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Home My WebLink About7053-zFO~ NO. 4 TOWN OF $OUTHOLD BU~,r~IN(~ DEPARTMENT Town Clerk's Office $outhold, BI. Y. Certificate Of Occupancy Bio...~6~0~ .... Date ... THIS CERTIFIES that the building located at .s4~, .llo~,~the~n ~lvd, ..... Street Map No.Aquav~te. pk~lock No ........... Lot No... iI~Z ............................. conforms substantially to the Application for Bui]di,~g Permit heretofore filed in this office dated ~a~ta~,.Zi~f ........ , 19.7~. pursno,~t to which Building Permit No. 7.0.~Z.. dated ~a~l,~.ll~f ......... , 19.~/1~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is issued is ... 0n~ .Fae~tl~. De~i.IA~ .............................................. The certificate is issued to .... JO~]lh ~,~la ............................... (0wrier, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .J.~l,~..~9.,..~.. .................. UNDERWRITERS CERTIFICATE No...N17~g61... ............................... HOUSE NUMBER..~00 ......... Street .. S~mth~n.~l~d,,. j~&t...MSF~.~.,. ~.; ..~, · Buildin~ Inspector (THIS I~ERMIT MUST BE KEPT ON THE I:~EM~ ~iL FULL COMPLETION ~F THE WORK AUTHORIZED) 7053 Z ~ ~, ~ ~,~ . .~...~..., ~ ~ ~ .t~, FORM NO, 6 TOWN OF $OUTHOLD 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-ex'st'ng' 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 ~, ,4 A, / ~ ,/'7 ~ New Building .~t~ ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locot o, Of Property ...... ...... ............ Owner Or Owners Of Property .... ~.. 41~./..~. ~:~.~f-~./.. .-,~7. ......................... Subdivision ................................................................ Lot No.../. ........ Block No ............. House No..~....v.:~.... rl ° "~'<.?'~- / ,./ , ,7~ s. ,. /4' ,~ , '. ~ Permit No .......... : .......... Date Of Permit ...'../.'...~./.~...Applicant ....... :..L./.x~..... ............ ,~..; ........................... Health Dept. Approval ..... ...... ,~.~..../.....~...~....Labor Dept. Approval ................................................ Underwriters Approval ....... /......~'.....(~.~...~.../~..... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Sworn to before me this.~, ....... day o, Construction on above described building and permit meets all applicable codes and regulations. · A I . -' ' ~ pp ~cant ...... ~.. .......................................... 4~__ (stamp or seal) ~ APPLICATION H.D. Reference No. FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant Address ~/,~,,~.~ ~~.~,~ 6. Section ' 2. Property location ~ ~o~ ~'~ Village ~%~,,~ Township ~0~.~ - 9. Public water 3. Public Water Company name Distance to main 4. Lot size: Width~o feet Length ~ feet (Enter on center plot below) 10. Sewage Dispos~ystem: A. ~0~ gallon septic tank: Precast ~Equivalent Block B. ~aching pools: Number ~ Precast~Block Special wen in blanks below: Tank capacity~f Gals. Pump G.P.M. Total well depth Depth to G.W. ~'~ -- Amount of water in ~ well Test Hole ~Data Feet 6 8 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto."~ 5J_~.-~/, '~ ~~ Date ~.~z~ ~/ /7~ Signed Owner / 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 can be installed on this plot. Date /~//7.~. ' Signed ~ '~--~.. - ~ S-15 Revised 4/]/72 /~D OF FIRE UNDERWRITERS I~l : aw -ua. Au o. ~ ~- ~~ %~-;o~K,oo3. ~ outside inthef~ingl~ ~n' e ~ 1st R. ~ 2nd Bilk w~ examine on a~ found to be in compliance with t~ requirements of th~ B~rd. fiXTURE OUTLETS DE¥~$ FL'treACLES SW"CHES 36 18 15 FURNAC~ MOTORS OTHRR AI~ARATUS: FIXTURES R~ES · · i::' I 1/0 NO, O~ HI-LEG EXHAUST FANS AMT. H. P, DIMMERS 1 1/0 1-1/Shp, 1-1/~hp !~!ike Siliris Main Rd. East Marion.L.I, 1193Q Per 11 COPY FOR BUILDING DEPARi;MENT. THIS cOPy. OF CERTIFICATE MUST NOT BE ALTE? INANYMANNER. ,~ ' BUILDING DEPARTMENT ~ '~ . TOWN CLERK'S OFFICE ~--.,~.~-~y ,~ .'~/~--- ~ /'L~.~-- ~n /~ V//// SOUTHOLD, N.Y. ~4~~ ~ E×amine~ ...... ~....t.SU, ,'~. '~,"~o,',o. ~. ............. ~ ............. ..;.:..... ................. ..................... , h , ' ........................ ........... ~ ~at~ .......... ~....J.X ..... ~..~.~...