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Home My WebLink About6641-zFOB~I[ NO. 4 TOWN OF SOUTHOLD BUILIHNG DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy o ............. Date ............................ , 19 .... THIS CERTIFIES that the building located ........... ~ot~:'e ~. ~ .~.g~z~--~treet Map No ............. Block No ......... ~..Lot No .................................. corfforms substantially to the Application for Building Permit heretofore filed in this office dated ......................, [9 .... pursuant to which ]3uildinR Permit No ......... dated ....................... , .... , was issued, and eorEorms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is f~ Oh! k' F/a ~ I L¥ ]-~ I~ ~ kk I rXl ~- The certificate is issued to ........................................................ (ZII~TL~', lessee or tenant~ of the a/oresaid building. EJA IvJ I~ v '/ ~/~\://~ Suffolk County Department of Health Approval ............................ ~ ....... Building Inspector FORM 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) N? 6641 Date ...................... JlAlae .......... 6 ........... , 19.~.~.. Permission is hereby granted to: .Y.~.ur~c r..m. t~me ~..Inc ................................... ........... ~o~t, he~.<~ ................................................. to. JSllil~ ..2~ew...one.. £amil~..dw~llln~ .................................................................................... at premises located at ........ ~/~...~.Ql~t,h..;~,...~',..,J~..~g~..~and.~..B. aa~ .......................... ...................................................... ~au, thcxld, ........ ~,Y~.~ .................................................................... pursuant to application dated ....................... ~T.~e .......... 6 ........... , 19~.,~...., and approved by the Building Inspector. Building Inspector l~O~l NO. S TOWN OF SOUTHOLD Building Deportment 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 duplicate 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 $5.00 Dote ......... New Building ...... ~ ....... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~.°.~?~.~.~.-~.t...~.~s.~.~..~.~.~.~.~?.~.L:..~.~..~.~.~.!~.~1~.~.).~..~.~ ............... ~"u ~, r* ~'~$ ~r~o~G I NC. Owner Or Owners Of Property ...~. ......................................... .~ ....................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~...~...~/..,~-~.... Date Of Permit ..~....H.~:.~.~.Applicant E~..<..~..~.J~.....~..~..~....~.~.....I.~....C..: ........... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .../~.~.....-~... ..................... Construction on above described buildingS_ ~e.r. ~m]'t_ m~ets all applicable codes and regulations. Applicant. ~.~..~. ........ ~: ........................... Sworn to before me this ................ day of ............................................ (stamp or seal) ~C Notary Public .................................... County ak THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ' ~ ~an~ar~ ~, 19~s ~O.H ST.EE*,.EW.OR~,~gR~ ,OOZE ~ ~""'~"'~"'0"~" N 140484 THIS C~IFI~S THAT Founder's Homes, Landl~ Rd., c/o Sough & Landing, 8outhold, L.I. in the followlng location; ~ Basement ~ lst rt. [] zn~ ~7. out,5 ida Section Block Lot ,~,~ -~,.~,~ o, January 2/~ · 1 917~7 ' and found to b~ in compliance tvith the requ~rernentsof this Board. FIXTURE OUTLETS SER~ fLKEPTACS SWITCHES iHC,.N~E.scE RXTURES t~NGES CO(OINGDECKS OVENS DISHWASNERS IT FLUOrESCENt' v**~r~e OaT't K.W. A~AT. K.W. I AM]', K.W. MT. K.W. SYSTEMS EXHAUST FANS AMT. H, P. 2 F DIMMERS l/O Charles M. Hall, Box41? SouthOld, L.I. 11971 11 copy F0.LBUILDINO DEPARTMENT. THIS COPY O~NOT BE ALTERED IN ANY MANNER. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~ow~9~R~ ~o~i~ i~( Phone~i.~J;~. Subdiv. Address~ ~ -- 6. Section 2. Property location~6?~.~¢~ O.~?~,~. ~~~,~.,,~ ~7. Lot No. .~ ~.~.~,~ ~ ~ 8. Private well Ya~ Village ~,~ Township ~-T~O 9. Public water Public Water Company name ~ Dietance to main Lot size: Width~ feet Length ~ feet (Enter on center plot Sewage Disposaz/.~System: Precast~/ E~uivalent Block__ A. /~D/O gallon septic tank: B. ~eaching pools: Number ~ Precamt~Block Special below) If private well fill in blanks~ below: Tank cap~_city ~Gals. Pump G.P.M. Total well Depth to__G.W~f~,5~ ~'~-~- Amount df wate~ in well ~ Test Hole Data Feet 2 4 lO 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date'~ ~ ~ ~ ~ Signed ~-~-~ z~ ~ !A~ . · '~'~ Own er~'~) r ~ ui;1 de r FOR HEALTH DEPARTMENT USE ONLY. Based oD the information presented herewith, it is the opinion of the Mealth Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date Signed ~ ~ -- S-15 Revised 4/l/72 05't .. ~OUTH N,82 ~ ~0. E. STREET ~ q-~Ol'{j I'4ENT WELL I'4AP '"'-' ' "" '-- '" AT SOUTFIOLD TOWN OF S, OUTHOLD Nth SUFFOLK COLr~TY HEALTH DEPARTMENT The Sewage disposal and ~'a~er supply facilities for this local!on have been inspected by this department and found %o be satisfactory.~~ ~- Chief of General Engineering Services g ........................................ , l~.. Pemif Na ..................................... TOWN OF SOUTHOLD BUILDING I~EfAItTMENT TOWN CLERK'S OFFIC:E SOUTHOLD, N. Y. ................. Disapproved o/c ............................................... . APPLICATION FOR BUILDING FERMIT,.j ~ /,~ Date ..,.,.I/...