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Home My WebLink About6331-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z.~)6 .... Date ........... 0Or .... ~. ....... , 19.73 THIS CERTIFIES that the building located at .. lkLl'Ol~ .Roa& ............. Street Map No. I~slan4 .... Block No. ~ ....... Lot No .... ~ .... 80~12~o.~ .... I~.Y.,. ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ J~ · .5..., 19.72. pursuant to which Building Permit No. dated ........ j~ ..... ~ ..... , 19.72, 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 . PI~ .~. ~.1~..d~ll~l~ ....................................... The certificate is issued to ... I~I,~X ~k~n. ]gSn~,~l'.~ ..... I}!~®1' .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .0.~.~..1...~.9.7.~...b.~...Ii....~.~...1~. ..... UNDERWRITERS CE RTIFICATE No... ~[ .~10~5~0... X~. 7...19721 .................... HOUSE NUMBER.. 11,~... ,~,~I,1~¢~ ............................................. ......................................................... Building Inspector I~OB~ 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) 6331 Z Permission is hereby granted to: ~e~_.....A...W~e~.s ..................................... to ..~[.Z~t..e~e~..ene..~'e~..e~ve.~L. Muag .................................................................................... at premises located at ...:~l....J~[re,~.,~;~,d, ........... ~.~e~.~a~.¢~ .................................................. .............. i ............................... ~out~z~:l~t ......... lJ.~ ........................................................................... pursuant to opplicc~ion doted ............................. ~T~I~ ........ ~ .......... , 19f~.~ .... and approved by the Building Inspector. Fee $~e.~K)- ........... Building Inspector TOWN OF SOUTHOLD Building Delm~tment Town Clerk8 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. ,,....~--~'"'"~. 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 3ertinent 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 Date ...... .~... ~ ~L ..~..~....!..~. ~/.. ~ ........ New Building ......~...~. ........ Old or Pre-existing Building ............................ Vacant Land Owner Or Owners Of Property Subdivision ..,.~.~ ........................................................ Lot No. ~ ....... Block No.~ ....... House No...~.,~,!..~. Permit No ..................... gate Of Permit .................... Applicant ...... !?..~...~......~ ~..n..~...l~...j..?t,?:~. ......... Health Dept. Approval ...Q.:.~L....t.r...L~.~.~ ........... Labor Dept. Approval ........ N../.~..; ............................ Underwriters Approval ......... N..!...0.~..~..~ .......... Planning Board Approval ....~.....~,. ........................... Request For Temporary Certificate ........................................ Final Certificate ........ ~..: ......................... Fee Submitted $ ............. ~ ...................... Construction on above described building and perrpit meets all applicable ~odes and regulations. Applicant ............. !~.~.....~..~. ....... .~V~.i ..v~......~. · ·~. .................................. Sworn to before me this //'~.~/('/ 7~ ........... l.. day of ...~.....L ,~,.,.7,,,?, ........ (stamp or seal) ~'~-~-~/' ~'~ Notary Public .................................... County ~----~/'~'~</~ 7 ~' )'~- SUFFOLK C6UNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address %V f ~ . %a)~y 2. Property location ~wc~ ~ Village. Township 3. Public Water Company name 4. Lot size: Width~OO feet Length ~;~ feet 10. Sewage Die--stem: ~. ~allon septic tan~_ Precast~quivalent B.~aching pools: Numbe~_~rec~s~lock__ 5. Subdiv. 6. Section 7. Lot No. 8. Private well]/ 9. Public water /f%'~ Distance to main (Enter on center plot below) Block Special__ If privat~w~l ~11 in Tank capac~y~s Pump G.P.M.~ Amount O~ well__ Test Hole Data .:~ 4 Total well dePth._~O ,, Depth t~ 8 10 12 16 18 installations will The undersigned ]ERTIFIES: "Construction of authorized be in accordance with the Suffolk County Department of Health's current stand- ards thereto." ~ Date ~..~' ~ 7~ Signed i~d~ ~,~I'~'JC~'f Owner 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. Date ~/~?.~ Signed ~~ ~ S-15 Revised 4/]/72 S-446691-A SUFFOI~ COUNTY HEALTH DEPART~N~ The sewage disposal and water supplT facilities for this location have been inspected by this department and found~ ~ to be satisfactory Chief of General E~gineering Ali distances to wells and ~1~~ls a~ by ~ocation from house ow~e~ and fJe~ observations, since most wells and cess- pools are not visible tbe~e dime~siOll~ ELEVATIONS ARE REFERENCED 1'0 AN ASSUMED DATUM. Unauthorized alteration or addition to this survey is a vlelatlon ~ s.ctJon 7209 of the New York State Education Lew. Copies of this survey mop not bearing the land surveyor's inked seal or embossed seal shall not be considered to be a valid copy. Guarantees or certif~calions indicated hereon shaU run only to lhe person for whom lhe survey is prepared, and on his behalf to the title company, governmenlaJ agency and Jendlng institution IJ$1ed hereon, and to the assignees of the lending institution. Guarantees or certiflcalions are not transferable to additional Jl~tJlulJofl8 oe sub~equenl owners. SURVEY FOR MURIEL WINTERS AT SOUTHOLD TOWN OF SOUTHOLD S U FFOLK COUNTY, N. Y. SCALE'. I"= 30' DEC. 28~1972 APR. 16, 1973 JULY 25, 1973 SEPT. ~4, 197'J GUARANTEED TO, SECURITY TITLE ~ GUARANTY COMPANY· RIVERHEAD SAVINGS BANK MURIEI. WINTERS LAND SURVEYOR N. Y. S. L lC. NO 28 ?~5 RIVERHEAD, N.Y. ELE VA TIO NS ARE REFERENCED TO AN ASSUMED DATUM. Unauthorized aJferallon or addition to fhis survey i~ a viola!ion section 7209 of the New York State Educohon Law. SURVEY FOR MURIEL WINTERS /~T $OUTHOLD TOWIV OF SOUTHOLD SUFFOLK COUNT¥,N. Y. SCALE". I = 30 DEC. 28,1972 GUARANTEED TO, LAND SURVEYGle, N, Y. S. LIC. NO 2~ :'2~ RIVERHEAO, N.Y. