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Home My WebLink About6731-zFOKM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. g6396 ...... Date .............Ap~.i ....9 .... , 197~.. THIS CERTIFIES that the building located at .. galtvard. Cnurt ......... Street Map No,alt. Ig~rd. ~ock No ........... Lot No..2 .... Ra.t.t :.~]~.. N.~9 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........J..u.~.~r .... ~.7., 19.7.3. pursuant to which Building Permit No. (~7-31Z.. dated ...........J.u.ly .... l~., 19.7.3., 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 . .P.r. $.~.a..t~...o.n.e' .f.a.m.f..~r..d.w. ?.~.~..~.g ...................................... The certificate is issued to David. Hog'ton ..... 0wne~ .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval &pl'~.~k .9. ~9.7.~. · by. .R,..V. il~l~ ..... UNDERWRITERS CERTIFICATE No.R ~069~ · · · Jan. ~.%.. ~ 9.7.~[ ................. HOUSE NUMBER ..... R6~ ......Street..g.$1s.t.~.a..rcJ...C...o~..t. ....................... Building InspeCtor SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Departn~nt Reference Number APPLICAI[ON FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~./-~0~ ~')~ ~tJ¢. Phone ~-~l.. 5. Subdiv.~ Address A/~J ~C , ~,.1. - 6. Section 2. Property Location ~./~ '~.~,,~z~..~ d~.~"Y 7. Lot Numb-~- 8. Private Well Village ~-~-llr-~. Township ~"(~y?~z)~-.J) 9. Public Water 3. Public Water Company Nan~ Distance td ~in 4. Lot size: Width ~ifeet Length ~' feet 10. Sewage~B~sposalx ~ System: A. ~O-~llon septic tank: Prec~'~ Equivalent Block B. ~_~aching pools: ~umber of pools ! PrQ~.as t ~(~1 ock .Special ll. I~riyate well, fill in the fol 1 owing blankS: A. Tank capacity ~/~). gallons B. Pump G.P.M. ~ C. Total well depth D. Depth to ground water E. Amount of water in well (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. FOR HEALTH DEPARTMENT USE ONLY. Basedon the information presented herewith, it is the opinion of the Heal th Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this p)ot. APPROVAL DATE ~ SIGNED ~111,11 S-15 Rev, 4/1/73 FORM NO. 6 TOWN OF SOUTHOLD Building DepoJtment 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: 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 .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..... . ..~...~.~....\...'~..~..~..~... ......................................................................................... Owner Or Owners Of Property ....~.....-......~..~.~.~....~........~..~..~ ........ .~..N~....~..; ...................................... Subdivision ~..~..~.~.~'...~...~.......~...~...~ ........ Lot No.....~. Block No ............. House No.....~....~...~. Permit No..~..~..~.! ......Date Of Perm, jr .................... Applicant ........................................ , ........................ Health Sept Approval ...~.... Labor De t A roval /~//~"~ ................... ~, ....................... p · pp ................................................ Underwriters Approval .............................................. Planmng Board Approval ...... /......~ .......................... Request For Temporary~CL~rtificate ........................................ Final Certificate ......... ~ ............... Fee Submitted $ .....~.. ............................. Construction on above described building(~e~rmit meet~_~ll ~al~codes end regulations. Applicant ,~.....'~.....~..~...-,,..~...~Z~.~.....~. ................................... Sworn to before me tl'~i~ ~ ~j~'/7~ ........... ~. day of ..... / ,d ,, , ~ , ~...~..~,.Z...~...~...~..~-. (stamp or seal)~~'~'ux~ ~'' Notary Public ...... ~~County~/////' ~_~c~~ SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICAI~ON FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~.~]~ ~'~ ~C. Phone ,..~-~'k. 5. Subdiv.~ Address b/b~ ..q'~c~,~ , ~J.,/ 6. Section 2. Property Location ~f~ '~-'~"r~J do~ 7. Lot Number 8. Private Well Village ()~l-~ (~-~¢~. Township ~'~?~ 9. Public Water 3. Public Water Companv Name Distance t~ main 4. Lot size: Width ~feet Length ~° feet 10. Sewage~sposal System: A. ~llon septic tank: Prec~l( Equivalent Block__ B.Leaching pools: Number of pools ! Pre,cast 1 ock Special 11. It~,~-~private well, fill in the following blanks: A. Tank capacity ~:~- gallons B. Pump G.P.M. ~ C. Total well depth D. Depth to ground water E. Amount of water in well (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date /-~_/_/_~.~ ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 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 and Water Supply can be installed on this p~ot. APPROVAL DATE ~//~/~ ~ SIGNED -- S-15 Rev. 4/1/73 ...... ........ . ....... / ~,,-ed ~.....~....' ........ ~.z ........ , ,~.?~. ~.~,,,~..L2.~Z...~.. Di~ppr~ o{c ,,, ,ix ...~ "~'. ........ .~ .......................... ,,~...? In~ector, with 3 ~ of plan~, accurate pl~ pl~ to ~le. F~ ~i~ ~ ~ule. b. Plot plan-~ng I~ati~ of lot ~ of ~i~ ~ pr~J~s, real,ship to ~jojn areas, ~d g,v~ a d~a!l~ d~r,~,~ of I~ of~ mu~ be dr~n on the dia~which is ~ ~f this ~lication.