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Home My WebLink About6322-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupnncy No.. ~.171 ..... Date ............... .~.... 3.0...., 19. THIS CERTIFIES that the building located at . .p~ .Re~d..1~. ($oMm .llll~reet Map No...x~x.. ........ Block No. ~ ...... Lot No..~OC. ~ttttUek..li,~., ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ,l~n.3 ...... , 19. ~3 pursuant to which Building Permit No.. dated ........... ~Ial~ ..... 3.., 19.~.3., was issued, and conforms to ail of the req~ir, e, --~ ments of the applicable provisions of the law. The occupancy for which this certificate is'- issued is ...P. r~.v.a..~,e. .o..~...f?.m. ~..].y..d..~..1.1.~.~.g ..................................... The certificate is issued to ....~. $~$.~..&...](J~l~...~3...g®.l~. ~ ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approvai I~.. 2~ · 4~7.~..1~..R~. ¥&11~ ..... UNDERWRITERS CERTIFICATE No...}[..~6819 .... lpr:Ll.. ~l[~. 1C~7~ ................ HOUSE NUMBER... ~. ...... Street .... .P3.~....R.q~.d. ~..9...(.~.0...hl~...R. 9.~.) ............... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~- Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6322 Z Date J'a~ttlt...~.. 3 19. ?.~ Permission is hereby granted to: ..... ~.,,.~,~...~..~.*.~...~..~....~ ...................... ............ .1.1.Q~Q..,q~ ......... ~.e ....... ~s~6~7 .......... l~att$ tuck II.Y, ~o .. ~.½.d....~.e...'...,,°.~,?...,f.~!½.~ ...d..,'.,?,,Z.,Z.,~..e. ................................................................................... I~/S PrSvate ltoad # (,Tohns Road) at premises located at ................................ [ ........................................................................................... ~4attStuek I~,¥ ~ pursuant to application dated ................. i ........ ..J....a~.......~ ............... , 19~,,~..., and approved by the Building Inspector. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Depai~ment Town Clerks Office SouthoJd, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 New Building b// Old or Pre-existing Building Vacant/and ............................ · ocatlon C~ Property .......................... .~...P..d....C ........... .~.~......./:~.....~..Z~.~.~....~. ..... ~ ......... .kt... ............. Owner Or Owners Of Property ........... [J. ......................................................................................................... Subdivision ............................... ..-~-.~ ........................... Lot No...'~'..-:;,... Block No.~.: ......... House No.......'--. ..... Permit No...~..~..~.....~=..... Dote Of Permit ....~..~..~..3.,..2.~..Applicant .~..: .~......v......./:~...l..~.~.-~.~...u...~......~....(;....¢..~...'~.... ~ ~- ~ ~ ~ -. . ....... .F...:.....~.... ......................... Heolth Dept. Approvol ............................................ Laoor Dept. Approval ~ ~& (~ ~ ~ Plann n" Boord Approval ~/ ' (~- Underwriters Approval ..............................................~ ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .r~....~ ................... Construction on obove described building and permit meets all applicable codes and regulations. ......... .............. ....................................... Sworn to before me this ~/~' ~O l ................ day of ............................................ (stamp or seal) ~,~7 / Pub,c .................................... Cou. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address 116~o $~a,¥0 ~,! ~q77v~ucq, ~W 6. 2. Property location ~u~rt ~,&~ o ~ ¢~ 7. ~ ~ ~,~ ~o 8. Village /~ ~?~-{~c~ Township ~o ~ ~'~ o l'~ 9. 3. Public Water Company name ~C Distance to main 4. Lot size: Width /~J,$~feet Length ~_~__~5~ feet (Enter on center plot 10. Sewage Dispos~System: A. /~0U gallon septic tank: Precast ~Equivalent Block Subdiv. Section Lot No. Private well Public water below) If private well fill in blanks below: Tank capacity ~Gals. Pump G.P.M. ~ Total well depth__ Depth to G.W. ~/z~ Amount of water in well Test Hole Data Feet o 2 4 ~/ 6 8 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date ~ ~/~ Signed ~...~e_--~/ ~ -r Owner or Builder installations will 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 ~ ~"~ ~-//~----- Signed ¢-- ~ ~ S-15 Revised 4/]/7~ Room 1'] Bath, Far~;ly 6024 3 Bedrooms Front Dinir 6024 4 Bedrooms Front D~nJng Room 1~ Bath 6024 2 Bedrcoms Front L{ving Room 2 Baths, Family Room THE NEW YORK BOARD OF FARE-UNDERWRITERS 8.~¢ BUREAU OF ELECTRICITY. ': ' :i 85 JOHN STREET, NEW YORK, NEW~!¥ORK 100381 -,,-. :::: N 190452 THIS CE~IFIE~ THAT ~y l~ e~t~ qu~/~ ~c~ ~ ~ ~t~ ~y 1~ ~t ~ ~ t~ ~ ~ht~ ~m~r iA l~ p~is o~ in rhe followlng Iocorion; [] Bosemenr [] 1st Il. [] 2nd FI. ol,~ t E ~ de Section Block Lot u~as e=cami,~a on (~C t, O b O ~ ~ ~1 ~ 10 ? ~I and /ound to be in compliance ,vitti the requirements of this Board. RXTURE LL~PTACLEsl WIT I FIXTURES I RANGES ICOOKmGDECKSl OVENS DRYERS FURNACE MOTORS FUTURE AI~UANCE FEEDERS SPECIAL REC P1 TIME CLOCKS BELL ~ I I & ;;':~''] ';-I~[:il.:'~:i''I'!i)~( ~ I SERVICE DISCONNECT ] NO. OF I S i R I C OTHER AF~ARATU$~ DISH WASHERS MULTI-OUTLET SYSTEMS EXHAUST FANE DIMMERS Moto~$~l-1/2hp Howa~ Dllltnzham ~attltuek,I,.~. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT . BE ALTERED IN ANY MANNER. ' z, oz~ z~o., TOWN OF ~UTHOLD~~ BUILDING DE~RTMEN~ TOWN CLERKS OFFICE ~UTHOLD, N. Y. ...................................... , .... Disopproved o/c .~.