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Home My WebLink About7393-z!~0~' NO. 4 TOWN OF SOUTHOLD Buu.r~i~G DEPARTM~.NT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No...~--~./-8~- Date 2~ ~7- 19..7..~ THIS CERTIFIES that the buildlns located at .~.7..0...~?..~..~.....-~...~...L..., Street Map No .... 3.~3~) Block No ........... Lot No ...........~. ~. ................. conforms substantially to the Application/or Building Permit heretofore ~ed in thi~ office dated ...........3.. 9.U,..(, 19.7.t{ pursuant to which Building Permit No. 7. ~...i~...~ dated ............ 10..-J.U.L..~., 19.'7..~/, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... ~. 0~1£ ..... ~ ~f.l.~.'¥. .... ~..W.~. ~.~. J N'..~-. .................. The certificate is issued to .... .~...~....1~. .... .H.~..~..~ .I.N .~. ......................... (owner, I~ of the aforesaid building. tr~D~.RWar~RS CERTIFrCi~ No..~4. · -~ ~.9 ~. I .a. ............................. .................................................Ccl.TC'~. .. Building Inspector 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? 7393 Z Permission is hereby granted to: ............... ~.~e ............................................ to ~lJll~l .~;,w...~u.e,.. £a~zLl~:..&~ze.;.i J.n& ..................................................................................... at premises located at ....]...o..t;....,~. ....... .~..9..o..~.e.....C..o.y...e. ............................................................................ 14oose Trail Cutchogue pursuant to application dated ........................~C~.~, ......... ~, ......... , 19.~..LE,., and approved by the Building Inspector. Fee $.~.,~ ~.O ........... Budding Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department 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 Date ,, ~.~..e. ,b..~. ~.,..2..5. ~... 1, .9..?..4. ....... New Bui{ding .......~ ...... Addition ................ Old or Pre-existing Bui{ding ................ Vacant Land .............. Location Of Property ...M...o..?.~.e.....T..~.a..i..]:.,. Outehegue ......................... Owner Or Owners Of Property ..~M,r.,..~..~c~,..,,Ro. be~...ll~.r.k.t.,,~ ....................................................... Subdivision ..........M.o. 9..s...e....C...o..v..~. ............................... Lot No....3..5 ...... Block No ............. House No ............. Permit No..Z.;{~.3~ ....... Date Of Permit .Z~'.].O./..'i'.4..Applicant .G~a~4~e..,/~,h.z~.~.~..~.l,d~c.,...Tll. e ...... Health Dept. Approval ~0.10~8.-..10~.~.4/..?.~ ....... Labor Dept. Approval ................................................ Underwriters Approval .Z~9,~.~.~-.14)~'.2,3./.~ ......... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......~ ................................. Fee Submitted $ ......... ~ ....................... Applicant .......... ..~...~ ........ Sworn to before me this ' / ................ day of ............................................ (stamp or seal) Notary Public .................................... County SUFFOLK COUNTY DEPART~NT OF HEALTH H.D.Reference No EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR AP~AL TO CONSTRUCT PRIVATE SEW~GE ..DISPOSAL SYSTEMS D~te'~ Approval t~ construct Said syste~ is requeSted,pertinent data herewith: Address Z~ ~.~ A~ ¢~¢~.~,~ ?-Section 2-Detailed pro~rty location ~,Z ~-, W ~, '-w ~,~, ¢¢~,:~ 8-Lot No. :: ~j Hamlet ~¥~:I~ ~ ¢~ Town ~¢¢/,~ ~J 9-Private well? : 3-Public water supp~ly name Distance to nearest main S-Lot Size: Width ~ft. Length ~.:~ft. (al~"enter on center plot plan below:) 5-Dwelling: Single Family ~_~ Two Family? ~ ~Cellar? ~.Slab? ~ ~Craw~l Sp?ce? ~_~ 10-Proposed system: Septic tank ~../Precast ~._~Cesspools $%,'/Shallow poo-s Il-Septic tank inside dimensions: Volu~e'~Gals.Length__ft. Width ft. Liquid depth ft. 12-Precast sections: ~ ~Number/ ~Square Ft. Cesspools: Block sizeL.~incs.D ~.ins. H_.~ins. Total blocks below inlet: ~1~2 PLOT PLAN Street Capacity~Gals. Nc ~tb The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, a~d amendments thereto, covering Private Sewage Disposal Systems". Owner er Builder FOR HEALTH DEPART~NT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this Plot. (10/65 Revis.) s-t~ Disapproved a/c ....................... '". .......................................... ?"-"r ..... ................