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Home My WebLink About8153-zFOI~I NO. 4 TOWN OF SOUTHOLD BUILDING DEFAB. TMENT Town Clerk's O~ice Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .R.*.O.;I~. ?i..R.~.Ii..K.?n.~.n?.~...R.o.~.dstreet Map No, ..X~. ......... Block No.. ~ ...... Lot No, . .X..X~., .$.o.u.t.~9.1.tt...N. :.Y.: .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. AP,I'.!i...1,819 .~.~.. pursuant to which Building Permit No..8.1.~.3Z... dated .......... A;.ag...l:~. .... , 19.?.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is Pr..i.v~te one fami.ly dwelling issued is ................................................... ,. The certificate is issued to .M~!.e.1..A..,. ~l.e.l.$.e.~. .....0~.. e..1, .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~.a.~l...~... }.~.76...b.y...Il.,..V..~.l.la. .... UNDERWRITERS CERTIFICATE No. ~.6~..~..~.... p~....ii...t~.7..~ ................ HOUSE NUMBER .. ~0.~. ....... Street..K..et~.n.e,¥..R.o,a.i ........................... Building Inspector I FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N'. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 8153 Z Permission is hereby granted to: O~e'e3,~ Ave ~l. ~uogue ............. .~...~.e.t..~.o.~..~..~...~...~t~.e.~...~.t.:L~x~..~.....t.~...~.~). ................................. et premises located at ....~.:..O..:,]:'~..:...~....~./...~...K..~..~...~I, ......................................................... ............................................................................... 9.~.~..~.a......~..,.L,. ................................................ pursuant to application dated ........................~.~',.:~......~.~. .......... , 19~.~....., and approved by the Building Inspector. ~ee ,!.0.~:.~ ......... Building Inspector FORM NO. S TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter 01t ink, and submitted in DUPLICATE to the Building inspector with the following; for new buildings or new Use: I. 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. D. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. 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. Certificote of occuponcy $5.00 2. Certificote of occuponcy on pre~existir~j dwelling or Iond use $.5.00 3. Copy of certificofe of occupancy $1.00 / .... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Propert~v_4r%~.;.~..:.~.~;~....c~.../¢..~.......'.,.',-~,4~/z~.,~4~.,..;.~..~.r~.*~...:__ ....................................... Owner Or Owners Of Property ..... ./...~.d~./~'//~.. ,~......~...~....Z~I(.../.,~;J~z~.. ..................................... Subdivision ........... ~ ........................................... Lot No.....L..-~..... Block No/ ....-~.. ..... House I)1o ............. Permit No./~../..~-...~..(,~. Date Of Permit ~..././..../..F//~'..Applicant ~.~)/~/.~'.~..~..~;.....~./.,.~.~...~..~.~...xJ,~'... Health Dept, Approval ,/..~.¢/~..7.~,,,,,/~.,',.~.[?,,/.<~,.,,..,Labor De~t. Approval ..... ~ .............................. Underwriters Approval /.,Y,....,~./,/.~42...:...f..'..c/./.~.Planning Board Approval ....... -~ ................................ Request For Temp~grary Certificate ........................................ Find Certificate ..........~ ....................... Fee Submitted $'..~.. .............................. Construction on above described building~-and?/ermit meetscIx V I?'~'~a~?ppnlit'abl~.,c°des and regulations. Applicant ................................................................................................. ~u....,~ Sworn to before me this /, I ................ d ye ........................................... (stamp or seal) ~. ,,~t~- ~ D Notary Public .................................... County /~O '~ "{~ K BOARD 'OF FIRE[UNDERWRITERS THE NEW YOR ~ ~ , ,,; , ~ ~1~," ' ' ~5 JOHN STREET NEW YORK NEW YORK 1,Jucso [ 1) I~ Il iL ~)~ ~,,~.~o.~o ~./,~l 822 89 ,~ , ,,~ , N ~, s Rd. abt.1/4~.,~o Sound Ave. mhoma & ~uriel Neilson, e/~. ~epny . ii2? ?L ', , SERVICE DISCONNECT Furnaces ,,~ Oil; i=~.-1/8 33 LincoLn ave...: ....... Lot~' 550E' ."~' '. ! a h L.I, l/~bL ' : ' : " ' ' !'..'~ MaStiC Be c , : ~ 'I ~I ~! I~ , ~' ~ ' ," ' ," , ,' ~,1 III J~ i.' !!1. I.t,.~!J- .'_.~= in~6e~tor~l may be Jden~JJe~ b h ~ t~ ~Jtered m an ma~ner; return to the ofnce ot the ~oara . ~ncu ,=~, ~ FORM N'O. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEt~K'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL / / File No .................................................................. uam .................... ...... ~..~........~ ......... .~ ......... ~ ....................... : ............ ..................... ' ....... M....:...4..~ ........ ~.. ........ / .............. ~o~ ~m,~ ~o co.~.....~ ...................... ~ ........ ~ ~, ~o ~e~ ~ .....~ ....~...:~......'~ :, ') / ,.--. ................ x" ....................... ~) ......................... ~'"V ............. ' .... SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services ~'i '7' Reference Number ._~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address <J,,~,,~., ~,.,~.r,,~ .,,,,~>~ k~ 6. Section 2. Prope ty Location ], ,, ~,~. ~.,~ ~,, ..... ~ ~2 ( 7. Lot Number Village ,r ~,~.~' Township e ~ ~ 3. Public Water Company Name 4. Lot size: Widthl~r, feet Length .~o0 feet 10. Sewage Disposal System: 8. Private Well 9. Public Water Distance to main (For Health Services Dept. Use) A. 900-gallon septic tank: Precast ~,~ Equivalent Block B. Leaching pools: Numbe~f pools / Precast .~' Block ' Special 11. If private well, fill in the fol- lowing blanks: A. Tank capacity / ~,, gallons C. Total well depth 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. .. :::::::::::::::::::::::::::::::::::::: ........... Date FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it ~'s the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal S.