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HomeMy WebLinkAbout6461-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. gr~'~26 ...... Date ..... : .........0at; ....t6 ...., 19..7.3 THIS CERTIFIES that the building located at Ya~a~. La~e ................. Street Map No.l~oos.~..CO.V.~. Block No ........... Lot No..~.k .... .C. tlgohague...I~ ,~f., ........ conforms substantially to the Application for Building permit heretofore filed in this office dated ......... }4,9,r...~2 .... , 19.7.3. pursuant to which Building Permit No. 6.~'~d.. dated ........... P~n.l?$~ .6. .... , 19.7~., was issued, ai4d conforms to all of the require- merits of the applicable provisions of the law. The occUPancy for which this certificate is issued is . .Pri~a~:a..one. ~.amLq,y..dwa].ling ...................................... The certificate is issued to ... Cha,~].e$..a. L,i31da. ~h~]eI' ........ 0~nex'~ ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. 0O.~. '.. 1 ~..1 973.. Dy .R,..V.:t,l.~a... UNDERWRITERS CERTIFICATE No. -1~. ~ $7921+ .... 0e-~; .2.. '1-97] ................. HOUSE NUMBER . .2~ ......... Street .. ~.a;cn. l~an~ ............................. ...... ........ ~ '~ Building Inspector ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6461 Z Permission is hereby granted to: ................. Bo~....~ ................................................ ...................... ~s~o~ ..................... i .............. to .~_t].d ne~ o~..~.$,J,y ~.~e~l],.fJa¢ ....................................................................... at premises located at ../~3t,..~. ........ .~-~ .............. Neoee.. -~<>~,e ......................................................... ................................... ~.a.~.]~.,s ............ .Cut;eho~'tte ......... :~ ~,Y.. .................................................. pursuant to application dated ..........................,~17......1.2- ......... i", 19.~..~..., and approved by the Building Inspector. ; Fee $~,,.~.~. ........... APPLICATION TOWN OF $oG'rl.lOt. D~, Building Department : Town Clerks Office $outhold, N. Y. 11971 FOR CERTIFICATE O1~ OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and st~bmitted 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 seW~erage 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 th'e Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plod requirements where applicable. B. For existing buildings (prior to April 1¢57), Non-conforming uses or buildings and "pre-ex'st'rig ' land uses: I. 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 o 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 ...~ .......... Addition ................ Old or Pre-existing Bdilding ................ Vacant Land .............. kocotion Of Property ........................................... ) ........... ~_ ......... ~ .............. ~. ............................................. Owner Or Owners Of Property ..~...~D...F)..~...~.?`.".~`~L`.~`.~.~.~."~`~..~...~....7~.~..~.. ...................................... Subdivision ..0.~..¢).c~.,~...~........C¢....O..:.4...~. ....................... Lot No....~'..,~.... Block No. '-- House No..Lq'....~..?.~ Permit No ..................... Date Of Permit .................... Applicant ..~L~..~k3...~........~..:....~..TC..'I'.C).'~....C~......~....rd Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......~ .............................. Fee Submitted $ .................................... App lica nt .~...~~........., 4~. ~..~.. ................................ :;.,~ .................. Sworn toz~,before me thjs ~3--/~'~';'of.~..