~ c~ ~ ne wo~ c~er~ by ~ a~!i.coti~ ~ ~ ~ comme~ before i~ua~e ,~.. ~ ~val ~s a~l~ ~ Butl~ I~r Will i~ a Bu~di~g:P~mit~to~he a~licant. ~h permit~ snau ~ ~t ~ me prem,~ ~an~m mr ~n~ m~t ~ ~rk. ,_ ~, ~No ~uildi~ s~al~ ~ ~c~pi~ or ~ i~whole or in ~rt for any pu~ whatever until a Ce~ fl~ ~ ~cu~y~ sna~ nave ~en gram~ ~ tne DuJloing In~lor. APPLICATION IS HEREBY ~DE to the Buildi~ '~ment for the issuance of a Bud ng Pe~it ~nt to T~U az~ns, Tar me co~rr~r~ ? ~a~f ~t~s or a~mhons, ~r ~or mm~al a r aumonz~ m~om on pmm~ a~ m Dui~l~ ~ ~ ~t~o~. ....... ...... .......... (Signature of applicant, or ~me, if a co~mtl~) ....... ~.........~~ ............................... (A~ of applicant) State whether applicant i~ lessee, agent, architect, engineer, e~ral contract~ electrician, plumbe[- or builder. Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Name of o~ner of premises ~..~..~...~m~... ~ ..~.~ .... . Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ...... .*~ .......... Street and Number .... ~..~..~J.~,~. ............ ~-~..~...~.'~... ................. ..' ......... .~~..~.~w~.~ ......... Municipality 2. State existing use and occupancy of premises and intended use_and occupancy O~ Pr°posed'construCtion: a. Exisiting use and occupancy ....... ~/,e.V..~.~ ......................................... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building ................. ,~ Addition .................. Alteration Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (Description) 4. Estimated Cost ....~...z:~.~..~..~.~.~.. .............................. Fee ..... ..~....~.......!...0. ................................................................... .. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ~. ................. Number of dwelling units on each flOOr ...... /. .................... f If garage, number o cars ............................................................................................................................................. 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 ................................ 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 ..... ~...~.. ..................... Rear ...... /~. ............. Depth ....~.. ............. Height .................... Number of Stories ..................................................................................................................... I 9. Size of lot: Front ...... ~.~...[ ....................................... Rear ............ /..~..! ............... ~... Depth ..e~..~.. ................. 10. .Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in whlch 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: (~1(~ yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .~.,../~:~/~........~.......~s_q~L~. ....... Address ..l~.......~....~-Phone No. ~..~..~...~.....~ PLOT DIAGRAM Locate clearly and d~st~nctly all buddings, whether existing or proposed, and indicate all set-Dock dimensions from ~:: property lines. Give street and block number or description acco~Jng to deed, and show street names and indicate whether interior or corner lot. £ STATE OF NEW YORK, COU NTYi~J~X'~'~'~/ ~J,~'~,-r~ ..................... ~ ~'~tk) ............ ~...~.~....,.t,.~L...~. .............................. ~....,being duly swo,rn, deposes and says that he is the 'applicanl '(Name df individual signing contract~ above named, r ~/~ He is the ...~ ..~....~....(~. ............ ~:7.~.~ ........................................................................................... (Contractor, agent, cat, rate officer, 'etc.) of said owner or owners, and is .du y authorized to perform or have performed the said work and to make and file this application; that all statemi~nts contained in .this application ore:true to the best of his knowledge and belief; and that the work will b& performed in the mann, er set forth in the application filed therewith. Swam Jo b~ore me this / -- · ,~- ........ J~.~..~..J/~.. day of ....... ...~....~....~....~.. ............. , 19.~.. Public,. ...................................... /_._ ...... County / /R~ignature of applicant) 200.00' SUFFOLK COUNTY HEALTH DEPARTMENT ~ ~ ......... t and found $1DOR Unauthorized alteration or addition lo this survey is a violation of section 7209 of the New York State Education Law. Copies of this survey map nol bearing the land surveyor's inked seal or embossed seal shall not be considered to be a valid copy. ~a~c.n '~ or c~rt;iiz~iions indicaled hereon shall run only Io the person, ~or whom the survey is prepared, end on his behalf to the title company, governmental agency and lending institution listed hereon, and to the assignees of the lending institution. Guarantees or certifications ore not transferable to additional instilutions or All distances to we Is a~l cesspools a~ by location from house owners and fieJa ph~e~vations, since most wells and cesSo pools are not visible lheSe dimensions cannot be certified. SURVEY FOR JERRY HORTON AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N.~ SCALE ' 1"~40' JULY 22,19;'4 REFERENCE, MAP OF EASTWARD MANOR FILED dUNE ~1. IS?l, FILE NO. 8UARANTEED TO, !AND SURVEYOR ~t:S° LIC. NO. ItlVER~EAD , I~ Y. '%, 't _A