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Home My WebLink About7276-zNO. 4 TOWN OF $OUTHOLD B~.F~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THiSCERTiFiESthstthebuildinglocstedn~o~ /~LId~ t-/~J Street Mep No. ~'~ Block No. .Lot No. conforms substsnti~lly to the ApplicsUon for Buildin~ Permit heretofore filed in ~ o~ice dated ............~.../..f~...~.'~ 197..~. pursuant to which Building Permit No.7...~. ?.~..~ dated ............~..~.. ~..~. :./', 19.7.~.., was issued, and conforms to all of the require. merits of the applicable provisions of the law. The occupancy for which this certificate is ......................................... ov.E.r~... ~A-~ ~.~'. · · The certificate is issued to JOS/~H ~' ~ ~u~c. t (owner, lessee or tenant) of the aforesaid building. Suffolk County Department Of Health Approval U~TDERWRZTERS CERTZFZCATE No. t~ ~ ~' :Z/? b ~) HOUSE NUMBER ~0~ EL~d/~'$ .1 ~ ~c' .............. Street ......................................... Bui]d~'ag Inspector NO. ~ TOWN CLERK'~ OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE Pl~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7276 Z Permission is hereby granted to: ............................... to ...~.~.I,,L ne~..mm'.:£~.e~:r...~e~..~ne ............................................ ~ .................. ? .................. ~ at premises located at .....~t..4~..,~.~l~..~ll~lt,~l~ ........................................ ~; ...................... ......................................... i ...... ~[ZS..ZXiJ~k!.~..~ua ........... ~tt~Ltu~lc ........... ~i ........................ pursuant to application dated .......................... ]~A~. ....... ~.~ ......... , 19.~..., and approved by the Building Inspector. Fee $.1r~,,.10 ........... Building Inspect~ BUILDING DEPARTMENT,~ / ·owN CLERk'S [xomined ....Z.~ ..................... , ! 9.L./.. , / ,, ~prov~ ........................................ , ~.....i. ~e~ No.~.~...C.~..~.~,_~ ......... .................. ..................................................................................... · , ............................ · PPLI~TI~ FOR IUILDIHG Date INSTRUCTIONS a. This application must be completely filled in by typewriter o~. 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 adio n na oremises or n,sh areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram widish s ~ ;f ~':m'~ '~l'i~[?o~''o PP . 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 o 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 in port 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 ,l~,rsuant to the ~iludi_n~ Zon.e Ordinance. of .t. he T.o,wn ,of. ~tho. ld, Suffolk 1Count, New York, and ~her applic~e Tho an,o. ns, .~or rne c.onsrrua?n o~ ou~al~S, additions or alterations, or for ~moval or de~litJan, e opp.conr agrecs ro comply with amm opplicable.l~, ordinaace, building cade, housing c~e, admit authorized inspectors on premises and in buddings for necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. aame of owner of premises ..~ea~ip.~....~..~.m.~..,9......,~.e..~...z,.~.~.,,t.~ ............. . .. If a. Pl~:ant is a'lcorpgfote, signature of duly authorized officer. ....Z',',2.,~., ........... 1...~.~.. ~..~.~ ............ ~.,. ............ (Name and t tle"~f corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ....~...O.~.~'.. ..................... Lot No..../..,~,~... ............. Street and Number ........................ /~.:~...~..~.....~....., ...... /~8 M.~., ................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................... use and occupancy ..... ~.t..~....O..~..~-.......~..~.~.,t..~..~....'~/~..~.,~.~.f,~.~..~.. ........................................................... b. Intended Nature of work (check which applicable): New BUilding~ :~:.. ........ ..... Addition .................. Alteration ................. F Repair .................. Removal .................. Demolition .............. :.H.. Other Work ..................................................... 4. Estimated Cost ........... ~......~..,~....O....O...?....~.......i....i...i..Fee ~.~ ~ (Description) ' -,~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ 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 .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ i 1. Zone or use district in which premises are situated ..................................................................................................... J2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No. ...................... Name of Architect .............................................................. Address ................................ Phone No.; ..................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-lxmk 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~,K/// ,, / I.,. ,. COUNTY OF ..~~'~ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Nome of individual signing contracf) 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 are 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~ne this _ / ~,~ .,~ / ....... of Nota, ...... ............................................... c/ (Signature o'~ applicant) JUDITH T. BOKEhf Notary Public, Stale of New York No, 52-0344963 Suffolk Commission Expires M~:rch SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO. CONSTRUGT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WA?