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Home My WebLink About7540-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z639.7. ..... Date ........... Apl*il... J.0. .... , THIS CERTIFIES that the building located at .COX. ~ane. & .~a.tthew. s -La. Street Map No. Na~%hwaod~ Block No ........... Lot No, . .~ ..... ~u.~hog~... ~ ~¥., ...... conforms substantially to the Application for Building Permit heretofore fried in this office dated ............ S~pt...%6, 197~.. pursuant to which Bulldog Pe~it No.. dated ........... Se~.. ~.., 197~., was issued, ~d confo~s to all of the requ~e- ments of the applicable provisions of the law. The occup~cy for which this ce~ificate is issued is . ~r~Y~$.~. ~9..i~%y. ~N9%~$Y~g ...................................... The certificate is issued to . D~Vi~. & .Dt~e. 0~teS ....... ~e~s .................. (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of He~th Approval . April,..9. · .1.97%...by. R, .Villa.. UNDERWRITERS CERTIFICATE No. ~ 27.. J.97%. ;~y. J.,..K~aCki ............. HOUSE NUMBER ..... ~ ...... Street . .~atghews. ~ ........................... 7~ Cox ~ne Building FOl~l~ NO. 2 'TOWN OF SOU'TI'IOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDJHG P ER,~AI'I' (THIS PERMIT MUST BE KEPT ON THE PREMISEs UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o z ~a,e ........ ~'"-/"-7' ................... , '"'?"7 Permission is hereby granted ta.~?')~?O..~..,..~c~(~ (~ ~,~..~! · ................................................. ~...~ .................. ~.~:.£..~..:/..; ......... . ......... at premises Iocated~at ..... ~ .................. ~ ................................. ~~ ........ L.. ~ ............................ .~.~L~::..~ ....... ~.r...<..~...~,?'....i....~,~: ..... pursuant to application dated .............. ~ ........................ , 19..~...~.., and approved by the Building Inspector. Fee $ ......... .~ ............. Building Inspector FORM NO. 6 TOWN OF SOUTHOED 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-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 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 $5.00 3. Copy of certificate of occupancy $I.00 w///~ Dote ...............1 .......................... New Building ................ Addition ................ Old or Pre~existing Building ................ Vacant Land .............. Location Of Property ~.~.~..~`~.~"..~..~V~`=.t..~...~..-..L~.!..~...~.j .~.........!.M..~..~.~....f~.~..!{.~.~.~...~7..~Tx (~` ~-~x .~ ~ ~4-~-- ........ Owner Or Owners Of Property'·..~..~.C~.(..~..~=.'~..~...OJ·...~.!i.dJ.......0.O~.~ ....................................... d,.. .................. Subdivision ~.0.C..~..~..L0...0.0.C~. .................................... Lot No....l ........ Block No ............. House NoJ.!..0..0 · q q q . ,, '-D ...... Permit No./J...~....~..C)..'~.. Date Of Perm.t .. I ........ ~....Apphcant J~.~.O.l.(~.....d .........(~.~..~..O.(TL~. Health Dept. Approval .... .~...i ................................. Labor Dept· Approval ................................................ Underwriters Approval .... ~ ...................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .' ../. . ... .... ~ ............................ Fee Submitted $ ................................. Construction on above described building and/p, ermit .mee, Jis al~/app~Jicoble codes and regulations. Applicant ...... /4.~ ~J,~. · · ~....~.C~'2.