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Home My WebLink About6336-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z. ~.1.~'2 .... Date ............. }t~y ....10 ..... , 19.73 THIS CERTIFIES that the building located at . t~Lii;IX .Dr. $.01~t~ .......... Street Map No. Go. lie. lleck Block No ........... Lot No. -~.9 .&. ~ ... $otltho~d ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ De~.. ~c~.., 19.7p. pursuant to which Building Permit No. 6336Z.. dated ............ $i11.. ~i$..., 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 . l~.iva.te, olle..f~:k~.y, d~.a?~ llllg ....................................... The certificate is issued to .Robert. Iiamillc~ .... 0vnel' ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... .&l~r..:J-.l, .49. J.~r~.3...b.y.. R.'..V.l..1.~.. UNDERWRITERS CERTIFICATE No. N..[~770~....KBT..2....1.~P~3 ........................ HOUSE NUMBER .... '[ ~[~C} .... Street... llmith. Dr.. 13~uth ............................ .... 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 WORK AUTHORIZED) 6336 Z Permission is hereby granted to: ......... .33.~6.....at...1.12 ......................................... ........... .~.a..f...o.~ ................................................... to .....~,~...~.~.~...~m~....f.~.$.~ .. ~,.~.~..],....:~. ................................................................................... at premises located at ..~1.....~.....&.~.O........~...g~....B..e.....~..$.q.~.....~...~..t,..a..~.~. ............................................... ........................................ ~..~a~.th..~.rA.va..aD~h .............. ~.~mtao2d. ................................... Building [ns~ector. Fee $.~.~ .~',,~ ........... FORM NO. 6 TOWN OF $OUTHOLD Building Depoffrneot 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 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 3. Copy of certificate of accupancy $1.00 $5.00 Date .....· .., ..,/~'..1~......~.. ................. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of ............................................................................. Owner Or Owners Of Property, ..... ~..D..~.~.,~ .~'.......,~...,~/./~.l./,,...Z".~..~... ............................................. Subdivision ....~...~...~...~. ~ ./..~....~..C.:..¥. ..... Lot "o.~/~.~ ...~.~. Block No ........ House ,o. · . Permit No.~..~.;~,~}.z.... Date Of Pe rmi, .I/,.J./.~.~'~...Applicant ..~...~.~...~...~.: ............ Health Dept. Approval ..~...../..../.~..ZZ.-~.. .......... Labor Dept. Approval ................................................ Underwriters Approval ~./~-~.../i...:~..~ ............. Planning Board Approval ........................................ Request For Tempos, fy Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...~. ....................... Construction on above described building and pe~r,,,mit meets/)~ll a~)plicobl~ codes and re~lX~lotions. Apphcant ........... ~... .......................... Sworn to before me this xx '{ If/~/~/~l [ 0 ( ? ~/,~ ................ day of ............................................ (stamp or seal) /~'I ~! ~ Notary Public .................................... County ,~ ),. ~ '7~z ~1 ~ WELL N 30° 30'W 'SUTFOLK COUNTY HEALTH ~DATE__ - _'The ~ewage .~isposal and ~te~ ~pplF , , ~ iTi.%'i~'~ ~or this lo~tiom have LOT 48 46' LOT 50 17126' / / / / '7" / / RED,A, TED: I - I0 -73 Z -26-73 346 ?3 4-13-73 TEST BORING ~su~/is a vldat/a, of section 7209 of the New York State Education Copies of this survey map not bearing the land su~myor"s inked seal or embossed seal shall not be considered to be a valid copy. Guarantees or certifications indicated hereon shall run oflly 1o the person for whom the survey is prepared, and on his behalf to the title company, governmental agency and lending institution [Mod hereon, and to the assignees of the lending institution. Guarante# or certJficatiofls am hal transferable to additional institutions or subsequent owners, 295" GUARANTEED TO: U.S. LIFE TITLE INSURANCE CO. OF N.Y SUFFOLK COUNTY FEDERAL SAVINGS AND LOAN SURVEY OF LOTS ~19 and 50 Fi/ed: Nov. ~2, 1948 MAP OF GOOSE NECK ~Te tva. 4ND DESCRIBED P~RCEL TOWN OF SOUTHOLD-SUFFOLK COUNT~ N.Y FOR: ROBERT 8, HAMILTON WILLIAM G MEIER S~ed: 8-2~-72 Wading Riv~, N.Y. S~le: I"= Land Sur v~or N.~ State License Ne. ~56 MOD NO. WELL 0 S. 30° 30' E. C) WELL LOT 8,3' LOT '19 ~ ~ ~ , 22546' LOT 50 WELL N. 30° 30'W. 171.26' LOT 50.4 48 / / / J / / / / REDATED I - ia / / DATUM ASSUM[D 295% alteration or addition to this survey is a violation of section 7209 of the New York State Education Law. Copies~of this survey map not bearing the land surveyor's inked seal or embossed seal shal~ not be considered to be a valid copy. (~amntees or certifications indicated haman shall run only to the parr, on for whom the survey is prepared, and on his behalf to the title company, governmental agency and lending institution lisled hereon, and to the assignees of the lending institution. Guaranteet or certifications are not transferable to additional institutions subsequent SURVEY OF LOTS 49 o.d 50 MAP OF GOOSE NECK FHed' Nov. 22, 1948 F.,le No. 166J ~NZ~ Z~ESCR/BED PZIRCEL TOWN OF SOUTHOLD-SUFFOLK COUNT~ N.