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITYi ~'~ 85 JOHN BTREET, NEW YORK. NEW YORK 10038 o~1 Wlnter~, w/s Birch ~. Z35' ~w/o Weot lend nd., Southold, L.I. in thefollmving location; [] Basement [] Izt FI. [] 2nd FI. OUt S ! ~e Section Block Lot was examined on A U~, U ~ ~ ~ E ~ 9 7 ~ and found to be in compliance with the requirements of this Board. OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT VAFOR MERCURY DRYERS I FURNACE MOTORS I FUTURE APPLIANCE FEEDERS SPECIALREC'PT. AMT. K.W. OIL H. P. GAS H. P. AMT, NO. A.W. G, AMT~ AMP. SERVICE DISCONNECT J NO. OF J S E R OTHER APPARATUS: COOKING DECKS OVENS DISH WASHERS TIMECLOCKS BI~IJ. IUNITHEATERS MULTI-OUT~ET i ' ~ YRA . ,~ SYSTEMS NO. OF FEET V I C A. W.G. NO. OF HI-LEG A.W.G. NO. OF NEUTRAI~ OF CC. COND. OF HI-LEG Furr. acen: 1-1/Shp, 1-1/12bp Special .Receptacles: 1-30~mp~, 1-20am[~s EXHAUST FANS DIMMERS Of NEUTRAL Towle ~ Sons Inc. 33 LZncoln Avenue L~.stic Be~chE !~,Y. llgq! GENERAL MANA~R COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. BUILDING DE.P,A. RTMENT TOWN CLERK $ OFFICE SOUTHOLD, N. Y. ,~ Examined '""'~'"' ............ ' 19"~""~"' "~ Approved ~.........~.~ ........ ~.. ............... , 19 '~. Pemit No./~....~.....u...!. ........... .... Disapproved a/c .................................................................. _...~Z. ~__ / _____._ ~ ~ ........... APPLICATION FOR BUILDING PERMIT ~ Date .."~. O,.IA., ~ '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, a 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 Occupanc? shall have beeql 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) ................. t ....... ..................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~.~..Y.'.~..~....~.~.~ ...... ...~.....i~ ..................................................................................... (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ......................... Street and Number ........................ .~.~.....~.~ ................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. fixisting use and occupancy ....... .~.. .................................................................................................................. , ...... b. Intended use and occupancy ...................................................................... x:;..'?"~'":,' ............................................ .2" If applicant is a corporate, signature of duly authorized officer. 3. ? Nature of work (check which applicable): New Building ........ ~ ....... Addition ..................... A. Iteratio ...' ..... ~ Blepair ~,, ....................... Removal ......................... Demolition ........................ Other Work .................... ' (Description) ~ 4. Estimated Cost '...~../..., ..,.~....~7... ................ Fee ..... ....... ,.~. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..i..,:,~ .......Number of dwelling units on each floor ......................................... If garage, number of cars .........t.,...,= ........................................................................................................................... 6. If business, commemial or mixed occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Deoth ................................... 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 .../~.u~ .................. Depth .~.~ .......................... Height .... ~"~'"'"'~5~ ..................... Number of Stories ...... ~.~.~....~...~..~....j;~.L.~ .......................................... 9. S ze of lot: Front ...... )c.~,..:~,.~ .................... Rear ........ t.+.~ ............................ Depth .~[i..~.... ....................................... 10. Date of Purchase ..... '.~ ....... ).-.b. ....... Name of Former Owner ~' ' ' · · .ff ........... '*-*;'~4.4.4-~ ......................o ...................... 11. Zone or use district in which, premises, are situated. .......~[ ........ .; .................................................................................. 12. Does proposed construction wolate any zomng law, ormnance or regulation: .......... ~.~. ............................................ 13. Will lot be regraded .................................... Will excess fill be removed from premiss: [ ]~,.Yes [ ] No 14. Name of Owner of pren~i~. ..... ~.~I~:;~.~;.~:~;;;~;~?;~;~v.-~.~;~:~.J;;~?~?;~; ............ Name of Architect ....~.,.;.i...,.~.~;;=T..:...i ............. t......;..,..;;;.:~,....i~;~.~i,..../1.;...~.,?.....ff;;.7.....i[~o~l.~.~ ........... Name of Contractor ...~..~ .......... ,.....~ .............. ;...4. ......................................... ~ ......... : .......... 1' ..................................... 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, ) SS COUNTY OF ....~i ............................................... ) .................... ; ................. .~....!,.~.~..~,..,.....~,~ ....... :~.,~....,,..~,. .............. being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the .................................. ~. ........... :~..,~ ............................................................................................................................................................ {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 statements 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. T-ERRt LEE EIJ~K ..................................... ,4M~AI~ ~UaUC~,Stat*.al.~t~,~0rk ............... 19 .~.,/~D ..... No. 52-616~9§ ~"°u~t~ A ,' ,; '~ applicant} Notary Public, I I t) N E ×' C ,~ ~,/ A T-'Z'. L.,