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Home My WebLink About6354-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z~? ..... Date ...........J~I.,Y. ~ ......... , 19. THIS CERTIFIES that the building located at ...~.~&y.o..¢~.. ~r!~m .......... Street Map No~&vOO5. _&Oral,lock No ........... Lot No. ~ ......S.O;t. ~;I~O~A...I~¥.o ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. g~. · .~l, 19. ?.~ pursuant to which Building Permit No..6.3~Z.. dated ..........,1~1~. '3~ ..... , 1973., 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~.~'&~;e .on~ .fam.tly. ~t~l'l:l~a~ ....................................... The certificate is issued to ... ~tX't, lU~ .~. .... 0~ae~' ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval · JULY.. ~ .. ~ 9.7.3.. by. .Ro. ~i].~& .. UNDERWRITERS CERTIFICATE No...1~. 09~002...g.l~O...~...'1.~. 3 ................... ttOUSE NUMBFR...~6~[ ...... Street ..... ~O&~.O¢~. D~.~l,¥O ............................. Building Inspector lvO~ NO. ~ 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) No. 635~ z Do,e ........ .~..~....~../... ............ Permission is hereby granted to: · ....~,~..~.~:...~.,~.~..+~.:~..~ ~ ~ ..... ,..~.~:...~: ...................... ./..... ,o ......~~ ,,..._... ~~.~. , ..~._.._~.~..~~.....~....~......~_~.~.....~..~ .................................. o, ~,m, ,=,~ o, ...~ ....... ~..~.....~.....~.~..~...~.~~ ............................... ............................... .~......~.~....t.....i...6~...~.;..~ ........ :.~..~ .................. i ................. ~uilding Inspector. ~ FORM NO. 6 TOWN OF SOUTHOLD Building Dopo0tment 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, buildi,ngs 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 Date . ~ ~lg~, .~.f... !..~.. 2 .............. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..~....~.~.kt~'~, ...... .~f,~,,t'~ .......................................................... Owner Or Owners Of Property~lJ-'gd:i~,~ ....... ~...~.~.~/~...~;.. ........................................................... Subdivision ..~.~.~ ..................... Lot No. ~,~..~..... Block No.; ........... House No ............. Permit No..~..~:~.~...~....Z~-. Date Of Permit ,,('~l~./l../.~Applicant .~.~./~.....~..'~..~4K'.A,.../rm.. .................. Health Dept. Approval .... ~ ............................... Labor Dept. Approval ...............~.....~. ........................ Underwriters Approval ...... ~ ............................... Planning Board Approval ..... ..~..{../.¥.~ ........................ Request For Temporary Certificate ........................................ Final Certificate ......... ~. ......................... Fee Submitted $ ...~.....~ ................. Construction on above described building and permit meets all applicable codes and regulofions. App,,ca,, Sworn to before r~ ~ ........... ~.. day of ~./'.....~ ......... ~.~.~. (stamp or seal) Noto~ Public ..... ~ ........................ Coun~ ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM feet 5. Subdi~A~ 6. Section~ 7. Lot No~ 8. Private'well 9. Public water Distance to main (Enter on center plot below) A.,/9~O gallon septic tank: Precas~ Equivalent Block B.k.~L4~aching pools. Numbe~ Precasl~ Block Special Street The~'~undersigned CERTIFIES: "Construction of autl oriz in accordance with the Suffolk County Depa?tment o Hea ds thereto." I t~4~~i If private well fill in blanks below: Tank capaci~ Gals. Pump G.P.M~ Total well dept~O~' Depth to Amount of water in well Test Hole Data Feet 2 4 6 8 10 12 14 16 18 installations will be Health's current stand- O~ ,M~ ~,{ ~ t~, ~n~ 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 /~/~7 ~ Signed ~ ~ S-15 Re¥~$ed 4/]/7~ SUFFOLK COUNTy NEALTH DEPARTNEN2 DATE~ H. D. REF. The sewage disposal and water supply facilities for this location have been inspected bv this department Dnd found Chief of Coneral Engineering Services ~T .o. z TOWN OF SOUTHOLD ~/-'/7~ 7~ ~, ~..~_~'"O~ . BUILDING DEPARTMENT ~ ~ ~ ~/~ TOWN CLERK'S OFFICE 7~/~ ~ ~ -~ ~- ......... ....... (..., ........ ........................................ , . Pemit No..~ ............... ~ ............. Di~r~ a/c .......................................................................................