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Home My WebLink About8347-zNO. & TOWN OF SOUTHOI,D BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z.71.8.? ...... Date ........... AU~..20 ....... , 19.76. THIS CERTIFIES that the building located at ..NFS..G~g.e.n.. L.a.~.d.t..n.g..R.o..a.d. Street Map No. ;xx.X ....... Block NoF, Tmc ........ Lot No..xx~...S..o.u$.h.q.~.d...}.' ;~'.,. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .D.~9 . ~0., 19..7.~. pursuant to which Building Permit No.. ~.?.Z. dated ...... De.c... 3.0... , 19.~..~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Prl.v. ate..one £~lty..dwelZ$ng ................................ The certificate is issued to J.o..b-V...&..D..~.l~..a.., .A~..~.~..cgy' ..... . .(~..~.r.$ .................. (ow-ncr, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval A.u.g.. ~?... 1.9.7.~... b.y..~.,..V..~! ~.a. .... UNDERWRITERS CERTIFICATE No...N. 2. ~..] ~.~.8. .... .~!a.y...~....].9.7.6 ............... HOUSE NUMBER . .~.8..0 ....... Street ..~..a.g.e.n...L.a.n.d..~.n.g..~.o.a.cl. .... .S.o.u..%.h.o.l.d. .... Building Inspector ~FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FER~IT CFI-IlS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8347 Z Permission is hereby granted to: ...,8..~£.J,,..~..+.!..t .......... ~.~.~.~ ........ ..e....o.~? ..... ..~.....4.?.....~....~.....b..!.~.~.~ ...... ..A...~..!.~.? v Building Inspector FORM NO. $ TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ~nk, and submitted in DUPLICATE to the Budding Inspector w~th the following; for new buddings 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 cerhficate 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 exishng buildings (prior to April 1957), Non-conforming uses, or buddings 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 prewous 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 dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .....~. New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .......... .~...~...~...~..~...~. ......... ..~....~.....~....~...~..~....~.....).....~...~...~.~.~.....~.....~.....~....t.....t~..~.~.!. ....... Owner Or Owners Of Property ............ .~.~....~....tZ~......%......~..~..~....~:....~.. ......... ...~....~.....~.....~..~...?'...~. ......................... Subdiwsion ......................... .~ ..................................... Lot No ............. Block No ............. House No ........... Permit No ..~....~...~..~... Date Of Permit !...~...~.?.~..ZApplicant ....~....~...~.~.~..!.....~..~..~.. ...... ...C~,....~......~..:.. Health Dept. Approval ...... ~...-..~...0.....~....~...O.....~. ....... Labor Dept. Approval ............................................... Underwr,ters Approval ..... ..1~........~"...!..~..~...~.. .............. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and~.~r~applicable codes and regulations. Applicant ........... ~¢'~ '~" ' '~~" '~ '~2~; ....... '_'"~ ................ Sworn to before me this / ~ 7~zzZ, ...... day of / ? ........................... (stamp or seal) ~z~jV~- l Notary Public Ca,,nV / THE NEW YORN BOARD OF FIRE UNDERWRITERS etI BUREAU OF ELECTRICITY' 85 JOHN STREET. NEV,," YORK. NE~,¥ YORK 10033 [ ' J. Angicer, Gagens Landing South Street, Sou'~hold, L.I. I GFI , I Post { icht Walter Finger Box 99 i O",".,:aAt Mattituck, L.t. 11952 LIC# El845 4/ Th,s certtf,cate must not be olte ed m any mcnner return to the off,ce of the Board ~f ,ncorrect Inspectors m~y be ~dent,fied k,, the~' cr~eden~al~ 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 J~t~ k,~-~ C~l?Phone Zq~- ~J~ Address t~,~ ~ ~,'~~t~.V ~,5~ 2. Property Location ~)~,,~,':~ ~-~ ~ ))~'J/, Village Township 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water 3. Public Water Company Name 4. Lot size: 'Nidth ~ feet 10. 11. Sew ag//g~]~s pos al Sys tem: A.~O/O~9~llon septic tank: Prat: t/Equivalent Block B. Lea~hing pools: Number of pools Precast / .