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Home My WebLink About7125-zl~O~ NO. & TOWN OF SOUTHOLD BUr[.r~ING DEPARTM~,N'T Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..~3~.~ ..... Date ............ l~l'~h... J.lJ..., 19.~.~. THIS CERTIFIES that the building located at . .l~e~mm~..l~&s.~ .......... Street Map No. Ih~Aal~eXlock No ........... Lot No. ~ ....... D~e~..[i,X, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........Nal,~h.. ~8., 19.7~ pursuant to which Building Permit No. ?¶~.. dated ........~r~h..2J .... , 19..~, was issued, and conforms to all of the requh-e- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pl*lva~. o~ .fm~:Lly. d~ell~g ...................................... The certificate is issued to .. ¥t.t'g:Ll~. & l:lell~... I~:LI.I. .... . .~m®l*& ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. 14a~...$0. J.~.~. · I~r .I~,..~i~.l& · · · UNDERWRITERS CERTIFICATE No..]12(~)O.J ..... Ja~.:. 2¶...1.¢)~ .............. HOUSE NUMBER .... .1J~30 ..... Street...(h'ee~. F~a;J~ ....................... fromM NO. ~B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (*THIS PEP~IT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK ^UTt-IORIZED) 7125 Z Permission is hereby granted to: to ..~¢..(A.~ .......... .8 ....... E~/.A; ......... E~.~.(.MX ....... ~.~._~.k..~.~..~.~ .............................. ............................ ;'""' ........................................... ~'~'"';"x;;~ ............ ; .......................................... pu~uont to opp icatiCn dot~ ...................................................... , 1~.., and approv~ by the Building In~tgr. ~ ~ ........................ Building Inspector FORM NO. 6 TOWN OF $OUTHOLD , 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: 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 end 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 lend use $5.00 3. Copy of certificate of occul~3ncy $1.00 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant land .............. ner 0, Of Property ................................. ,, n'~¢z/3,~ ~ ..~..~.....~.....~..~ ~- ~,... Bi/ack ~..'/0 Subd,v's'o ........................................... o ,o ....... .o ..... . ...ouse.o ............. Permit No. 2.~.Z.~f~.Z Date Of Permit~'e:~L.~..~.~..L/Applicant .~...~.'.~,'.~.~..-- ................ Health Dept. Approval .... ..(~...:...~.?. .......................... I~bor Dept. Approval ~ Underwriters Approval .... ..~... ............................ Planning Board Approval ...... -~. ................................. Request For Tempora~ Certificate ........................................ Finctl Certificate ......(~...~....~. ...................... Fee Submitted $ ....~...,....0...-~.. ................. Construction on above described building and peFn~it meets alLapplicable codes .end regulations. Sworn to before me this SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant, Phone 5. Subdiv. Address , 6. Section 2. Property L6ca~ion ., ~ 7. Lot Number ..~ / ~ ~.~ ~.~,,~ ~- - , 8. Private Well Village ~ 3. Public Water Company Name 4. Lot size: Width F ~., feet 10. Sewage,~isposal System: A. O~gallon septic tank: Precast ~ Equivalent Block B. Leaching pools: Number of pools ~ Precast~O~Block Special ll. If private well, fill in the following blanks: A. Tank capacity ~ c B. Pump G.P.M. C. Total well depth D. E. gallons Depth to ground water Amount of water in well ~ ~,- Township. 9. Public Water --- Distance to main Lengt~ -~ //~feet (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. 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 plot. APPROVAL DATE ~7~/~? ~ SIGNED ~ ~ ~ Rev. 4./1/73 BUILDING DEPARTMENT ~WN CLERK'S ~FI~ ............................. Pe ,t No ....... APPLICATION FOR BUILDING PEIU~IT Date .....~.1. ,..r.,,,~..../... 4~;: .................. i ~'~...~¢..... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 set~ of.plans, accurate plot plan to scale. Fee according to schedu · b. Plot plan shOWing 'location of lot and of buildings on premises, relationship to adjoining premises or public streets ~ areas, and giving a detailed 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-appr0val of this application, the Building Inspector will issue 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 er 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 i~uildln.g' Zon,e O~inance of the Town of Southold, Suffolk County, New York, and other,applicable Laws, Ordinances or egu at~ons, mr the construction of buildings, additions or alterations, or for removal or demo tion, as here n 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. (Signature of applicant, or nome, if a corporation) State whether applicant is owner, lesse~e, agent, architect, engineer, general contractor, electrician, plumber or builder. · .. ~. : .'