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Home My WebLink About8124-zTOWN OF $OUTHOLD BUn,DING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .. II/~ .Gl~ae~fSald. L~... Street Map No. lh~eeIM~ielcl~lock No ........... Lot No..12.: .8o~.tho~d...1~,~.~ .......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ........... AW....~..., 197.~.. pursuant to which Building Permit No. 8.~Z.. dated ........... A~4~...~. .... , 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.r~..~a~;e...of4e. ~'..a~.;~_y..d..we..1.1.~ ...................................... The certificate is issued to L~s. ~a~ol.. .... .'.~el' ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval J~. ~..~97~. · .b)'. ~ .¥~-J,l& ........ UNDERWRITER~ CERTIFICATE No.. ~267289... J. an. 2~. 197.6 ................. HOUSE NUMBER ... ~{~ ....... Street ...l~'.e.e.~f.~e.~. ~ ...... .~..~.t~..~ ..... · ............... FOI~I NO. ~ TOWN OF SOUTHOLD BUIL~)ING DEPART/v~ENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: Prest~ae.t..~oz-p....A~.C..L~a..H~do,~ .................. ............... ~t~t~..~a~s .......... ~.~ ............. to .l~ui~...n~...o~..£~ll/:..~].~n~ .................................................................................... at premises located at -..~0~*-'~ ......... G:~e~.:~®~.d~.-~-.gm~hold- ........................................... ................................................ X~.S..~r~e~£~Le;~...l~ .......... ~mathe~.....~. ......................... pursuant to application dated .........................~12,~ ....... ~ ............. , 19..~..~.., and approved by the Building Inspector. Fee ~X~O. ............ FORM NO. $ TOWN OF SOUTHOLD , Building Depoltment Town Clerks Office Southold, N. Y. 1197] 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-0 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 pete ..... ............... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........................................................... Ow.er Or Owners O~ Prope.y ..... ..Z....o..m.h......~.C.e.~ ......................................................................... Subd v s on · ( ....... at No ...... Block No ............. House No ............. o° -'Y -~ · ~.~ r Permit No. ~.L~.~.Z... Date Of Permit ............... ~App ,c~t . .r.~.sEr..~..c.~.......Ca.....p.. ................. Health Dept. Approval ..... .....~........~ ........... L~bor Dept. Approval ............................................... O Underwriters Approval ........~.. ............. ..~.....~ ........... Planning Boord Approval ....................................... Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ ...~...~ ............................ Construction on above described building and permit~_~_ ~meets alV,~pp~ca~ regulations. Applicant SWorn to before me~t~ ..... ...... ....... o,,,o,, '0~ Aug ~ 1~?~ we a ~ew dwell~ f~r L~ ~odo~ a~ L~ 1~ ~emfield~ ~divlslo~ certificate ~ ~N26~2~ ~e e~plaimt i~ ~o fol~ - fa~t~ ~tee~ri~ wireing ~o~ation which lets In wa~e~ ~ ~i~ a~d a e~aek in aellar floc~, the electrie~l eempt~i~t~, X~dly advise w~ yom will m~ to ~ repairz of SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number 10. ll. Address ~rope~ty Locatior APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Public Water Com~'~ny ~ameJ<~j~ Lot size: Widthj~,~i fe~ Sewage Disposal System: A.[.,9~O~.~allon septic tank: Preca~t-~ Equivalent Block B. Leaching pools: Number of pools , { Precast~O~Block Special__ If private well, fill in the following blanks: A, Tank capacity_~allons B. Pump~G.P.M. ii . C. Total well depth~ Phone~ D. Depth to ground water__ 5. Subdiv. ~,~?~!d 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main (For Health Dept. Use) E. Amount of water in well i~i'~~ The undersigned CERTIFIES: "Construction of au~nor~zeo ~ns~a~m~ons wlmm ~ in accordance with the Suffolk Coun~ Depar~ent of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and m~ be renewed if a current local Building Department Permit is in effect. FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health DeP~F~ent that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot, A PROVA DATE SI NED ____- S-15 Rev. 4/1/73 BUILDING DEPARTMENT L.', ~-- ~ - Examine~ ............ ~ ......... , 192~. _ ~plication No. ~~ ........ _ ".g . , ~pr~ed ........................................ , 19 ........ ~emit NO....~..L.~ ................... ~1~ ~ ~4 ............................................................................ ~.~~ ........ ', , _f ' ' (Building .... ................. Insp~torF~ ......... ~~'-'--'"'"""'"-~'"'-' ~ ' ~'-- ~ ~ ................ .... ~. Thi* ~ppli~tion mu*t ~ eom~t~l~ filled in b~ W~rit~r or in ink ~nd ~ubmitt~d in triplicate to the 8uildin~ b. ~lot ~lan ~owinfl Iocetion of lot and of buildin~ on pmmi*~, r*latiomhip to ad~oinin~ ~r*mi~ or ~ubfie ~i~in~ ~ d,tailed d~cription of la~out of ~ro~r~ mu~t b~ dr~wn on di~ram which is pert o~ thi~ a~ficetion. e. Th~ work co~r~d b~ thi~ application m~ not ~ ~mm~n~d ~fo~ i~uance of 8uildin~ ~rmit. d. ~n *~ro~al of thi~ ~licetion, th~ B~ildin~ In~ctor will i~*u~ ~ Buildinfl ~ermit to the ap~licent. Such ~rmit ~h*ll b* k~t on th~ pr~mi~ ~i~M~ for in*~ction throughout th* work. ~. ~o buildin~ ~hall ~ occupied or u~d in whole or in ~ for ~n~ ~ur~o~ what~er until a C~rtificat~ of Oecupene~ ~ant~ b~ th~ Bui~din~ In~ctor. 