£R 1. Applicant ~/o~ ~Y/o~,z~ Address ~/ ~~) ~ 2. ~Property Location ~/ ~z~'~ ~,n~ ~/2~ Village ~i ~ ~ Y~t~ Township J~fb,- .~ 3. Public Water Company Name 4. Lot size: Width /~2 feet feet 10. Sewage Disposal System: A. 9~gallon septic tank: Precast ! ~quivalent Block B. Leaching pools: Number of pools / Precast2~xm Block Special ll. If private well, fill in the following blanks: A. Tank capacity B. C. D. E. gallons Pump G.P.M. ~ Total well depth Depth to ground water Amount of water in well 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main (For Health Dept. Use) S-15 Rev. 4/1/73 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 eff~t. Date /~..~__ ~ t~ 1~/ Signed ~/-'~:~' FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Heal th Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE ~"//~/~ SIGNED ~ ~,, 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 approvat 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ........S..e. ~..¢..e. ~.b...e.~....1..?..?....1..?..?.¢ Sworn to before me4bis ..... Coun, New Building ...~..e..~. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..l~'/~;],j,j~]3,.!~..~a~13,Q~...}f~3,.%.C.~,.~.~,.q~..~.w....~.q~ ....... ~,~...~..~.0..~.5....~.o..¢.....1.5 Owner Or Owners Of Property JoseRh a~d .~'na Sullivan Eli jo.13.' s ~e"~'~'~ .................................................................................................... Subdivision ............... ~e~3.'EiO.Zl...J ............................ Lot No....J.5.... Block No ............. House No ............. Permit No..Z.2..?.~.~. ....... Date Of Permit ...~/...2.}../.Z?.Applicant ...~..~.~.o. zt....~..o..?..e...~...~..~..?.: ....................... ,eolth Dept. Approvo, ....... Labor Dapt. Approvo, ........... .............................. Underwriters Approval ...... ..~/.l..~....~....~....~..~.' ................ Planning Board Approval .............. ~ ......................... Request For Temporary Certificate ........................................ Final Certificate .......................................... F ~u' it' '* (5 On '~ ~;'~e L~ ~0 Z ~,I~Z- ~'~"~?.bb ee 3 Dm tea ~) .-.-?-.:/~....-.~..-.,~.~-.1--,.. ~ ~-r~,,u Construction on above described building and permit m~ets all applicable codes and regulations. App,icont ........ ...... h.... ....................................... (stamp or ;eal) No. 52-092~775, ,,' County Commission Ex~ires r,~arch 30, lg~/ :l er e~rhe~scd secl shall not be considered to be a valid copy. LANE 4 78 162.00' N .38°14'50"W. .~ ELIJAH'S LANE ESTATES 162.01' SURVEY FOR JOSEPH Eit ANNA SUL L I VA N AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SCALE; I°'= 40' MAY 14,19;'4 REFERENCE: M/O ELIJAH'S LANE ESTATES, SECT. I MAPNO. 6065--FILED 2/14/1974 8UARANTEED TO = JOSEPH ~ ANNA SULLIVAN TIPTON HOMES,/NC. LAND SURVEYOR N.Y.$, LIC. NO. 28~5 RIVERHEADI N.Y. ELIJAH'S LANE All distances fo wells and cesspools am by location from house owners and field observations, since most wells and cess- pools are not visible them dimensions cannot be certified. 162,00' ELIJAH'S LANE ESTATES Unauthorized alteration or addition to this survey is a violation of section 7209 of the New York State Education Law. Copies of this survey map not bearing the land surveyor's inked seal or embossed seal sh(~lJ not be considered to be a vain copy. ~_~rcn~ees or cerfiticalio~s indicaled hereon ~hall run only fo the per=on for whom lhe survey is prepared, and on his behalf to the tide company, governmental agency and lending institulion listed her~on, and to lhe assignees of the lending institution. Guaranlees or certifications are not transferable to additional inslilutions of subsequent owners. SURVEY FOR JOSEPH 8 ANNA SUL L I VA N AT MATTITUCK TOWN OF SOUTHOLD ~UFFOLK COUNTY~ N.Y. SCALE ~ I"= 40' MAY 14,1974 JUNE II, 1974 AUGUST 6,197'4 M/O ELIJAH'S LANE ESTATE$,S4~J~: I MAP NO~ 6065-- FIL ED M/ARA#TEI~ TO' JOSEPH ~ ANNA 3ULLIVAN AMERICAN TITLE INSURANCE SOUTHOLD SAVIN6~ BANK THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC~ · . , ~-- 85 JOHN STREET. NEW YORK. NEWERK 1.OO38 THIS CE~IFIES THAT 'rzp~on uo~8 ~n~., w/~l~e m~ F Lane, ~78.02' sZo Rebeka~ Rd. Nattt~uek. L.I. Job 231 in the fol~ing ~at~n; ~ B~ement ~ 1st FI. ~ 2nd FI. 0 Ut S 1de ~tion B~k ~t ~examin~on ~ep~e~e~ 13, 197h andfou~tobeincomplia~ewitht~r~ui~men~ofthis~rd. ~XTUeE LgC~AC~Sl SWITCHES I flflXTURES 1~ { 39 18 1~ RANGES 1 10 .I SERVICE DISCONNECT I NO. OF I S E R 1 50 OB ' x 1 2/0 ICOOKINO W:KS [ OVENS {DISH WASHERS AMT. K.w. : AMT. K.W, , MT. K.w. I I1MICLOCKS] BELL UNITHEATERS MLILTI.OUTWT OTHER AFPARATUS: iWater heater: 1-/l.Skw Motor/E: 1-~/~hp Eleo.room heatel-s: V I C KO. OF HI*mKG A.W.O. 1-2.0kw, 7-1.Skw, 1-1.25kw, 1-.75kwS 2-.Skw i I' DIMMERS gaatbrldge Elec. Inc., P.O.Box 2~ St. James, L.I. 11780 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. A P PP-~.E D AS ED INSPECTIONS: 1, BEFORE BACKFILLING FOUNDA. 2. BEFORE COVERING PIPELINE !