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Home My WebLink About6353-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTM~NT Tow~ Clerk's .Offiee Southold, N. Y. Certificnte Of Occupnncy No. a~809 ...... Date .......... ~eb ..... ~ ....... ,10...~. THIS CERTIFIES that the building located at . 9outt~ .~ross .Roa~ .......Street Map No. Fleets .~ · Block No ..... ~; .... Lot No.. xx... ~utehogue...N,~.~ ....... conforms substantially to the Application for Bttilding Permit heretofore fried in this office dated .............Jan.. 29, 19.73. pursuant to which Building Permit No. -63.~-~ · dated ..........Ja~ .... ~0..., 19. ?3', 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 .. Pr.$va~e .o~, .£ami3,lr. laellt, ng ...................................... The certificate is issued to .... Rclmmcl .¢&r~oLl ......l)v~ez' ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. Fab.. UNDERWRITERS CERTIFICATE No..]~..1.092.~1 ...... Aug...1 ~...~97;~ ........... HOUSE NLrMBER .... 2.7-~ ...... Street...8outh .Cross. P~ ...................... Building Inspector\ l~OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PEPu~IT MUST BE KEPT ON THE PP. EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6353 Z Permission is hereby granted to: ..... ~.~...T.- ........ ~.~..~.~..~... ~ ~ ..t ......................... ....... · ~....~..D.~.~.~ ......... ~./.~..~..~.LL_ to ..... Jg/,O.z_,~.. A. /~M£ [~-~ ~.,< ......... .~.~.~-..~-~.,~v ~ et premiss I~at~ ~ .................................. ~O~.H ......... ~'~'~ ...... ~'b~'~ .......... ' ........... ................................................................................ C.~.~..~..a~u.~;. ...................................... pumuant to ~lic~ion dat~ ........................... ~ ....... ~.~., 19.~, and appr~ by the Building Inspector. TOWN OF SOUTNOLD Building Depa~ment Town Clerks Office Southold, N. ¥o 1'1971 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 occupancy $1.00 $5.00 New Building .........~)~ ....... Old or Pre-existing Building ............................ Vacant Land ............................ L~ation Of Pr~e~ ...... ..... ~ ,~~ ~ner Or ~ners ~ Pr~e,y ..~ ....... ~~...~~ ......... .~:. ............................... ~ Subdivision ................. ~ .......................................... Lot No.......'-. ..... Block No.......~ ..... House No ............. Permit No. ~e..~[.~..~.....~'... Date Of Permit .//..~..°/].~.Applicant ..~~-,~,~: ............ Health Dept. Approval /~.,~,~3~d/..~...~. ................ Labor Dept. Approval ........... ~ .................................... Underwriters Approval .~-,A~..*/~...~...U,~ .............. Planning Board Approval ....... '~. ................................ Request For Temporary CertificateL/ .............~. ......................... Final Certificate ....~...~........-.. ..................... Fee Submitted $ ......~.'~..'...~ ................. Notary Public .................................... County Construction on above described building an,~Lpermit meets all~applij::able codes and regulations. Sworn to before me this ...... ~.......~. day of ....~.....~. · ....... (..~..~...e.L ........ (stamp or seal) ~-- SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference NO, ~-~a--/~O APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant , '. Phone 5. Subdiv. Address ,'i -. ' ~ 6. Section ~- 2. Property location~/. .. , 7. Lot No. '- 8. Private well Village · .~ . --- Township 9. Public water 3. Public Water Company name .- Distance to main 4. Lot size: Width ~ feet Length, .' . feet (Enter 10. Sewage Dispos~/~'~ystem: A. ~909/gallon septic tank: Precas~i B. %_Le'aching pools: Number~- Precas~Block The undersigned be in accordance with ards thereto." on center plot below) Equivalent Block__ Special If private well fill in blanks below: Tank capacity Pump G.P.M.ff Gals. Total well depth Depth to G.W.~ Amount of water in wel Test Hole Data Feet 0' 2 4 6 ~8 10 ~ 12 ~ 14 18 :ERTIFIES: "Construction of authorized installations will the Suffolk County Department of Health's current stand- Date Signed Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based is the opinion of the Mealth Department, that Disposal System can be installed on this plot. Date /~/~ Signed S-15 Revised 4/l/72 the information presented herewith, it an adequate and satisfactory Sewage 1;'0]~11~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................... . .