~Block Special__ If private well, fill in the fol- lowing blanks: A. Tank capacity ~ gallons B. Pump G.P.M. ~-,t'~.~.-~,~$ C. Total well depth ~'~ De Depth to ground water Amount of water in wel ~o~,~-,- Distance to main Length ¢~feet (For Health Services Dept. Use) 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 ~ere- 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 ?//2.~/'7,,c_ ~' ~' SIGNED S-15 Rev. 4/1/73 lvOR~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMEI4T TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~{~ ._.~0, 75 ............................. Y7 ........................................ 19 ........ Permit No ..................................... D sopproved a/c .......... ..... .................... APPLICATION FOR BUILDING FERMIT Date ..... ............................ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildin: Inspector, with 3 sets of plans, occur(ate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Iot and of buildings on premises, relationship to adjoining premises or public streets o, areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is port of this application c. The work covered by this opphcotion 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 permi; shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until o Certificate of Occuponc) shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department {:or the issuance of a Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, 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 t,_- admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signature of applicant, or nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises If appli_b;~nt is a cD.o[porate, signature of duly authorized officer. (l~lame d~l htle of corporate ofhcer) Builder's License No ..................................................... Plumber's License No ..... ..~....?...~...,~,.~.°....'~.....~,.!...~J-...c3,. Electrician's License No...~...1~,...~.'.~.~. ...... Other Trade's License No ............................................... Location of land on which proposed work will be done, /v~ap No ' . ..................................... Lot No ......................... Street and Number ........ 1.~.'. ....... ~-.-~...~..~. ..................................... ~'~v ............................... , ............ : ...................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisitmg use and occupancy b. Intended use and occupancy .................. ~?..-(~..%.=...~T;~ff..-.C'.-...(~... ............................................................................ 3. Nature of work (check which applicable) New Building · .............. ~ . Addition .... .... ...... Alteration ............. Repair ................ Removal ................. Demoht~or ........ ....~4. Other Work .................................................. 4 Estimated Cost .............. ...~..:.~.T.~.?...?..?.....-:::.:. ........... Fee~'~'/~¢Y' ~ ~ (Description) (to be pa~d on filing th~s apphcabon) 5 If dwelhng, number of dwelhng umts .................. J .Number of dwelling umts on each floor ......... %..""~. ............ I If garage, number of cars ............................................................................................................................. 6 If business, commercial or m~xed occupancy, specify nature and extent of each b'pe of use ........ ..I~...L..CTT... .... existing structures, if any: Front... Jt~ I...~. .......... Rear ................................Depth .................... 7 Dimensions of Height ........................ Number of Stones ............................................................................................................... D~mensions of same structure with alterations or addmons' Front ........... ..l'~....J..l~r. ........... Rear ....................... Depth .............................. Height ........................ Number of Stones ................................ 8 Dimens,ons of entire new construction: Front ....... ...