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~'~ a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building ~ Inspector, with 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 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 be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue (3 Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work· e. No building shall be occupied or used in whole or Jn part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector· APPLICATION IS HEREBY M~E to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of thea~'own of Soutll~ld, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constructk~'of buildings~additions or alterations, or for removal or den~lition, 'as herein described. The applicant agrees to core,IF with a applfcable laws, prdinances, building code, housing code, and regulations, and to admit authorized inspectors/~ premises ar~ in buildJn~ for necessary inspections. (Signature of applicant, or name, if a corporation) Cox Leue, Cu*ehos~e, N~Y.. (Address of applicant) State whether ~plicant is owner, ~hitect, engineer, general contractor, electrician, plumber or builder. Name of ~l~lgi~i~!~.....J~..S~......~....~..e.~!..~.~..l'...~..l:.~..~ ..................................................................................... If applicant rat~thoriZed officer. C N a rg~ ~t,i~t_.~,o f p~ll:po r'~e officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~,~ 1. Location of land on which proposed work will be done. Map No .'~'J~'o'~- ~ Lot No. TM Street and Numbe~.~l. gL..?..~..~.~..~.~....C, lc.~.l~.~Rl~....~.~.~ .................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................................................................................................................................. b. Intended use and occupancy .......... ~.Z...I..I:..~.~ ................................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ...................................................... . ].~ ? ~ (Description) 4. Estimated Cost :~ll~tJ~e t~ Fee .......................................................................................... (to be paid on filin~ 'this application) 5. If dwelling, number of dwelling units ......qll.~. ................ Number of dwelling units on each floor ............................ If garage, number of cars ......................... IIt~. ........................................................................ ., ................................... 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. Dimensi6ns of entire new construction: Front ........ ~.~... ....................... Rear ............................ Depth 14' eae Height .................... Number of Stories ...................................................................................................................... Size of lot: Front ..... .J....J~...e. ................................... ' ....... Rear .....J:...J~...e. ............................. Depth ..J..J..~...e. ...................... Date of Purchase ........................................................ Nome, of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... & Does j~roposed construction violate any zoning law/ordinance or regulation: ........................................................ Will lot be regraded' , ...................... ~.... Will excess fill be removed ~.c~el~,r~l~es~j) Yes (Z) No Name of Owner of premises .................................................... Add~ ................................. Phone Ne. ...................... Name of Architect .............................................................. Address ...................... .; ........ Phone No ....................... Name of Contractor~...~...~...A...~...~.?.'~'"~'.....~..~.~..?.~..!.~.?.'.e Address ...~..?..~...~11...,~..~1~.. .......... Phone Ne. ...~,,.~.~..~?... PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. ~Give street and block number or descriation according tO deed, and show street names ,and indicate whether interior or ~:omer lot. 10. 11. 12. 13. 14. STATE OF NE~ YORK, I c c COUNTY OF ~..~t~e~k ...............[~'~ ............ ...~.......~..?...~..~..~.~...~..~..e...?...;~....~.~.~....e~....~. ........................... being duly sworn, deposes and says t~t he is the applicem (Name of individual signing co6trac~ above nam~. ~t 1daf He is the ................................................................................................................................................................................. (Contractor, agent, co~orate officer, etc.) of said owner or owners, ~nd is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are t~e~~l~e and belief; and that the work will be perfor~d ~n the manner set fo~h m the apphcahon Swam to before me this ( I ~ ~ , ...... · ...................... ...................................................... JUDITH T. BOKEN ~otat7 Public, State of New Y~k No. 52-0344963 Suffolk Count¥'v~"'"' ~iOOS~E