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Home My WebLink About6754-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy . THIS CERTIFIES that the building located at .. Dayton .Rd. ~ .I~,RQacl..~Q Stree~ Map No....xx ........ Block No .... ~ ..... Lot No. xx SOUthold N .Y · conforms substantially to the Application for Building Permit heretofOre filed in this office dated ........... .J..u!.y...2.3., 19..7.3 pursuant to which B~ilding Permit No..6.? .~..Z.. dated ........ Jl~ly. .... 2~..., 19.73., 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..t.v.a.}e...o.n.e., .f.a.m.i..1~..~.~..e.l.l..l~. g ....................................... The certificate is issued to . .,T..o..1~...F.a..1.i.o.n...&. ?.u.t.h..~ .a~. s..f.i.e.l.~ ..... ~..',~..e.r..~ ..... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .J..a.n...8....~.9.?~...b.;~..R.,...~.~.~..~. .... UNDERWRITERS CERTIFICATE No..P.e..n.d..L~.g ................................... HOUSE NUMBER ...~.6. ~.~ ....... Street ..... ~!o..~..t~..o..a.d.T.o...I~...Y?'.~.e.w. .............. 12~ Dayton HI) t Building Inspettor FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~l'4 CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6754 Z Permission is hereby granted to: at premises located at ...... ~)&~ll~dlll~.&..~eB~illt..lJeltll...~r~..~ir~W ............................................. pursuant to application dated ............................. il'~l~'"'~.,~ ....... , 19~3..., and approved by the Building Inspector. Fee $~11:~.~ ........... c~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ]-- January ~?) ~, ~.9~JOHN ST"EET. NEW YORK. THIS CE~IFIES THAT Southold, L.I. outside w~exami~don ~rltt;tPy ~ll~ ~7~ andfoundtobeincompliancewiththerequirementsofthisB~rd. RXTUR$ I I I F XTURES RANGES C~K NG DECKS OVENS DISH WASHERS I NACE MOTORS I ~URE *mlAKE ~E~RS ~KIALRKPT TIMECL~Ks I ~ lUNITHEATE~ MULTI~TL~ DIMMERS ~ OTHER APPARATUS: Water heater/s: 1-4.5kw .Electric furnace/s; 1-22.0kw 1-q 1/2 ton AcC. unit, l-1/]hp garage door opener, 1-10amp. garbage compactor W. B. Hul o~n d Mattltuck, L.I. Per ' ~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF $OUTHOLD Building Deportment Town ClerkJ 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 19§7), 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 $§.00 /~//~/~ 2. Certificate of occupancy on pre-existing dwelling or land use ate~$5'00. 3. Copy of certificate of occupancy $1.00 / New Building .....~......... ..... Old or Pre-ex, ling Building ...... ~ ................... Vacant Land ............................ Owner Or Owners Of . p y ...... ~..______...._._,............... .... Subdivision ................................................................ Lot No ........ .....~J/0ck No .......... ...House No ............. Permit No. ~...~..'~...Z Date~Of Permit ~_.~,-~kpplicant ~...(~.. /,;~--- ,.~~..~..~.~.......~...'~/~'/ ............... Heath Dept Approva /..c'_..~........Labor Dept Approval .................................... Underwriters Approval .............. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .... . ..~..... ............................. Fee Submitted $ 'L~'-. ~ Construction on above described building and permit meets all al~plicable codes and regulations. Sworn to before me t~,, ~ ~(~,c .~ C. 3 ......... L..~.. day of ..... ..~? ..-'Z~z........../..~.]..~... (stamp or seal) ,~,~-~ ,,5-? "~ Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~L~~ Phone 7~,~/~/0 5. Subdiv. Address ~0 C~~ f~~y_~ , 6. Section 2. Property~ocation y~J~l~'W#~.~..~)~7?_y~/~/~ 7. Lot Number Z~-}~ ~m~) 8. Private Well~ Village ~_~e~u]~l~-~(~([ Township_k_~m~ 9. Public Water'""-~ 7 - 3. Public Wa~er Company Name Distance to main 4. Lot size: Width ~m~feet Length ~ feet 10. Sewage~Disposal System: (For Health Dept. Use~ A. gallon septic tank: -j - Precast ~/rEquivalent Block B. Leaching pools: ,' ~ - Number of pools ~ ~/ ~ Precast[~ZBlock ~pecial 11. If 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 y~/~- / E. Amount of water in well / The undersigned CERTIFIES: "Construction of authorized installations willie in ac :ordance w!~ ?e S~fo~k County Department of Health's current standards thereto./This ap~ ication w~) De vam~d tor one year from the date of approval indicated below and ~ay be renewed if a current local Building Department Permit is in effect. Date ~//~/~ Signed~~ ~ ~=~===~====~ ............................... ~ .... -~ .................................. 