~ .................................................... Sworn to before me this Notary Public ......./~. ....................... County PETER M. COLEMAN NOTARY PUBLIC, Sto~o of New Yor~ No. 52 -5658570 Qualified m Suffolk'County Commission ~ms March 30, 19-76 SUFFOLK COUNT~ OEPARTMENT OF HEALTN Health Oep~rtment ' Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SVSTEM AND A WATER SUPPLY ~'' ...... ~ ..... : ~.hdiv~ . . ~ .' ~-~ ~ , ~- ~ c- 3, ~uD/ic ~a~er bompany ~ame 4. Lo/~ size: Width feet Length. feet 10. Sewage Disposal System: A. allon septic tank: Precast_~quivalent Block B. Leaching pools: Number of pools pr e c as t_::~q~o c k___> pe Cl al ll. If private well, fill in the following blanks: ^. Tank capacit allons B. Pump G.P.M, ~) C, Total ~cll depth D. ~epth t~ ground water E. Amoufi~':of water in well .... (For Health Dep~o Use) The undersign~ CERTIFIES: "Construction of agthorized installations will be in accordance with the SuffOlk County l)epartment of Health's'current standards thereto. This application will be valid 'for one year from ~he date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date EOR_~_~ALTH DEPARTMENT USE ONLY. Based on the information presented herewitb~ it ~s the ~i6'~S~ the Heatth~-~a~{~6nt that an adequate and satisfacto~ S~wage Dispos~ S~stem and Water Supply can be installed on this plot. APPROVAl. DATE ,.-:-~ / / SIGNED / S-iS Rev. 4/1/73 SUFFOLK COUNTy DEPARTMENT OF HEALTH Health Depmrtment Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT 1. Applicant2/4~V//~ j~/~?'~ Phone Sub d i v./~/~ ~/~d~)~ 5. Address ¥,~)~ ~-(,, ~-~y~-~'/~ ~/~- <-~7~. Sectign. 2. Property Ldcation /(i///,~:~,C,~ ~ ~ c~<' Y-~ , ~ 7~. Lol~ Nbmber ~/~ 77-,~' / z~F' . _ _ ~, Private Well ' Village ' ~_f_~-__/-J,~/~ Townsnip -~ '~(,~)~/c/O~-~ ~. Public Water - 3. Public Water-C6mpahy Name Distance to main ---- 4. Lo~ size: Width feet Length feet 10. Sewage Disposal System: A. 90~] allon septic tank: Precast )<~ Equivalent Block B. Leaching pools: Nunber of pools Precast,,/~F-~ock Special ll. If private well, fill following blanks: A. Tank capacity in the ~'al lons B. Pump G.P.M. '-~ C. 'Total (~L-11 depth. D. Depth ~'lyo ground water E. Amoun~'of water in well (For Health Dept. Use) The undersign~ CERTIFIES: "Construction of aNthorized installations will be in accordance with the Sufifo~k County r)epartment of Health's'current standards thereto. This application will be vali~or one year from ~he date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. ........... L' .... ..... y____ ................. FOR ~EALTH DEPARTMENT USE ONLY, Based on the information presented herewith, it is the ~inion of the Health Department that an adequate and satisfactory S~wage Dispose) System and Water Supply can be installed on this plot. S-15 Rev. 4/1/73 /! omos, _a~agw .mgg4mmlea clescrlpt .k~. of la~ta OSlamperty must be drawn on the d,ogram which ~' c. .l~e work OaSiS.- by thi~ opphcation ~n~y. nat be ~,~-nrnenced before iss~ce ~ ~ ~. ?'" ' Jil ~_ ~Ul~e~_~ __??~_ _~ .~_ appl.,t~..ion; ~ BUiI~..I~ !.n~.tor will issue a Building Pen~it to the ~ ~'~i'' No ,building shelJ .be _or, c~ed or .used in whole or In part for any purpose whatever until ~/ ma ~neveeeengrontedbytheBullding Inspector. J? ~, .A, .P. PLI .C~AT,O~,I~ .IS HEREI~.Y.MA_DE to .t~e .B~.i[dt~ng. Del~rtrnent for the issuance of a .!~ (Signature of applicant, m name, if o ~) (Addr~s of emdi~.~) State whether ~applicant owner, lessee, agent, a~t~ct, engi~n~r, general contractor, -electrician, plumber or builder. is .... 9~9.~..A~.~C~n~c~l &~nf, ca~.~.¢¢ ..... : .., ...... .. ~ .., .......... Nome of owner of premises. ~&T;L~l,.~,~i~t~ ~ .... - . . . ' ,' ' If applicant is o corporate, signature of duly aut~rized officer. (Name and title of coq~orote officer) ~ Builder's License No, ........ ' ......................... ~' Plumber's License No ................................................. -~ Electrician's License NO ....................................... .~... Other Trade's License No ............................................... Location of land on whic~ proposed work will be dane. Map No.: ..