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Home My WebLink About6653-zFOB,M NO. 4 TOWN OF SOUTHOLD BI. nfl.BlOC. DEPARTM~.NT To~ Clerk'~ Office Southold, N. Y. Certificate Of Occupancy ~IS CERT~S ~t ~e b~g locat~ ............................ Map No. ~ .... . ...... . Block No... ~ ..... ~t No .................................. co,om mbst~y to the AppH~on for B~d~g Pe~t h~etofore ffl~ ~ ~is office dasd .......... ~..~.Q~(., 19~ p~u~t ~ wM~ B~g P~t No.~........ dat~ I ~ qU~ 1~ was ~sued, ~d co,ores ~ ~ of ~e r~ ments of ~e app~cable pro~siom of ~e law. ~e occup~cy for wM~ this ee~ca~ ~u~ ~ ~f37.~ ..... ~.s ea~"~ ...~.~.[?.U.f. ................ ~e ~e~i~e ~ ~.ea ~o. [~.~ ~ .~ f.~ ~... ~ ~ ~.~ V. ~...q.q.. ~'5. .......... (omer,~) of ~e ~ores~d b~g. S~o~ Co~ty Dep~ent of He~ Appmv~ ~ ~.~ ~ ).. ?. ~ .~.~ ........... ~~IT~S C~T~ICATE No. ~ ~ ~ ~ ~ ~ ~ HOUSE ~ / d 9 b~ S~t WE~r ~ ~ L ~ ~ ~ O ~ ~ Building Tn.pector FO~M NO. ~ TOWN OF $OUTHOLD 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? 6653 Z Date ....................... ~TU:T~ ..... .'].~ ............. , 19..?9. Permission is hereby granted to: ...F. ~:~Vle.~.. ~.tl], ~ ;~ ~r~g, .g.c~r:p ...................... ..... f~- ....... ~T~es..~ ........................................ to ..... ]~,t/~J~.. ~.. ~...~_~_-~-t~'.-~ i.I ~-~g ................................................................................. at premises located at ..t~.4.....t~le..~a~,..4¢~2.?.)...-~..~..~/e.s~~..~a~, .................. .................................................. t~%:t ~e~... ,,~,o~., .......................................................................... pursuant to application dated ......... ~/~ib~....~J[~.-.-.~ .............. , 19.~.~i.., and approved by the Building Inspector. Fee $.2Ct,OQ ........... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUI~ANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of properW 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-exist~ng dwelling 3. Copy of certificate of occupancy $1.00 4.Vacan~ Land C.O. $5.00 5.Updated C.O. $15.00 $15.00 Date... ~.~'...~....~. ['~.~;~.~ .... NewCons%ruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~ ~)..u~.. ~ .~..,...~. i.U.C.~"* r,; Owner or Ownersof Prope~ ~J.~.~.. ~Q~..~ ~.~. ......................... County Tax Map No. 1000 Se~ion .l ~ ........ Block . / ~./...~... Lot .... ~ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..L,. ~ ...................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ~.~ ............................ Rev. 10-10-78 THIS CERTIFIES THAT THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY' 85 JOHN STREET, NEW YORK. NEW YOFIK ~OO3S November 20,1973 ,~,,pt~.t~o,,~/o.o./,. 680639 N 128787 only the eleetrtceJ equ~ment as d~edbed belom a~ in~ ~ t~ ~mt M~ on t~ ~ ~t~ ~m~ in t~ pm~s oy h~vL~ ildg. ~. n/v/c/ West ~alh ~. & ~nt7 ~. 27A ~ttlCuck,L.l. =~.=.=~o. ~mhr 16,1973 a~foundto~incompliancewitht~r~ui~ntsofth~d. FIXTURE [ECEPTACLES] SWIT HE ] FIXTURES RANGES EXHAUST FAIt AMT,~ H.P. AMT.' ' WA'Frs COOKING DECKS OVENS DISH WASHERS AMT. K.W. ] AMT. K.W. ,MT. K.W. TIMECLOCKS[ Ho [UNITHEATIRS MULTI-OUTLET R v I C E NO. OF CC. COND. A.W.G. NO. Of HI-tEG A- W. O. 2 SERVICE DISO~INECI' -Tlko. OF I S I 100 CBI z ,,, OTHER A~IARATUS: 1-~0 amp vacuumunLt------ COPY FOR BUILDING D~ARTMENT. THIs COPY OF CERTIFICATE MU~ N~ BE ALTERED IN Ti-IWN I-IF SQUTHF1LD OFFICE nF aUlLDINr~ INSPEnTOi~) JtJ~l ~3 ?~ ~: 37 Tr'lWN OLERK'S OFFIOE Mr. 2.1':. kaEmerer Commissioner of Public Works Suffolk County Yaphank Ave., Yaphank, N. Y. Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated Laws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that ...................................... has applied to the Town of Southold for a permit to construct a building on ...~.Z~:4....~:;~t¢..