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Home My WebLink About6326-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi[icate O[ Occupancy No.Z~]!3 ....... Date ........... ~.~ .... ~ ..... , 19~3.. THIS CERTIFIES that the building located at ¥Olld,T. D~.iVO ............... Street Map NoROL~..l~g~ood Block No ........... Lot No.. I~O1~ · . .l~,l[, ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ .... ~ .... , 1~.. pursuant to which Building Permit dated ........... ~al~ .... ~l...., 19~J.., 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~'.~'ga.~....~.0..~..a~.. !Y. d~ll..J~g The certificate is issued to .0a~,l..&. Ca~lt ~l]l~almeh ...... O~ol'8 .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.l$1y. ~...~.~.~...by..Ry. ? .~.l!.a' ..... UNDERWRITERS CERTIFICATE No.. 11..'~O3~14,~. · · ~'11~...1.9.. ~.9~.3 .................. ttOUSE NUMBER. ~.O~ ........ Street..I!IO~.DII'.~'~ .................................. Building Inspector ( FOB. M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERY~QFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PEPJVdT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6326 Z Permission is hereby granted to: ....... ~.~.....~f...'g.~..,.£.~..'..'..~.....~'/~- ...... ~./.~.........g..e. ffA.....~...~.f.C!~.g.......~,e z/<~ ~v ~,,~ ~ ,,,, at premises located at ............................................................................................................................ .................~ ~ 5. ... .'EE... ... ..... ... .... .. .~"'~ ~"'..Y / A u ~ ~' z. pursuant to application dated ........................................................ , 19. and approved by the Building Inspector. Fee $......~..~.....~. Building Inspector FORM NO, 6 TOWN 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 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 dispcsal--(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 3. Copy of certificate of occupancy $1.00 New Building ....,~.i ....... Old or Pre-existing Building .......................... ;. Vacant Land ............................ Loco,,on of Pr erty ....... Owner Or Owners Of Property ...~....~.Z....~..,.'c ..~ .~......~.~...,~/..~.....~/...~..~...~.. ...................... Subdivision ........... ~.~.....~.... ............................. Lot No ............. Block No ............. House No...~....~...~? Permit No. (.~.,...-~......~.. Date Of Permit//.~/....~'...~....Applicant ................. ~ ................ Health Dept. Approval ~./..?.~./?..,~.........~.....O~..~.~.,~abor Dept. Approval ................................................ Underwriters Approval ..~...Z..~...~...?...~'..~... ............. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........ ~ ......................... Fee Submitted $ ............ ~ ................. Construction on above described building and permit meets all applicable codes and regulations. Applicant .... (" . ._. '~"~"~'~'~"'~' '~' '~'"" ~' ' ' '~ '~' ' ' ~ ~ ........ ./)/I ~ ...................... Sworn to ~efore me this ~ '~/' - "~'~(./ ~;~__~ ~ .~.~doy of ,~..ZZ~ ...... (stamp or sea~ ~/~[ Nma~ Public ..~~ ...... Coun~ ~ ~' ~, .~ bl~c, State o~ ~ew - Co~m~on Expires March 90, 19~ SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT ~Ri~,~.Y. APPLICATION FOR APPROVAL TO COMSTRUCT PRIVATE SEWAGE DISPGSAL SYST~HS Approval to construct said systems ia requested,pertinent data herewith: i-ipplicantT~A~ t~'~, '~.~g. Phone.~f-2~Jo b-Sub Address.9-~ ~r,.~& AA¢? _~,~,,//,, Al ¥ 7-Section 2-Detailed property location u37 ~q'~,,.,.I..~a 2'~'^}1.~ f~r~n... 8-Lot No. ~,~,a ~}u~ ~_~e! A,,? I ' ' - 9-Private well? 3-P~bl~c wate~ supply nam~ ~- Distance to nearest main 4-Lot size: Length/__~ft. Width/~F ft. (Also enter on center plot plan below:) 10-Proposed system. Septic tank/ /Precast/ /Cesspoo~$ha!]ow~peels/ /other/ il-Septic tank inside dimensione:Volume~O Gall.Length Ft.Width___ft.Liquid depth 12-Precast sections:/'~/Number.