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Home My WebLink About6431-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No... ZUI~.~ .... Date 8opt i17 19.?~. THIS CERTIFIES that the building located at ...~ll~...~..~. ~ ........... Street Map No. ~. ~e~. Block No ........... Lot No. ~ S~ ~,~* conforms /~bstantially to ~e Application for B~ld~g Permit heretofore fil~ ~ this office dated~'~// ...... ~... 2~.., 19..~ p~suant to which Building Permit ~o.. ~.~.~. dated /.? ........ ~ .... 2~.., 19..~ was ~su~, ~d conforms to ~1 of the r~uire- men~ of ~e applicable pro~sions of ~e law. The occup~cy for which ~is certificate is ~sg~ i~,~.. Private..o~. ~$~ .~1!~ ...................................... ~[ ~,'~, · .................................... ; .................. ~he afOresaid building. Suffolk County Department of Health ~Approval (owner, lessee or tenant) UNDERWR[TERSCERTIFICATE No... t.11;~..0~.1 .~..~..~.0 1~.3 HOUSE N uM',BER ..... 560 .... Street... ~' .]~.~.~.1~.. ~ ............................. Buil~ling Inspector / , FOll~ 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) N? 6 31 Z Permission is hereby granted to: · .tlm'~...We~'l.s..-..,~/{]-..A~e~..tt~ ................. ............ 8aut~ho.ld ................................................. to ..h,,~ '~ &.z~aw..~rm..fm~t~...cl.well~.~ ................................................................................... at premises located at .-Let,..~ ...... ~&.]/-.l/,a~/e~..~..,~o~i~].4 .................................................... ........................................ 2a~..il~ve~...I,e~e .............. ~e~th~td. .................................................... pursuant to application dated ...................... ]~4~ ........... '23 .......... , 19...~t~, and approved by the Building Inspector. [(OrZ~t 2 Sets pla~s dttee Fee $~'~'0~ ........... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. 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 . .A.~..=~.~..3..0.~..~.9..8.~ ........ ............ Vacant Land ............. Addition to building ~[];~/w~3~ ....~ ......... Old or Pre-existing Building Location of Property . .5.6..0..~.a.~..H.a?.e..n..~.a. 9.e f..S.o..u. ,t~..o.l..d ................ House No. Street Hamlet Agnes Elizabeth Hart Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section . 88 Block 4 Lot 2~ Subdivision.. ~ Haven at $outhold .Filed Map No. 2910 .Lot No. 29 Permit No ........... Date of Permit .......... Applicant . .~9.~.~s,..~.~.~.z..a.b,e.~.h., .H.a.r. ~ ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... × Request for Temporary Certificate ..................... Final Certificate ...................... ~u0 e ' 1,00 I~ F eSubmltted $ .............................. ~ 'l~' {' Constructlononabovedescnbedbulldln an m S . l!~l~I '1(~\\0 .... g ~n~ neets~l a~plijFal~e~3Oi~es and regulations. ~ ~ / ~> ~pp,icant . .t.~x'. ,~'..C~_.~/~,'j~I,_~...~/. q'..~,~5'. ~"'wCr,.-~-~ ......... ...... Rudolp~'/~. Brue~, ~o~ney for Agnes Elizabeth Hart Rev. 10-10-78 FO~M NO. 6 TOWN OF SOUTHOLD Building Delmr~ment Town Clerks Office Southold, N. Y. 11971 APPUCATION FOR CERTIFICATE OF OGCUPANGY 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. 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 $1.00 $5.00 Date ........ ~.¢~ A ..~. 7.~..]. 2 ? ?J ............ New Building .........~. ........ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...... ]~a~T..~{a.vez'...~ze~..~a,~..JJ~'v'~ns..,.~e.~.+,,b.~.,~ ........................................................ Owner Or Owners Of Property .....A.~ ..~....s....~.~.J...~..~..b..e...~......~..~?,. .......................................................................... Subdivision .... ~.~...~.a,.y.~,.s~.~..~.C~.l~t,~Q],~, ................. Lot No ...... 2,9... Block No ............. House No ............. Permit No ...../:~Z~ ..... Date Of Permit ....~/2.~.?.~.Applicant ....... A~..~a,:~ ............................................ Health Dept. Approval ........ ~ .............................. Labor Dept. Approval ................................................ Underwriters Approval .......... ~ .............................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ~....0..0. ............................ Construction on above described building and permit meets all applicable ~:gdes and regulations. ....... ....... ....................................... Sworn to before me this Notary Public ...... .S...~.. ~.9..~.. ............... County ~'~m'y Public, State of Ne~ yark (stamp or seal) SUFFOLK COb~TY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: 1-Applicant h//~'l,~l'~ ~£zz-s PhoneT{~-$7~ 6-Sub div Address ~/~ ~6 .~ /~/~¥ ~-~ /¥, ~7-Section H.D.Reference Date 2-Detailed property location / 8-Lot No. ~ ~ Hamlet Town_57/~//~D c ! 9-Private well?//~-3 3-Public w~ter supply name /~ Distance to nearest main 4-Lot Size: Width/~-- ft. Len$~h /~o--ft. (also enter on center plot plan below:) 5-Dwelling: Singl.e Family ~ ~ Two Family? ! 3 Cellar? ~ /Slab? ~ f Crawl Space? 