~?...I:.~..`:`~.....f`.c..*~..~,~.`~'...~..i~Z.~...k~i~...:~.~.~ ..... as shown on the attached plot plan, submitted in triplicate, dated ................ ~.~.~..~. ....... ~.1 ...... .1.~7...~.. .......... and titled ..~.~.~.?.?...°.}.~...~.?.~L...~.~..?..~..~.~..?.?.~..!~L~.[.J'.~;f'~I~: Co Z~o We shall withhold further action on this application for ten days or as otherwise provided in the aforementioned Section 239K. 5/i5/73: Appz~oval Withheld-' pursuant Very truly yours, to See. 239K of the General Mtmie~al h~d~. Buildin~ l.spector Town of Southold, N. Y. TOWN OF' SOUTHOLD OFF'IOE OF BUILDING INSPEOTOR TOWN OLERK'S OFFIOE SnUTHOLD, N. Y, Mr. ;~?, Y4~.~.__~;~eL~ Commissioner of Public Works Suffolk County Yaphank Ave., Yaphank, N. Y. Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated La~ws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that ...................................... ..~.m...T.~..~.4.~t~...c. ~..~.r~ .......................................................... .... ~,.....~.~...~.,.j ..... ?.~..~.,.~!?.~......~L:.::L.. ......................................... has applied to the Town of Southold for a permit to construct a building o. ~/~?~?~;i~:~{;~)~A~/~!~:~t~??~i~;~?~ as shown on the attached plat plan, submitted in triplicate, dated ................ We shall withhold further action on this application for ten days or as otherwise provided in the aforementioned Section 239K. Very truly yours, Building Inspector Town of Southold, N. Y. FORM NO. 6 TOWN OF $OUTH~LD Building Department 'l'own Clerks Office Sauthold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s applicatton must be filled m 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 w~th accurate Iocahon 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 farm or equal). 3. Approval of electrical installation from Board of F,re Underwriters 4 Commercial buildings, Industrial buildings, Multiple Residences and s~m~lar bu,ldings and installations, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of compleled s~te plan requirements where apphcable. B. For existing buildings (prior to Apnl 1957), Non-conforming uses, or buildings and "pre-ex~sting" 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: I. Certificate of occupancy $5.00 2 Certificate of occupancy on pre-existing dwelhng or land use $5.00 3. Copy of cerhficate of occupancy $1.00 Date ............ ~...~. i'.....f~.'..~ ..../, ..~/... .... New Building ................ ition ................ Old or Pre-existing Building ................ Vacant Land .............. t_acot o. Of ....... ...... ....... Owner Or Owners O{ Property ............ !.~.?....~..~.!1.~[.?...~.....~... ........ ....~...?.~...L....~..I:.-~.[.<...~.. ...................................... Subdiwsion .............................................................. Lot No ...........Block No ............. House No ............ Permit ,o .~.~.?,..~.....Z;... Date Of Permit .................... ~pplicant .................................................................. Health Dept. Approval ?..g...c~...?..~ .....~..~...~...~.?..~Labor Dept. Approval .................. .../:v~....(.~.. .................. Underwriters Approval ..~...../...Z:..~.?...~'..~.. .................. Planning Board Approval ............ ..,/~'...../..~....' .............. Request For Temporary Certificate ....................................Final Certificate ......................................... Fee Submitted $ ......... ..~,..~ .............. Construction on above described build,ng and~p,rrz:~cneets/~apphc~le codes and regular,ans. Applicant ........................................... Sworn to before me this ............ !...~day of ..0...6.?(......?..~/.. ......................... Notary Pub I, c~,~../~ ~, .~../....r/~:..~?~ ._.3..