The URL can be used to link to this page

Home My WebLink About8115-zFOlt~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z6.8~ ...... Date ............... ,]'alS.. ~. ..... , 19 THIS CERTIFIES that the building located at .l~o~$e~l~ .l~me Street Map No. N. orwold... Block No ........... Lot No, .~0. &p~2.t · .~l~l~oglle .. N.,.Yo.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Jul]y...~0, 19..7.~ pursuant to which Building Permit No.. dated ......... J'..~.ly...~.0 ..... , 19.~.%.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P~::~v~.t.e .one..f~II,v. Ow. elling ........................................ The certificate is issued to .. Dale. ~ .Jeal~, .Bll~ler ..... 0~mer.~ .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~a~a,..%.. ]9.7.~.. hy..R,..~illa ... UNDERWRITERS CERTIFICATE No.. N262~66 .... D~e .. 23..19~ ............... HOUSE NUMBER ...'/.~.0 ....... Street ..... l~lon~ell .~a ......................... Building InspectOr 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 CQMPLETION OF THE WORK AUTHORIZED) N? 8115 Z Permission is hereby granted to: .... ~..~. ........... .~:,...~la..~.~ ...................... Rivert~ea~ 1)ttild new one family dwelling pursuant to application dated ....................... ..~..~.~. ....... ~..0. .......... , 19~',,.~...., and approved by the Building Inspector. Fee $,,, .~...~..e...(~... ......... ..................... b",;il~ ................... l~O~ NO. S TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Soutkold, 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 disposal--(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 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 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 occupancy $1.00 Date New BHilding ......... r~''' Addition ................ Old or Pre-existing Location Of Property t Owner Or Owners Of Property ...... ~ ~- Subdivision ...b~.~!-.~..~:.(z~.(:.~.~Z':!..~.~.~:::; .................... Lot N .c~...D.,~..~!~.~J~ck No ............. House Permit No. ~..~.../.~.~:....~ '~'~' Date Of Permit ....~.h.~Z~..~.~Pplicant ..~..*~ ~ ~-~ ~l[ ~~ ~,~ .~ · ..... :.... r..:...7 ......... ; ...... ,¢.,..~...~..~. ............ Health Dept. Approval /~'Z..~: ................. Labor Dept. Approval ............. ~..].~. ......................... Underwriters Approval ................................... ;J..~..-~../~F6..,.~ Board Approval ........................................ Request For Temporary Certificate ................................ FinoJ Certificate Fee Submitted $ ../.?.· ............................ Vacant Land .............. Construction on above described building and i~ermit m~eets all applicable codes and regulatiqns. ........... ....... Sworn to before me ti; ~ day of Notary Public ............ (. (stamp or seal) q~h ~'c~ '-~ 4'' °"~eeember 23, 1975 .,p. ta.,,~i,,,,,:,,,, .,,y.,~ 831446 onty the electrical equipmc~ as d..crlbed be~ a~d ~ntrodu~ed ~y t he .pp~icen~ r~med o~ the ~o~e oP~lca~lO~ nu mb~ in ,~he pr~l~e~ Of Dale Butler, 750 Monsell Lane, Cutchogue~ L.~. "~* · ~' ~"~""~ 0" December 19, 1975 land found to be ~, co,npttatw. ~thl~ r~u,rel~,t~o~l~:s~oard,/." - This cerhf cate must,not be a ter{~d n any manner; return 3o the:~aff~e o~the ~oOr~ ~I incorrect.: ~spectors may: l~ MO. 1 BUILDING DEPARTMENT] ~ ...~. TOWN CLERK'S OFFICE --~ ~U~D, N. Y./ ......... .......... ................. ..... APPLICATION. FOR BUILDII~G PERMIT...~_,,_. ~ ,/ INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicots to the Building~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pl~.t plan showing location of lot an(~ of buildings on premises, relationship) to adjoining premises or pub c streets o~ areas~ana 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 wi'Il 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, additions or alterations, or for removal 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. ..R.~..V..e..r.~.~..d..e. a~$; Tnc~ .......... (S!gnature of applicant, or name, if a corporation) ..' P. · O. ~ox 274~ l~Lverhead~ ~ew York 11901 (Address of applicant) State whether applicant is owner, leSsee, agent, architect, engineer, general contractor, electrician, plumber or builder.',~ -- builder Name of owner of premises ..l)ale..Iva..~nd..l~ll~..J.q.~g...l}.~.l..e..r. ........................................................................................ If applJc,~.t is a corporate,~s~ln~ture of duly authorized officer. (Nome and title of corporate officer) Vice President Builder's License No ..................................................... /~ - ~7 - ~ ' ?.Z ~-I Plumber's License No ....... ./t.I~.I~.-..P.. ............................... Electrician's License No. ..55.0.-..F,, ............................... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop 'No.: .....l~..p....o.~..~.o...r~...a..l:..d. ......... Lot No....................20 and pt:.....21 State existing use and occuPancY d intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~acant land ...................................................................... b. Intended use and occupancy ..... .