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Home My WebLink About6414-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..~.~..~..~ ...... Date .............. J~., .... 16..., 19 THIS CERTIFIES that the building located at ~~ .I~ ............. Street Map No..~I~.~. ,. P~.~ Block No ........... Lot No. ~ .... .~tt~ho~l~ .... i ,.~.* ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........I~al' ..... 16., 19..~ pursuant to which Building Permit No. dated ........1~....~.6 ....., lg.?3., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is, .Pr..i.v.~.~.e..o..~., .t..~.$.~ .a..~..~. ~ ....................................... The certificate is issued to · ~x*omiva/;~xz. g~ms%rm:~;$on, g.~rp ...... 0~,s ....... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Sxtl~y...S6.. ~[$~.. ]~.R....~[$~l~ .... UNDERWRITERS CERTIFICATE blo..Il..l~9~ .... ~TRI~;. i~.... '~C~ .................. HOUSE NUMBER.. ~.'l.30 ...... Street ........ ~,8,. ]t0~0, ......................... FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP-,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6~14 Z Uote aaz~h 16 ~9.7.~ Permission is hereby granted to: ....b.~...s..~.~?. ......... .~..~.~.$. ................................. ..... .,,,~,,.~...~..t.....,~:~.... .................................. Build ney one £aud. ly Let ~. at premises located at .............. 3.~... .......... ~t..~g..~.m;A..~.g..,~...I~f,).]3 .................................................... pursuant to application dated ........................ 1~.~ ....... .~.~. ............ , 19~7~..., and approved by the Building · Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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 triplicate 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. Ax:curate 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 $1.00 $5.00 Date .......7. · ."~..~. · .~...-'.. · .7...~., · ................. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of Pr.~,erty--~>~J~.~.~/~J~....~--i~,~......~.~/~X/...~t~/.....(~.'.'~/~) / ' /'~__ ........................ ~ivision ~....~...~ ................ Lot ~~lock ~o. ~..... Houze ~o ............. Permit No..~Z~. D' ate Of f Permit .~:/~:T?~.,Applicant ~.~...~ Health ~pt. Approval ~.~..~..2~/...~]~....Labor ~pt. Approval ................................................ Underwriters Approv~J ....... ~.~Z~.~.....Planning Board Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Certificate .......................................... Fee Submitted $ .~.~ .................. Construction on above described building and per~~~~s~~ Applicant ..... ~~.~. ............. Sworn to before me this .... [.~ ........ day of ..... '~ ............................. (stamp or ~eal) ~ -0 C~, ~ ~/~ ~-~ / T~RI ~E E~K NOTARY pUBLIC, State ot ~ew York ~o,.s ....~. PR~m/ATE S~TAGE DISPOSAL SYSTEYS . ~ ~.z~'.._ .',,.'.;~_~__ ...... -~w~ . , ,, Date ~.~.'ova~ ~o c~..~u~ said systems is requested~pertzn~nt data nerewitn./(~ - , ..... ~ , · ~ .~, ~ .o~ , ;., -~ 9-Private well? ~' ~-.='--~_~ wa~ar' supply name ~ :~, Distance to nearest train -- - -~-- Smze; ~ '~' ft. L~.~.:~.:~. (also enter on center plot plan ' ~ D-- ''-n~* S:n:~ie'Fa~'v ~"~ Two Fatal!v? ? /Cellar? ~ /Slab? ,Y ]Crawl S~ce? 16-Prooosed system: Septic tank ? [/Prec~7~Cesspools / /Shallow pools / ~Other , / ' ~-?~cast sections: ,25 /Number~Square Ft. C~sspools: Block ~i~L incs. D ~ns.H PLOT ~Grade Indi :ate Tankl Capaclcy~ ,,,.l ?ne Un~ers~gnea CERT!FVE. S: "Construction of authorized installations ~c,~ordan,~e with ,~he ou~zol~ County Heal,~h DeL:~.rtmencs current S~anda~s, Bul~etlns, ar.d amendments thereto, Covering Priv~e~e ~posal Systems". ' -.: .......... ~;.~:~.5~¢,. USE ON~_. Based on the ;nIo~aa~on presented here~th, zt is the c:inion cf the Health De~rtment, that an adequate and satisfacto~ Se~ge Disposal System .... se ~no~-ea on this Plog. APPLICATION FOR BUILDING PERMIT ~4 ~J Date ........ ~"~'".../....~.. ................ , 197~.....~...~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 3 sets of plans, accu~;ate 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 area giving a detailed description of layout of property must be drawn on diagram which is part of this application. 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 e Building Permit to the applicant. Such permit shall be kept 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 un;di a Certificate of Occupancy shall have been granted by the Building Inspector. D to the Building Department for the issuance of a Building Permit pursuant to the Building/Zone. Or.d.i~ance o.f .th.e Town of So.uthold, Suffo!k County, New .Y.ork, and otb. er appli.c, able Laws, Ordinances or Regulations, for tl~ const~ g~ bm!dings, add!t,.o, ns or atterat,?ns, or for removal .or demoht,on, a.s hereln.de~rlbed. The applica, nt agre .es to ..c?.m~. ~Mt al~ical~e law~, !; ordinances, budding code, housing code, and regulations, and to admit authorized Inspectors on premises and ~n bu~ldmgs for neces~ry inspect, ions. ~ (Signature of applicant: or name~ if a corporation) ~ [~A r~g:~E'~'*''* - ................. i ......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, *electrician, plumber or builder. .B~f~.t,~b~.,~.~..~...~.,,,c...~.e,.