***~ ................................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This epplication must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~[ 3 sets of lans accurate plot plan to scale. Fee according to schedule. I' b. PlotPplan showing location of lot and of bud ngs on premises, relationship to adjoining premises or public streets or areas, 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 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 Zo~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constructiomo$ alterations or for removal or demolition, as herein described. The apphcant agrees to comply w~th all apphceble bu d ngs additions or ordinances, building code, housing code, and regulations, and to admit authorized inspectors on prem ses and in build ngs for necessary inspections. (Signature of applicant, or name, if a corpora ion! _.~ .............. ........................ State whether applicant Js owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ............................................................................................... Name of owner of premises ................................... .~... ........................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · . P'~/-~-,~ ~, 7- /~ 0 a. Ex~st~ng use and occupancy ........................................................ .'~... ............................................ ~r ..................... ~", !n~enaea use ana occupancy ...................................................................................................... · ........... 1. Location of land on which proposed work will be done. Map N~ ............ r...-..'"~'" .................... Lot No ......................... Streetand Nnrnher ~../~/'/A/.~ ~':'I~,,~Z) (,~,~'/K'~,.7'/...- 7z;~"/OI /uJA"'/7"I T'LJC.~ ........................................................... .......................... /" ...................................... .......... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... AlteratiorT,3.:....: .... Repair .................... Removal Demolitio Other Wok ................ (Description) 4. Estimated Cost ............... ,~., =,/,..' ".. .-- ............ 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 occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Del)th ................................... Height ........................................................... Number of Stories ....................................... ~ ..................................... Dimensions of same structure with alterations or additions: Front .......................... Rear Depth ............................................. Height .............. ,~-.,, ................... Number of Stories ........................................ 8. Dimensions of entire new .cgnstruction: Front ...... ......... Rear ..:. ...... ..........Depth ......~.~.. ...................... Height ........................ ~..../.....'~..."* ........... Number of Stories .............~..../~....~.~. ................................................................. 9. Size of lot: Front .......... .~/...~....~... ............... Rear ............ /...~....~.. .................... Depth ........ .J....~....~ ............................. 10. Date of Purchase ............... ,..:...,....-...-.. ..... Name of Former Owner .................................................. ..................... 11. Zone or use district in which premises are situated ........ ~. ~'.--q ~ ~ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................. ~...O. ............... ..-. .............. 13. Will lot be regraded ........... :..--u....~.~.. Will excess ~11 be removed from premises: [ ] Yes 14. Name of Owne o p ....................................... ~ ...................................................... .~.. ............................. (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No,) Name of Contractor ....................................................................................... ; ........................................................... {Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-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. STATE OF NEW YORK, ..~'L//::::~-~,/,- COUNTY OF ......................................................) ............................ .................. t ing duly *~orn, d~ and ~ that he i~ th~ applicant abo~ riled. He s the .......... .~..~.~.~ ..................................................................................................................... (Contractor, agent, co.rate of~cer, etc. } of said owner or owners, and is duly authorized to ~rform or have ~rfor~d the said work and to make and file this a~plication; that all statements contained in this application are true to t~ ~st of his knowled~ and ~lief; and that the work will ~ ~Horm~ in the ~n~r set forth in the application filed therewith. JUDITH T. ~O~N ............................... ~..day of ............................ ~ - ~ ' (Si~m~ of applicanO · · d/ a=WS,ONS YOUNG & YOUNG Dl~. ~/ /,r?~' 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG PROFEIJmlONAL ~N~]NgI~lq AND ~ND SURVEY FOR:' ~CF LESLIE ALGER a MINERVA A~¢,~,~.?o / MATT ITUCK u,c ~ ~JT~L~RA* Eq ). ~OWN O; OFN .EV,$,ONS YOUNG & YOUNG D~.. ~,,/,rTt 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ,'~'/J'~ /~ /fT~ ALDEN W. YOUNG HOWARD W. YOUNG PROFESSIONAL ENGINEER AND ~ND IURVEYOR ~' MATTITUCK TOW"O' ~UTHOLD I DATE: C T.