI C)N A--A