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Home My WebLink About7370-zTOWN OF SOUTHOLD BUW.nlNG DEPARTMENT Town Cl~k'~ 0~ Sou*hold, N. Y. Certificate Of Occupancy Map No. !~...~.~.k.~.. ~..CBlock No ........... L~t No, .~;~ ...... .~.U.7'..C./). ~.~.//,L~, ...... conforms substantially to the Application for Building Permit heretofore filed in ments of the applicable provisions of the law. The occupancy for which th!~ ce~Lflcate Is ~,ed ~,.. P..h ,u,,t'r-~.. o. ,¢,..C.. L'T.,~. ~., .~ .~r.. po~,-'.~, ~.,, ~.s.:... ............... (owaer, leasee or tenant) of the aforesaid building. Su~o~ County Depa~tme. tot Health App~ov,1 'i/o c'/'' ')'r' '¢'q') Sm" ~)~,~'~'~ UNDERWRITERS CERTIFICATE No....~/~.~9!~ .............................. . HOUSE N-LIMBER.../.~. ff.O. · · Street., ~/~.~ ~ ~ ~-... ~.,-.~l,,,.., .................. FOB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PP. EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7370 Z Permission is hereby granted to: Dote ....................... . .'.'.'.'.'.'.'.'.~ r..~ .~ ........... , ..... ..~.~.~T~.~..~L ......... ..h(....~.../~ D....V...~.~.E at premiss I~ at ......................................................................... 7 ....... '~'""~'~'~'~ ..... ....................................... ~ ........... ~.~..~.~. ............ ~.~.s .................................................... / pumuant to application dated ......................... ~ ...... .~.~.~ ....... 1~.., and approved by the Building I~ector. Building Inspector ~OUTHOLD, N. Y.. ............................ ~:......, .......... . ~l~m~ ~r~ .........................~.~., 19~.~. ~it No ..... ~.~...~...~~ ................................................................................. b. ~ p~n ~infl I~i~ of lot ~ c. ~e wo~ c~e~ ~ ~ a~licati~ ~y d. , U~.~I of ~is a~ic~i~, ~ Buildi~ I~tor will i~ o Buildi~ Pe~it to ~e ~licont. Such shall ~ K~ ~ ~ p~iS~ ~il~le ~r i~t~ ~ ~ ~rk. e. No buildi~ ~all ~ ~cupi~ or u~ in ~ole or in shall h~e ~en gmnt~ ~ ~e Bui~i~ InCr. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the_ , on vf ....,,..~, ~"~I~IIIIUTI~ Ur gllJr[Jt"ll;~"i~ or mr removal' or a~moiltiarl~ ~j I"l~jl, t described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and re~tlafions, and admit authorized inspectors on premises and In buildings for necessary inspections. ......... . - ...... (S~gn~, of ~ ,nt, or~7'~' ~'~;~;~i~5 .... ///~.~..~, ......... ~.~...~..~/~. /~ ........... ~:~...//..~';~ (Address of applicant) State whether applicant is owner, lessee, agent, orchite~t, engineer, general contractor, electrician, plumber or builder. ........ ~.~.~.~ ......... · ............ ~/.~ .../. .,~,,.~..~.~ ........... , ..., ome o, .......... iZ.Z..ii..." iii .... ::::::::::::::::::::::::::::::,ii.. ' If applicant is a corporate, signature of duly authorized office~. " ' (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ............................. Electrician's License No ...................... Other Trade's License No ............................................... Street and r~umber ~/~'.~ ~... ~..1~'~ Z ~..' .~..'~..'~: ............ 7~' .......... : '" '"' .............. ......................... .~ ................ ~....,R..:(...) ................ ~'.~/-.~.~ 2. State existing use and occupancy of premises a~d intended use and occupancy of proposed construction: ~xisiting use and occulmncy ................................................................................................................................. ' Intended use and ocCupancy ....: ........... ./........~.~ ...... .~..~ ................................... : ................ , ...... 3. Nature of work (check which applicable): New Building.. ...... Addition Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelling units ............................ Number of dwelling units on each t~iaor ........................... 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 coqstruction: Front .................................... Rear ............................ Depth ...................... Height .................... Number of Stories ..................................................................................................................... 10. Date of Purchase ~./a,ao..~...~...~..~. ·..Nome of Former 11. Zone or//se district in which premisSs are situated ....................................................................................... ~.... ...... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ..~..$.. ...................................... ' ..... 13. Will lot be regroded ...........~t~ ............ Will excess fill be removed from premises: ( ). Yes (,~) No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-boCk dimensions from property lines. Give street and block number or description according to deed, and show street narn~ and indicate' whether interior or corner lot. s couNw ......, . ................................................................................................. being duly ~orn, d~oses and says t~t he Js the opplican~ (Name of i~ividual signing c~tmc~ above name. He is the ~ [ ' · ..... (Contractor, agar, co~-officer, etc.) of said owner or owners, and is duly aut~rized to ~rform or h~e performed the said work a~ to ~ke and file this application; t~t all statements c~tai~ in this a~lication are .tree to the ~st of his ~ledge and belief; and tha~ the work will ~ perfor~ in the ~n~r set fo~h in the. opplication fil~ ther~ith. Swam~.~ me this ~..~' ~/ ~ ~, ~ //- ~ .......... o,, ...... ............. . ~ (Signature o* applJca~ ( . JUDI~ T. BOKEN Nota~ Public, ~late ~ New York No. 52-0344963 Suffolk Cou~ ~mmi~i~ ~pi~ ~ 30, 19~ ·' FOP~ NO. 6 TOWN OF $OUTH~LD Building Department Town Clerks Offic~ Southold, N. Y. 119~1 APPLICATION FOR GERTIFICATI~ !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 bulldings or new use: ]. Final survey of property with accurate location of 911 buildings, property lines, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and ~ewerage 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 line~, streets, buildings and unusual natural or topographic features. ' 2.Sworn statement of owner or previous owner as to us~, occupancy and condition of buildings. 3.Date of any housing code or safety inspection of buil~dings or premises, or other pertinent inn formation required to prepare a certificate. ~ C. Fees: 1. Certificate of occupancy $5.00 ~, 2. Certificate of.occupancy on pre-existing dwelling or lan~d use $5.00 3. Copy of certificate of occupancy $1.00 ( I ^ New Building ....... Addition ................ Old or Pre-existing ~uilding ................ Vacant Land .............. Request For Temporary Certificate ........................................ Fin6l Certificate ;.~...... ................................. Fee Submitted $ .................................... Construction on above described building and permit meets oil Applicant .................. .~:.~ ..... Sworn to before mex.~_ ....... .. day of .. : .... ! ppplicable codes ,and regulations. ....... (stamp or SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTE~ AND A WATER SUPPLY ~/~,._/t Address~2)~,~ I~ ~d.~}~/}~,','~" //~-4'~Z 6. Section Property LOba~ion~~Zl}~e'~ 'X~e~ ~r~ Lot Numb~ ~/~J~__~ - _~ ' 8. Private Well Village ~'~m~ Township~~& 9, Public Water Public ~ter C6mpan~ Name [ Distance to main Lot size: Width/~ee~ Length~ feet ' 10, Sewage Disposal System: A. 900-gallon septic tank: Precast /Equivalent Block B. Leaching pools: ,~N~mber ~f pools / Pre~a..st V/ Block __Special If ~[ivate we!l, fill in the fol- lowing blanks: A. Tank capacity, .~/~ _gallons B. ump C. ~Total well depth_ D. Depth to ground water E. Amount of water in well, 11. (For Health Services D__ept, Us_9_e) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Service~ current standards thereto." This application will be valid for one year from the dateibf approval indicated below and may be renewed if a current local Building Department Permit is in effect. ================================================================================= FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of t~ Department of Health S~rvices that an adequate and satis- factory Sewage Disposal: System and Water Supply can b~ installedx~ this plot. S-15 Rev. 4/1/73 DAV~ D5 S~FFOLK COL~,~'Y ~XALTH DEPART~N~ ~?~JUL 2 ~ ~975 .. ~. ~. ~ ~' The ae~e d~po~], and ~ter su~pl~ Services W.A~EN WALDV__ .~'1~ GLIA ,D..AN; EE.~ TO TH[i TITLE dULY PL°T , APPR~V_=o XS~NOT~D ,, DATE: ,, ,, FEEl .~.~.~~-- ' ' ~. NOTIFY EUILDING DEPARTMEN~ FOR REQUI~ ' , :' ~ 1, BEFORE , ' ~' , ' ~, ~ ~ FINAl ,- ," ~o~ ' ASPHALT SHIM&LES 15~4 ASPHALT ROOFI)J~ FJI. T/~ 2 u'r~:~ RM, ~' ~ ~V/A L L SECTIOM $c,*.~ ~ C.R --""1 IF 11 fi-O" T-109 TOTAL-- 4 RA~&E 12'- I0" $8'-0" 'ti lg"ll" LIVJN~ ROO~ DIV. Ib"E" c.ou~'r e. lz VAr'lILy o~ 3'- AREA 4 HJ&N ROOM PIUD 6ENERAL 13'. 9" .,34"'0" $'4" &'-O" -I~'-R" 4'-0" Norl~'s i- ~:~"~" OVER ~ OR "1 ~N YE~ ~INE, OR E~UAL U~S~ O~ER~I~E NO~O OR SPECIFIE~ 7'-0" UP y OYgR T'yP~ DOteR /&'-O" g4'-(~" T-109 ,i CONC, HEARTH RAISED I" ABOVE FIREPLACE RISER :2"r4 ' ~8'-0" 35'-'I" 22'-$" 5'.o.) 7'-0'* ........... l ~' , I . i ., ILL- IU No~-~' ~ I . a~ ~SE COU~ 12" CO~C.S~ ~ -- S'-Z' I~ q'~ _ i 34'-o" ~4'-0 TRF~D T-109 SHEL~F-- 4 TOTAL -- 4