~ ................................................................................................................................... Name of owner of premises '[~..~.9.f~.l~..L~..~....'[..Ij;.g,....04~,~...~...~,.~.~., .................. : .......................................................... If. al~olj~ant.~~ll~ a n~and ~i~' 'lo~f ~~i~ )is~ll corporate, signature of. duly authorized officer. ....... ~ Lot No.3..~..... [ 1~. Location of land on ,~ich propo~:l work will be done. Map No.: ...g~}~. ....... .; ............................. ~...Lot strut and N-mber .~,/~....~.~.~.~t~.~.r~...~.~....~.....~.t~t~_~T~......~ ..... ~. Stata e×i~tin§ um and o~upancy of pmmi~ and intend~l u~ and o~¢upan¢¥ of propo~l con,ruction: a. tx,~t,n~-~ and o~-~n~¥ . ...~...~.. ~O.~.,t.T~;'D/~. ............................. b. ~n~d-~ana o~upan~¥ ..Z.{..~.at~......~.,~.~,&....~.~,~)~..~}~.~.t..I..~ ....... ; ................ : ...... ~U 3. Nature of work (check which applicable): New Building; ............. ......... Addition ..................... AIteret~on ............... ' Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... i.(. ,Oessr pt on) 4. Estimated Cost ....... c~...~..~;~/. .........; ....Fee" ......................................................................... (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 ....~.,.'~'...(~¢~....~z¢~/~,~.~. ................... ,..-;-~ ................ ~ ......... ;..~ ....... ~-." ................. 6. If business, commercial or mixed occupancy, specify na~u~ and extent of each 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 . ............................... ... .. · ... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..!~.~¢~ .............. Ree~ 2..~...~2 ............... Depth .. ~.~....~...'~.. .................... .... ..o..;.'. ..... Height ............................... Number of Stories ..... .~.. ................................................................................ 9. S,ze of lot. Front ..~..~..~.,.?.~ .................... Rear ...~......~.,.~·: ....................... Depth ~....t}/.~...... -.- ........................ ..... .. 10. Date of Purchase ...... ~.. ................... Name of Former Owner ..'l~.~l~o..'[~d[~{~..-'.."..-'- .......... ".'." .......... " ..... 11. Zone or usa district in Which premises are situated ................................................................... ; ................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.~.~.......~ ...................................... 13. Will lot be regraded -.~ ........................ Will excess fill be removed from premises: [I/J Yfis [ ] NO 14. Name of Owner of premises .~[1~ L~t.'~.~£....~.~.....,~;~ff..~.~....~.~'~.._~....~~ · (Phone No.) (Address) Name of Architect ......~ ~ .~; ~..~... "D"~-'~"P~"~ "~.'a~i;~';;[ ................................... ii~;3' ~'~3 ............... . Name of Contractor ~,J...I-Z~....~-gw~.....'~.~g-~c...~-~..~i~*;~-s.). ...................................ilyl~;;~.~,i ............... PLOT DIAGRAM I,ocate clearly an~l distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property ines. G ye street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) SS COUNTY OF ......................................................) (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or ha~s I~rformsd tbe said work and to make and file this al~lication: that ell statements contained in this al~lication are true to th~ h~st of his knowledge and belief: and that tiaa work will be ~ssrformsd in the manner sst forth in the application filed therewith. ....................... of ........................... CxI'~RING ToN 75 R:22.00' L:~90' Unaufhoffzed alteration or addition to this survey is ~ V~ola~'~D 9f section 7209 of the New York State Education L~w, Copies of this su~rvey map not bearing the land ~uweyor~s lr~ seal or embossed seal shall not be considerecJ to he a valid copy. Guarantees or certificaflons indicated hereon ~hall run o~ly Ca tho person for whom the survey is prepared, and on hi~ behe[E fa the title company, governmental agency and lending in~Jtutioo ll~t~:J hereon, and to the assignees of the lending in~ltution. Guarantees or certifications are not transferable to additional institutions or subsequent owners. dOB 38~ SURVEY OF LOT 59 6 MAP OF NASSAU POINT CLUB Fi/ed' May 7, 1926 No7806 SEO~ D A?Z' NASSAU POINT- TOWN OF SOUTHOLD SUFFOLK COUNTY~ AL. Y. I WILLIAM G. MEIER J Surveyed: I I - I - 7"2 Wodmg Rtveq N. Y Lend Surveyor Scoie: t" = N. Y Stere License No 21656, Mop NO.: 723201 // and water zuppl7 location have ~n~ General Engine~rin~ SEDATE 0 7-6-73 GUARANTEED TO: -0o $OUTHOLD SAVINGS BANK ~_ USLIFE TITLE ~NSURANCE CO. of N.Y. Z c,A/¢,~/iVG T'oiv R=22.00' 'L: 55 90' / / Unauthorized alteration or addition tO this survey is a section 7209 of the New york State Education Law seal or ~bos~d s~l ~h~ll no~ ~e con~Me~d ~ ~e a valid Guarant~ or cedificotion~ indicated he~ Sha~ ~n ~ly ~r~n ~r whom the su~ey is pmpa~ and o~ his b her~n, and to the a~ign~s of the I~i~ JOB $85 SUFtVEY OF LOT 59G MAP OF NASSAU POINT ClUB F/led- May ~, 1926 No:806 S~'C~ O AT' NASSAU POINT- TOY/N OF SOUTHOLD SUFFOLK COUNTY, N f FOR CAf¢0£ PETERS ! WILLIAM G, MEIER ] Surveyed: I t - I - 72 Wading River, N Y Land Surveyor Scole: I" = 30' N. Y State License NO. 21656 Map NO.:72~201 APPROVED AS NOTED --I 4.,, 4.4 o '1 '¢ "=1:o' Z'4