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Home My WebLink About7334-zTOW~ OF $OUTHOLD B~,nIN~ DEPARTMENT Town Clerk'~ Oltice $outhold, ~q. Y. Certificnte Of Occupancy THIS CERTIFIES that the building located at ..... .~.L..E..~.~.1 .... .-~...~.~..~.... Street Map No..~. ~. ~ .[~.. Block No......~. .... Lot No,..~. ~. ............................ conforms substantially to the Application for Building Permit heretofore filed in *.hi~ office dated ............. !.~...J.V..~' lg?. ~. pursuant to which Building Permit No.~..3..~.t/.~.- dated ............. I.y .4.~..u.L ~gv. y.., wa.~ ~.~ued, and conforms to an of the ~u~ ments of the applicable provisions of the law. The occupancy for which t. hi~ certificate is ~uedis ... ,A O~f~-' ~'~t.y .... The certificate is issued to .... xJ. fi..C.~.....~....~.0..? .0...'"J~. '.¢... ~t].~.~.~...-~..~..T~. ......... (owner, ~--^ of the aforesaid building. Suffolk County Department of Health Approval .~.~?.?~....~. ~,aw~i~,~s c~,a~iFICa= ~o .... ~...../..~..z'.~. a~. ....................... i~ous~. ~u~.a .... .?..Z. ~.. Street... ~..~. ~ .~! ~ ..... .?.~. ~. ............... FO~ NO. i~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7334 Z Date .......................... eT~.....~I~. .......... , 19..~t-. Permission is hereby granted to: ~t premises located at ..~O$,..1~9 .......~&t..¢~e~k...Es.ta$,e& ........................................................ ........................................ ~GS~nn..Ro~d .......... Sauth~ .................................................................. pursuant to application dated ................................ ~'aZ~'""S~'"', 19'~1'", and approved by the Building Inspector. Fee $.~.~m:t.O. .......... , -v -- Building Inspe~et'6~' -] ' ~' A,PLICATION FOR .UILDING ,RMIT ~/~ : -/'7 ............... ' ...... INSTRUCTIONS ' a. This alN~ication must be completely filled in by typewriter or in ink and submitted in triplicate to the Buit(IMg Inspector, with~, 3 sets of Plea. ns accurate plot plan to scale. Fee according to schedule. b. Plait ,l~lan sho~fng:location of lot and of buildings on pim,ilses, relationship to adjoining premises or public streets or areas, and~' giving:a ~dd!ed. des. cdption of layout of property must be drawn on diagram which is part of this application. c. Tbe work~co~Yed by this apptlCation may not be commenced before issuance of Building Permit. d. Upon approval of this aPPlication, the Building Inspector will issue a Building Permit to the aPPlicant. Such permit,shill be kept onT~ the premises available, for inspection throughout the work. a. No building shall be occupied or used'in whole ~r in pert for any purposc whatever until a Certificate of OecopamW shall have bee granted by the Building Inspector. * - , ' " APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit purma~t to the Building Zone Ordinance of the Town of Southoid, Suffotk County, New York, and other aPPlicable Laws, Ordinances or Re~ulatiMll, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with MI applicable laws. ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildingr for nesemary inspections. (Signathre of applicant, or name, if a corporation) (Address of applicant~ I C:) ~ ? State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises If applicant is a corporate, signature of duly authorized officer. (Name a~d title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... ~L. Other Trade's License No ..................................................... · · 1. Location of land on which proposed work will be done. Map No ............................. ~ ............... Ldt No ......................... Street mid Numher ..~.....~......~......~.....~....O.. .... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed (~OM~uctien: a. Existing use and occupancy .........................:......; ................................................................................................... b. Intended use and occupancy .........................~....~....~..<~,~..~.. ......... v..t ......... *3. Nature of work (check which applicable): New Building ........ ~ ...... Addition ..................... Alteration ............ y. Repair ..................... .... Removal ................... . ..... Demolition ........................ Other Work .................................... (Description) 4. Est,mated Cost ..........-~.*...{.~J~.... .................. Fee ~' .