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Home My WebLink About6766-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnle Of Occupnncy No. [976 ...... Date .............. .J.~il~...2~...., 19. THIS CERTIFIES that the building located at .. ~./$..0.r. egg~ .R.~t..d. ....... Street Map No..XX ......... Block No...xX. ....... Lot No....X:A~......l~.t..t.~.t..x~.k...N:.Y.o ........ conforms substantially to the Application for Building Pemit heretofore filed in this office dated ............ JU,].~..3~1., 19..?3 pursuant to which Building Pemit No..6.7.6.6Z.. dated ........ J..u~y .... 3~ .... , 19.73., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .Prl~a.?e...on.$..f..a~..i.ly..d.~.e.l.l.i.nl ....................................... The certificate is issued to ... Rchlr~;. lto~ehl ..... 0~er ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...l~.a~.. ~ .8...~..~..~....by..R. :.V~ .~..a .... UNDERWRITERS CERTIFICATE No..N..~ .~.~.~..~. ..... ~..t~..e.. ? .~...~..~.~.. .............. HOUSE NUMBER .~0~ ......... Street ..... 0re[,~n. Ro~d ........................ Building Inspector FO~M NO. 2 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 V~/ORK AUTHORIZED) 6766 Z Permission is hereby granted to: pursuant to applicatioq dated ................ ..~...1~. ....... ,~.1 .................. , 19~.~..., and approved by the BUilding Inspector. Fee $~.~.~. ?..~..~. · ......... ! ~ Building qnspector FORM NO. S TOWN OF SOUTHOLD Building 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 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 alt buildings, property lines, streets, and unusual naturat 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 eccupancy $1.00 D te ...... ..... Owner Or Owners Of Property ........... ...~...; ...... ~.~...../~ ................................................. Subdivision ................................................................ Lot No ............. I~Aock No ............. House No ............. Permit No..~..~.~....~...... Date Of Permit ..~/...~.././~..~....Applicant .... ~...~..~......~ .......... ~'~'~ !..~../.~.~.~....Labor Dept. Approval ................ .~......!.¥.. .................. Health Dept. Approval ................ ./ ........ Underwriters Approval ..... ~...,..~.~,../..~.~...~.. ....... Planning Board Approval ........... ..~/...:....~... ................ Request For Temporary Certificate ........................................ Final Certificate ..~ .................................. Fee Submitted $ 5 ~ Construction on above described building and pe~/~eets/~ll r~p~l, icab. le cad_es;nd regulations. Applicant ....... ..~.~~....... ~ ................................... Sworn to before me t~s ....... .2day of .......... Notary Public ..... ~ ........................... County (stamp or seal) THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ! 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date J?dl~(~13R 1974 /~pplicationNo. onfile 6994O1 164923 THIS CE~IFIES THAT N only t~ e~t~ ~u~m~p~ ~ ~ ~ t~_ b~ appq~ ~ ~ the ~b~ ~pl~atton flum~r in t~ premiss of iathefollowinglocation; ~ nozementX~ ]stFl. X[] 2nd FI. OtltS~Ld~ Section Block was examined on J urge 10 t 19 7 4 and found to be in compliance with the requirements of this Board. Lot FIXTURE I E i FIXTURES OUTLETS EC PTACLE5 SWITCHES INCANDESCENT FLUORESCENT )~v~~Y 40 59 Z 40 DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS A~T. K.W. OILi~ H.P GAS H.P, A/AT. NO. A.W. G, SERVICE DISCONNECT [ NO. OF I 150 CB METER. S . RANGES iPECIAL REC'PT E COOKING DECKS OVENS DISH WASHERS AMT. K.W. A,V~T. K.W. LMT. K.W. I 1 1.S TIMECLOCKS BELL ]UNITHEAFERSUNITHEAFERS MULTI-OUTLET I I V I C E EXHAUST FANS DIMMERS AMT. WATTS OF CC. COND. z/o NO. OF HI-LEG OF HI-LEG OF NEUTRAL Box ^3 Reeves Para Riverhead, ~.Y. 11901 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CtKrltmCATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPRO~AL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS~. Date Approval tn constr~ct said systems is requested,pertinent data herewi~n. 1-Applicant f~ ~[~ Phone~2? 3v~-~6-Sub div Address U,~ ~ f~ ~ ~.~ 1l~33 7-Section' Z 2-Detailed prope~y~ lo~ationO~ ~ ~~ ~ 8-Lot No.I -- Hamlet ~1 ~ ~ Town ~J~ 9-Private well? 3-Public water supply name Distance to nearest main 4-Lot Size: Width 3do ft. Length~f~ ft. (also enter on center plot plan below:) 5-Dwelling: Single Family l~Two Family? ~ /Cellar? ~Slab? ~ lCrawl Space? 10-Proposed system. Septic tank l~Prec~'-/CesspoolS ~Shallow pools / /Other / / Il-Septic tank inside dimensions: V~lume~$~Gals. Length ft. Width ft. Liquid depth ft. 12-Precast sections: /f/Number~_~sqUare~. Ceaspools.