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Home My WebLink About6734-zTOWN OF SOUTHOLD BU~.nING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z '7 ~0 e ~.~ Date ~J U h l E I.,~ lg.~..~. ~IS CERT~S ~st ~e b~d~ l~st~ at ~?~ .~.~ ~?~.~.~... ~ V.~ S~ Map No ............ Bl~k No ...... ~ .... ~t No. ~ ~ ~- ~ ................................. co~o~ subst~ti~ly to ~e App~ce~on for B~d~g Pe~t h~fore ~ ~ *h~, o~ce dat~ ~U~( ~ ~ ...................... , 19 .... p~su~t ~ which B~g P~t No. ~T.~ dat~ d~L'C ~T 19.~, was ~su~, ~d co~o~ ~ ~ of ~e ~ men~ of ~e applicable pro~sio~ of ~e law. ~e occup~cy for w~ ~ ~ca~ ~ ~ ~ ........................................................................ ~e c~ica~ ~ ~u~ to ~ ~ ~ H E ~ ~E ~ ~ ~ 0 ~ ~ (o~, 1~ of ~e ~ores~d b~d~g. S~o~ Cowry Dep~tment of Hed~ Approval ~/.'~ .1~.~ ..... ~. ~. ..~.~ ~ ~T .~ ~.. U~T~ C~ZC~ ~o .... H .... ~. ~. ?.~ .~ P. ..................... HOUSE~ER I~o S~t L ~ ~a~ ~V~ ..... Building Tn.~-~tor ~OUI'HOLD, N. Y. mG PERMIT (THIS PERMIT MUST BE KEPT ON THE P~.EMiSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6734 Z .......... ~...~.~,Lg,t, .......................................... ,~ ~.~;L~B,. ~.~...m~e... ~'~t~...d~e:L3.tn~ ..................................................................................... at premise~ located at %e~,.b~. ...... ~erln~t~...~,~Z'ew ....................................................................... ........................................ J, ee~d,..ll~i~m ......... 8etz~m eZ~ ...,l~ ,-2., ............................................. pursuant to appl{cat{o~ dated ......... .. ................... ~kt,],~ ....... ~.'~....., 19~.~..., and approved by the Building Inq~tor. Building Inspector FOlt,~ NO. $ TOWH 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 DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. 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 far the building. 5. Submit Planning Board approval of completed site plan requiremen*.s where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex/sting" 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: ]. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ..... ~Addition ................ Old or Pre-existing Building ................ Vacant Lend .............. Property .. 1..~.].~......~..~/~'.~. ~.l~.J~ ...... ~. ~/~......... ~ ~..~...~. J'j..~. ~, ...~..y ....~./.;. ~.. .......................... Location Of Owner Or Owners Of Property .....~...~....~/,.-~ ..,~........~.,.....~'./.~./~./'~../.'..(..~.,.Y.~.., ....................................... Subdivision ...L,~--~.eK.A../~.~......,/~F.~.~_~ ............. Lot No....~...~... Block No ............. House No..I.O.U..t2 Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval .... ~....'T...~i~...-...$.~..~.. ........... Labor Dept. Approval Underwriters Approval ....~.~F~/..~./.'~"J~..;. ..................... Planning Board Approval ........ ~ ........................ Request For Temporary Certificate ........ ~ .....................Final Certificate .......................................... Fee Submitted $ ..... .~....~...0.. ................. Construction on above described building ~,'~ets~ ~J~ ~ ,codes,~end regulations. Sworn__,_~to before me this ~/ ~'/' /~......~. da of " ./.. ~'2;2~"~;bli~-.~...~ · C,~I f '" '~?'~'~ ........ '..~..Z/ (stomp or seal) ~O.~_~ ? O~ 7--~/iV, '7' ... ....... unty No. 52-0344963 Suffolk Coun!~.~ Commission Expires Mazch 30, Jg~ THE NEW YORK BOARD OF FIRE UNDERWRITERS *-~' BUREAU OF ELECTRICr~e* ' '-- 35 JOHN STR~ET~ NEW YORK. NEW YORK 10038 THIS CE I~I'iFIES: THAT. ' · ndfound ~o ~ in compliance ~ith th~ r~luirements of thi~ · 77 3? '27 26 i' : M ~CONN~'T S II '?uz'maces: O!1 1-L/~.{hp, 2-.I/12hp TIM! CZOCK$ C '.~B~x"I~03, Souna Avenue, ~attltuck, L.