°..n..e....f..a...~:...1.Y....d..~..e..1..1..i...n~. ..................................................................................... 3. Nature of (check which applicable): New Building ...... ;x ......... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition..... ............... Other Work ...................................................... (Description) 4. Estimated Cost ..... ..l~....~...~..~ .................. Fee .~...~ ~-r,~ (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 ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ......................... ... 7. Din-~nsions 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 ............ ~..8..~..8.~.'. .............. Rear .....~..8..~..8.'.~. ............. Depth ...... .2..2.~ ............. · Height ...... ~....16..~.... Number of Stories ....¢~.e. ............................................................................................................ 9. Size of lot: Froot ............... ~q5 ..................................... Rear ....... 1./T3~.4 ....................... Depth ....Z3.6/.,.~.3..~ ............... 10. Date of Purchase .............. ~T.9~e...[0.S,.~.~.7.,5. ................ Name of Former Owner 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded.. .......... ,....~ .....Will excess fill be removed from premises: (x) Yes ( ) No 14. Na me of Owner of premises ...9Ja...[..e....~[.,....aR .ct....E..°..[..Z~v.....3..e. .a..a.. · .]~..1:,~ ress · ..' 'B°''.x...~§ ....Y~...t;,.t, ~ ~,u~:~e No. -2. .9. .8. .'' .5. .c). .5. ~ ..... Name of Architect ...ea~H,,-~...~.d...T~de~,aslrd,.... AddressS(~,..C~tt~l;i:~..~ ..... Phone No...7.Z7..-.~.,5. .... Name of Contractor :~j_ve.t,~Lde..~s.~..Z~0.c. .................. Address .~..~7..6c~..~l,.~t~;~P~l~one No. ,.7.;[7..~.,5. .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from properh/ lines. Give street and block number or description according to deed, and show street names and indicate,--~ whether interior or comer lot. SURVEY ATTACHED STATE OF NEW YORK, I ¢ c COUNTY OF .......... ~l~][l~.]~...-... i~'~ ,. ~[C'~l~.~'A~;X(~3,~. . be ng duly sworn, d~oses and says t~t he is the applicant (Name of i~ivid~l signing contr~ above name. He is the ................... .~..~.~g~..g~..~R~g~.?..~g.~[~L .................................................................................. (Contractor, agar, co~orate officer, ~c.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his kn~ledge and belief; and that the work will be performed in the manner set fo~h in the app~ion fil~ therewith. Sw~ to ~fo~ me this I ~ .o,0 .................... "'-~ , ~ ~ / _ /~ ' / ~ (Slgnatum of applicant) ~ A C~NA~ / ( ~ ~ . ~ .[ I ~chard ~andeloski ~ARY PUBLIC. State of New Yo~ ~ ] ~ualified in Suffolk Coun~ ~ v No. 52-4601884 Commission Expires March 30, 1~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES . lqOMES, P,o. BOX 274 APPLICATION FOR APPROVAL TO CONSTRUCT ~VhE~4fu'J),N.Y. lt?O~ PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applican~ ~~ Phone ~.~ 5. Subd~v. Address~/~ ~ ~~. ~-~- , 6. Section 2. Prope~t~ocatio~/~ ~S~ ~ ~ 7. Lot Number~/~F~ ~ ~ ~q.~ ~ 8. Private Well ~ Village ~~ Township ~A~ 9. Public Water 3. Public Water Company Name ~ Distance to ~in 4. Lot size: Width ~/feet Length~feet lO. Sewage Disposal System: (For Health Services Dept. Use) A~allon septic tank: Precast~ Equivalent Block B. Leaching pools: Number of pools / Precas Block Special~ If private well, fill in the fol- lowing blanks: A. Tank capacity ~ gallons ~ ...... ~ . Pump G.P.M. C. Total well depth. ~<~ D. Depth to ground water E. ~ount of water in well ~ ~* S~ ~ C ~ ~ ~e undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Depart~nt of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated below and may be ren~ed i f a current local Buil ding Department P~~t~. ~ FOR ~[ ~[PgRT~[~I OF H[~[IH SffR~ICES~ US[ O~kY. Basod on the ~nformat~on presented here- .~'i~h, ~t ~s the open,on of the ~epar~ment of Health Services that an adequate and sat~s- ~facto~ S~a~e D~sp~sal Sy~stem ~and ~ater Supply canoe ~nstalled~th~s plot. Rev. Health Services Reference Number ~ flOW or poul ZeneSki formerly / SUF~OL]( coUNTY HF_~TH D~PARI~ ~ JAN 05~7~ ~. m ~. ~5~-~ The ss~-a~e ~is~osai and weter sup~l~ ¢~'~,~' for this 2. ocatio~ hav~ hee~ Chief of General Engineering Se~ices ~ THE ~AF~K OF~FFO~ C~ ~ M~.I3,1939 AS FIAF NO 12F5 THE f ....... ~D CESSPOOLS AHDIO~ ~OI~ DA~A OBTAJBF. D ~O~ OTHER~ COPIES OF THIS SURVEY MAP NOT SEARING REVISIONS YOUNG & YOUNG OEC. 1,19F5 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK JAA~. ~/9~'6 ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: GUA AT CUTCHOGUE SUFFOLK CO., N.Y. [ ~~~sY '-"c "--' ~ ..... ,' SCALE: / '~ ~' DATE: JULYS, 1975 75- 420 UNAUTHORIZED ALTERATION OR ADDITION TO THf$ SURVEY IS A VIOLATION OF SECTION ?209 OF THE NEW YORK STATE EDUCATION LAW THE LAND SURVEYOR'S [NKED SEAL OR IO ~r F~ LL ~ ~4¢'