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 altm'ations, 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 necessar?~j~j,~. ~-/~na.~_ re of applicant, or name, if a c6rporation) (Address of applicant) It State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ .................... .......................................................................................................................................................... Name of owner of premises .~Cl'~,~,l..,1~1,g~. .................................................................................................................... If applicant is a corporate, signature of duly authorized officer. Name and title of corporate officer) ' G~-een~'ields At lleatheld 1. Location of land on which Proposed work will be dOne. Map No.: .................... Lot No....I.~....., ................................. Street and Number ...~/.~..92~eextf;Le3.dLY~ane ..................... ...................................... -q~ut~el4 ...................... . Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: m Existing use and'occuPancy ......... .T.a~tL..l~zt. eTp~.~,~ ................................................................................. ~ ..... b. Intended use and occupancy ....... .o...~..q....~....a~...[...]-.7.....d,.~..~.~./..~-.Tl& ........................................................................... ~ Nature of work [check which applicable): New Building Addition ..................... AlteratioJq ............... Other Work R~n~ir Removal ................. Demolition ........................ ................................. (Description) 10. 11. 12. 13. 14._ 4. Estimated Cost ............... Fee ........................... ................................ (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.....t... ...... .,.. .. . ...... .... ... ... . .. ... . .. ...... ............................................................... ....... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. D mensions of ex st ng structures, if any Front; ................. ,.j~ear ,c.'. ................ ~,~. ~)e~th ................................... r f. ~L ' '.~. ~' ~ Height ........................................................... Number of Storl,~,.~. ................. ; ............. ' ............ -; ........................ Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ , , .... .'....,, .......... 8. Dimensions of entire new construction: Front ... ~ .......... Rear ...... .~..~ ......... Depth .......... Height ......... ~..~.. ............................... Number of Stories ..../ ............................................................................. '~ ,~ ' ... Rear .... /..x~...f.~... ' ....... Depth /~'~ I ~, ;~ :~' 9. Size of lot: Front ....~......~.. .................................................................................................. Height ...; ................................................ Number of Stories ...~. ................................................................................ Date of Purchase ..................................... Name of Former Owner ............................................................................ Zone or use district in which premises are situated ................................................... ... ... .... · ... Does proposed construction violate any zoning law, ordinance or regulation: .../..~..)..~.. ................................................. W; ,-+ ~,~ -=-,a~ed, ~.,~; .'~.. ..... Wil excess fill be removed from premises: [ ] Yes [ ] No ..... Name of Owner of premises ....c~.....~..~..(.~.......v...: ......................................... : ........................ . .......... :~: ...... ......~ ........... · (Address) . ~,rnone No.I Name of Arch,tect ....~. ....................................... ~ .................... i~,~J;~i ............... :' ....... "alJ~ii~'~;;'l[l'~:~ ............... ~. ~, .,,,._,s .~, ~,r~{'~'~,~4,~ ~--~-~ I~:. . f...~..;.....~......!....X' .~;....~-~-J~!~...-....~;-..-: ............... ~ame o~ ~,;Onu=u~,., ...... ~ ....................................... {Addres~'~" .... ~"(Phone No.) _ PLOT DIAGRAM ' · Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or cornier..!ot. · · .... I'f sTATE OF NEW YORK. i cou,t¥ ......... ) ...~;~.~,,.~,~..~.......~..~_~..f,.~.~.~..~.~,./~1~ ........................... being duly sworn[ d~s and says that he is the ~li~nt above na~. -- {Na~e o~ i~ivi~ si~ing con.act) ~ :" ::' . .... : ' , He is the ....~.U-L~.~.~. .............................................................................................................................................................................. - (~nt~ctor, ag~t. co~te of~cer, etc.) of said owner or owners, and is duly agthorized to ~rform or have ~d the said work and statements contained in this application are true to t~ best of h S kn~ed~ and ~ef~and that the work will ~ ~ffor~d in t~ ~n~ ELIZAB~H ANN NEVI[ set forth ~he ap~ cat'on filed t~rew'th .. ~p~L~.~-~ff~LN~ ........ ............ .......... FRONT EASTWOOD MONTAUK HWY., HAMPTON BAYS, N.Y. 11946 REVISED " ' I t:1 NO. PURCHASER LOCATION DROP ~" WA L 1 S -/ 7 II .I 8'~7'° O,H,D WALLS FOUNDA TI 0 N I0 DECK, 7 // OB PLUMB TF~ EE LEFT SIDE 7 SECTION 16 ~IGHT SIDE EASTIM00D BUILDERS ....... INc. PURCHASER-