~ .................. ~ ~ / ~/ /0~ APPLICATION FOR BUILDING PE~IT X ~; ~ -- ~ TRU~IONS D a. This appli~tion must ~ ~mpletelv filled in by ty~writer or in ink and submi~ed in tripli~te to the Building Inspector, w 3 ~ of plans, a~urate plo~ plan to s~le. Fee a~rding to ~dule. b. Plot pl~ showing Io~tion of lot and of ~ildings on premises, relationship to adjoining premiss or public stree~ or areas, giving a detail~ ~ription of lavout of pro~ must ~ drawn on diagram which is pa~ of this appli~tion. c. T~ wo~ ~vered ~ this application may not ~ commen~d ~fore i~uan~ of Building ~rmlt. d. U~n a~roval of this a~li~tion, ~ Building Ins~or will issue a Building Permit to ~ applicant. Such ~rmit,shall be kept on the premiss available for ins~ction throughout the work. e. No buildi~ shall ~ ~pied or u~d in whole or in pa~ for any purpo~ whatever un~il a ~ifi~te of ~u~nw shall have gran~ by t~ Building Ins~ctor. APPLICATION IS HEREBY MADE to the Building Department for the issuan~ of a Building Permit punuant~to the Bulldi~ Ordinan~ of the Town of ~uthold~ Suffotk Count, New Yo~, and other appli~ble ~, Ordinanms or Regulations, for the ~nstru~ion of building, ~ditions or alterations, or for removal or demolition, as herein de,rind. The appli~nt ~s to ~mply with all appli~te la~ ordinance, building ~de, housing coda, and regulations, and to admit authorized ins~on on ~emJses and in ~ildin~ for ne~a~ ins~ions. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, a~Rhitect, engineer, general contractor, electrician, plumber or builder. '. .............................................. ....... ..................................................................................... Name of owner of premises ...,'~..~....'~...~/.&........-'~..~.)~..t~.~ .................................................................................................. If applicant is a corporate, signature of duly authorized officer. ............... I Name and title of corporate oHicar) Builder's License No .......................................................... Plumber's License No ...... .~....~..~..~..~. .................................... Electrician's License No...~...~...~..2...~. ................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No.....~'..~.?....~.....~..~...f. ......... Lot No. ~...~. ................ Street and Number '"'"'~' '~'~Z~'~'~'' ~)~/~'.~ .3'~ ............................... ~"~'~D'/c~' .......................... I~l'~'r~i'~i'l~'~ii"t~ .......... 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 occupaocy ............. 3. Naturetf*vf~f~k (check which applicable): New Building ...... ~ ............ Addition ..................... Alteration~.:.;.:....~.., ~ Repair ..................... Removal ........... Demolition ........................ Other Work .................................... .... ' ............. (Description) ._ - _ 4. msfimated Cost .............I ............................ 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 ................................................................................... t ........................................................ 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 ......................................... Denth ..... He ght . . . Number of Stories ........................................ 8. Dimensions of entire new construction: Front .....~...~ .......... Rear .....~...~. .................. Depth . .~......~.i ....................... Height ......... ~.. .............................. Number of Stories ......................................................................................... Size of lot' Front . ! O..O.' ........ Rear L~...°.~. ............. Depth ]~.~.../. .................................... 10. Date of Purchase ......-d'Jd, d~....'2...5. ................ Name of Former Owner ....~ ............ (.~ .......... .',;..~,~'~.~ 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 p,remises: [ ] Yes ~ No, 14. Name of Owner of premises ....J~F,4~.'~P-...~.~lT, tl.e~ ......... ~-~..h.~....~'~..~.[.~. .................~t..~....~.~..,~. ...... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... ~ .~ (Address) ~ ~ . (Phone No.) Name of Contractor ..~.~[~A~....(-~t//~[¢~...%....~ ....... ..~.-.Q.-.'~..-~.~.~......-.~-.. -~..~ ......... ."L?' ?' "-- "O' "6"?' ?' ....... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from properW lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. J 00' ea u3ao D STATE OF NEtWay..R.K~/.~ ~, ~ . ) COUNTY OF~.. .............. ) ~ ............. ..,~.,~.~.~......,~..;..,,.(~,,.~~ ...................... being duly sworn, deposes and says that he is the applicant above named. (Name of indi~id~l si~ing con~acfl (Contractor, a~nt, cor~mte officer, etc.] of said owner or owners, and is duly authorized to ~rfo~ O~rmed the said work and to make and file this application; that all statements contained in this application are true to ~t,~l,~~d ~lief; and that the work will ~ ~rformed in the ~nner set forth in th~ application filed therewith. No. 52-0344963 Suffolk Cou~ ............... ........ , ............ ........ ......................... (Signature of applicant) DATE NOIlFY BUILDING': 765-2660 9AM TC~ , ED JBISPECTiONS':' 1, BEFORE BACKFIL FINAL V I 11 ,1