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Home My WebLink About8006-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice $outhold, N. Y. Cerli icnte Occupnncy THIS CERTIFIES that the building located at . ~./$. eR2?..-..E ./S. ,Leon..t.~O~reet Map No. XX .......... Block No...xx ...... Lot No, . xX.., Soutt~alcl.. Iq,¥., ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 'k~g. --~' 1 ' ' ', 19 '7~' pursuant to which Building Permit No..8t ~. dated .. J~e. ].8 .&. ~ug.. 21., 1~5.., was issued, and conforms to all of the requir~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Erl.v~te..qne. ~ .¢we3.~i~g. ~..~r~V~..(.~qg~.~q~Y.).. g~Y~g~ .... The certificate is issued to .q9~9~..~gY~$ ..... ~. ........................ (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval .. ~P,~ .~,, .~.~7~...~Y. )~ ~. ~ .... UNDERWRITERS CERTIFICATE No.. ($~N~Y. ~P~PY~. ~~P~ ....... HOUSE NUMBER .... ~0S30 .... Street. C.,J~,. 2F...&. ~.qOn. ~a ................. Building Inspector FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH*OLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8006 Z Permission is hereby granted to: C 9.n s t ~.. ,n.,c. ~... S..~.~.-~ .e.~ .................. .............. ~.g~th~14 ......... ~.,I~ ............................ at premises located at ...~l%.~.,~...~Q~,~.....~C..~..v.t...~cta~) ............................................................... .......................................................... ,Sou~;~ol~ ......... ~.,~.,, ............................................................... pursuant to application dated ..........................~..~......~.~ ........... , 19'~.~...., and opproYed by the Building Inspector. FOP, M NO. 6 TOWN OF SOUTHOLD , Building DepGftment Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OP, ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildFngs or new use: 1. Final survey of property with accurate location of oil buildings, property lines, streets, and unusuo$ natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage d~sposol--(S-9 form or equal). 3. Approval of electrical installation from 8oard 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, For existing buildings (prior ta April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: l. 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 ...... .... New Bqilding ...... ~.,~.. Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .................................. Owner Or Owners Of Property .. .~..~..~.. ..... ,~ : ......................................................... Subdivision L~.~.~......~.. ......................... ~:.~..,.~....~ L~L_ot No.... ".~.'~.... Block No....~.~. ..... House No ............. 75 _ · fa, Health Dept. Approval ............................. Labor Dept. Approval ........... ~.f....~... ........................... ~/'/~ Underwriters Approval ...Z...~.'~../R/..~./..C~...~.: ..................... Planning Board Approval ..../~../..~..~..: ....................... Request For Temporary Certificate ........................................ Find Certificate Fee Submitted $ ..~z .............................. Construction on above described building and pe,n~it meets a~l oppl~i%able c~es and regula.~on.s. Sworn to before me tl~ ~_~/ ~ ~' ~ ~g~ ....... ~....~.. day of ....~,~.:.~,,~,-...~..~.'...~.;~ ...... ,stamp or sea,)~ </~t~, / (D ~'/¢ · jj.) ak -J Z O 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 Con,tenSe Suw!e~t Phone 765 2282 5. Subdiv. Address N~,,t.h ~ ,Soui~hol¢~. £~ 11~?1 6. Section 2. Proper~y Location qm,~h m~ t~m~,th R~. 7. Lot Number m~n~. hn~ ~'~_ W~ of ~f~on~ Rd, 8. Private Well Village ~,,~hnld Township 5a, th~18 9. Public Water X 3. Public Water Company Name G~mmmmm~ W~a~ W~mka Distance to main 120f~. approx, 4. Lot size: Width 10~: feet ~fl Lgngth 1%0 feet 10. Sewage Disposal System: (For Health Services Dept. Use) 11. A. 900-gallon septic tank: Precast ~" Equivalent Block B. Leaching pools: Number of pools [ Precast ,~" Block Special If private well, fill in the fol- lowing blanks: A. Tank capacity gallons B. Pump G.P.M. C. Total well depth Do Depth to grgund W~ter E. Amount of.water in well The undersigned ~ERTIFIES: "Construction of authorized installations will be in accordance wi th the Suffolk County Department of Heal th 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 Signed FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can. be qn~t~]led~ ~ ~ qn/this~ ,'~°t/~/"~ '~ APPROVAL DATE I~t~ SIGNED '\~,~Yb~ O/:..~k>'~ S-15 Rev. 4/1/73 TOWN ElF SOUTHEILD OFFIE]E OF BUILDING INBPFOTOR T[]WN OLERK'S []]FFI[]E SOUTHOLD, N. Yo Commissioner of Public Works Suffotk County Yaphank Ave., Yaphank, N. Y. DoSe ..................................................... . . . Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated Laws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that ...................................... .... .................................................................... has applied to the Town of Southold for a permit to construct a building Leons B.o. ad..(. Private. Road) on ................................................................ ~u:~...~J.u..a o~=n..~oa= ~ Southold as shown on the attached plot plan, submitted in triplicate, dosed ................ ........... ~'~'"'~ ~'""$9'~"~' and titled ...... .~it3~J~,Ct~l,.~'~.~...~..~..~...~.