~.~;.....~,..~.. ............ Rear ..... ..~....~.....~ ...... Depth '7-~'J ~ Height ...'~......'~.. Number of Stones ............ ~ ...................................................................................... 9 Size of lot: Front ........... !..~....~.. .................................. Rear ............~...O....~. ..................... Depth ...... ~..~,~...~... ............ 10 Date of Purchase ~O...~..:.....J..~..~.,..~.. ...........................Name of Former Owner'. ......... ~....~.;..~..~...~....~....~....L...!...i~.. ........ 11 Zone or use d~stnct m which premises are s~tuated .~....~..~. ~' ID ~..~..J ~ t2 Does proposed construction wolate any zoning law, ordinance or regulabon ............. ~ ...................................... 13. Wdl lot be regraded .... ...~ ............. Will excess fill be removed from premises: ( ) Yes (~'No 14 Name of Owner of premises ............ Address'~.~.¥..~.?..f...~..~.. Phone No ...................... Name of Architect ................................................... Address ................................Phone No ...................... Name of Contractor ...~..~..~.....~..~.....Lr.~.~O.... C~ ...¢~..... Address~..'~.)..~..~ ................. Phone No..~..~.~'..Z...~...~.- PLOT DIAGRAM ~' ¢t~-~'¢~"~L ~c-"t f~' "1 ' Locate clearly and distinctly all buildings, whether ex,sting or proposed, and red,cate all set-back dimensions fran property hnes Gwe street and block number or description accord,ng to deed, and show street names and ind~cat- whether interior or corner lot STATE OF NEW YORK, ~ S S COUi~Y OF ........................ ....... .~.~.'..~; .~~ ........................ bemg duly sworn, deposes and says that he ,s the apphcar KName o~ md~wdual signing contract) above named. ................. .......................................................................................................... (Contractor, agent, corporete officer, etc of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and f~l this application, that all statements contained in th~s apphcohon are t~e to the best of h~s knowledge and behef; that the work wdl be performed m the manner set fo~h ~n the opphcat~on filed therewith Sworn to before me this ...... .... co.. ........... ............. ~ ~ (Signature ~ appdcant} No 52 ~B22C26 - S'~{~',~ Coun~ Opmmi~smon Expires h~arch 30, soUTH STREET now or ~ormerly Bogovich vac an ! S.8 ~'58 '10 "~ 1~1. 59 ' now ~ formerly Horo~glia · -'MONUMENT ASSUMEO DA TUM, ~P soIL LOAM SANO SAND · ~BA VE~ COPIES OF THIS SURVEY MAP NOT BEARING REVISIONS 400 OSTRANDER AVENUE. RIVERHE/D, ALDEN W. YOUNG PROFESSIONAL ENGINEER AND J SURVEY FOR: Xc-~© 450* / / JOHN ANTICEV AT SOUTHOLD , dOflN ~TICEV & OIN~ ANTICEV Tow. oF SOUTHOLD ~__ ~-~ ,,,=,o,, , souTH STREET now or formerly Bogovich N..eTO,~e'/O'~./e5. 4~" now or formerly Horaboglia W~L L 0 l$0 ' , TE~F NO~E ~ SOIL SANDY LOAM SA NO ...... SAND ~ G~A THE £0C.~ FZ~N CF 17ELLS AND CESSPOOL~ SHOWH HE2,'~N £PE F2OF& FIELD OBSERVATfOI~ , ,AI~D/O.~ F~02'~ DAFA OF,?AIU£D F~O.~ OT[IER$ aEWSZONS YOUNG & YOUNG MAR.~I~ 1976 400 OSTRANDER AVENU£, RIVERHEAD, NEW YORK ALDEN W YOUNG HOWARD W. YOUNG PROFESSIONAL ENGINEER AND LAND SURVEYOR LAND SURVEYOR, N.Y,S. LIC. NO, 12845 N Y S, LIC. NO. 4~93 SURVEY FOR: JOHN ANTICEV ~ DINKA A~TI~ ~;;~ /,/? ,,-'%X X AT SOUTHOLD ~ I,dOHN~EV B'D~ AHTICEV [ I~SLIFETI~L[~ INSp~ ~CE CO . I~ - /~ TOWN DY SOUTHOLD ~ " l, ,, /-.~. SUFFOLK CO., R.Y. ~?~~~~ I DATE:DEC. I 9~ .... '~ ' ' ~ ~ SCALE. I": 40' ~ 75-899 UNAUTHORIZED ALTERATION 01~ ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7E09 OF THE NEW YORK STATE EDUCATION COPIES DF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR*S INKED SEAL OR EMSOSEED SEAL ~HALL NOT BE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE · JRVEy IS PREPARED~ AND ON HIS BEHALF TO THE TITLE COMPANY~ GOVERNMENTAL AGENCY AND LENDIN{3 INSTITUTION LISTED HEREON~ AND TO THE ASSIGNEES OF THE L APPROVED AS.NOTED P~E: ~_~ ~' NOTIFY BUILDING DEPARTMENT