~...~..;.,...;,~. .................... , 19 ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witl~ 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 are~j, 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 ke~,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-o~d granted by the Building Inspector. ' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building 2{one 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 regu at ons, and to adm t author zed nspectors on pram sas and n bud ngs for necessary nsbect ons {Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generpl contractor, electrician, plumber or builder. ......................................................... ............ ...................................................................... Name of owner of premises ....~9.~..~..f~.t~,......~t<.9...~...~..~....I .~...C.... ...................................................................................... If a pli ant is a corporate, signature of duly authorized officer. ~ " ( ame';"nd tit e ;' c;;'¢~'~;'te o '[~7i ..................... 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. Existing use and occupancy .......................................................................................................................... ? ........ b. Intended use and occupancy ....(~l.l~......~.,~fl, J~.~{. ....... ~lr....~../~.~.~..~.f~.: ............................................................. 3. Nature of work (check which applicable): New Building .......~.... ............ Addition ..................... Alteration ............... Repair ................. = ...... Removal ......................... Demolition ........................ Other Work .................................... · 11 ~' ~/' ~ ~Description) 4. Estimated Cost ..... ~e(.~.f..e..9. ........................... Fee ......-/,~ ...................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .~. ........ Number of dwellin~ units on each floor .~..~..~?..~..~..Je~l~ .......... If garage, number of care ........ J ................................................................................................................................... nd 6. If business, commercial or mixed occupancy, specify nature a extent of each type of usa ..................................... 7. Dimensions of existing structures, if an?: 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 ..~..fz ......................... Height ..... L~ ........................................ Number of Stories ...... I...,~..-~....~....Y~., ................................................................ 9. Size of lot: Front ....... I.~.~ ....................... Rear ...... L.~.t. ........................... Depth ...~.~. ........................................ 10. Date of Pumhasa ....~..~...~...:..Let~...~.. ..... Name of Former Owner .....~..~..~.....[ .~...u...~...s...'~... ................................... 11. Zone or usa 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 premises: [ ] Yes [V~No 14. Name of Owner of premises ....~...~.~.~.~.~......~...~....~.......L..~...C'..: ........ ~..e..~...L,,~..~.l~., .......... .~...~...~.....~,.~,~....o. ............ · (Address) (Phone No.) - . - ~, ~ ~ .......... ~....' .......................... Name of ~rcnitect ............................................................................................................. (Address) (Phone No.) Name of Contractor ................................................................................................................................................... (Address) (Phone No.) PLOT DIAG RAM I.ocate cleerl? 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, ) ~'~¢'II'N~ L&I~/I)IN6 RS/~D COUNTY OF ...................................................... ) ............................ ~']~'~;'i~i'~ ................................ '~'f'" ................. being duly sworn; deposes and says tha~ he is the applicant above named. He is the ......................... : .......................................................................... ~ ...................................................................................................... ~ ..... (Contractor, agent, corporate officer, etc. J 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 tothe best of his knowledge and belief; and that the work will be perl~ormed in the manner set forth in the application filed therewith. ~; ...................................... dayof .................................................. 19 ............. ~ ~ /1 " Note~ Public ...................................................................... County ..... ~ ~.G,~'~-,.,~t:~-/~..~..:~ ...... ..................................... . ' I LL_ _- _ _ ~11 ii, [ I -L ..... J qOTIFY BUILDING DEPARTMENT ?65-2660 9AM TO 4PM FOR REQL ED INSRECTIONS: 1. BEFORE I~ACKFiLLING F(~UN[ TiON OR START FRAMING 2, BEFORE CO~[RING PIP~LINE DESIGN G-130 ,.,--I ,...~[w.~,o,~o.,~,,o P L A N - I TOTAL ~ 3 ,~lON ,.RO~. 0 © © 0 ./ L__J~ DESIGN-G-1730 s.E=- Z , PLAN - I ToT,,L-- 7'3 L :l -F DESIGN- G-130 I ,.~- PLAN - II TOTAL--