~ We shall withhold fu~her action on this application for ten days or as otherwise provided Jn the aforementioned Section 239K. Ve~ truly yours, ~OTE~ There ~re o~he~ houses on ',Leon'~ Ro~d~ Commissioner of Public Works Suffolk County Yaphank Ave., Yaphank, N. Y. Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated Laws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that ...................................... ............. ..................................................................... has applied to the Town of Southold for a permit to construct a building as shown on the attached plot plan, submitted in triplicate, do~ed ................ .......... ~.ul~...$~.....~-~.. and titled ..... ~1~ ~ t~. · .:~0'~ · · ~1~1.t,.1~,I~ We shall withhold further action on this application for ten days or as otherwise provided in the aforementioned Section 239K. Very truly yours, Building Inspector /' Town of Southald, N. Y. u~ l~O~U~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE .~OUTHOLD, H. Y. ~prove~ :::::::::::::::::::::::::: 19::Permit No. ¢~.~..:..~ Disapproved a/c~-~,,.. ....... :::>. ............. ......................................... t (Buildino In~poctor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No ...... ~...~.....b. ........... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ 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 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 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, add tons or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applic~able laws, ordinances, building code, housing co, de, and regulations, and to admit authorized inspectors on premises and in buildings for nec~ary inspections. ,.~ , /) ~ · Lg://Bignatu~ of dppl~cant, or name, if a corporation) .~.o.~ ~-...~,.0.~, ........ 8.0.:.¢~ .o. ~,~l..... ~.~: ~ ..... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................ ,&~>~. ~.¢... o~....o.~me.r ......................................................................................................................... owner of remises Constance Sawmckm Name of p ................................................................................................... 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 ............................................. Other Zrade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ......... ~ ..........................Lot No ......... ~ ........... Street and Number E/..~.~.e.QT~ ~.0.~......0.~ ~/.~ t~.o.~.t~ ~q. pad .... ~gZ~h.o.l~....~.Y~. .......................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: e Exisiting use and occupancy vacant tot (app. roved by. Bd A,~p, eal,s.) one famil~ dwe!lin~ b. intended use and occupancy .................................................... property lines. Give street and block number or description according to deed, and show street names and indico~ whether interior or corner lot~ 3. Nature of work (check which applicable): New Building....~ ..... Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior. .................... Other Work ................................................ .... (Description) 4. Estimated Cost .................. .1.?..t..~..9..0...~ ....................... Fee ...2...~.t..O..~ ............................................................................ (to be paid on filing this application) one 5. If dwelling, number of dwelling units ............................ 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 ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... ..~..,..,. ............... Rear ..~...6. ...................... Depth ,.. .2. ~. ,-.)+. ........... Height .................... Number of Stories ...... p.~.e. ........................................................................................................ 9. Size of lot: Front ....1.0..~ ........................................... Rear ....... .1.0.~.....+. ....................... Depth ...... J..~.0....+. .............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..... !!..~.~.!....c]:.J:..s..~. ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~.O. ................................................ 13. Will lot be regroded ..... ..~..O. .................. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .g..°..Tf-...s.~.~...~..q.e....~.~,~.~.e.~.Jr. .......... Address $o~tho:l.d Phone No. Name of Architect .............................................................. Address ................................ Phone No ....................... ' Riverhead Name of Contractor ....... ~.~'~..~q ..................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from e STATE OF NEW YORK, ~ c ¢ COUNTY OF ......... ~l~'.~.l~ .... ~~'~ ..................... ~..o..~..e.D.~.....8..~,~f.~.g..~..~ .......................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............................ ~g.~D..~....o..~....o..~.~.~.~. ................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ood 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 hls knowledge and belief; and tha~ the work will be performed in the manner set forth in the applicat/i,on filed therewith, Sworn to before me this / / .................. .1..8.. day of ........................ · i Su.~fo - Notary Publ c, . ...................... ~-.~. ................ ~.... County ..... ~..g.';.~. .. 7/.:.=...../ ........ ~~~ ~ ~:,~ (Signature of applicant) v ELIZABETH ANN NEVILLE ~ · NOTARY PUBLIC, State ~f N~w York No. 52,8125850, Suffolk Term Expires Ma]ch 30, ~_'~