~..~/...~: ..~r~ .......................................................................... Na me of owner of premises .~-)..~ ~-~s.....~... ,~l~.~t~4L7 .............................................................................. If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ........ ..~..~../..~..'. ................................. Plumber's License No. ~'~ ~ C- / Electrician's License No. ~......'~l....~....~r~ ....................... Other Trade's License No...!':.!..../.~..: ............................. 1. Location of land on w~h proposed work will be done. Map No.: ....~.~.~...~.~..C' .......... :....: Lot No. ~,..~ .............. Street and Number .~.~....;...~....~,f.~ ................ .~u,q.ue~..~,..J,,~..'..I.~'. ..................................... / ! Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exi.sifing use and occupancy ......~'...L;....-C~..~,~..,~ ........................................................................ b. Intended use and occupancy .?~.... .... .,cL:~,~,,., ~/.. " .................. ~ · ' :~ ~ * ~'..~,x ~?~:,e.:~. .....--.-... .. · ..J'~" ~ ~,w ~ / 3. Nature of work (check which applicable): New Building ,~.~ ........... Addition .................. Alteration .................. Repair .................. Removal .................. DemolitiOn.;; ........ ;... ..... Other Work ...................................................... (Description) 4. Estimated Cost ...... 4~/..(,.'?..~..w:?,~I ........... "'""'""i ........ Fee .................... ~ ................ [ .................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units-..~C~.~-,(**,. ............ 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 ....... ..-T.. .................... ~ .............. :...~..~..~i.;.. .................................................... Dimensions of same structure with alterations or additions: Front ..~ ............................... Rear ............................ Depth ..................... ,, ....... Height ......... ..'T.. ............... Number of Stories ..... ..'z.. ....................... 8. Dimensions of entire new construction: Front ...... ~..~ ...................... Rear...~..~ ................ Depth Height ...~..~,..~ ....... Number of Stories ..~,~r~m,- .................................................................................................... 9. Size of lot: Front ....J....~. ...........i ............................. Rear ...~..,~ ........................... Dep~..,'~.....~...~..~...7 ...... 10. Date of Purchase----~'"~-~¢:.'"~-- "J4./..-9..~.....~:____ ..................... Name of Former Owner ~'Ul.~,~::~..~.~w~...-~__ -"~ "'- ...... distric(~n 11. Zone or use which premises are s,tuated .I(...~,....~..,.~..s~..G.~.,.~,.... ........... ~ ................................... 12. DOes proposed construction violate any zoning law, ordinance-- ~or regulation: ...... ~:~....?. .................................... t3. Will lot be regraded' ~,~.,e,e~ ...............Will excess fill be removed from prem. ises: ( ) Yes ~ ) No 14. Name of Owner of pre ~ W.&.~. ~; ..~ ...... Addressr~~.~;..J~'... ~ No ....................... Name of Architect .............................................................. ^ddre~ ................................ Phor~ No ....................... Nome of ................. PLOT DIAGRAM Locate clearly and distinctly oil 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 .heth,r ~nter~or or comer ~ot. ~ ~o >~/~ ~,~ ~-/~/~ y ~'~--------/~ ..~ ~ . . . .~ ..., .... - STATE OF NEW YORK, t c c COUNTY OF ................................ ~' ~'" being duly (Name of individual signi6ni6b-.g controc~ above named. 2.7' ~ sworn, deposes and says that he is the applicant He is the ...................................... ; .',~,~..~.~.. ...................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have pe?f0rmed 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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ Notary Public,. ................................................... County ...... .~....'..l.~,~. · .~... ~..~ · .,~. 4~...~%~ i ........................ v '~ (Signaf'E~ otr 6'pplicant) Y ONLY TO APPROVED AS NOTED 3. FINAL WHEN JOB COMPLETED