~ounty SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Depari~ment Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address ~ ~'A~I~'-.~, $1~ (~rF)~C~,$f~zj 2. Property Loc~tion ~/k~ C~/~/m~ ~[~.~ ~'~ vim/age ~l~'m(l'uc/c Township 3. Public Water Company Name 4. Lot size: Width Io~-~ feet Length f~ feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: (For Health Dept. Use) A. 900-gallon septic tank: Precast~ Equivalent Block B. Leaching pools: Number of pools ~ ~ Precast ~YBlock Special Il. If private well, fill in the following blanks: A. Tank capacity B. C. D. E. ~ gallons Pump G.P.M. ~ Total well depth ~0 Depth to ground water i~ Amount of water in well ~(~-~t The undersigned CERTIFIES: "Construction of authorized installations will be in accordant with the Suffolk County Department of Health's current standards thereto. This applicatic will be valid for one year from the date of approval indicated below and may be renewed ii a current local Building Department Permit is in effect. Date Signed 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 and Water Supply can be installed on this pl,ot.. .... , ~; ~/~ S-15 Rev. 4/1/73 TOWN OF ~OUTHOLD . . _/~,Jfa /~-r~----- EJ,LO,.~ ~p..~~/~ ~ ~ ......... ........... . .o. .......................... ~isa~raY~ O/~ ............................ ~ ............................................... ~ ~. ~ ....................................................................................................... ~. ~ t~ ~ ~U i ",~ .......................... Z.~ ...... ~.~.....Z ............ ~..-- ~,. ~.....~. ............................ ~..~...., IN~IONS~1 ~ --~7 ;~ o. lhi~ ~licotim mu~t be compl,t~ly fill~ in b~ ~rit~r ~ in ink ~nd ~mi~ in tripli~ ~ ~ 8uildi~h. - In,tot, ~ith ~ ~ ~ pl~~, ~coumt, pl~ plan ~ ~l~. ~ ~o~ to ~h~ul~. b. ~lot pl~ ~h~in~ I~otion of lot and of buildi~ ~ pr~misa~, m~fion~P ~6 ~inin~ ~remi~ or ~ublic ~tr~ m[' oread, ~nd ~ivi~.a d*t~il~ d*~ripti~ o{ Io~ o{p~ mu~t b~ drown on th~ di~m ~i~h i~ ~ o{ ~hi~ appfic~ti~. ~ c. The worE' covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permi~ to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. , e;., No .building sba!! be .occu~pi..ec~. or u, sad in whole or in port for any purpose whatever until a Certificate of Occupancy~ snau nave oeen granted by the ~uilaing Inspector. ~,~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~Build!n.g. Zon,e Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows~ Ordinances or Kegumhons, Tar the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinance, building code, housing code, and regulatiom, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (A:ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~..~..~.~ .................................................................................................................................. If applicant,~is a corporate, signature of duly authorized officer. .......................... (Name an~itle of corporate officer) Builder's License No ..................................................... .L~o. E ' Plumber's License No .... -. .............................. Electrician's License No.~..~l~/~.~...~....~.,(A'V,~..~. Other Trade's License No ............................................... Location of land ~ which proposed work Will be done. ~ No.: .................. ~. ...... ..,. ............ Lot No....~.. Street and Num~el~r C~/~l~,../~...~.~......e/~l.~...._/~....'~.....~..~.~....~l~......~i~il /~ ~0 I~ ~ ~7 ~/~ Mumcl~ll~ State existing u~ and ~cu~ncy of promises ~nd~intended ~se and ~cu~ncy of prod c~tion. o. ~isiting u~ ~ ~cuponcy ... ........................................................................................................... b. Intend~ use and ~cu~ncy ..~t.J~.&~......~.