~ INSTRUCTIONS a. This application must be completely filled in by typewriter ~ in ink and submitted in triplicate to the Building Inspector, with 3 ~,~ 0f~plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing 10catioh of Jot and of buildings on prem,ses, relationship to adjoining premises or public streets o~ areas, and giving 0 detailL~l description of layout ofproperty must be drawn 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 ~ssue a 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 part 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 pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to. admit authorized inspectors on premises and in buildings for necessary inspections. (./(Sight, re of applicant, ~r rj~ne, if a corporation) (Address of applicant) '~" / State whether applicant isj~vner, lessee, agent, architec( engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ ..~...~ J~. ........................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's,License No ..... ~:.......~.~ ............. Electricians License No....~...'. ....... ~ ........ Location of land on, whichj, proposed ~lork will be d~e~ Ma_p No.: ..... F,.~. .......... ¥ ........ :..~ ..... Lot No ......................... Street and Number .~~-~-~/'~ '~ ...... t~.....oL ........... 4~..r....~.~ .................................... ~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: . a. Exisiting use and occupancy .1~......~;..~'~-'~ , b. Intended and use occupancy ............................ ................._, ...... .......................................... 3. Nature of work (check which applicable): New Building: ~ Addition ' Alteration ~ Repair Removal DemOlitio~ .................... Other Work ~ [..~..~ (Description) ' a.m ted ........... ............. Fee ........................................................................................ (to be paid on filing this applic~'ion) 5. If dwelling, number of dwelling units ........ .~ .................. Number of dwelling units on each ~lqps' ............................ 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 san~ structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ...... _. -.....- ..-.-.-)~ _Number of Stories-- .....j;..._.~.. ........... ~.~/~ 8. Dimensions of entire new construction:'Fr°nt".;,y.~._..~..,..u......_ ............... Re°r'"".~..'.?.'''''' .... Depth ...~..~/.... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot.' Front ........................................................ Rear ......................................... , Depth ................................ 1.0. Date of Purchase ...................................... ~ ........... .....~laznke of Forl~er Owner ........................................................ I1. Zone or use district in which premises are situated ..... ..~...~..1~.. ...... ...~.. ......................................... ~ ............................. 12. 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 ................... ~ ............ Phor~No. ...................... Name of Architect ...... ~: ....... ~. ........................................ Address ..................... ,.....,.,.. Phone No ....................... Name of Contractor ......~.~:.l~<v~.....~ .........................Address ..~ ........... 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~.~ [ COUNTY ...... ~. S.S ................. ~...~/1~..~, ........................................ being duly sworn, deposes and says that he is the applicant (~.ame d~ fndividua'l' signing contracf) above nam&d: He is the ....... . ........................................ L~..~~t .................................................................................. . (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 thar the work will be perfOrrl~k~n the manner set forth in the application filed therewith. Swam to before me this \ \ .~ ................Z...H. 0, ...... ........ , /'/ . Notary Public, . .................. ~ ..................... County ....... ~~-..~-.,/ ......................... ~// / (Signature o~l~ant) ,// MAP OF PP. OPEP-.TY 9U~VEYED FOP- JOSEPH TU~qILLLW AT F_./~T MAPJON TOwN OF 50urHOLD, BOU L E"/A P-D 280.00 ~z~ JU__.~L 99 1914 The Sewage ~isposal and water s-~ply facilities for this location have been APPI~)VED AS NOTED DATE: !~_ ~C~ ILI. (~'Ju~ NOTIFY BUILDING DEI~RTMENT 765-266019AM TO 4PM FOR REQUIR- ED INSPECTIONS: 1. BEFORE BACKFILLING ,COUNDA. TiON OR START FRAMING 2. BEFORE COVERING PIPEUNE 3. FINAL !WHEN JOB COMFI.ETI~'~I '-i '4'~