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Home My WebLink About8081-zFORM NO. 4 TOWN OF SOL~fHOLD BUILDING DEP~=RTNrENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34954 ~te: 05/18/11 T~IS CERTIFIES that the building NEW DWELLING Location of Property: 4505 VANSTON ROAD (HOUSE NO.) County Tax Map No. 473889 Section 111 subdivision CUTCHOGUE (STREET) (HA24LET) Block 14 Lot 5.2 Filed Map No. LOt NO. conforms substantially to the Application for Building Permit heretofore filed in tb/s office dated JULY 14, 1975 pursuant to which Building Permit NO. 8081-Z dated JULY 17, 1975 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH DECK. UPDATED 5/18/11 FOR DECK AND OWNERS NAME. The certificate is issued to NANCY ELLIOT of the aforesaid building. ( OWNER ) SUFFOLK COUlfI"/DEPARTMENTOFt{EALTHAPPROVAL R. VILLA ELEL-rKIC~25 CERTIFICATE NO. N 310353 PLIghtERS CERTIFICATION DATED N/A 09/30/76 11/03/76 ~~ut horized Signature Rev. 1/81 FO~M NO. :~ TOW~ OF $OOTHO£D BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PT~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8081 Z Permission is hereby granted~t~o: ..... ~.o..~.~....~...~.~ ...... i~?.~:.....!..~ ..... ,~o ...~. L~.2...~ .~.~ ....... ~..~.C.~..~..~..~..~.....~.~.~..~.~..~..~..~. ................... otpremses o~otodot~, ~.~..~.~Q...~" ....... ~' ..................... .............. pursuont to opplication doted .................................. , 19. Building Inspector. Fee $.../.....'.?. ............. FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Cerli~icnte O~ Occupnncy THIS CERTIFIES that the building located at , .V.a.tl.S.~..01}...R.O?.~ ............ Street conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. .~Y...~ 19. ~.~ pursuant to which Building Permit No.. "~h,ed ............ ~Y...1.7., 19 7[., was issued, ~d conforms to all of the req~re- ments of the applicable provisions of the law. The oecup~cy for which this ee~ificate is The certificate is issued to O~.o~gg..~. ~!$~ ..... ~ ......................... (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval ~pg 30 ]976 by R, Villa UNDERWRITERS CERTIFICATE No. ~6~Tgat ~t ~ ~97~ (t~mp) ~. HOUSE NUMBER ... ~0[ ..... Street ~ans~ 1~O~ ~O. 6 TOWH OF $OUTHOLD , Building Depo~tment Town Clerks Office Southold, 14. 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 oil buildings, property lines, streets, and unusual natural or topographic features. :2. Final approval of Health Dept. of water supply and sewerage disposol--(S-9 form or equal). 3. Approval of electrical instal[orion 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre*existing" land uses: 1. Accurate survey*of property showing oll property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy ,~nd condition of buildings. 3. Date of any housing code or safety inspection of buildings or promises, or other pertinent formation required to prepare o certificate. C. Fees: ]. Certificate of occupancy $§,00 2. Certificate of occupancy on pre~existing dwelling or land use $5,00 3. Copy of certificate of occupancy $1.00 ,/ / Date .......... ~.././../..~ ~... ......... New Building,.....,...,...../ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. ..er Or O, .rope. · Subdivision ~..~.....~.~.~..~,x..~...-T.~x~'~,L~l~N~x~..~...~..'~..... Block No ............. House No...,~.~ Permit No...~.....~../....~.. Date Of Permit ..7/.{.~'?../..~...,'"~ppmicant ,~¢T~,.~.....?..~....~..~..~'.,~ Health Dept. Approval -...~.,,/.~, .,/Z/....~. ....................... Labor Dept. Approval ................................................ Underwriters Approval ..... /.~'./,/v/,~.~ ......................... Planning Bo0rd Approval ........................................ Request For Temporary Certificate ......... .~..~..~ ........................ Finaj Certificate ............. ~ .............. Fee Submitted $ ...... ~....~. .................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ...... ~.,.... day or .,~.,~...~ .................................... Notary Public .....~.,~-~.~....., County ( tamp or seal) SUFFOLK COUNTY DEPARTMENT {~F HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Appl 1 cantc~ ~;~<,'~:~ .~/~one ~ --7~:~Z~,~. Subdi v. Address,~,~.,~) ,~,~ ~--,--- .( ,,~,, ~ / /-~,~ 6. Section 2. Property Location /~/,~.-z~-~_,~ ,,~ ~--. 7. Lot Number~ Village ~--,,,,,,_~ ~-~,~:: ~. /, 8. Private Well ' To~nship_..~.>~z2 9. Public Water' 3. Public Water Company Name -~- Distance to main 4. Lot size: Width/zc, feet ~ Length /~'~'~eet lO. Sewage D~isposal System: A.L.~-gallon septic tank: Precast J~quivalent Block B. Leaching pools: Number of pools ]~ [ Precast ~Block Special__ ll. If p. ri~v~te well, fill in the fol- ~ owl ng~B~ anks: ~ Tan~apaci ty ~-~ gal lons ~:PumD"~. P.M. ~ ~ Tot~q~well depth ~.