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Home My WebLink About8415-zFOI~M NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . . .S./.S..L.e.e..t?.n..D..r ......... Street Map No....X~:x ....... Block No....~.... Lot No, ~ .S.o~..t.h..o.l.d....N:.Y.~. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... M.a.r.e.h.. 9, 19..~..6 pursuant to which Building Pemit No, .~..1..~... dated . ...Mar. c..h...1.0...., 19 .7.6, was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...Pr.l..va.t.e .°..rig..f.~_?:i.l.y...d.wp.l. 1 .~.g ................................ The certificate is issued to . .A.d.d.l.~.o.r~. & .B~..r.b.r.a....B~..k.@ ....0~..e..r.z .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Jllly 2 . .1.9.7.6....b.y..R...V..i.1..l~. .... UNDERWRITERS CERTIFICATE No...17.291.2.7.? . . ~.un...e..~.0..~.9.7...6 ............... HOUSE NUMBER ..... 8.0~. ..... Street .... .L. qe..tp.n..D. 2 ........................... FORM NO. 2 TOWN OF SOIJTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON ~:HE P~,EMISES' UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8415 Z Permission is hereby gronted to: ~ ,o .. ~, ~ ..~...~.:.~..~...~.,~ .......................................................................... : ...... .............. : .......... :..:...:,...,.~~ ....... : ............................. : ..................... : ................ ., - ,! .............................. ;. ......... ~ ...... '. ..... ,~...,.~. ............ ~ ......... ~ ........ ~ ......... Building Inspecto. ~ ......_~,~.~ ....~ ~ FOR~ NO. ~ TOWN OF SOUTHOLD , Building Depn~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 w,th the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, aha unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industnal buildings, Mulhple 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 s~te 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 hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condit,on of buildings. 3. Date of any housing code or safety inspection of buildings or premmes, 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 ocCUl~ncy $1.00 New Building .......~. ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~e~e~..~.~-~`.e-~.~.~.~.~e~w~ ................................................... Owner Or Owners Of Property ........... ~c1:.~.~J~.~S..~.~..:~.~'~..~.`8:.z`.~.~.~e~ ........................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ........... Permit No ....8..~..,]..~ ........ Date Of Permit ..~../..]:..0./..7..~.Applicant .q.~...0..~...C-.~.....A~...~..R..S..,....~.~.D..~...~.~...~,C... Health Dept. Approval ...~...-..~...0..-:.2...0. ......................... Labor Dept. Approval ............................................... Underwriters Approval .... .~...~.~..2.7...7. ......................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate ........................................ Fee Submitted $ .................................... Construction on above described building and per[n,~: meets all applicabJl~,codes and regulations. .... ' ' ~pp~can~ ..........~.,r:....~:.~;.....~..~ ............... ; ......................................................... Sworn to before f~ Q~O~G~ ~S, ~D~, Z~C. ~7~/~ .......... .... .......... Not~ Public ...~~Coun~ /~;~l' ,~ I-' i _- .... - : , - --~ E~U~AU OF ELEG'~RICiTY. , ,, . , ,' -' -~: '1. ~p~. ~,r~o'~-':~:;..~.~ .o~ ~79~ ~'I'~ '~..~ ~?F~ ~,F~~' ~ the fo l~ing~tiO~tt ~ B~bm~t ~ is~FL ~ 2~d ~ - '- oOTS Loe · · . · ~ a~6' IQ~ ~foa~d~b~tneom~a~w~t~herequ~reme~h~sBoard. .__~ t~oo ~ :~, t__:__,~ ~ , ..... Motor/s: l-1t2hp ! GFI Oustav 3artra 227E. BCeakwater Rd. Mattituck, L.I. 11952 41 .3 ow r,,-/o; O, AL. 0.t /., (0, '~ /! SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~'I-'~- a ... ' "~ ' Phone Address ~ ~' .... 2. Property Location "' ' ' ~ Village-"' ~' ~"'7 Township 3. Public Water Company Name 4. Lot size: Width ~ feet Length ~ "' feet 5. Subdiv. 6, Section 7, Lot Number 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: (For Health Services Dept. Use) A. 900-gallon septic tank: Precast ~-~'Equivalent Block Be Leaching pools: Number of pools Precast ~Block Special 11. If private well, fill in the fol- _]owing bSanks: A, Tan~apacity y'/~' gallons 8. Pum~. P.M. .C. To..t~q~ well depth. D. DeR~ to ground water E. Am~qt of water in well ~ 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, Date ?"" 4' Signed ' FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the infomation presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal S,~stem and Water Supply can be installed on ' plot. Rev. 4/1/73 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~ ~.%~F~,t//-(~,,~/(/'/ . Bat ..... ........................ , ICT I~$TRH~IO~$ o. lhi~ o~licotion mu~t be compl~t~l~ fill~d in by ~p~writer ~ in ink ~od ~miff~ in triplic~t~ to Ih~ Buildlng Inspector, with 3 ~ o{ plan*, ~ceumt~ plo~ plan ~ ~o~. ~ ~cco~ing to ~h~ul~. b. ~lot plan showin~ Iocotion of lot ond o{ building* on promise*, relation*hip to ~oining pr*raise* or public ~reos, ~nd oivi~ a d~tail~ do~ription o{ I~out o{pr~ must be drown on th~ dioomm which i~ ~ o{ thi~ ~pplicotion. c. Th~ work cov~r~ by thi* ~lic~tion may n~ be commenc~ before i~uonce o{ Building ~ermit. d. Upon ~pprovol of thi~ opplicotlon, the Building Inspector will issu~ o Building ~rmit to th~ opplicont. Such sholl be kept on th* premises av~il~bl* {or inaction throughout th~ work. e, No building shall be ~cupi~ or used in whole or in pa~ for ony pu~ose whoever until a Ce~ificate of ~cupancy sh~ll have been grant~ by the Building In~ector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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, os 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. ~ ..... ........... : ............. ', (Signature of applicant, or name, if a corporat.on) ~ ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Name of owner of premises ..... ..A.~..d,~..$.~.p...~.,......a~..~....~...~.?.~..a.¥..a......]~:....~.~.e. ....................................... ~ ................................... If applicant is a corporate, signature of duly authorized officer. George Ahlers, President (Name and title of corporate officer) Builder's License No ...... ..~.7..Q.,.~ ................................ Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... ]. Locotion of Iond on which proposed work will be done, MOP No.: ........................................ Lot No ......................... Street and Number South side of Leeton Drive, Southold, New York Municipality 2. 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 ........................ .cl;..w..e...1..]:~...~ ..................................................................................... 3. Nature of work (check which applicable): New Building .... .~. ........... Addition .................. Alteration .................. Repair .................. Removal Demolition .................... Other Work ...................................................... .................. (Description) 4. Estimated Cost .......~_~21~0.0 ............................. Fee .......................................................................................... (to be paid on filing this application) 1 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of c~rs ............................................................................................................................................. 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 same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... ~.~0 ...................... Rear ..... ../~'~J. ................ Depth .......... .2..~..! ........ Height .....2.]..! ........ Number of Stories .............one .................................................................................................. 9. Size of lot: Front '100' Rear 100' Depth 200' 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated A. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ .rz...O. ........................................... 13. Will lot be regraded' 7.es Will excess fill be removed fmmJ~r~nses ( ) Y~s, (x) No ........................... 1~:~ l~ro~p~;on i~a. .. 14. Name of Owner of premises ~,(;1,~.~.QT~..~.~,:R~ .................... Address .~a~.dDz~..C3..t,y.... Phone No ................ Name of Architect .............................................................. Address '~"~"~i'~ ............ Phone No ....................... Name of Contractor ..G...e.P...~.g..e...~..e..zT..s.~.....~..~...J:.]:.~?..~.... Address .~,u.'F~}z~e ......... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock 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, ~ S S COUNTY OF ....... g~ffO].~ ....... ~' ' ............................... l~'~t~..~r::[;I.1~O .............................. being duly sworn, deposes and says tl~at he is the applicant (Name of individual signing contracf) above named. He is the ........................................... f~,~f~..fQ~...D.QZ3:~C.'I:O~. ..................................................................................... (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 thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this . dayof ........................... , .,. Coun ,.T/,~...~....~=.. .~.~.,' ........ Notary Public,. ........................ 'qU ~ f'O3-1C ...... ty ./,~.. (ii'~atu ;; ';;~";~pli';';r;~')' ........................... EL ~LL NOTARY PUBLIC, State of New ~or~,./ No. 52.8]25850, Suff0~k County ( ~fm fxpi[~s March 30, 19~.~ t __%