~ .................................................................. ~,~: Nature of work (check which applicable): New Building .......... I~....... Addition .................. Alteration ~ Repair .................. Removal .................. Demolitio~ .................... Other Work ...................................................... (Description) 4. timated ........................................... F, ..................................................................... (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 .....( ....................................................................................................................................... 6. If business, commercial or mixed occupancy, s,p.ectJfy nature and extent ~f each type of use ........... '1 ............... 7. Dimensions of existing struCtUres, if any: Front ...~.~.. ................... Rear ..~1.0. ......................... Depth .~...~. .............. Height .~/..~./. ............. Number of Stories ........... ~/. ................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories . 8. Dimensions of entire now construction: Front ..~.~. ............................Rea'; i~.~'iiiiiiiiiiiiiiiiiiiiii'Depth ..~.....~. ............... Height .I..~.. ............ _ ,Number of Stories ...-1 ..................................... ,_--," .............................................. ,~/e~'"'7 ................... Size of lot: Front ...1[0..2~.....[ ...................................... Rear .../.7.~...' ............................ Depth ../.~..~.. ....................... D~te of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated .................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ...~..e...--.. ........................................... Will lot be regraded ..~r~ ................. Will excess fill be removed from premises: ( ) Yes (~') No Nome of Owner of premises ~-'~I~UI~...~I~....~..;. .......... Address'~....~....~.'.~.~.....~..~. Phone No.~/:'~t..~..~/..~... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..~.~.~.... ........................................ Address ................................ Phone No ....................... PLOT DIAGRAM from and indicate 10. 11. 12. 13. 14. Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all property lines. Give street and block number or description according tO deed, and show street whether interior or comer lot. STATE OF NEW YORK, COUNTY OF .............................. ............ .~.k~O......!.~.~.~l~..~c."/w~. .......................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract~ above named. (Contractor, agent, 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 all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed~the manner set forth in the application filed therewith. Swam to before me this (Signature of pp'licant) \ / TERRI I.~E FLAK II~'ARY PUBUC, Stlte of New Ym'k No. 52-6165295 Qualified in Su,lc~ Co::nly Commission Expires triarch 135 REVIGIONG OCT. 7, 1974 OCT. 9, 1974 · = MONUMENT ELEVATIONS ARE REFERENCED TO AN Is,~^~,~..ua ~',s~u'ror~ ASSUMED DATUM TEE [OCATIO~ OF WE[[~ ~D CE$~PO0[~ ro $~OWN HE~EIH A~E FROM FIE~D YOUNG & YOUNG 400 OSTRANDEE AVENUE, EIVEEHEAD, NEW YORK ALDEN W YOUNG HOWARD W. YOUNG SURVEY FOR: FARMVIEW BUILDING C~ tIZGEN 135 11846 /'°/'/'no/Yd"' CaS,bo/. '//20 HOTE ·: MONUMENT ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUM REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W YOUNG SURVEY FOR: TOWN Of SOUTHOLD '~s89 , SCALE. [ :30' PATE'MAY21,1973 IN°' ~ j[ APPR~JVED AS NOTED DATE: '~(~-'~ ( '~ ,J~?~.-~ FEE: ?P~ B~. ~ NOTIFY BUILDING DEPARTMENT 765-2660 9AM TO 4PM FO~ REQUIR- ED INSPECTIONS: ]. BEFORE BACKFILLING FCUNDA~ TION OR START FAAMING 2. B~FOR~ COVE~ING PIPELINE 3. FINAL WHEN JOB COMPLETED NOT ReS~ONSI~E~ FOR D~SIGN OR CON- STRUCTION ERRORS · [