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 pl. ot. C S-15 Rev. 4/1/73 TOWN OF SOUTHOLD/c2~v~ ~,~ //~ BUILDING DEPARTMENT~ ~ - ~-~ ~r TOWN CLERK'S OFFICE ~ ~ ~ ' ~ ~UTH~D, N.Y. -- . ~ ~ ~. ..~ ........... ~~%~~ ~-~, ....................................... ........ ................................ t.....~ ......... ~.~~eF~, ~- ............ ~. Thi~ l¢~li~tion mu*t ~ completel~ filled in b~ t~rit~r or in ink and ~ubmi~d in tripliea~ to the Bui d n~ n*~ct~wit~ . ~. ~lot ~lan ~howin~ Ioc~tiOn of lot and of building* on pr~mi~e~, r~l~tion~h p to adioinin~ ~r*mi~ or ~ublic *tr~ or ~wIn~ 8 ~t~il~ ~ri~tion of la~out of pro~rt~ mu~t ~ dr~n on diagram ~hich i~ ~ of thi* ~li~tion. e. T~ ~o~ ~md b~ thi~ ~pplie~tion m*~ not ~ eomm,n~d ~for~ issu~n~ of 8uildin~ P~rmit. d. H~n ~o~t of thi*a~li~tion, th~ Ouildinfl In~etor ~gl i~u* ~ Buildinfl ~ermit to th~ ~p~ rant. Such ~rm t *hall th~ ~mmi~ ~il~b~ for im~etion throughout th* work. ~. ~o ~fldi~ *h~ll ~ oeeu~i~ or umd in whol~ or in ~rt for ~n~ pur~ ~hat~r until a ~ifimt~ of O~u~n~ *hah ~r~n~ b~ t~ ~ildi~ In*~etor. ~klC~TIO~ IS Hfi~fi~Y M~fi to the 8uildin~ D*~m~nt for th~ issu~n~ of a 8uildinfl P~rmit ~ur~uant to th* 8uildin~ Zo~ Ordin~nm of ~ 1o~ of ~uthold, ~olh Count~, ~*~ Yo~, and other ~limbl~ kaw~, Ordinan~* or ~ulation~, for t~ ~n~tru~ion building, ~dition~ or ~lt~ration~, or for r~mo~l or d~molition, a~ h~r~in de,eri~. Th~ ap~limnt a~ree~ to compl~ ~ith all ~limbl* ordi~, buildin~ ~, hou~in~ ~, ~nd r~ul~tion~, and to admit authorized in~ctor~ on ~r~mi~s and in buiffiin~ for nee*~a~ (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~ owner of premises ~..[./.~.....,..~........~x...~.~....~/~~ ....... Name of If applicant is a corporate, signature of duly authorized officer. .............. ............... Imame and title of corporat~officerl 1. Location of land on which proposed work wil! be done. Map No.: ...~...~,,,.... J_ot No ........ ...~... .............................. Street and Number ~~..~~'~:~/~.....~...~~..~~ ...... / / / / MuniCipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~/.(,.-/¢~.L/a.~ ..................................... : ................................................................ 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 .....c~ ~- r~,_~,r3.~a..~...j.~..~...~..~.C~. ....... 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 .~.~...f. ............ Rear ...~.~. .................. Depth ..,,-~. ....................... O' Height ..... ~.. ......................................... Number of Stories ...~'~ .................................................................................. 9. Size of lot: Front ....~,~..~...~...,....d~... ............... Rear ...~.....~...~...:.~9.~. ................. Depth ..J...~..~..~....~). ........................... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of For[nerOwner.~_ ~ -D.'"~'"'q~7~~~(.... ......................................... 11. Zone or use district in which premises are situated ...... ./..~ ......... ......... .......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~',2~.~.. ............................................... 13. Will lot be regraded --..(,~t~O ...................... Will excess, fill be removed from premises: [ ] Yes [~[No 14. Name of Owner of premises Zf~,,~..~[:UTZ..~/..L.~.~.t..~ ............ j././,~./~..~..:~.(~.~,~.~F,~.. ..... ( (AddreSs) (Phone No.) Name of Architect ....... (Address)~ (Phone No.) Name of Contractor ..~~....~.~..~.. ....... ~...~....~..i~-~/,fffffff/~....~~..~.~.....~g9 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. ...................... ~~~'~ ................. being duly sworn, deposes and says that he is the applicant above named. He iS the .......~gn'ng c ~J~~ fl~__t_.__._o~~_.~ .........................'. .......................................................................... ~ (Contractor, agent, corporate officer etc.} of said owner or ownars, and is duly authorized to perform or have performad the said work and to make and file this application; that all ,;tatements contained in this application are true to the bast of his knowlad~ and belief; and that the work will be performad in the mannar set forth in the application filed therew~ t~} T£1tRi LEE ........................ ~......l..day of ......... ' '~'"'Y'"J:~"~'i[~[:J':? ~t~l'F'~$'~',~ ~'"x. ' - '~ { /~ I'~ ~JJill~liss,on Expires March 30, Notary Public, ..~.....~,~l~..~ ...... County ........... :...~..~ .................................................................... '4 (Signature of applicant} , AppR(~VEI~ AS NOTED NO'TIFY BUILDING D£PARTMENT