//Cd/Square ft.Cesspools:Block sizeL___ins.D ins.H Date / / PLOT PLAN Street Tan , Capacity.zF_Gals Test Hole IndiCate Nobth Data Feet 0 2 8 18 The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards,Bulletins, and amendments thereto,covering Private Sewage Disposal Syst~,-". F(I~ HEALT~ 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 ~ .~-~ ~'~. ( o/65 evis.) Francis ~(. Re ev, (~oc~) es, dr. Formerly ~°~v °~.W°ss°° NOTE: · = MONUMENT "~V,S]ONS YOUNG & YOUNG DEC /~)/~7~ 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: ~ OF . C ARLG. FA LKENBACH&CAR/ /~:,~,~M~~ G~RA~TO: ' ~T L A UR E L , sg~ffilT~ o~t~] Y c0. ~ COUNTY E~E~L SAVINGS Tow. or SOUTHOLD X~ SUFFOLK C0., N.Y. ay .. SCAL~: I" = 40' I~aTt: NOV. 15~1972 Francis ~e eves, Jr. ! NOTE: · -- MONUMENT REVISIONS YOUNG & YOUNG D~£ /~../.97-~ 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK · ~E~., ~/~7~ ALDEN W. YOUNG HOWARD W. YOUNG d~ /~/~ PROFESSIONAL ENGINEER AND LAND SURVEYOR SURVEY FOR: CARL G. FALKENBACH ~ CA~EN ~~ GUAF AN~EEDTP{~: '~ ~ ~ AT LAUR E L sEcu ITYJ flT~l ~D SUFF LK~ =OUNT ~L~IN, S & TOW. O~ SOUTHOLD L~ ~S~IAT~& J~ SUFFOLK CO.,' N.Y. aY '~ TOMARK CONSTRUCTION INC. 5250 SUNRISE HIGHWAY SAYVlLLE, NEW YORK 1178Z LT 9-2030 LIVII'~ I~D~A [h~Tl~¥ ~D t:f.P f~ LEI~ f,,tA~ LLf. VA"C I0/'~ FORI~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Pemif ..... Disopproved a/c ...................... ~ ............................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date /-- '~ 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 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 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) ........................... ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; .............. .................................................................................................................................................... Name of owner of premises ~'~z,~-/ ~ ~ ~*~-~ '~/~c& If ap,~cant is a corporate, ~nature of duly auth~?,~ized officer. ...... .......... (Name and title of cofp~l=ate officer) 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. , Street and Number ....... ~.~...~ ................ ~.-7.:.¢. ..... .~../.~.~. .... .~..~ ................ . Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy ...... ../.....i~...~..~.:'.~/~.......~.~..~.~..c~'...~...~.¢..~.. ....................................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 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 ..... ..~....7..../. ......... He ght ................................................. Number of Stones ......................................................................................... 9. Size of lot: Fr6nt ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 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 regraded ___~.~...~. ..................... Will excess fill be removed from premises: [ ] Yes [,V~] No · . ,~ (Address) ,.~ (Phone No.) {Address) ~ (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. / ?J. STATE OF NEW YORK_ ) COU.TY .............. .............. ........... ~,./.i.-~.~..-~-.,.Z~,,.~.,,..,..~£!/,:/~.~.~.../.i .................................. being duly sworn, deposes and says that he is the applicant above named. (Name of indiuidual gigning contract) (Contractor, agent, corporate officer, etc. ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all :;tatements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. da, of Na~ry Pub',c, ..:.:.~'.'~--~lO.,$2.'.?$2O$O..$~Gl~..Ceu.t,/County ..... ~....~J ................ ~~~ ...................... · ~ Term ~xplres iV, arch 50, 19'~ % (Signature of applicanO