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Home My WebLink About8083-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi~icnte O[ Occupnncy No...~, .~..~.. .... Date ............. ~ .t~. .... 8 ...... , 19. ~.~. THIS CERTIFIES that the building located at . ~./8. ~.o~1~..d. Av~ ........... Street Map No..~ ....... Block No..~ ...... Lot No~ .~$~$~.. ~.~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~r...~8.., 19.7~. pursuit to which Buildfng Permit No.B~O~Z... dated ........ ~...1.8 ..... , 19~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is ,, P~V~..q~9..~. ~.~g. ... The certificate is issued ~o . .~. 80~.g ......... ~ ....................... (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval .J~. JS.. ~6.. ~. g.'..~ ...... u , awa TEaS C aZ FICAZ ..... ................. HOUSE NUMBER ...~78~ ...... Street ..... ~9~. ~Y~. .......................... 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) No. 8083 Z Permission is hereby granted to: .,.ag3r,,&.,Ita~.. So~e:~.~ ............................... ............ l~at~u~k .............................................. at premises located at' li[/~,. ~,~, .~..~..,e. , ( .~,.0.,~,~, ~,~...~...~.,) ................... . .................................... ~%~ ...... ~,.Z,.s...~*~.~ .................................................... pursuant to application doted ................... .. ...... ~. ....... ~. ...... , 19.~.., and approved by the Building Inspector.' FORM NO. $ TOWN OF SOUTHOLD , Buildi.g 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 dlspasal--(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 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 oil 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: l. 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 ......... ..... / New Bt~ilding .......~........ Addition ................ Old or Pre-existing Building .../. ............ Vacant Land .............. Location Of Property .~...j., ................................................. r..=~,.,.~.,~ ................ -'T" .................................... ! Owner Or Owners Of Property .~.~J...~..~ .......... .................................................................. Subdivision ................................................................ Lot No...~. ....... Block No...; ,~, ...... House No..~,,Z.~,.~- Permit No..~ ~:..~..~....~: Date Of Permit .~..:.L)'../.~.r/...~Applicant.. ................................ Health Dept. Approval .......................................... Labor Dept. Approval ................................................ Underwriters ApprovaleJ ~..%1.,....~...~. ...... Z~....~. .............. Pla nmg Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate ..V'.. ...................................... Fee Submitted $ .................................... Construction on above described building and perm~i~tx~eets ,all applicable codes and regulations. Sworn to. before me this ('/// J"~V'~/~7 ..... ~.....~.. day of ~~,..~.~.Z.~- (stamp or seal) ' ' 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 : Address -'" 2. Property Locat~.gp · 3. Public Water Compafi~Name 4. Lot size: Width feet Phone Township ~'Length ,.?.. ~,;~] ~, 5. Subdiv. 6. Section ~'~<"~ 7. Lot Number ~,,~. ~,,,$ 8. Private Well ~ 9. Public Water ~' :~ Distance to main feet 10. Sewage Disposal System: (For Health Services Dept. Use) ll. A. ,9'O'O)-gallon/ septic tank: Pre~a~t~Equivalent 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. Total well depth gallons D, Depth to ground water E. Amount 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. 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 installed on this plot. APPROVAL DATE SIGNED S-15 Rev. 4/1/73 formerlY, R05O67' UNAUTHORIZEO AETERATION OR ADOITION TO THIS SURVEY I~ A VIOLATION OF SECTION 7~09 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY MAP NOT 8EARtNG 400 OsTRA~ID~R AVENUE, RIVERHEAD, NEW YORK ALDEN W. ~OUNG HOWARD W* YOUNG ~URVEY FOR ':/~ 0~ " I, / ?" ' >~,:'7, X AT .. '~,~/I~,.. ' {' ~GUARA'N~[{D TOt/ SUFFOLK CO,, N.~.: ; ~~.'~ SUFFOLX COUNT ~ .~TH DEP,~:,_ ~,IENT The sewage dispo;~al ~nd wa{~r supply facilities for t~is ].c:~ io:~ have been inspected by this depar~men~ a~d found to b~ satisiacto~ ~ ~ ~ Chief of General Engin~i~ Services CESSPO0£$ ?Of~ F~KLD OBSERV~TIOI~$ 1F~O~ OTHERS COP1£$ OF THIS SURVEY MAP N0Y SE&RING REVISIONS YOUNG & YOUNG AUG. 25~I975 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK NO~ ~6,19F5 ALDEN W, YOUNG HOWARD W. YOUNG SURVEY FOR: t?UTH $OB~t?IAIG UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY I$ A VIOLATION OF SECTION 7~O9 OF THE NEW YORK STATE EDUCATION LAW formerly. NOTE: .... ~a = MONUMENT -' YOUNG & YOUNG 400 OSTRANOER AVENUE, RIVERH£AO, NEW YORK ALDEN W. YOUNG HOWARD "~'YOIJNG SURVEY FOR: --,~ oF ,,,. RUTH SO~E~tNG " ~ ~ TOWN OF SOUTHOL D ...... ~UILDING DEPARTMEH~'~~ ~L~ - ~ ~ ~ TOWN CLERKS OFFICE~ ~ ~ ~ ~ , , ~UTHOLD, N. Y.. ~/~ ~ ~ ~ ~ +/~, ::::::::::::::::::::: . _ ~o~od ., ~,..L.. ~,~ No ............................... ~ ~ ~P~ . i~opprowo ~/c ....... ~......~ ........ ~..~.....~ ~ ~ w/ / ' ........... ....... .............. :. '~'~A~ ~~:~ - f .... , oo~....~_~ ....... ,..~ ............ , ,,...., ....... Ins~ector, witk 3 iet~ o~ ~l~s, accurate ~lot ~1~ to ~1~. ~ee a~ordi~g to ~eaule. b. Plot plan showing location o{ lot and o{ buildings o~ premises, r~latid~ship to ad}oi~i~ premisas or publi~ 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 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 o~cupied or used in whale 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, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildihg code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. .......... ........ .......... :.:.: ......................... / ~ ~/4~-~'~'~ ? (Signature of opplj~an,~/name, if a corporotion) ~.~¢.....~[~::~.,.:~....~.:~.,/n., ..m.~,:~.,~.~.~....~..~:!..~:L~, . (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .....~.3.~..~.~..~.c"..'~ .............................................................................................................................................. Name of owner of premises ..... .L.'.~..t.~.,~.,......~..?.~...~ ·~..~...~'...~. ......................... : ......................................................................... If applicant.is a corporate, signature of duly authorized officer. ......... ...... (Name ~n~V/~e of ~orporate officer) Builder's License No ..................................................... Plumber's License No ...... *.,~....~...7. .............................. Electrician's License No .... .~..l...~ .............................. Other Trode's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ............... ~ .................... Lot No.....~. ............ ' ..... Street and Number .~.?./~. ........ ' .............................................. ~ ........................................... Municipality State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: , a. Exisiting use and occupancy .....~.....~...¢...~......~....~ ........ ~-~*.~...~.*.** ........ ; ................................................................ b. Intended use and occupancy ...~...1~...~......~.~.*~ ...... .~.'..~...~......i.~....~....~'...~..~..~.......~.~.~..t~.~, ................................ 3. Nature of work (check which applicable): New Building.. ............ V/ ..... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... (Description) 4. Estimated Cost ....... .~.)c...47...:~..~....o...o....:..-:. ........................ Fee ..~....~:.~...o. ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .._.O..?...~ ............Number of dwelling units on each floor ...........---: ................ If garage, number of cars ......... ~...o.. ~..¢. ............................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........ ..':z... ............... 7. Dimensions of existing structures, if any: Front ....~...~. .................. Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ...... ~./.C~ .................... Rear ............................ Depth ................................ Height ............................ Number of Stories ............... t ................ 8. Dimensions of entire new construction: Front ....... .~..~..:..~,..~, ............. Rear ....~..~/f.....:= ............ Depth ...'~..~.....--~.. ......... Height .I..~.[..~..~..E..'=. Number of Stories ..... ~.t-e...¢. ............................................................................................ 9. Size of lot: Front .... .q~.~..~..-..~..~-. ................................. Rear ..~-......~.......~.~ .................. Depth 10. Date of Purchase ........ /.'.~..~....~. .................................... Name of Former Owner ...... ~.9.~,~.~.4..,.~.~.,Lt~.: ............... 1 1. Zone or use district in which premises are situated ...~..C.....~..u...$..f..~..~.f./~.~.~..~.b.~.~:......~ .................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~....o. ............................................. 13. Will lot be regraded . .......... ?..~ .......... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..~..?..Y...C=..~.~.......~.?.J$.~..%.).¥f....~..:.. Address ................................ ~'none No. ~.~..~.:.~..?..'~..~. Name of Architect . ..~....l~.~..q.~!....~l~.l~.k?...~..~ ......... ~.:.~ .......... Address .'.~...~...~..~.~..~.~..~ ...... Phone No ....................... Name of Contractor .L~..~k.~,~.~..~. .~'~-~:~. .,, '},~r~ ~'#~'~'~¢~bne No. ~..~.r..:~..~:_~... .................................................... ~aaress ....... c ....................... PLOT DIAGRAM ~ ~¢.ee.~c~ -.'K 1~"~ 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~A)RI<,. ~ ~SS COUNTY OF ....."m~,,,f:¢,~,~.....~ ' ' ................~J.~'/~..,...........~ ~' . ..~....~"-'-- ..................... being duly sworn, deposes and says that he is the applicam ~r~e of individual signin~ contracf) 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 ar~ t2ge to the be~ of his knowledge and belief; and tF~at the work will be performed in the manner set forth in the ap~lic~t~Sj~r'~iJe~ ther~f~.~,"~ Sworn ~fore me this . -- ,,~_,/~ /,/~r/! , ...... L ............... day of ....... ............ .,...., NotcI~u, blic, . ................... ~County ................................... .~.J ...................................................... ~ ~.,~ (Sigf;ature of applicant) APPROVED AS DATE: ,,,/~1. ~ FEE: 3~ ~ NOTIFY BUILDING DEPARTMENT AT "'AlterolJon of this Doc e:~cepl b>' o Licensed p~ ~lona! Engine;er, ~s Ifiegal' Section 7209. Subdivisio . N, Y St~te Educah~n j Q ~[0H trL // JlI "Afler6llon of ihls Docum%nt excepf by ~ Licensed Profes- sional Engineer, Is illegr~l". Section 7209, Subdlvtsian 2, N, Y. Sf~$e ~ducatlon L6w.