~ FOR: ROBERT B. HAMILTON WILLIAM G MEIER Wading River, N.Y Land Surveyor N,Y State License No. 21656 SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No, APPLICATION UR APPROVAL TO 1. appxxcan.~3 . ,',, ~ , ,, _ 2. P~ope~ty location,~ , ~ , .., 7. ....... ~ ' ...... ' 8. Private well :' ''/' ~-~ VillagF'~ Township... ~ 9. Public water ~ 3. Public Water Comp~ name ., 7 / Distance to main~ ~ 4. Lot size: Width/ feet Length feet (Enter on center p~t bel~) 10. Sewage Dispos~ystem: ~ ~ ~m A. /~00J gallon septic tank: ~ecast Equivalent Block ~ CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Subdiv. Section Lot No. in blanks._ be.~ Tank ca~".acity-~~ Gals. -- Pump G.P.M. Total well depth Depth to G.W. f~ 'Ahount of water well Test Hole Data Feet 0 2 ' 4 ~ 8 '~ 10 12 14 Street ~" 16 18 installations will stand- The undersigned :ERTIFIES: "Construction of authorized accordancec be inthereto.- with the Suffolk County Departm th's current ar ds /~'/ Date ~i "'"'~C~ Owner or~B~l--der 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 f/~ '~ Signed ~ S-15 Revised 4/1/72 TOWN OF SOUTHOLD . ~ ~ V. -~ BUILDING DEPARTMENT · · ,:n~.C./_.r..~__,c~' -- TOWN cLERK's OFFICE ~%¢~'~'~7'~,~,6~-.-/x ~..--~'~ ~"~: SOUTHOLD, N.Y. ~,~'~'--~',,'~,,m~-,~,7 ,,~4.~,~,~ ~-~ Application No. (g~...~.. .................... APPLICATION FOR BUILDING PERMIT A '~'~ Date .......... .~... .......... ~ ....... , 19 INSTRUCTIONS (~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 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 progress of 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 hove 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 deL-nc~itign, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building cede, housing code, ~J regulations. (S'gnature of applicant, or name, if a comoratioD) :::.. ................... ............... State whether applicant is owner, lessee, agent, architect, engineer, e~ contra-c~o~r electrician, plumber or builder. If appl/i~.~a/~rp, orate, ~ig.nature of/~uly authorized officer. (Name and title of corporate officer) and on wh ch proposed work be done Map No ~ 1. L~ation of ' cw' . ..~ ................... Street and Number~ ~'~ ~~ Z~ .................................................................. 2. State existing use and ~cupancy of premises and intended use and occupancy of p~osed co~tmctJon: a. ~isiting use a~ ~cupancy ..~....~ ...................................................................... b. Jntended use and ~cupancy~' ~ . .... .............. 3. Nature of work (check which applicable): New Building ....... Addition .................. Alterotipn ........... j.~... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 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 .....e~ ............................................ j ............................................................. 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 ...~....r_~.. ............... Height ~..~..- .......... Number of Stories ................................................... : ................................ ~:~ ............................ ./.,~.,,c>-' ,, .. ~'~ ' :::Z~..S 9. Size of lot: Front ....~..~...~.. ........... Rear .................................. i~eptrl ...... X../.../..~ .............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ~ !:.1.' .Zone or u~ district n whicJ~ pYemises are situated ..................: .......................................... ; ....................................... 12. 'Does proposed construction vio__late any~.zonjng lay/, ordinance or regulation.;> .... ~.~--../~..~..,e .......... ,~.: ......... 13. Name of Owner of premises ~ ..~.~'.Address .~.,.~.1~.~~)'~'4~./~..~....~.. ........... Name of Architect ................ ~-~-~ / ,~ ~-~- ~_~ ~r;' .................................... Address ................................ ~r~ne No ..................... Name of Contractor ...¢:..~..:....~e...~.~../.~.~......~Ct.~-...~...~Addre~...~...././....~.~.~....~.~-Ph~ne 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 whether interior or comer lot. s-r^T~ OF N~R~' COU N't'Y Of~ ,..; ......... , ............. ;.........? .......................................................... being d~l~z~rn, d~s and~ he is.t~app cant above named. He is the ......................................................... ~,..~~~ ....... ,. ...... ........ ~f said ~wn~,r or ~ner~ and is duly authorized tg ~erform orh~e p~ed the ~id work and to ~ke and file this app~icatmn; that an s~tements contomed in th~s appli¢~ion am tree to the best of his ~owledge and belief; and tha~ the work will be performed in the manner ~t fo~h in the appllc~i~ fil~ there~th. Swam to ~fo~e this ........... o, ..... Nota ~,~ ~--~- -'. --~---- ................. q ,I : ,' SALEM~ .,. ~; ~OTA~7 1,, I I I I I 7-._."0 FLoo~ F P..A hq~l~ q IQ44 l THE SALEM TOTAL~ 4 WIRING SYMBOLS CEILING OUTLET RANGE OUTLET ~) tx'T H T C bO, .Si 1044 THE 3ALEM SHEET-- ~OTAL-- h/ -- r = ~~ _1_ J SHEET-- '1