The URL can be used to link to this page

Home My WebLink About8559-zFOR3~ HOo 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Ottice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES~ that the building located at (Iorik].!n I~:t Street ~ap No..~.a.~.~.~..~. ~e..i~t~ ~o ........... Lot ~o. ~*~. ~.~'.~ .... .~.~'~... conforms substantially to the Application for Building Permit heretofore liled in this office dated ............ ~I~... ~,., 19.?~.~ pursuant to which Building Permit No..~9~. dated ............. ~.. ~.., 19. ~/~, was issued, and conforms to ~1 of the req~e- ments of the applicable provisions oi the law. The occup~cy for which this certificate is issued is . PY.$~9}P..9~9. :~a$~:l. ~?~.~l.~a ....................................... The certificate is issued toA~*~)~:l'. ~?:~.. ~I~ ................................... (owner, lessee or ten,t) of the aforesaid building. Su~olk County Department of Health Approval .~. ~3~373 ~e ~0 UNDERWRITERS CERTIFICATE No ....... ; ...................................... HOUSE NUMBER .... ~. ...... Street eo~l~l Rd ..... ~}}$~ . . Building Inspector! 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? 8559 Z Permission is hereby granted to: Adelp. hi Land Cor M,~tt$.tuc to Bui,.1.d n.e.w oBe' ~..a.~.~..i..1.k dwe? lSng Conklin ~ Oak Pl ~'iattituck pursuant to application doted ................. !?.a..y. .......... ~ ................... , 19...~.6.., and approved by the Building Inspector. Building Inspector 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 disp0sal--(S-9 form or equal). 3. Approyal 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 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 ........... .~ ........ I ......................... New Building ................ Addition ................ Old or Pre-existing Building ................ ¥ocont Land .............. Location Of Property ............... ................ ~.. Health Dept. Approval ............................................ Labor ~pt. Approval ................................................ Underwriters Approval .............................................. Planning D~rd Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Certificate Fee Submitted $ .................................... Apphcant ~ ............. .~ Sworn to before me Notary Public .. County tstamp or seal)/~-~ ~) THE NEW,,YORK BOARD OF FIRE UNDERWRITERS : Adelphi Land Corp., Grand.~venue, Eattztuck,~L;I;. . . . . . r~ /' ~ ' ~q : ~.. ~ ~::-.,~,'; :: Oats].de.'. ~"~: s~b, ?'mJ~~ :' 'w sexa edon June O~ ~11 .. ' /." , ~ndjout~d~ob~i~cbmpliance'wlth tHereq~i~rement~ofthisBoard. 9 22 NO OF CC COND A W G NO OF H(-LEG I A W G NJNo. OF NEUTRALS Wall;er .~ ~.n~er ' ~o~'e~'.,,-k L I 11952 ' ~ . Lic.~)1845-E: .' -; ~[ ~ ~UFFO~K ~U~Y DEPARTMENT OF HEALTM SERVICES i ' Health Services Reference Number ~APPLICATION FOR APPROVAL TOCONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant i~'k~,q~ ~t',--~j ¢,,j~Phone~-~+~ 5. SUbdiv. Address ~.~,~ ~, ~ ~,~., ~ ~- ,~_~,, ,~,~ ,,~, ~ ~_ 6. Section- 2. Property ' ~ ' -,~ ~ ~. Lot Number Location ~'~' ~"~' '"~ '~> ~ '~ , 8. Private Well Village ~.,~,~,,~,~ Township ~q,~,~,~) 9. P~blic Water 3. Public Water Company Name ~,o~ Distance to main 4. Lot size: Width ~., feet Length ~, F f~et lO. Sewage Disposal System: A,~ 900-gallon)septic tank: Pre6~§~' ~uivalent Block B. Leaching pools: Number of pools ~ Precast ~Block Special If private well, fill in the fol- lowing blanks: A. Tank capacity Bo Pump G.P.M. C. D. E. ~gallons Total well dept~ ~ Depth to ground water Amount of water in well, ~,~ 11. (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' 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. ) i~ . Signed Date t L~ FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Serv,ices tha~ an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE S-15 Rev. 4/1/73 FOruM NO. I TOWN OF SOUT.OLD BUILDING DEPARTMENT M__,..~.,~ TOWN CLERK'S OFFICE / ~.~,~... ~ ~,~,. i~opproved o/c .... ~ ......... ~ .......................... ............. ................................ '/~ .~. ~a,~ ~ ~ ~ ~uilamg Ins~tor; / t~ ~ ~ ~ ~o ~- ~ APPLICATION FOR BUILDING PE~IT a. This app~caHon must be completely fil~ gn b~ ~p~wrlter oe ~ i~'and s~m~tt~d ~n~ector, with 3 ~t~ of ~ans, accurat~ plot p~an to ~a~e. Fe~ accordi~ to scbedu~e. b. P~ot plon show~n~ [~atio~ of lot o~d o~ buildings on pr~m~ses, relationship to odjoi~J~ premises or public streets areas, and ~v ~9 detai~d descr ~t o~ of ~yout of~rope~ must be draw~ on the d~a~ram which c. The work Covered by this application may not be commenced bef6r~ issuance of Building Permit. d. Upon approval 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 or used in whole or in ,v , rtificat ancy shall hove been granted by the Building Inspector. ~____~_~7/~7 ~/C~..