¥st~m and Water Supply can~Jal installedJ~n, this plot. '~1/73 All distances to wells and cesspools are by focatlon from house own®rs an ~ Fiefd canno~ be certified. Unauthorized aherc~finn ar cddilion to 1his survey is a v~o[afion of Chief of Csnsral Engineer Services % ~lffV£Y FOR THOMAS S. 8 MURIEL A. NIELSEN AT $OUTHOLO TO~N OF ~OUT~LD ~UPF~K ~UNTY, N. ~ALE* I'= 40' JUN~ 12, NOV 17, 1975 a. This application must be completely filled in by typewriter ac. in ink and submitted in triplicate to the Building Impeator, with 3 mt~ of plans, accurate plat plan to .tale. Fee according to schedule. b. Piot plan showing location of lot and of buildings on premi.ses,.relationsh, ip t.O adjoinl .rig. p.?ni~eli or...p~.' li¢ ~.r~.. c~ areas, and giv ng a deta led dmcr pt on of layout ofpmperly must be drawn on the diagram Which ,s part at th~ al~cmmn. 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 pppllcont: 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 Bulldlng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit purmant to the ~ Building Zone Ordinance of the Town of Southold, Suffolk County, New .York, and ?ther applicable La~!.., Oral .i~anc.,es or ~ Regulations, for the construction of building=, additions or alterations, or ~or removal or demolition, .al wemm aescn .~ea.., The applicant agrees to comply with all applicable laws, Ordinances, building code, housing code, ana m~ulatiom, and to ~-I admit authorized Inspectors on premises and in bulldlnge for necessary Impectlons. V ...... ........ ........--:-~ '~.-..-~ o .,, ,, ' .~.~......~.:.~..~..:_..~...~:,..... ..................... (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ ..................................... .~.~ ................................. ~ ........................................................................................................ ~omeof~n, ro'p~m'--s ........... ~.~.~....~.m~S~ ............................................................................................. 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 .... ..~..~~ ~ /~O- ~.~&"'~- :~-, ~/' Other Tmde's License No ............................................... Location of land on which pmp~ work will be done. /~p No.: ..;...;. ....................... Lo;'No ......................... Street and Number }~'~. ~ ..r~....~ ..... ,... .~-..~t.~/...--~.~TL.0....f:.~.' . ...... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~,s,t,ng use and occupancy ......... .~...~....l,~ .............................................................................................. · ~ ~ ,ll~, ~ '~ .. 3. Nature of work (check which applicable): New Building......~... ........ Addition ........'. ......... Altei~otion ................. Repair .................. Removal .................. Demolition .................... ~her Wo~ ..................................................... 4. ~timat~ Co~ Eq ~O O. - ~O 50~ (D~cription) (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~.~ ............. Number of dwelling units on ~ch floor ...~ ............. If garage, number of ~m .......... ~.~ ............. ; ........................................................ 6. If busine~, commercial or mixed ~cupancy, speci~ nature and extent of ~ch ~e of u~ ............................ 7. Dimensions of ~isting structures, if any: Front ...... ~.~ .......... Rear ................................ Depth ....... ............. Height ........................ Nu~er of Stori~ ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... R~r ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... '.~.~ ..................... Rear ....... ~.~ .............. Depth ..~j ................. Height .................... Number of Stories ...................................................................................................................... Oe 9. Size of lot' Front ~ Rear 10. Date of Purchase ...~[[~......~.~ ............................. N~me pf F~r~er ~ner .......... ~.~ ............................. 11. Zone or use d str ct nwhchpremsesarestuated ...................................................... 12. D~s proposed construction violate any zoning law, ordinance or regulati~: ....... ~.~ ........................................... 13. Will lot be regraded ..... ~ ............ ;... Will excess fill be removed fr~ promises: ( ) ~ (~) No 14. N o ~ r o p em,,s .--....z.~U~....~..[~. ...................... A~ .~....~.~. ........... ~ No..~.~ ............... Name of Arch tect ~ ~ A~r~ ..... ...................... .......... ,o ....................... Name of Contractor PLOT DIAG~M L~ote clearly and distinctly all buildings, whether existing or proposal, a~ indicate all ~t~ck dimensions from prope~ lines. Give street and bilk number or description according to de~, and show street names and indicate whether interior or corner lot. STATE OF NEW' ~_ORK .................. "'ZT;~.."-.%T'~H....I.;.:..!.~I:..~.. ~'''~'' ................................... being duly sworn, d~oses ~nd soys t~t he is the ~pplicem (Neme of i~ividu~l signing contmc~ obove n~m~. He is the ........................................................ .~..~j.~.O.~ ............................................................................... (Cont~ctor, ag~t, c~rate officer, etc.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; an8 that the work will be performed in the manner set fo~h in the application filed ther~ith. Swam to ~fo~ me thi~ ~ 9~..~ ~ Noto~ ~ublic, . ........ ~ ........................... ~ k I /// ' ' (Signature of applicant) ~TARY PIIS~ ~e of N*W Yor~ No. 52-812~J~, iU~k C0ufltv Term E~pi? ~ ~, 197~