~ ~ (to be paid on filing this application) 5. If dwelling, n~mber of dwelling units .................Number of dwelling units on each floor ......................................... If garage, number of cars ................... J ...................................................................................................................... 6. if business, commercial or mixed occtmanc~, specify nature and extent'of each type of use ............ ~ .................. 7. Dimensions of existing structures, if any: Front .....~...L..~.. .....Rear ...... *......' ................ Depth ................................... Height .......................... .... . .... ... ... .... . Number of Stories ............ ;~ ..................... ~ ........................................ Dimensions of same structure with alterations or additions: Fro.nt ~ ......................... Rear ......................................... D~,h ..... Heinht ~. .... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... ~,....&~.. .......... pear ....... ~.... ................. Depth ........ .~.....~ ................ Height ......... ~..~......~-.?. .......................... Number of Stories ..........;.:,~;,..~ ...................................................................... ...... ~' t~'i~" In~ .~' 5~'~ .. Denth ' .I..,~...~!. ............... 9. blze o1' O~: from ........ ~. .................................... i..~. ....................~ .............. L)~ ~'l~ Former Owner ..~... ............... ~.....~'~.'}~I:..'3[~.. .................. 10. Date of Purchase .....~ ............................... Name of ~',~ C, 11. Zone or use dis/trict in which premises are situated ...................~...~-~...~...l~..~..., ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: I,-, ~ 13. Will lot be regraded ................... , .......... Will excess fill be removed from premises: [ ] Yes [~1o ....... . vo ......................... 14. i~lame o~ uwner u, p~=m~-~ .~ ........................................................................ (Address) (Phone No.) Name of Architect ...................................................................... i~,~i;~'s'~i ................................... i~'~'~l'~i'_"~.' ......... ,rr ......... ........ ,~ ............................................................. {Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW Y~K, ./,/, //' (Name of individual signing contract} (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. ............................ ...... SUFFOLK COUNTY DEPARTMENT OF HEALTH Heal th Department Reference Number · ~'~_~ C/~- y~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant ~i~ C~t'~'~.~.'t~,l (~4~Phone~q~o~f~'~ 5. Subdi~. Address ~q, lw- 6. Section Property~Location 7. Lot Number 8. Private Well 3. Public Water Company [lame 4. Lot size: Width ~-~%' feet Village ~--~-~ Township J%'~lm 9. Public Water " Distance to main Length. /~'~ feet (~oF'Health Dept. Use) 10. Sewage Disposal System: A. ~/~-gallon septic tank: Precast. ~[quival en~I~.~/ .Block, B. Leaching pools: Number of pools ~ Precast ~B1 ock Special ll. If private well, fill in the fol 1 o~ing blanks: A. Ta~k capacity ~' gallons B. Pump G.P.M. ~1~ C. To.tal well depth D. Depth to ground water ~ E. Amount of water in well ~0~ 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 ' I" ~ }'1~ Signed l .... L ...... ~_~_~ ............................. ~ ......... 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 p)ot. APPROVAL DATE S GNED <- S-15 Rev. 4/1/73 FORM NO. 6 TOWN OF $OUTHOLD Building Depa~tment 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 os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $$.00 3. Copy of certificate of occupancy $1.00 Dote t O New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~---~1.,~ .l~..t~ ~--~:> ~ Owner Or Owners Of Property ..~....O~,T~ .vi Subdivision ..~.~.....~.~)~......~.~Z.~.~.Lot No....~.. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant ~ ~.~.~.~.~.~.~ Hea~th Dept. Approval ...... ~..Z.~.~.Z.~ .......... Labor Dept. Approval ................................................ Underwriters Approval ...... ~..~.~.~.~. ...................Planning Board Approval ........................................ Request For Temporary Ce~ificate Final Cedificate Fee Submitted $ ......... ~.~.... ......... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this "~ /0/~/? y ................ day of ............................................ Notary Public .................................... County (stamp or seal)~o t 0'0