10-?oposed system. Septic tank f /Prec~_/Cesspools Y /Shallow ~ools ~ ~Other / / ll-oeptic tank insi.de dimensions. Volume~t/~als.Length. ft. Width ft. Liquid depth ft. 12-Precast sections. /.9/Number~Square~. Cesspools. Block sizeL ' incs.D ins. H ins. Total blocks below inlet: PLOT PLAN Street L/ / ,%fade G ~W.L. Capacity ~ Gals. ~e Data Feet 2 ~ - 6 12 Indi No The Undersigned CERTIFIES: "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". Date ~-/~- Z~ Signed Owner or Bui~d~r 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 7/~F?'~ ~ Signed - ~ ~ (~0/65 ~evis.) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , ........ Pemit No ..................................... Application No...~....~...~./. .................. Disapproved a/c ......... ~ .................... ~ __ (Build~spector) APPLICATION FOR BUILDING PERMIT ~ Date ...... . .~..a..r..q .h....~.~. ,. ....................... , 19...7.~. ..... 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 and 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 whicl~ 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 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 have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zon 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 applicable 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) Ba Haven Southold NY (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Name of owner of premises ~,g"0.~l..]~..~,k"t~ ...................................................................................... If applicant is a corporate, signature of duly authorized officer, k (Name and title of corporate officer) 1. Location of land on which proposed work will be done Map No · 2p~Q / Lot No ......25... Street and Number ........ ~r..~.y.e.D.....7~..e.,...S..q~.t~],¢, ................................................................................................ Municipality 2. Stat,e existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy ................. ~5..Va.t,e..?~o~ ......................................................................................... ~ 3. Nature of work (check which applicable): New Building.......................X Addition ..................... Alteration ............ ;.. Repair ......................... Removal ......................... Demolition ........................ Other Work ................................... Fee ....~.:...~..~ .............................................................................. 4. Estimated Cost ........~.2. ?. ~ .0. ~.....(~.. ................... (Description) (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 ............. .1. ............................................................................................................................. 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 ........................... Oepth ................................... 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 ...... ~. ............... Rear ....... ~ ................. Depth ......... 2~ .................... Height ................................................. Number of Stories ....... .~.. ............................................................................... 9. Size of lot: Front .....1.2..~ ............................ Rear ........ ~ ............................ Depth ........ .1..2.~ .................................... 10/ Date of Purchase ....2.~..1./.7~3. ..................... Name of Former Owner ...... ~/..~.]~..i..~...~...~..e.~.~..s. ............................................ 11. Zone or use district in which premises are situated ........... ~.s..i.~.e.~.t..i.~..l. .................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ~.0. ............................................ 13. Will lot be regraded ~Q .......................... Will excess fill be removed from premises: [ ] Yes ix] No 14. Name of Owner of premises ......,~...e..s....~.,....~.~ ............. ~:x~f2~o.-Ld. ................................. .~,~..~Z .......................... (Address) (Phone No.) Name of Architect .................................................................................................................................. (Address) (Phone No.) William Wells Name of Contractor ....................................................... ~.o.~,~,~. ....................................... ~,~ ........................ (Address) (Phone No.) PLOT DIAGRAM ~.ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. //3 STATE OF NEW YORK, ) COUNTY OF ..........S.H~'~.9~],~ ............................. ) .............................. .,~.~.~:.]:~a~..,.~..?.~,.1..s. ............................................. being duly sworn, deposes and says that he is the applicant above named. (Name o£ individual signing contract) He is the Builder (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, ~,is_._ ~-k~n~IgAedge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ~-~"~ .~,~cl~ ............ ................ d,y of ...........' Notary Public, ~...~......~e~,~,C~o~u~ty ..................... .~, ,~,,~.....,~,,-.~ .................................... ~ (Signature of applicant) $C/RV'EYED FOR. )Z~SA/E~ ~LIZA~E7';~ /-!A~T' SEP '~ 4 1973 #,~. -,/._.¢.~." dJ - ~ ..... ~. D. REF. and water supply location have been /