~..~......(~., 19Z..~. ApprovedD,sapproved ................................. a/c ~.........~i~i~ .~....~ Pemif No ....... .~....'~....~......~....~ ........ ............................................................ ........ ....... ....... ................. : ................ (Building Inspector) Applicotion No, ~'~ ~' -~' APPLICATION FOR BUILDING PERMIT Dote 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 availabl~ 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, Suffo[l~ 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. (Sig/~re o,~,icant, or name, ifa corporation) ......... ................. ii~i' i~h' '(~i~ire; iPf ' iCr~n tm i is Se;Wn e~.""~"?':" i'i .(.~~.t..~..~. :~en, era, contrac to r, el ect rician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ................ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~....~..r ....................................................................................... b. Intended use and occupancy .~1.....~~..,.~...,.~.~....~.~~1 ~ .-/J // /~ /~/) - ................. 3. Nature of work (check which applicable): New Building ....... ~)~. .......... Addition ..................... Alteration ............... Repair ............. ............ Removal ......................... Demolition ........................ Other Work .................................... {Description) 4. Estimated Cost ....... ~...~./~ .~ ................ Fee .......... ~....~....~..~ ........ .~.../...?~. ·. ?...~. ·....~..;~.. ~....'~...~ ...... (to be paid on filing this applicatio~J 5. If dwelling, number of dwelling units I ................. 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 ..... __'"~'" .~.. ........ Rear ......... .~....~... ........ Depth .....~....~ .............. Height ........ ~.....~. ............................... Number of Stories .~..~.....~..~..~~.. . . / u - 9. Size of lot: Front .......~..-~.... ..................... Rear ....... ~....?-.../. ........................ Depth ..~....):..5.....+......~........(-?. .................... Height ........................ ;'. .......................... Number of Stories ...................................................................................... 10. Date of Purchase .....l~...~..~...?.~..~...~.. ..... Name of Former O.wner .~.~..[,,[~...~..~....~..~.'.. 0 11. Zone or use district in which premises are situated ..... /..~.~.,~.y.~,,~4~'. ........................................................... 12. Does proposed construction violate any zoning law. ordinance or regulation: ..... ~......'7.. .......................................... 13. Will lot be regraded_,.~J::.~,,~.~x..~..~.,,~7..Will excessfill be removed from premises:J~ ~--,~ ~ /~-~-_~ _ . ~ ~'[ !Yes D~ No - 14. Name of Owner of premises ..~..~.J~/~34~.~ ...... ~~../..:.'...~...~ ................................. (Address)~O (Phone No.) Name of Architect ................................................... ~ ......................................................... ~ ................................. ~ ~ ,~ ~Address) (Phone No.) Name of Contractor ................ ~ .~...t.....~..~..~..7.~..~...~.~. ~Address) (~ l {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. STATE OF NEW YOR K, ) ,~, COUNTY OF ............... ~ ...................................... ) ....... ~.....~.~k~-~ ....... ~~ ........................... being duly sworn, deposes and says ,hat he is the applican, above named. ~ (Name of individual si~ing con.aCt), Ha ~s the ........................................................................... ~ .................................................................................................................... (Contractor, a~nt, corporate officer, etc.} of said owner or owners, and is duly authorized to ~rform or haw performed the said work and to mak~ and file this application; that a~l statements contained in this aoDlication are true to the b~st of his knowledge and beli~; and that tho work will b* ~rform~d in Ih~ ~nnar sat forth in the apO!icatioo filed therewith. DEPAET~N~ Chief of General Engineering (~. EARt::eOL L ,.q7'- 'I HT tl !045 -A APPROVED AS t-[OTED 765-2660 9AM TO 4PM FOR REQUIR- SE. CTION 4'-0" It ~o,,~ 'L_ t 1045-A ,T~ 54'A ,BO.(,. ~ I $7'- 7" ' - .., ~ ,~ ,, ~ ~ , @ ~ ~ ,,_~. ~f~ x , ~, ~ ~ ~ I x ~/~ ~ I ,~ /~ 7~ ~,_~,,