~i Dept~to ground water ~- Amou~ of water in well (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance wizh 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 Signec FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Based on the information presented he~ with, it is the opinion of the Department of Health Services that an adequate and sati~ factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE 7/f~L~' SIGNED S-15 Rev. 4/1/73 ,AT EMBOSSED ': "' igl ,Geo,-,W, Qu ey , -- ; 8 '~,' ~'i" GENERAL MANAGER Peconic, N.Y...' 1195 . : ~: ". . "-~ ~,s ce~sf~cate must not be altered m any c . p y y ~ir c~ ' '' ' :' ' ' ' ~' '::manner r~tum tO ~ office of lhe ~ard if n orrect ns ectors ~a be dentlfled b ther c~ dentlaJs. TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/STRAPPING ,~FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FmERmSmSTIU~'CO~CT~O. [ ] FmRERESmST~n'~.ETRA'nO. DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING ~FINAL ~--, FIREPLACE & CHIMNEY [ ] fiRE SAFETY INSPECTION RRE RF.S~ANT C0NSTRUC'n0N [ ] fiRE RESISTANT FENE'mATION REMARKS: DATE INSPECTOR.-~, ~ ...... ......... . ........... .... ~ ~ .... ~~ ........................................................................ a. ~ ~lic~t~ m I in ~ ~ewHter ~ in i~ ~ ~i~ in tr~l~ ~ ~ ~i~i~ ~ I~, ~ 3 ~ ~ p~, ~ p~ p~ ~ ~ F~ ~ ~ ~le. ~ ~ b. ~ p~ ~ I~ati~ of I~ and of ~ildi~ ~ premix, m~iP t~ ~joini~ p~i~ ~ ~lic st~ o; ~ ar~s, ~ ~v~ a ~i1~ ~ripti~ of I~ ~ m~t ~ d~ ~ t~ d~mm ~i~ is ~ ~ ~ ~hc~. ~ c. ~ ~ ~ ~ ~ ~licati~ ~ ~ ~ c~ ~m i,u~ of Bui~i~ Pe~. d. ~ .~ ~ ~ ~1~, ~ ~i~i~ I~t~ will i~ o Buildi~ Pe~it to t~ ~. ~h ~rmit shall ~ ~ ~ ~ ~ml~ ~le ~r i~ ~ ~ ~ e. No ~lM~ ~11 ~ ~c~i~ or ~ in ~le or in ~ ~r any pu~ ~er until a ~ifEa~ ~ ~ ~ ~PPLI~TI~ IS HEREBY ~DE to the Buildi~ ~ ~r ~e i,ua~e of a Bm~i~ Pe~ff ~ ~ ~e ~ Buddi~ ~ ~i~e ~ ~e T~ of ~ld, ~k C~, ~ Y~, a~ ~er ~ ~, ~ ~ ~ R~ti~s, ~ ~ c~s~l~ ~ ~ildi~, ~ or al~ o~ ~r ~ or ~it~, 'm ~in ~. ~mit ~z~ i~ ~ p~i~ ~-i~ ~1~ ~ ~~ti~. ........ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electriCian, plumber or builder. Name of owner of premises ..... . .~...¢~?.~-1~'...~'.. ....... ~....'~ .~..~'.~....z~....~.....~'..~.... ................................. ~ .................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...................... , Electrician's License mo ........................................... ------ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ..:......~...~.....'~... ....... ~ .......Lot No. ~ .............. - Street and Number ..... ~ .~.~.'~......:~...~.....~.~...~'....~~.....~.~../.~ ........ ~.~..~4~.;..~..~. 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 .....~./...-:".~.~....~_~-~.~..~"~Z37~... ............. '. ...... : ........ , ..... 3. Nature of work (check which applicable): New Building...................J Addition ......... ....... .. Alteration ............ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ....... ..~.....~..~ .......................... Fee I (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 .............. ~ ....................... J ............................................................................................... 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 ............ X'"'" ................ Rear ............................ Depth ........................ Height .................... Number of Stories ........... ~. ...................................................................................................... 9. Size of lot: Front ..~:.~..O.....~...~',','~ ............................... Rear ......... ../...~'....O.........~.....~Z... ..... Depth ...... .../~....'~...,~.../..~.~...f..... 10~ Date of Purchase .............. .~./../.~.~.~.... ................... Name of Former Owner .~'/~ .4~......~'~......~.~....../...'~... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~.O.. .................................... 13. Will lot be regraded .....~ ............ Will excess fill be removed from premises: ( ) Yes ( ~ 14. Name of Owner of prem,ses4~.~..~..~.....~..4'~'.~.~.~'ddmss .~..'~...:.?~...~.~, Phone No. Z.~'.~...C...'~.,,~....'~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Co~ntractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-lx~k 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 NL:~V YORK, COUNTY OF ............................ ~.~' "'~ .......... ~..~....~.....~........~..../..~....~...~..~ .............. being duly sworn, deposes and says that he is the applicon, (Name of individual signing corff~acf) above named. He is the ................................................................................................................................................................................. (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 that the work will be performed in the monner set forth in the,application filed therewith. Sworn to before me this /~ .... /.~... d of 19 NOTAblY PUbliC, StatS'of New Yorl< No~ 52.0253310 Qualified in Suffolk Count~J Term Expire%March 5./ APPROVED 'AS NOTED~_~ 765-2660 9AM TO 4PM FOR RBQ~IR. ED INSPECTIONS: 1. BEFORE BACKFILLING FOUNDA- TION OR START FRAkalNG 2. BEFORE COVERING PIP~LIN£ 3. FINAL WHEN JOB COMFLETED NOT RESPONSIBLE FOR DESIGN OR CON- STRUCTION ~RROR5 /' /