~,~/,~x ?' ' ' , ~ '~ ..... ....... Notary Public ~~ ...... County (stamp or seal) FOP~I~ NO. 6 TOWN OF $OUTHOLD Bultding 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 s~bmitted in DUPLICATE to the Building Inspector with the following; for new buildings or new dse: 1. Final survey of property with accurate location of ali 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 compleled site plan requirements where applicable. B. For existing buildings (prior to April 7957), 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, pccupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildiF, gs 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 ..... .~...q~.~.....~...~..., ..~....~..."l'..~. ..... New Building .....~. ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property.....F../~. t_~ k3...................._ _--~m""~"'"k0"F~'~"" . ........... .C, L~.'~...~...~....<:z)..<~j~ f-~._ ................................ Owner Or Owners Of Property ...~.~.%....~1....~....~.....~...~.......?.....~....\'"~:~'".~.~ ............. .~.~..~..~....~.....~...~ .............. Subdivision .....~....O. fD..%...-~........~...o....'-2...~.. ............... Lot No ....... Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant ... ............................................................... 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 qppli~:a~e co,es and regulations. Sworn ~o,/before me this · day of Notarv~ublic ..~,....~z.~;..,, County (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTH H. D.Reference A~PLICATION FOR APPROFAL TO CONSTRUCT PRIVATE S,EWAGE DIsPOsAL SYSTEMS Date Bka~c.~, Approval to construct said systems is requested,pertinent data herewith: · l-Applicant ;-. i~Cb~ ~'~6~r ~c~ Address ~¢,~ ~ , "~%a~-~C?~ ~3~y. % %~f9~ 7-Sectio~ 2-Detailed property location ,~ ($ ~kO~- ~ ~ ~,~L 8-Lo% No. Hamlet~.~% f', ~%~i~_ TO~ ~'~'[~ 9-Private well? 3-~blic ~ter supply name % Distahce to nearest ~in 4-Lot Size: Width%mc~ ft. LeJgth~%Q~P ft. (also enter~on center plot plan below:) 5-~elling: Singl? 'Famil~ ~Tw6 Family? / /Cellar? f Iplab? /,~rawl S~ce? lO-Proposed system. Septic tank ~recast ~esspo~ls ~hallow pools il-Septic tank inside dimensions. ~91~e~Gals.Length ft. Width f~. Liquid depth ft. 12-Precast sections: / ~umber~quare Ft. Cesspools: Block size~mncs. D tns.~ins. Total blocks below inlet: ~1 ~OT PLAN Capacity W~als, --1 O.P.M. The Undersigned CERTIF~S: "Constmction of authorized installations will be in accordance with the Suffolk County Health De~rtments' current Standa~s, Bulletins, and amendments thereto, covering Private Se~ge Dis~sal Systems". er -or' ~ Builder FOR ~ALTH DEPART~NT ,USE ONLY. 'Based on the infomat~o~ presented here~th, it is the opinSon of ~he Heaigh De~mon~ ~ha~ an adoquag, and ~a~sfaego~ can be installed on this Plot. Date 7~/~3 ( 10/65 ~evis. ) s-is Signed Indi e Nc .th Test n( ~ Dat~a___ ~eet 0 2 6 8 10 12 14 ~6 4. ,4,.f ~ , . - , . ,~. , . . -~ '"~ ,,, ~,~.o / ~ ~)~.~s-/ ~ ~ ~-~ ,,, ~., -' ~ ~ ~>. ~,-I~ o.~. j o i '- ~ DATE: ~ :,-, " ' , .- , ~ -: _ , , HERMAN H. YORK. ARCHITECT I ~~ ~ ~ ~ ~ ~ -- ~ ~ t~tT . , ~ . = _~_ ~ =, _~ . , . - I ~o ~ [ ',~ ~ ~¢0~r ~o~ 11 I ~ ~ --~ , ~ - --- ~ ~LI: ~ ~1I -- ii ........ Il , , _ - , ~ ,~ ~ __ ___ -~%:~ = _~- ~, . -.~ I ,_. ---: - ~ = ., ~ ~-~ ~ - ~ '11111~~/~-~~- ~~L~~~ ~.~., , . ~ ~ Ill . l ~ ~ ...... i ii I~ ~ ~:V:~lO.S: i ,HE[',MAN H. YOEK A~HITEQT D~WlNa NO~ e~ ~ ~o-04 I~1 ST.[ ~ICA ll~2~ NEW ?O~ i' "~ ...... il DATE: ONE FAMILY RE.GIDENCE blE~MAN H.YORE AD, C. HITEC--.T  IAICA I~2; NEW YO~[4. __ ~.:.~ ...... C-'Z?.4~, (N..T.) II . ~ ~/~", ~ 15~" ' ' ~~1 I I I ~, . ~' ~., S" i'1~'' 'l ¢1~ , a' IVY' ~' ~" I'~" ~ ~.I. I ~ i" ~~ . . . ~_~u.=:t~.~, . ,OTE: , ' ' " " . : / -' ~ ~, ~ ~ ~~-2;¢.;~ ~,~~.~ ~:.. ~ · ~11 , ~ llll lll'la~ ,~ , H ~l ~-- --~z ---- ~ ............ - · , ~ Im ; L~OqDqV.~ ~T - , '~; II i [ ~~m ]~.'-- I!~11" ~E'~ ~~ I · Z -. ~ ~,- ' i ' ~' L~ " ~ I ~~J ~,1 d ~.~, I~~L~ ; T~"~ ~'~.~ ~ ~ I . , ---~::i ~'4 ~ ,~ I,/,~, ~ - - -.~ ..,): I I I I ';/'~:~" - · - ,' - , ' , , ~ ,:,;~.' .- I ' ¢',%~//J :.J.,o.- NERMA~ N. YORK. ARCH TEOT ' ' ' ";"": ......