~.,~ .............................. Lot No...~ .................... Street and Number ..... ~,R.~Rrifl ..................................................................... ~+,~tJ:l~,q~ .......................... State existing use and occupancy of premises and intended use and occupancy of p~ ¢onellmcflon: a. ExisJting use and occupancy ....~d~s,~,~Jl~llJ~j,a,~, ........................................................................................................ b. Intended use and occupancy ~..,Eesf~Le~ ................................................................................................... 3. Nature of work Ccheak which applicable): New Building. ~: Addition .................. Alteration ......... ~, .... -' Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ..2,0.,.0D.0.,.: .......................................... Fee ..~.~..,.g..0. .......... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..,2, ....................... Number of dwelling units on each floor '~ ................ If. garage, number of cars ......3, ................................................................ : ................................................................... 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' ..~t ....... ~. .................... Rear ~.6.~ 26t ......................... Depth ........................ Height ....2Q!. .......... Number of Stories ~ 9. Size of lot: Front ...~,~.~ ............................................... Rear ...~..2.~. .................................. Depth .~.0. ...................... 10. Date of Purchase ....~.t.9.~,.b.~.~...~.c~,~ ......................... Name of Former Owner b-'t, ag.~a~¢:~ 11. Zone or use district in which premises are situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~o ............................................... 13. Will lot be regraded ....~.~?. ......... ; ........ Will excess fill be removed from premises: ~ ) yes ( ) No 14. Nome of Owner of premises ..... ..~.~.V..~.......~...~..T...~...~. .......... Address ....~...u~..~..~....~..g..-~.... ,~ ~,_ -/.~,.~. O~r'~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phorm 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 t~ whether interior or corner lot. STATE OF NE~/~..)(OR,,K,,, ,,.,. ISS (Name of i~iv~ual signing c~tm~ above name. He is t~ ......~.~ .................................................................................................................................... of said ~ner or ~ners, and is duly a~rized ~ pe~orm or h~e' perfor~ the ~idwork a~ to ~ke and file this applicati~; ~t all statements contain~ in ~is a~lication.am tree to the ~st of his k~le~e and belief; and tha~ t~ work will ~ ~ In ~e manner ~ fo~h in the application fil~ ~I~. · Swam to ~fom me ANNA W~BS r (Slgna~re of opphcant) N~ Public In State of New York No. 52-7057150 Resldin~ in Suffolk Coun~ Or j¢liu¢ forr~rl~l $~ir UNAUTHORIZED ALTERATION OR ADOITION TO THIS SURVEY IS & ¥10LAT~ON OF SECTION 7209 OF THE NEW YORK STATE EOUCAT~ON LAW A SUFFOLK COUifTY E.EALZH DEPARTi'~¢EN~i'~1 APR u ~ ~975 zJ THE [OC.~TfO~ OF ~'EL~S A~'D CES,~POOr-.~ A~D/O~ F~i-~...-;. ~ ~':'" ~-~ ~ ~ ',.~-*=~'~D~ F~O~ OTHEBS~ ~OTg: · =MONUMENT SUBDIW~ION MAP FILED IN ~E OFFI~ OF THE ~ ~SUFFOLK ~OUNTY ON MA Y 2~ 1970 AS FIL~ N~ 54 69. REVISIONS OCT. /0,1974 ~m. £,/975, YOUNG & 400 OSTRANDER AVENUE, RIVERI~AD~ ALDEN W. YOUNG SURVEY FOR: DAVID OATES a DIANE OATES LOT NO.I," NORTHWOODS" At CUTCHOGUE GUARANTEED TO: 6UARANTEED TITLE DIVISION OF AMERICAN TITLE iNSURANCE CO. TOWN o~ SOUTHOLD DAVIDS, DIANE OATES PAULINE CASE SUFFOLK CO., N.Y. SCALE: I" = 40~ IDATE: DEC. 6~ 1973 73-ll82 1 rr APPROVED AS NOTED ,I WIRING SYMBOLS PUSH BUTTON SPECIAL PURPOSE OUTIET~ CHIMES FAN TELEPHONE TRANSFORMER ,E TOTAC-- Il! ~': ,¢" ~_/,'e'L ¢: 4t 't 11 ' I