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Home My WebLink About7077-zNO. 4 TOWN OF SOUTHOLD BUIT,BING DEPARTMENT Town Clerk's Office $ouflaold, N. Y. Certificete Of Occupency N~. ............ Date ......................... , THIS CERTIFIES that the building located at~.6..~...~../.~..1~..~.0..~.....~.~.A. ~... Street Map No. .............. ~ [ ! d Block No. --.. .... . .Lot No. ~..~. ................... conforms substantially to the Appllcation for Building Permit heretofore filed in thi.~ office dated ............/.I. ?..~..., 1~..~.. pursuant to which Building Permit No.7..O..7~.. dated ...........././.. ?..~.~..., 1~.~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ued is .... .~. ..... 0..~..~. ...... f?...~../.~. -f. ...... .~., .w. ~- ~./_../..~..~.,. ............. · he certL~icato is issued to ....... . .~..U.~ .... .~. ~'& ./.~. ¢..0 ......................... (owner, lessee or tenant) of the a~oresaid building. ~'~ ~ ............... U D .aWaTT .aS ...... .................. HOUSE~LTM~ER ~.0t) Street ~4tJ)~oo2~ ~ ~u.r.C.~.osv Building Inspector FO~M NO. $ ~ OF SOUTH~D BUKDING DEFARTk~ENT TOWN CLERK'S OFFICE ~IJTlgOLD, N,~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 7077 Z Pen~ission is hereby granted to: ........ ~a~tm~ ............ I~,,L, ....................... Bu~.d Iletr ~e f d~ell ......... [[.... ........ to ..................................... '....m~..~Z.. . ~ ....................................... at premises located at ~t,.30. ...... ,....F~atg~o~.~tat~..~ep...~.....~ .................. , ................ .............................. ,.~;L~..~..R~;L~t~..~ ................. ~utc~.....~.~.~ ........ ~ .................. pursuant to application dated .................... ~.l~h......~.~ .................. , 19..~..It.., and approved by t~e Building Inspector. NOr~E Check average setback both streets 1 p~ $..~.....o..~ .......... FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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: ]. 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, o 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. Far existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. 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 /0 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property /'//~/~UP/3 ~'~j~ .~. /"tDLbE'I~/ I~YIZ ~-'~"T eU Owner Or Owners Of Property ,Sb'~" /'// /~-- / I L/- O Subdivision .... 7/....'.~ ..................................................... Lot No ............. Block No ............. House No ............. Permit No. .. Z.~..~.~ ..Z'Dote Of Perm t, !1 /~LT~TA-~DD cant I/t/lltll~V~/~fl~'££1.~. f~)l~l~ ~I'v'C..._.._ ,eo,th Dept. Approvo, Dept. Approvo, ......... ........................... Underwriters Approval .....~......./...~..,..~....~...~..~../ ............. Planning Board Approval' Request For Temporary Certificate .............. .......................... Final Certificate ............ ~ ..................... Fee Submitted $'-~ Construction on above described building and permit meets all opp~ cable codes and regulations Sworn to before me this /~ ................ aay o~=...~....: ....... :.Z.Z..: ..... .~ - (stamp ~al) Notary Pub~ ....... J..~./~j; ....... ~ County ~ ~~ ~' NOTARY PU~LtC, ~i%o~, No. 52-4522026 ' $uffo~ County SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number Village ~i:~2 ~ ~.- r ~,6~ 3. Public Water Company Name 4. Lot size: Width/~¢x~ feet APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant '~r? .-<~/c~ Phone~ ~ / ~z~ 5. Subdiv.~F~)~'~ Address~.~6 ~U~S7 ST -/~ ~/~Y~7~J~.~J,/ /x~?5 6. Section · Property Location ~/~ ~, mw ~.~ wm~, ~,.,~ :: x2~ ~ '~(g,/'~:,~,~/7. Lot Number 8. Private Well Township '~SF~,F/,~: ~ z~ 9. Public Water Distance to ~in Length / 7j~ mZ feet 10. Sewag~ Disposal System: A. OO0-gallon septic tank: Preset ~v Equivalent B. J_~aching pools: ,Number of pools ' Prec~st~ Block Special ll. Block If private well, fill in the following blanks: A. Tank capacity. Kt~ gallons B. Pump G.P.M. C. Total well depth D. Depth to ground water E. P~nount of water in well //f (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date /~,',~ ~ / t Sig ,~ '' ' FOR HEALTH DEPARTMENT USE ONLY. Based on the information pPesented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE ~-/~' ~/ SIGNED Rev. 4/1/73 THE NEW YORK BOARD OF FIRE UNDERWRITERS aN' BUREAU OF ELECTRICITY l-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CEETIFIES THAT on/y the e/~ctr~c~d ~quqmwnt as d~cr/bed in the yollowing Iocotioa~ [] Basement [] 1st Fl. [] 2nd FI. 0~3~8~d~ Section Block Lot w= exami,~.a o, .TUly 22, 197 h ,~ lo,~a to be in eomplbmc~ with the requirements of this Bo=rd. RXTUBE RXTURE$ RANGES COOKING SECKE [ OVENS DiSH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS KITUI~ APftlANCl FIEDEIS SPEClALRlC'FI TIMECLOCKS BELL UNIT HEATERS MUtTI-OUT~T DIMMERS SYSTIMS SERVICE DISCONNECT NO. Of S E R V I C E 1 100 OTHER APPARATUS: ?ovle&Sona Man,lc Beach,L.I. 11951 ema~A aA~Ae~ Per . COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIC:ATE MUST NOT BE ALTIRED. IN ANYMANNIEL /' ~ TOWN OF SOUTHOLD ~U~D~G DIP&~TMINT S T. D, Examined ....... ..... .......... ................ 