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Home My WebLink About6750-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No..Z. [99.~. ..... Date .............. ~l~-y... ~.0. .... , 19.7.3. THIS CERTIFIES that the building located at ...E/8 .$~'unk. I~ .(]~ay .lv} Street Map No.. l~ss,-.F~s Block No ........... Lot No..$07 ..... gutchohu~.. ~.~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~uly-..161973. · pursuant to which Building Permit No..67.~(~. dated ......... July" 21+ ..... , 19 ~3" was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pr.~v~te. or~. $am~.ly. dwel ~ ~ n_~ ...................................... The certificate is issued to L~Roy. l)e~lot.t ..... Owner ............................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) .,/u. ~.C. II ~. ~.~ ~ ...... .1~.. ?.~.~..,-..~. UNDERWRITERS CERTIFICATE No.. ~] 67~ · · · J.u~e..2~. ] 9~ ................ HOUSE NUMBER ....~27~ ...... Street .... Skunk. La~e .......................... Building Inspector / FOBM 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°. 6750 Z Dote ........................ ff'l..Y~ ....... ~ .......... , 1~ ...... £ Permission is hereby granted to: Ge.o=&e..~b~e~.s.. Ru~d~=...I ne .....J~.a..~e~.oy De~Iott ..... g.ut,.c~.~e ..................................................... at premises located at ~.°.~...1..O.~......~.~.~.~..~.~,T.~.JI ......................................................................... .................................. ~J~..~lga~..Iama .......... Cutchogua....~.:~. ............................................... pursuant to application doted ......................... ,,T.~. ....... .1.~ ......... , 19.~.., and opproved by the Building Inspector. Fee ~..6...,..~...0. ............. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerk~ Office Southold, N. ¥, 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 opprova~ of completed site plan requirements where opplioable. B. For existing buildings (prior to April 19§7), Non-oanforming 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 .....6. /. . .]. .2. /. .7.. ~. ........................... New Building ....... ~ .......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~.~../..S.~.S.~.~..u..~.~.~..a.~.~.e.~.C.~.u..t.~.c..h.~9~i[.u.~.e.~.N.~.¥.~ ......................................................... ~ner Or C~ners Of Property .~L~.,...~....I).e.lV~a.t.~ ...................................................................................... Subdivision ................................................................ Lot No..~.0.'{..... Block No ............. House No ............. Permit No...6...7..5..~..~.. ...... Date Of Permit ..7./...2..~./.7...3...Applicant .G.~.e~.~.~.e.~.A..h...1~.e...z`~.s.~.~..u.~.t~..d~.e.?.~.[.~.~.~.c~.-~ Health Dept. Approval 6./..[...[./..~.~...?..3...-..5..0...-..8..1~. ...... Labor Dept. Approval ................................................ Underwriters Approval .~...]..~.'/..2..?..6.....6./...2..~/.7..4.. ......... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........X ................................ Fee Submitted $ ...':~...... ........................... Construction on above described building and permit meets all applicable codes and regulations. GEORGE AHLERS BUILDER INC. Applicant Sworn to before r~'~s ................................... ...-~,;-..,,.,......,.,......:...,,, . .....,_.:._..... .......... / .0, day o~....~',.~..7,...~, ...... "' /"7 ........... r 'r ' Notary Public .[~/ ......................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS ~,c su.E^u oF E'=C'~.'Cl~'' ~s Jo.. ST..T. N~W ~O.~..~ ~ ,OO~ ~ June N 1 67296 T~I~ CG~I~[~ THAT Out~ide ~7 ~ examin~ on ,~U~ ~ U.~) --X. ] fl a~found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKINODECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 31 UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET E R V I C 1 ~THER APPARATUS: Special Receptacle/s; 1-50a~p.~ ~/ater Heater/$~, 1-4.Skw. l~lec. Room Heater/s; 2-1.0kw., 7-.7~?~'., t..~otor/s; 1-1/2hp. Panelboard/s; 1-11cir,~ lOOanp. NO. OF CC. COND. A~ W. G. PER ~' OF CC. COND. ~/0 NO*OF HI,LEG OF HI-LEG 2-.Skw.) 1-.3Skw. NO. OF NEUTRALS 1 OF NEUTRAL l / o Leroy Demott 4 Nantucket Lane Oceanside, ,~.Y. 11573 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No~'jO - ~O~ EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval t~ construct said systems is requested,pertinent data herewith: Date.--?~'/~'~ 1-Applicant ,(,.,'l/~,,/_~if /( /,~; ¢ Phone /~/~6-Sub ~ Address ,~¢~ ~'~'"~/ ~ .~'~.r. ///~ ~/l~,,~ , 7-Section 2-Detailed ~ro~e~%~ ,Iocatxon ~/7,~/// ?~ ~i ~ ~ . 8-Lot No. iff Hamlet / / ! ~//? ~'/z,/-~ / Town ,~//~/~" 9-Private ~ell?~/~ 3-Public %rate9 ~suppl~ na~e' - Distance to nearest main/ 4-Lot Size: Width~j~_ft. Lengthier/ft. (also enter on center plot plan below:) 5-Dwellin~: Single Family ~Two Family? ~_/~ellar? / /Slab? ; 10-Pressed syst~: septio tank L~ Precast ~Ce~s~ols ~JShallow ~ols ! /Other ! il-Septic tank inside dimensions: Volume~/f/? Gals. Length ft. Width ft. Liquid. depth ins. H incs. D 12-Precast sections: ~JNumber~.~Square Ft. Cesspools: Block sizeL Total blocks below in~et: ~l ~2 PLOT PLAN Street ~A y ~ l/Y- / ins. Capaci~__Gals. · G.r.~. O-- 'ad~ Indt The Undersigned CERTIF~S: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments there%o, covering Private Sewage Disposal Systems". Date ~/~/7~ Signed Owner~r~or ~Builder 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. ~./// . Oate Signed ~th Data Feet ~ I 0 2 6 8 lO 12 ~ 16 18 (10/65 Revis. ) Disopproved o/c ............................................................................................ APPLICATION FOR BUILDING PERMIT ~.~ Dote. ../..~.. ..................... , 19..?~...-~.......~'\ 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 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 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 beer~, granted by the Building Inspector. ~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone 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) , (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ Name of owner of premises .... .~./~x..~~...~~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .................... Lot No ..... ./...~....~.... ........................... Street and Number ...... .~.~...~.~,~ .............................................................................. i ................ .... Mun cipa, 2. State existing use and occupancy of premises and intended use and occupancy-of proposed construction: a. Existing use and occupancy ....... ~. · g~/-~-~, a:~.. · ~~~. ........................... b. Intended use and occupancy ..... ..~.....~J..~ 7: ................................................................................. 3. Nature of work (check which applicable): New Building .,....~... ............. Addition ..................... Alteration ................ Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) Estimated Cost .....'~.~--q~.,..~..~.~.~. ........... 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 ...../. ...................................................................................................................................... 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 .......,~.....4~..~...~...././..... Depth ..~.....4~...~....~...~. .......... Height ....... ~..~ .................................... Number of Stories ..J. .................................................................................... 9. Size of lot: Front ..... .~...~...:. ....................... Rear ...... ...'~...~..~. ......................... Depth ......,~.~...~.~.~...- ............................... Height .....~.../. .......................................... Number of Stories ./.. .................................................................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ....... .'".'~:i ...... "--..P...!...~.....~.... .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .,~. .................................................. 13. Will lot be regraded _.~-.~ ....................... Will excess fill be removed from p[emises: [ ] Yes ['-']/No 14. Name of Owner of premises/.~,,/.~r,.~.....~r......y2?...~.i.....~2f...../~.~:~...~...~...~..~.~-- .~r~ ,~,-~ .~ ---- ....... ..,__ _ ______Z~/~.--.¢.....~.;~.,~,/,w~.. (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ~~.. ~.~. ........ ~...'~...;.~.~...~..~..4/-'-'-'-'-'-'-'-2~....~t~-~..~.C..~. ~/ ' ~Addr'ess) (Phone No.) ,~,~ PLOT DIAGRAM Locate 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. COUNTY OF ............. ~/~..~..~......c. ................ ) ................... ~~...~ ............................. being duly sworn, deposes and says that he is the applicant above named. ( Nam~ of indi,idual signing co~ . He is the .......................................................... ~ ........ ~ ......................................................................................................... (Contractor, agent, corporate officer, etc. } c~ said owner or owners, and is duly authorized to ~rform or have ~erformed the said work and to make and file this a~p}ication; that .;tatements contained in this a~plication are true to the best of his knowledge and belief; and that the work will be ~rformed in th~ manner set forth in the application filed there~th. TERRI .......................... ~.. ........ day of ........ ~--7...~: ........ ~- .............. Notary Public, ~.,.**~..~.... County .... ~...~ .............................................. ~,~5~.~ ~ (Signature o/applicant/ P/NE TREE ROAD LO! 106 107 NOTE; · = MONUMENT SUSOIVISION MAP PLIED IN TNE OFF/CE UNAUTHORIZED ALTERATfON OR ADDITION TO THIS SURVEY PS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATfON LAW COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKEO BEAL OR EMBOSSED SEAL SHALL NOT 6E CONSIDERED TO BE A VALID TRUE COPY REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVF¥ FOE: LEROY DE MOTT LOT 107 "NASSAU FARMS" TOWN OF SOUTHOLD SCALE: I" =40' DATE: dUNE 20,~d~86 ' TITLE NO. S-277550 ~ PINE TREE ROAD N. 82° N,82 Lof UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY iS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION 106 107 Lot 108 NOTE: · = MONUMENT SUBOIVIS/ON MAP F/LEO IN THE OFF/CE OF THE CL~RK OFSUFFOL~ COUNTY ON MAf~ 28~ 1~5 ~S M~P NO II 79 SHOWN HEREZZZ ARE FEO~ FIELD CBSEBVATI ~D/OB/"~0£4 D~2'zZ C31AZZZED i~2,0M OTH~ .~V,S,ONS YOUNG & YOUN ~,.~T-%- ~,,t~17~ 400 OSTRANDER AVENUE, dAN. 29,1974 PROFESSIONAL ENGINEER AND / /.~ LAND SU~Z~6R ~ SURVEY FOR:' []~,~ ~ ~''~ ) :, LE ROY DE MOTT 8 DOROTHY D~M~TT~ Z;~' / ~ mm mm ~ ~o~ moz N~SS~U ~R~S ~'~. ~/ / AT GUARANTEED~ PECONI C so~D SAVINGS BANK TOWN OF USUFE TI~E INSURANCE CQ OF N.Y~ SOUTHOLD SCALE: 1"=40' I JUNE20,1973 IN°' 73-486 ,i, ;AP~ EROVED ~AS NOTED '~ NOTIFY BUILDING DEPARTMENT 765-2EE0 9AM TO ~PM FOK ' ED INSPECTIONS: ~, BEFORE BACKFILLING F~UNDA- TION O~ STAKT FKAMING 2. BEFO~ COVEKiNG pIPELINE 3, FINAL WHEN JOB COMPLETED