-j~t~ APPLICATION IS HEREBY/v~kDE to the Building Dele i~suance ora ~u~la~ng P'ermlt pursuanf~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 a~terations, or for rer~oval 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. '~- ......... ........ ..................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde> Name of oWner of premises ........ ..~.....~...~.?..~.! ........ ...(~..../~...*~....(~... ......... ~...(~..~ .............................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ....... .~.....~....~... .......................... Electrician's License No. /~j[..~...~.~...,-,:~...~....-.~.....~c_ Other Trade's License No ............................................... Location of land on whic[~ proposed work will be done. M9p No.: ...~.....~.'..~..?....~...~.......~....~...Hf'....~?Lot No..~..~..~...~..? Street and Number ..J.! ......... %r?j.~....7...:: ....... ~ ...... ,~....z ........................................................ ~f/~ ......... (--~-~-~ '~( , Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ~ ~&l D ~,.,"C ~" 3.- Nc~fu}e of work (check which applicable): New Building ~ Addition Alteration Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cos~ ....i......'~.L..~.....'T. ................... Fee~...~......~.....~. .................................................. (to be paid on filing this application) I 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........ .I ................. of cars ............................................................................................. If garage, number 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 .~...,e......?....: ............. Depth ~ ........ Height ...~ ......... Number of Stories ......................... ~ ............................................................ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ · ' ' r 'n ' ~"'~) -~' 8. D~mens~ons of enhre new const uct~o : Front ................. ~ .................. Rear ............................ Depth ........................ Height ......~...~ ....... Number of Stories ...................... !..]./....L~.. .................................................................................... 9. Size of lot: Front , i ~',O~J ! ~ ...... ./..~...O....O.. .... ...................... : ................................. Rear ......... ~.~...O....~.: .~.~. ............. Depth 10. Date of Purchase ........................................................ Name of Former Owner ...~.../..../~......~.~...~..~.~. .................. 11. Zone or use district in which premises are situated .................... I..'~...~,.(..I...~...~....~ff~..c....~.~. ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................. ...f~.....~.~. ........................... 13. Will lot be regraded ......'~.~,..'"~ ............ Will excess fill be removed from premises: ( ) Yes (~""No 14. Name of Owner of premises ~C~....~....~...H t ~,~ C~/~'~" Address J~e'l~")CJl.l~ ................................................................ .,~. ................ Phone .................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .~ I~e-~ ~' Address ................................ Phone 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 NEW YORK, lc ¢ COUNTY OF ................................ ...................................................................................................... ~ duly sworn, deposes and says that he is the applicam (Name of individuat signing contracf) above named. He is the ..................... ',~.~,~.......'.c~...~,~.~.,~.~ ............................................................................... (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 oil 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 ........... ............. , , , Notary Public,. ..................... ..~.b~-i~.Jr~,.... County ....... ..~.~.......~"~ ....~..~ ................. (Signatu r~T applicant) ELffiABETH AI~ NEVILLE NOTARY PUBLIC, State of New York No. 52-8]25850. Suffolk Count Term Expires March 30. lg'~_~ // ,f~ .: 4&~u,z',~%,%*/7" ':vCE 4~ L°t ~ Lot pt/~C~ SUBDIVISION MAP P/tED IN THE OFF/CE ~P FIVE ClErK OP SUPFOI K COUNTY ON d~INE g4, 19~9 AS MAp NO. ~ /'~'