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Home My WebLink About7614-zTO~N OF SOUTIIOLD B~m,nlNG DEPARTm~r Town Clerk's O~iee Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the buflalng located at .l~eot .R~L~i .Ro~l .......... Street Map No~alvea 3eekBlock No...i ........ Lot No.l~ ...... 8o~the~4..l~.¥o ......... conforms substantially to the Applicat~m for Building Permit heretofore filed in thl, office dated .........0et. .1~..., 19~I~. purm~a~t to which Building Permit No. 7611~.. dated ...........0et-. ~-1 .... ,.19~+., was issued, and conforms to all of the recluire~ ments of the applicable provisions of the law. The occupancy for which tbi~ certificate is The certificate is issued to. lla-~,lW. & -gva..Beeh~ ....... 0~ners .................... (owner, lessee or ) of the aforesaid building. Suffolk County Depa~-Lme~t df Health Approval . F~b. 1.1... 1~.7~-. b~ 4/,. ¥1LII~ .... UNDERWRITERS cERTIFICATE No. P~,ng ................................. ... HOUSE NUMBER ..~ 9~.~ ....... Street. ~Itll. l~o&~ .... !~0u-'M NO. ~ TOWN OF SO4,1THOLD BUILDING DEPARTMENT TOWN CLERK'S Of?ICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7614 Z Date ................... Oel~be~ ......... .~-~ ...... 19...~, Permission is hereby granted to: A..34~J~y..&.bio...lJo..A/ll..ihms/..Jeeht & ~ at premises located at .~dll~..b....~&],ll~..31e~l: ............................................................................... .................................... ..v..,......~..~.........~..~ .......... .~.~e:L4.....I~.,.:C.,. ................................................... pursuant to application dated ......................... ~t,....~: ............. , 19..~., and approved by the Building Inspector. Fee d.l~t ~1~ .......... pEP. MIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE pREMISES -BY DRIVFWAY coNSTRUCTION ~ CESSPOOL coNStRUCTION CELLAi~ CONgRUCTION IUII.~M~ DEPARTMENT ..... ......... . ........................................ , 19.. Pe~itNo ..................................... ........................... ........................ ......................... APPUCATION FOR-BuILDIN~ FERMIT . Date ........................ , INSTRUCTIONS '~ a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicat· to the Buildinl~ Inspector, with 3 sets of plans, aCcurate plat 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~J areas, and giving a detailed description of layout ofproperty must be drown on the diagram which is part of this application~ c. The work covered by this application may not ~e comr~enced before issuance of I~L~ilding Permit. ~ d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such penn shall be kept on 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 by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the i~uildlr~.. Zon,e Ordinance. of .the T, ,c,o~n ,of. Southold, Suffolk .County, New York, and oth~ applicable laws, Ordinances or egu atmns, tar the constructmon at ouitaings, additions or alterations, or for removal or 'demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hot~slng code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corparatlon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plUmber or builder. Builder Name of owner of premises .................................... If applicant is a corporate, signature of duly a,~thorized officer. ~ (Name and/title of co~porate officer) Builder's License No ......................................... Plumber's License No. .~....~. Electrician's License No. Jl&ssolx! Other Trade's License No ............................................... ' .... [~ 1. Location of land on which p. roposecl w, ork. wjII be,done. Map No.: 0aX~.e&..[eeM ............. Lot Nb & ..................... Street and Number ............~......~.L~...~..~ ....... ~..~.~....t~...~..~...~.~...~..?.~.~ .......... i ......... ~ ....... i .................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed comtrucfion: a. Exisiting use and occupancy ................................................................................................................................. b. Intended use and occupancy ..... .1...~.t~...~.¢~,~,~ ............................ , ....... PE:,h'll' INCLUDES AP?,,,..~ .: 'FO REMOVE EXCESS ~: f'?OM ABOVE PREMIZ~. C ~LLAR. CCNSTP, UCTION · OTHER _ 3. Nature of work (check which applicable): New Building.. ........ .~.. ...... Addition .................. Alteration ................. Repair .................. Removal .................. Demolitior. .................... Other Work ................................................ . .... (Description) 4. Estimated Cost ..........~&~l.~i.~.l.0.Q ............................ Fee [ C~ ~.. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ 2 If garage, number of carS ............................................................................................................................................. 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 ....~.~...~ ......................... Rear ............................ Depth ........................ Height .................... Number of Stories ....... .1 ............................................................................................................. '9. Size of lot: Front ....~)&.e...t .......................................... Rear ....85 ................................. Depth ..... t..~ .................... 10~ Date of Purchase ........... ~...-..2...0..-..?..~.. ........................... Name of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ Will lot be regraded ............................ Will excess fill be removed from premises: ( ) yes (Z) No of Owner of rem~ lal',~, ]JeO~l.~; Name p 'ses .................................................... Address ................................ Phone No ....................... Nome of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor A. ]Ee~.~.[[ a~ Soma, ~[mOoAddress ................................ Phone No. PLOT DIAGP~M Locate cleaHy 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 whether interior or corner lot. 11. 12. 13. STATE OF NEVer, l/ ~SS COUNTY OF .C;)~/.~...%~..: ........ )' '-.~, .............~ '~,r ~.-' ~-- ~,,~ "~' 'l~)'~'~',x~.~'''''''~''''''~''''/'''~''''~''''~'''~''~'''' ............ being duly sworn, d~oses and soys ,~t he is the applicam (Nff~e of i~ivid~al ,s~ning c~tmc~ above nom~. He is th~ ................... ~.~.~.~ ................................................................................................................. (Contractor, agent, co~rote officer, etc.) of said owner or ~ners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; that all statements contoin~ Jn this application are tree to the best of his knowled~ and belief; and tha~ the wo~will ~ perfor~d in the manner ~t fo~h in the application filed therewith. .S...~:..T..t..~...~2 d;;tho~ ....... ~ ............. , 19.~Z -~ ~ ~' ~ ~ ............ .......... ......................... ~ q~~ ~ (Signature of opplica~) ~ota~ public, State of New York No.52-03~963 Suffolk Count~ ~mmi~ Expires March 30, 19~ FORM NO. 6 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 $5.00 3. Copy of certificate of occupancy $1.00 New Building ..... Addition ................ Old or Pre-existing Building ................ Vocont Lond .............. Location Of Property ...~,.,, ....................................................... : ............................................................ :..... Owner Or Owners Of Property /-//'° ~' ~, 4~ ,/Y'/, Subdivision ~'~/~-~'-~'J ,g/~'C~ Lot No. .~... BlockNo. HouseNo ............. Permit No..7..~../..~...~,,. Date____Of Permit ./...O~.~.../?/.Z,,~Applicant ..~..,-~'t~/~- 4~,~' v- ,.,[' ,~/vd' -'~'D-'C Health Dept. Approval ...... .z../.../././....?....,~.. ................. Labor Dept. Approval ................................................ Underwriters Approval .... ..~..~..'~...~../...x~..~.~. .................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ ...... . .~...~...o...~. ................ Construction on above described building and permit meets all applicable codes and regulations. Applicant .~~..~..~n¢.....,..~........ ~ .............................. Sworn to before me this '/ ........ ~....1~ dayof ......... .~...~ ........ ../...~...?....~. (stamp or seal) ~'~ Nota Pub, c ........... County SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applican~/./.,/(~y~.~,~J Address ~ 2. Property Location Village .~ ~ 3. Publi~ Water companYNa~ 4. Lot size: Width /m ~ feet 10. Sewage Disposal System: 5. Subdiv. d~Zwd, 6. Section 7. Lot Number 8. Private Well 9. Public Water ~-~ Distance to main Length Y?)'"feet (For Health Services Dept. Use) 11. A. 900-gallon septic tank: Precast &~Equivalent Block B. Leaching pools: Number of pools ~ Precast ~ Block Special__ If private well, fill in the fol- lowing blanks: A. Tank capacity~_, gallons B. Pump G.P.M. ~ PU~.~-F< C. Total well dept. h ~ D. Depth to gro~?d water__ ~ E. Amount of ~ter in well ~ The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date Signed " ~ .... ~ ~ ']':~ FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposa~/Syste~..__ and Water Supply can b~ installed on this plot. APPROVAL DATE //.~'",'~/ . / SIGNED / S-15 Rev. 4/1/73 WI~$T v1 ! L.L. I~,C~,,~ ID sUFFOLK COUNTY HEALTH DEPARTMENT sewage disposal and water supply ~.,~]:itios for this location have boon ~ns-,eoted by %his department ~d fo~d Chief o f;G~era g Services ~fTLJ,%TL~ ~T ~ C) LJT r-I cg L ['~ s'OUT ;.~c)t.r~., H.y, TITLE- ~dAI~,ANTr-LH-J TO TI-i ~.& TITLE ~Ol%-I~lCl& VAN THYL , lfiC. i