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Home My WebLink About7220-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .O~,ep.n..Road ............... Street Map No..?..a...? .... Block No..~.ql~..e .....Lot No....1.2 ............................ conforms substantially to the Application for Building Permit heretofore filed in this office dated . .1~..~_s ............. , 19.7.1~. pursuant to which Building Permit No.7220. F,. dated . .gay .2,. 197~ ........ , 19 ...., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to }dlnda .Way Bu:L]Alng. gol~. ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .Oat,..1~. 3.97L~.. f4ef,..~. ~1~0,~.~.. UNDERWRITERS CERTIFICATE No .... }I~827.10 ................................. HOUSE NUMBER ~O2O ......... Street .. ~l~m~.~o. ad 0. ~outb. old,1 li ,. ¥.*t ...... · 0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTIIOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7220 Z Date ~ 19 Permission is hereby granted to: Wi~wa~..~u~A~$n~ ..~or~ ................................ ......... ~oz..~.~ ...................................................... ....... .q.t.....,T.~.~.L...t/.t.~.., ........................................ to ..~.~,.~..~,#~... ~x~e...£~l,~..~t~m~ .................................................................................... at premises located at .~..~, ....... Id~s:~..C~eek..es~t~l~. ......................................................... ..................................... ~.J~...O~Lezm..~o~ul ......... ~t~e~....llo~o ...................................... : ....... pursuant to application dated .................. .L~Je.~.....2 ....................... , 19'/~...., and approved by the Building Inspeator. Fee $~...1..?../...0..~. .......... l-' BuiloXlng Ihqa~tor / 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 oil 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 Dote ............. ............ New Building ........~... ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .... .~/~......~..~.~z~j.,~/~ ......... '..~Z~.../..,...~..~.... ~....~/..~....E,~.....~..~.~,.,~.e~ .................... Owner Or Owners Of Property /,,~.~.~..~.~. ~../~....) ...~....O..~.J...~ ~.~/ ~'~t. ........................................ Subdivision ....~...P~,......~.....L~..~'.......~...~....~-C,...~.~...~...,~... Lot No.....J..'...'~... Block No ............. House No ............. .... Permit No...~.....~..~ ..... Date Of Permit .......... ..~...'~...App icant Health Dept. Approval .... ~ ....................................... Labor Dept. Approval ................................................ Underwriters Approval .... ~......./....~...~...2./...?. .......... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ .................................... Construction on above described building aad permit meets al app cab e codes and regulations ' Apphcant . .y.~,,~.~. ~. z¢/..~ ::~/,/~/.~,~...~,. ,,,/,; ~<~.... ..................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) 10. SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number zTZ,~_~ ~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant~ ~,)r,,~' ~L ,~'-~ :'~Phone~'l"')~)~ 5. Subdiv.h~'~~' ~'~ Address J~ ~ ~ , 6. Section~ Property LBcation'~y) ~' ~JJ ~-~ ~m~,~l J ~.~ 7. Lot Number ~..~ .~ ~ S~o 0~?'~ ~" ~ ~'~8. Private Well Village ~5,~{~0 Township ~3.~.~J~O 9. Public Water "-- Public Water Company Name ~ Distance to ~in Lot size: Widthj ,?-~ feet Length. J ~ ' feet Sewage~Disposal System: (For Health Dept. Use) A. ~ga~on septic tank: Precast~F Equivalent Block 11. B. Leaching pools: Numb-er of pools Precas~Block Special If prl~ate well, fill follo~Ag blanks: in the A. Tank capacity ~. gallons B. Pump G.P.M. C. Total well depth D. Depth to ground water ~ ~'' .... E. Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's 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 ~1,.( ;~t Signed ,,~...;,"~ , ~,,, ~ ,,,~ ,.¢,.z~..- ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 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. APPROVAL DATE ~///~//~ ~ SIGNED ~ ~ ~ S-15 Rev. 4/1/73 THE NEW YORK BOARD OF FIRE' UNDERWRITERS BUREAU NEW YORK.,~.~Fu~)RK ' .IOO38. Appl,.,,_ N 182710 THIS CERTIFIES THAT t~eaex.minedon :~ept, etmer ,L',~ s ~'JYq [] 2,~a r~. outside Section Block Lot and found to be in compliance with the requirements of thla Board. RAm ~T, lC. W. SPECIAL REC'ET. 1 3o R RXTURE [ECEPTACi~SI SWIT E I FIXTURES 23 /58 2~ 23 ! SERVICE mS(:ONNKT I NO.O~ { S x METER. biO. OF CC. COND. A.W.G. 1 150 1 1/0 OTHER APPARATUS: mpu~.,*naoes: 011 1-1/Shp, 1-1/12bp IFutu~e appliance feeder/B: 1-2#8, 2-2~10, n2-2~12 MotOr/B: 1-3/qhp EXHAUST FANS DIMMERS OF NEUTRAL 1/o Robez't A. Goodale, ~.~ RR ~1R ~ox 'tSAR /'~.ln Rd.R Mattltuck, L.I. 11952 ~aA~m COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. BU&DIN~ DEPA~I'MINT~*~ /~-f'- /~,/~. "b~, .,~ SOU'mOLD, N. Y..~_ ~%'./~,o /~..~ -~:,~ ~ .~:>, om,ned ...... ........ _, .______ ................ ....... ....... . _ " ,,_,,,,, , ...................... ................ ,~,g~i~'~,,f/~'. /~ ~,/~.~ / APP,LICATION FOR BUILDING PERMIT,. / ~-~'~/" ~'/'f~f' ~: ' *: ~b' ~T-~9~-~//x~... Date .................. :.. 19..~..~...~: a. Thi* apPlication :must be completely ~ill~:l in by ~pewrit*r or mmk and sffom~ffed m tnphcote to the Inspec~v~ 3, ~ O~plans, accurate` ploe~ Rlan:to~,sc~le~ F .~ee.