~.. 11952 ii SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference %PPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant.) Phone 5. Subdiv.'~ : " Address ~, ~' ~ ~ ~ ,~ '., ~.. 6. Section ,' , 2. Property locationj,~ 7. Lot No. -v~ ' ~ - ' .... ": 8. Private well Village' ,, .~, '~ Township ~ ~ ~ C~ 9. Public water 3. Public Wafer Company name . Distance to main ,, Lot size: Width, feet Length ~f~ feet (Enter on center Sewage Dispos~System: . / A. al on septic tank. Precaat_ Z._ quivalent Bloc B. ~aching pools: Number'~--Preca~lock Special Street The undersigned :ERTIPIES: "Construction of authorized be in accordance with the Suffolk ards thereto." Date plot below) If private well fill in blanks below: Tank capacity .~Gals. Pump G.P.M." ' '-/ Total well depth__ Depth to G.W. Amount of water in well Test Hole tr~¢) Ilata ~. Feet · : .-~,_ ~..., 0 ;~ ,,,'~'- 2 4 ! 6 ~ 8 ~ 10 ~ 12 14 16 18 installations will County Department of Health's current stand- ,,/ .' '7 Signed . Ow'ner' or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate Disposal System can be installed on this plot. Date ~/_~/~ ? Signed C __ ~ and satisfactory Sewage S-iJ Revised 4/1/72 om, ....... , ,, ........ r~ ~.....LL.~ ....... ~p .................................. .ppr ed ..................... ................................. ............... ~ ., ~,F F ~il~i~ I~or) ~A ~A"- ~ ~1~ _ ._ _. o. This o~licati~ must ~ co~letely fill~ in by Ins~tor, with 3 ~ of plum, ~cum~ pl~ pl~ ~ ~le. F~ ~o~i~ ~ ~h~ule. b. Plot plan showing location of lot and of buildings on premises, re at ohship to acrjoin ng premises or pubic stree~ o~~ areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this ppplicat~on.~ c. The wOrk covered 'by this ppPli~ati0n may not be commenced before issuence of Building Permit. d. ,U,pon?pp .m, Val of t.his alapl~,~t. ~on; th? Bui ..l~g I,nspoc.tor wil! issue ,a Building Permit to the applicant. Such permit~ shall oe Kept on me premises available mr ,nspection mroughout ~ne WORK. . e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy(> shall have been granted by the Building Inspector B .A,P,.PLIC~ATIO~N .(S HEREB. Y MADE to the Building Department for the issuance of a Building Permit pursuant to the uualng :one uralnance at 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 law% ordinances, building code, housing code, and regulatiOm, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of app State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner - builder Name of owner of premises ...~.~.~D~I,Q~..~.~.~'~.:~.~..O.~g~... If applicant is a corporate, signature of duly authorized officer. Builder's License No ..................................................... Plumber's License No. Steele Electrician's License No ............................................. Other Trade's License No ............................................... ~'-~ 1.Location of land on which proposed work will be done. Map No.: ..L..e..e..l(.a...~.~....A..o...~..e...~.....'... Lot No. L~ Street and Number ........ ~W&:~..D3::LT..el ~l:7.U,~O'i~, ......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exi~iting use and occupancy v&oant o~ ~.~q~.l ~ 1 b. Intdnded use and occupancy ............... .,7'......~.q...~;~t~t ............................................................................ o 10. 11. 13. 14. Locate clearly and distinctly all buildings, whether exi~tine or nmnosed and property I'nes. G~ve street and block number or descr ption~accor~din-~g to'deed whether interior or corner lot. Nature of work (check which applicable): New :Building ..~ ...... Addition .................. Alteration ............ :~.,~. Repair ................. Removal .................. Demolition....; ............... Other Work ................................................ . ..... (Description) Estimated Cost ..... .~. 1~..0~....O. .--+ .... Fee . 8~. ~..~.~... ........ (to be paid on filing this application) If dwelling, number of dwelling units ...... .o.~.9. ............... Number of dwelling units on each floor .. .......................... If garage, number of cars .........~r.Q ...................................................... If bus!ness, commercial or mixed occupancy, speCify nature and extent of .each type of use ............................ 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 ................................ Dimensions of entire new construction: Front ......... 2.0. ...................... Rear ....... ~..0. ................ Depth ..~...~../.. ....... ~6.... Height Number of Stories ode Size of lot:, Front .....1.:LI~ ............................................ Rear .......................................... Depth .....~.1].._.+_ ............... Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated "Att (1:[.st, Does proposed construction violate any zoning law, ordinance or regulation: .............. ][O,~ .................................. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes (Z) No Name of Owner of premises ~.~...~.~'~.~.~t..o..~..~. ....................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ...... ~,f~ ............................................. Address ................................ Phone No ....................... PLOT DIAGRAM indicate all set-back dimensions from and show street names and indicate See, file(1 Plans STATE OF NEW YORK_ [,, COUNTY OF ....... J~.Ig,~ Q~J[ ........ .. ~t,el;~hen Pe~eo~e ............................................................................................ oemg duly sworn, d~oses and soys t~t he is the applicant (Name of i~ividual signing contmc~ above name. He is the ............................... ~e~..~..~.~ .............................................................................................................. ' (Contractor, agent, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed the said work ~d to ~ke and file this application; that all statements contained in this application are tree to the best of his k~owledge and belief; and tha~ the work will be ~rformed in t~e manner set fo~h in the application fil~ therewith Swam to before me this . .. 2 f... 73 ' ................... ....................... ............... ........ j ........... .............. ~i~nnture of ~pplic~nt) ' TERRI ~E E~K ~T~Y PUBLIG, State et ,,~:'~ No. 52-6168gS~ Qualified in Suffolk Goumy ~mission ~p[res March 30, lg REVISIONS MAY 15, 1973 JULY 3, 1973 NO TE: · -' MONUMENT SU~OI¥1$1ON MAP F/l-EO IN THE OFFICE OFTHE C~E~KO~SUFf'OI~ ¢OUNTYON dUNE 4,19TI A S FIL~' NO. 5599. YOUNG & YOUNG 400 OSTRANDER AVENUE, ~'IVERHEAD, NEW YORK ~,LDEN W. YOUNG HOWARD W, YOUNG SURVEY FOR: STEPHEN PERRICONE LOT NO. 48," LEEWARD ACRES .'r BAYVIEW Y/~~~-~"~"~.~r ~ ·, ....... o. II ~~;~:~ ~ 00. ..... SOUTHOLD SUFFOLK C0., N.Y. ' I = 50 APR. 10, T~E Z, OCATIO,¥ OF WE~,~$ )~ND CE$$PO0£~ SHOWN HEREIN ARE FfiO!4 FIELD OBSERVATIOI~ .~¢DIO~ F~OM DATA ~BTAIr(ED F~O~,~ OFtIER$ NOTE: · -' MONUMENT SUOMVISION MAP F/LEO IN THE ~UNE 4, ISVI AS FILE ~. ~. . R~V,E,ONS YOUNG & YOUNG i MAYIS, 1973 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK JUCY ~,, 19T'5 FElL 28,1974 ALDEN W. YOU'NG HOWARD W. YOUNG SURVEY FOR: STEPHEN PERRICONE LOT NO. 48," LEEWARD ACRES AT BAYVIEW" GUARANTEED TO: AT BAYVIEW GUARANTEED TITLE DIVISION OF AMERICAN TITLE INSURANCE CO, TOWN OF SOUTHOLD SI~PHEN PERRICONE SUFFOLK CO., N.Y. SCALE: I" : 50' DATE: APR, 10,1975 ~ -3,1~' " ~k, LL 5L ~ - o4Lo NOTIFY BUILDI~JG DEP,~RTMEN/ 765'2~60 gAM TO'4PM FO~ RE~UIR. 2- BEFOR~ COVERIN~ PIPELIN~ 3.~ ~ NA'L WHEN J6B II J -1 ~0'-0'[ ,I '1.