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Home My WebLink About6356-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No..~23~ ..... Date ............. J..u~.e....~.8 ..... , 19. ?3. THIS CERTIFIES that the building located at ]~,/.~ .l~eebe. ])r. tve .......... Street Map No. D.e.z.q.p.r.op.e Block No...X~. ..... i.Lot No. ~ ....0~..~.o. h0g~.e....~.*.Y..* ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Feb .... ~.. ,, 19.7~. pursuant to which Building Permit No. 63~6Z.. dated ........... Feb. ....~..., 1973.., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ?r.~.v.a..t.e..qn..e..f..mn. $.~y..d.?e.l~ .~. I ........................................ The certificate is issued to .~/..~1..cl.~.a.y ~.~..~.d.~?.g..C.o..~ ...... .0~1...e.~. .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... J~e.. 20.. ]9.7.3.. UNDERWRITERS CERTIFICATE No..0'..~1~....~.'J.,. ?.~3...~.. ~. ~*...~.~..~.~.~..~' ................ HOUSE NUMBER...~.~00 ...... Street .....~b~. ,I~'~..~. .............................. Building Inspector 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 ^UTHORIZED) N? 6356 Dote ....................... ~.bU~..~.--T~'..... ~......, 19..2,~. Permission is hereby granted to: ...~..~X~.v.~. .............................................. ....... ~..t;.. ~emc~.....~.,~.., ....................................... to ..~u.~.~...r~...on~ ...~:a~;~J.~...u,~e,,. ~r~ ....... ~ ~z~d,..£~Lo o,~..~£~Lr~Lsl~ecl,~ ....................... at premises located at ..~l'~.~..~a~b~..~J~L~.e ....... .(~.~/'~..~.~a,.~....~.,~j~). ................................... ............................................... ..a..u...t.g~.o. ~...q ....... .~...~.,. .......................................................................... pursuant to application dated .......................... ~.e..l~. ....... ~.. ............ , 19~7~ ....and approved by the Building Inspector. Fee $...~3.e.~.0. ......... Bulldinglnspector ~ FORM NO. S TOWN OF SOUTHOLD Building Deportment Town Clerk~ 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 occupancy $1.00 $5.00 Date ......~./.~1..~ ~..). ~ .................... New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..~.~.~.....~#..~..~...~.~.~.~.~.......~..?...~..~--~,.~..-.-.~.~.~....~.~../~..~...~'.~.~.~7 Owner Or Owners Of Property .~,..(..~.,~(. ~,,....~. ~tf.~.~...~. 6,,~,.' Subdivision ........................................................ Lot No ............. Block No ............. House No ............. 'r,3 z Permit No ..................... Date Of Permit ............. Applicant .................................................................. Health Dept. Approvol ............................................ Lobor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Finol Certificate .......................................... Fee Submitted $ .................................... Construction on above described buildingand permit meets all aj;~licable ~odes ,gnd regulations. IV,,e* Sworn to before me this ..~ ....... day of ....~..../~.~. ............ (stamp or seal) ( ~ ~ v/~ Nota~ Public ........... Coun~ ~ ~ ~ , . . , /~ ~. 52-2~1~, ~k ~ ~ SUFFOLK COUNTY ~]~iA~'I~i~NT OF HEALTH ~M~ ~ H.D. Reference No. ~0--/ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1.. Applicant ~ ~tO~:~ Phone ~ 5. Address ~*~t~? ~, ~['~, %~W~ 6. 2. Property location ~ ~,~,,~:~ Village ~m~ ~£~F Township ~,rb 3. Public Water Company name 4. Lot size: Width ;~ feet Length ,'~ feet 10. Sewage Section ~ ....... ' 7. Lot No. ~ 8. Private well~ 9. Public water~'~ Distance to main (Enter on center plot below) Dispos~-%System: A. ~0~ gallon septic tank: Precast ~Eguivalent Block B. ~aching pools: Number ~ Precast ~Block Special__ N If private well fill in blanks below: Tank capacity_~a~als. Pump G.P.M. ~ Total well depth__ Depth to G.W. ~ Amount of wet well Test Hole Data ~eet 0 2 ., 4 6 8 10 '12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." i~,~9~ (~ ~;~,~ f~,~p, Date Signed "/ '/"' ~ /" /~ ~/Z Z 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 plo~_~ Date Signed /-- ~ ' __ ' ~ S-15 Revised 4/]/7~ I~A~ OF' TOWN OF SOU HOLD ~.~ ~.~/~-- ~.~-~ BUILDING DEPARTMENT .,-x~ -~ ~ ~' ~.-~-. TOWN CLERK'S OFFICE ~,/'"/~ F~ c_~.~,~, SOUTHOLD, N. Y. ~,~7/?~ --.~n-~-~-~"~-'~'~ . ~. Exomlned .... ~ ............................. 19..~ ^ppH¢otion mo ................................. Approved ~9.. p~m' _...,t r~o ..................................... ?-~._,,.~- ,.~,/,~ ~-'f,-~/,7~ .. .......................... ..~,.?/.-- ~,.~z.-~,~--~---.~ ,~_< Disopproved o/c ~ ~ .,..'~"~"~ .............................................................................. ?-.~. ~ ~ ~?~-~-. AP'L,CAT,ON,O..U'LD'NG P'.M,k v ........................... ............. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict 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 th~s apphcat~on may not be commenced before ~ssuance of Building Perm t. d. Upon approval of this application, the Building InSpector will issue a Building Permit to the applicant. Such permit?hall be kept or[ 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 bythe Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zor~e Ordinance of the Town of Southold, Suffotk 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 authori zed inspectors on premises and in buildings for necessary inspections~ (Signature of applicant, or name, if a corporation) ..... (Address of applrcant) ,~' ~ , State whether applicant is owf~r,~lee, agent,,,_..,~_.,~-~:'--+ _-~-~!~.-.~ .~--~'~=" ;.;.;.;r~.~..~--~l=,-+,~.~n, . . .~"~'~-~7- ..... or builder. Name of owner of premises ............................................................................ ,~, ................ If applicant is a corporate, signature of duly authorized officer. ~ ........... ............ ~' (Name and title OT corporate officer~ Builder's License No .................................................../~ ~.; ...... ~, Plumber's License No...~'~.q"~l.~'..~....~-.,r,l~..J/~'.'~.~.....~...RLr..~.[?. 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 ~ j z~' ~ ' ~' O I~ ~ ~, ~/~', u' Number ........~.....~..~.~. ............ ~: ............... :.0.1~.....~....~.......~...~,~.~.Z..= ........ ~ii~i~l'i~ .......... 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 3t' Nature 0f W~rk (check which applicable): New Building .......~... ............. Addition ..................... Alterati~n~ ...... * Repair ............ Removal ......................... Demolition ........................ Other Work ' ' ~ (Description) 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 ............ 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 ..... .~..~..I. ............ Rear .......4','..~.:. ............... Depth .......~...: ...................... O~ Number of Stories .......... ~...'~:.. ....................................................................... Height ............ .~. .................................. ' /Z 9. Size of lot: Front .......~../...o..~..:.?...~.. ........... Rear ...... ./....o...~.:.~....-~. ................... Depth ...... ..~...).L.:...~'.,~ ......................... of Pumhase ..................................... Name of Former Owner ..... ..-~..:.~/~/~..t~.t.~ 10. Date 11. Zone or use district in which premises am situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ../~..,o. ............................................. 13. Will lot be regreded .................................... Will excess fill be removed from promises: [r~'Yes [ ] No 14. Name of Owner of promises ....~.~..~.:.{-~/~ .~.ta.~ .................................................................................................. (Address) (Phone No.) Name of Amhitect ..................................................................................................................................................... (Address) (Phone No.) Name of ................................................... , ....... ! ................... · .......................................... · ......................... ..... ! (Address) (P~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 wheth- er interior or corner lot. // STATE OF NEW YOR. Kx~' / · · ~ ) ~ COUNTY OF ............ ~ ......... ) ~.....~.:'....i~..~ ............................. being duly sworn, deposes and says that he is the applicant above named. t' ] (Name of individual signing contract) He is the ....~ ............ .~....0:~...".J~l~....~....;....' ...................................................................... ~ ........................ .' .................................................................. ( ConO~tt~Tt~mt, 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 ell statements contained in this application are true to the best of his knowledge and be~ll~P~.ttlA/OLhe work will be performed in the manner set forth i,n.~he application filed therewith. NOTARY PU~UC ~ ~ ..., ,R, esldlng in Suffolk C~unty ........ :. ....... .................................. .... SUFFOLK COUI~TY HEALTH DEPART/~J~F~/~.~/~ :-:~x~JUN 20-~g72 ~. ~. ~. faoi!itSes for this location have been inspected by this departmen~ and found Chief o~ ~e~eral Engtnee~in~ Semites ~"' o 3z~O ,, ~~ t F_A 'r C UTCHOC. UF-.. ~U~VOLK CO. ,N.Y. <J~AN A.WEND[LL DEC. 1~7~ ~AN~ H..m,'rK~W.,~N, L.3. E.Y 3T~_ ~C.~. 3%403 I=_lll II II 11--1 I=lll [1 ii .It=[ Po '1 II1]]1l I,,..,~ ![I II £LLVA: iON F V CELL^R, 9_", P~" CF ~tST$ ~", ~".¢~KDE~, ovER. 0 v [ ~, ~.~t"~ ~.'~" H ~." '~ r.., 'F"~' Q., oN ?LA '/ FU tON ~LOC~WRLL S E C'Ti 0 No - gibe , ELEVATION,