~c¢~i~g,to,schedUle: · 6.' P16t ~Jon ShoCvi'n~ Jo~fibn~f'i~t andiof buildings on~premises~ rel&tionship to adjoining premises or public streets areas, and givingld detai:led description of layout of Prb~en"y must be drawn on the diogrotn which is part of this application. c. The work cov~ered~y this application may not be commence,ed before is,suance of Building Permit. ' d." [Jl~&h cipp~:~vOl'df ~H~' OPp *icotiOn~ ~he Bu' ding Inspector will issue a Building Permit to the applicant. Such permit shall be kepf-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 havebeen granted,bY the Building Inspector. APPLICATION IS HI"REBY MADE to the Building Deportment for the issuance o{ a Building Permit pursuant to the Building Zone Ordinanc· o{ the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for' the cor~truction o{ buildings, additions or alterations, or {or r~moval or demolition, as herein described. The oppllcont Ogres to comply with all appllcoble I~, ordinance, building cafe, housing co~e, and regulations, and to admit outhori-ed inspector~ on pr~mise, and in buildings {or neces.m~ impecfions. ..... t..~. .O~ ........ : ..................... (S~gnoture of applicant, or frame, ff a corpomhon) ......... .... (^ddmss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ ............................................................................................................................................ Name of owner of premises ....H.?..~.-~..~......~......~.......~..~..[/.~.!.~..~.....~.-,....~q..: ............................................................................ If applican~is a corporate, signqture of duly ,authorized officer. (Name and title of corporate officer~ Builder's License No ..................................................... Plumber's License No ............. ~ ........... ~ ...... .~ .... Electrician's License No....~.?..6..~.~:~...~..~...~.~?...~. ........ Other Trade's License No ............................................... .(..'...P~... J~.~.(....e~....~... Lot No....J....'~.. ............... Location of land on which prapose~d work wiJl be done. Mop ,No,: ~...~,,6..(.. Street and Number .... ~'./.,S ........................ .~. ............ '..~..).. ......................... .~ ...................... ..~'..~-, ......................... Municipality State existing use and OCcupancy of premises and intended use and occupancy.of proposed construction: o. Exisiting use and OCcupancy ..... b. Intended use and OCcupancy ............................... ~ .................. .~ .................................................................. 3. Nature of work (check which applicable): New Building ...... ~ ...... Addition .................. Alteration ......... ..=...~.. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . ..... ~"/ ~ ~0~ (Description) 4. Estimated Cost ~...~.,~.~.:' Fee ' ' .. (to be paid on filing this application) 5. If dwelling, number of chvellJng units ........ J~ .................. Number of dwelling units on each floor ............................ 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 ...... ~.~.~. ...................... ~ o"-0 ' 4/ Rear ....~..a .................. Depth ........... .~. .......... * I Height ....~...~'. .......... Number of Stories ..... ~...7. L, ........................................................................................................ 9. Size of lot: Front .............. IEt.~. ................................... Rear ......... (.~..?..: ......................... Depth ...~....~..'....~.~'. ........ ~ ..... 10. Date of Purchase ....... ..~../.-~'.l.~..~. ............................ Name of Former Owner .~...~,...e~.~q~.,....~-.~..~..~ ........................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~..0. ................................................ 13. Will lot be regraded ...~ .~.....f~q~. ......... Will excess fill be removed from premises: ( ) Yes (b~No 14. Name of Owner of premises ..... ..~...~t.~.a,C.~.~/..~.d.~'./l~.l~. Address ~..~..~..~....~.~ ........... Phone No. ~',','~:..~..:~?..?.~.. Name of Architect ........... .~./. ............... ~ ............. /.f. ............... Address................................'tm ~'~,-e*~ Phone No ....................... Name of Contractor ........ ~ .............. a ................ /~. .............. Address ........ ./.: ....... .~.~. ........... Phone 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 whether interior or corner lot. STATE OF NEW Y..~RK~ ~ . ~ ~= COUNTY~''''f ~'° ................ ~....~ ............................. being duly sworn, deposes and says that he is the applicant (Name of individual, signing contract0 above named. He is the .......................................................................................................................................................... (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 ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ....... ....... .......... ....... ...... ....... .................... NOTARY PUBLIC, State of New Yak No. 52-2841400, Suffolk COOllbj Cemmission Expires Match ~1, 19 N 0 /v. ~'. BTAT~ ~C. NO. 3a~03 ~F_~ / ~TAUK~T~ N. ~i N I L _-]tl~l 1 =_1 %1 I I11 I I I~1 =1 ~ Itt =t F_. L E V A '1' 1,0 iii - 0~ CELLAR,, F OUNi) AIiON PL/~N I i I FL(~ 0 K, ,1 S[COl l/)FLO,OK, O ',/E:n. &E'kl CROSS S[CTIO N