19. O'~ ~plicati~ ~. ......;.........~..............-- ~proved ~( '~ 19 ~ ~ pemit No. 7~ ~ 7 ~ g/~7/~ - ~. ........................................ ' ............. ........................ . ........................ ........ APPU~TION FOR BUILDING PER~T ~. T~is ~li~tion ~t ~ ~om~l~telT fill~ i~ by ~riter or I~s~tor. ~lot ~1~ ~ho~ing I~tio~ of lot ~nd of B~ildings ~ ~r~is~, rel~tion~i~ ~. Th~ ~ork ~rod by this ~li~tion ~y ~t B~ ~o~b~f~re d. Upa~ o~r~l of t~i~ ~li~tion, t~ ~uilding I~s~or ~i~l sh~ll b~ ~t ~ t~ ~re~ises ~il~bl~ for i~ti~ thr~t th~ ~r~ss ot th~ ~or~. · . No building sB~ll ~ ~i~ or ~d i~ ~BoI~ or i~ pa~ for ~y ~u~ ~t~r ~til ~ ~ificote ~ ~cupancy 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, (Signature of applicant, or name, if a corporation) (Address of applicant) ~'~'~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If ~t/i~,~rate, signature offal, authorized officer. ~ (Name and title of corporaTte officer) 1. Location of land on which Rroposed work will be done. Map,~ ..~....~..~.../.~... ................. Lot No..~.~.. ............... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~.' ~l~ure of work (check which applicable): New Building '~'''/ Addition Alteration Repair .................. Removal .................. Demolition .................. Other_.~/ork (Describe) ....................................... 4. t moted Cost ..................... Fee .Z.: ...................................................... (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 L .~..,/.~...~....~....,~'....~;~... . . 6. If business, commercial or mixed occupancy, specify nature and extent of each b/pa 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 .G"~ '-- ~.t/ ~ / .,/ ! ................................ Rear ~..~....'C....~.J ......... Depth ~,'~...~.. ........ Height ../'~..../. ....... Number of Stories ..... ./. ................................................ 9. Size of lot: Front../.~'.;;3..a.~...~.. ...... Rear ....~.z~4~..<...~.4~..../. ........ Depth . ./..~.~.,...~.~.. .......... 10. Date of Purchase ....~.....,~..~.......'~..~4..../..~.~..~.. ........... Name of Former Owner .~.~...,~'..~.-'~.~,,~..~-~. ........................ 11. Zone or use district in which premises are situated .~......~.../.~.~-2~...~.~....~.. .............................................................. 12. Does proposed construction v olate any zon ng aw, ordnance or reclu at on? ~...~. .......... - 4~,5-~' ~'~5 7' ~',~,~- ~'" ...... ~ .......................... 13. Name of Owner of prem.ses,~.~F.....~'..~.-...~../..~.../c...~.. ....... Address ,~.~r,,~...4;?,~'.~d~,~.~... Phone ~o-../-~...~...~...-.~...~..?.7 Name of Architect ..... ~...~....4~.....~... .............................. Address .......................................... Phone No. · 'ame of ~ tracto,~.../.~'.. ~. _--- ~ .... /,6'¢ ~'-~, ,~'/-~,?--~ .................... ~on ..... ~ '..'~.~...~T...Address ,~'_~~,~ ..~..-~.~.. Phone No~.~..-~..~.~.... PLOT DIAGIGau~ 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 comer lot. STATE OF NEW'~YORK~ 1. S S COUNTY OF ....... ' ................................................................................................. ,being ~luly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .......................................................................................... ~,. ............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perf0~m 'Or have perf'orr~ed the said work and to make and file this application; that all statements contained in this application are true to the best bf 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 ~ , x / / .......... of ' Nota PublP ~ - ~'~" ~'~,//',~2~'~_ ' _ .............. "~" '>/' "~'~'~4~'/'".~-~· ............................... ry ~;~*-..~..';..:..'~.3~N~..~nty (Signa~ of applicant) Notary Public, State of New York No. 52-0344963 Suffolk County Commission Expires March 30, 19._.~ su FFOL~< COUNT'¢ C~.~ ~=~'S O~F~CE *S ~__~p ~o, 5CA LE - 50'=. I 13) '-' I I~ON PIPE El = TITLE CO, NO, G~AP, AhiTEED TO T1.4E TITLE The sewage disposal and water supply facilities for this location have been inspected by this department and found ~o bo satisfactory. Sorvlc¢$ APPR~VI~D AS NOTED ED INSPECTIONS: FINAL WHEN JOB COMPLETED ~ODES;~L.L FEDERAL,~TATE AND t. OCAL CODE.~, ~)RDiI~IAI~C[S, REGULATIONS ETC., SHALL BE ~.ONSIDEFif ' '.? r.-:,~T OF SPECIFtC;ATIONS FOR rills BUIL',.',i~G AND '~HALL TAKE P~EFERENCF OVER ANYTHING SHOWN, DESCRIBED OR IMPLIED WHERE SAME ARE AT VARIANCE. ELEVATIOn"? f':- ',~'"~,~::',AGES, PORCHES, ON PLA, i'.::::;, ~2 i'C., Ar,2 ,2;UE:,JECT "~. ? TO MEET TOPOGRAPHICAL CONDITIONS, ~CALE: ~/'+ ~ t0L 4-" H~CAVAT~D ~LAN. q - &, ~D RO0~ ~,l~ ~L/} DDO~ 5'- d' ~' :%d' ~0 0 NJ CLOS" DtI'41~G 3 MASTE~ ~5ED RO0~ ! 8L G" ' I1LO" F4OOMI LIV t H~4 -- ?__%.4~-, ,S_~:~,,,¢_z 'Z.%'- lO" $4'-2" IG i I F L 0 0 Q PLAM 1 pLAN -..4