~-~Block sizeL incs. D ins. H ins. Total blocks below in~-~: ~l ~2 $3 / ~-~ ~ PLOT PLAN Street ~ .~ 3oo ,O ! G ~ade Ind~ Capacity~Gals. --1 G.P.M. Z~ ~te ~h Data ?eet ~ 0 ~ 2 4 3 6 12 18 --- Nc The U~ersigned CERTIF~S: "Construction of authorized installation: will be in accerdance~th the Suffolk County Health Departments' current Standards, Bulletins, and amendmehts thereto, covering Private Sewage Disposal Systems". v ~ ~ ~ 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. Date 7~7~ (10/65 Revis. ) s-15 Signed Disapproved o/c ~ INSTRUCTIONS a. This application must be completely filled in by typewriter aP, in ink and submitted in triplicate to the Building~ Inspector, with 3 sete 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 of areas, and giving a detailed description of layout ofproperty must be drawn on the 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 been 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 appli...c~ble Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demohtion, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ...... (Signature of al~ii~ant, or frame; if a corporahon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Lic~se No ..................................................... Plumber's License No ...... ~.~ .................. Electrician's License No .................................. Other Trade's License No ............................................... 1. Location of land on which pr_oposed wOrk will be.dona. Map Ng._.' .~--~.....,~....~... .......... Lot No ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Intended use and occupancy ............. ~.....~.~......~ ................................................... 3. Nature of work (check which applicable): New Building ...... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... t: b'~ ~," ~) , /.~, ~. ~ (Description) 4. Estimated Cost .................. y ........................................ Fee .................................................................................... (to be paid on filing this application) 5. If dwelling0 numl:~r of dwelling units ~ ~' '. ......... Number of dwelling units on each floor ~. .......................... If garage, number of cars · .. ~ · . .i . .. 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 ............................................................................................... ..~.....~... ........... 9. Size of I(~.' ~ront ........................................... ~ ....... Rear ....... :..;~ ............. dCL.~..~,,~l...~ te~ ............................... 10. Date of .Purchase ....................... ~ ............................ N~me o,f~r~.Owner ........................................................ 11. Zone or use district in which premises are situated ....~'..~ ...... !...'~....~..../..~... .......... ; ...... ~.~,..~ ..................................... 12. Does prOPosed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be ~re~radecf .................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...~ ................. ~ ....... ~.~ ............. Address ................. , ........ t Phone No me of Arch tect ~.~ ~ ~ __..k' .....~.. ['. ............. Address~..~ .......... ~...~/PPhone No. Harn.e of Contractor --..~..~. ', ~ Address ~;~'~'~ ..... - ": ...... ; ......... "-'?/' .................................................. ~none mo ....................... Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. COUNTySTATE OF N E~L~,'~v~~..,~.?, ~ ................................................................................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing controcf) above named. He is the ................................................................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the ~ work and to ~Ee ~nd file this application; that all statements contained in this a~lication am tree to the best of his knowledge and belief; and tha~ the work will ~ performed in the manner set forth in the application filed therewith. Sworn to b~re me this : ..................... .......... , Not~ Pub c (Signature of ~pplicent) JUD~ T, BO~ o~6°~ ~0 ~O o SURVEY FOR ROBERT ROWEHL AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N.~ SCALE I''=40' dULY 6, 1973 DEC 6, 1975 TEST BORING RIVERHEAD~ N.'f SURVEY FOR ROBERT ROWEHL AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N.~ SCALE I'~40' JULY 6, 1973 TEST BORING i ' VS~ $obLb LO~'I) ~i"~i~IUG Co~vC. 4,LK. - -~ AP[~O~VED AS NOTED ED INSPECTIONS: 1 BEFOR~ BACKFILLING F UNDA- L~F ti c'- 'F .i / IS'- ~"