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Home My WebLink About7811-zFOR, M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BY. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...Fr.e.d. , .S.t?e.e .t ............ Street Map No.. ~ ........ Block No. ,.x~x. ...... Lot No, ,. ,x~, ,x.. ,N,e.v,, ,S~I, ,f~.o, .LI~, ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... Apyi.1...9, 19. ?~. pursuant to which Building Permit No...7..8.~.~.~ dated .... ~.p.r.i.1... 9 ..... , 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.i¥.a.t.e.. o.n.e...l'.a?i.1 .y..d.w.e. 1.1i.n.g. .................................. The certificate is issued to C.har. 1..e.s M.a.g.il.1. .... . .(~.e.r ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 0c.t; 12, J.976..by. It...Villa ... UNDERWRITERS CERTIFICATE No. N. 2~.9.6.Q6 ..... 0~.~..l~. ] 9.7.~ ................... HOUSE NUMBER .. 3~.~. ..... Street .... F.v.e.d..s.~;.~.e.t..,, .N.e.¥..S.u.~'9~.l~ ........ FOR~ 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 COMPLETION OF THE WORK AUTHORIZED) N.o, 7811 Z Permission is hereby granted to: .......... ~e~...~o~lc ........................................... to...~..u.~.~....n..e.~....o..n..e....~.~.~z..~.~.e...~.S-..~g. ................................................................................ at premises located at ..... .~...~..e...~....~...~.?...e..e...~. ............................................................................................ ..................................................... ~.e~...~.~£~.a~ ................................................................................ pursuant to application dated .........................J~.~L~ .......C,:,) ......... , 19.~.~.., and approved by the Building Inspector. Fee $..~.~.e.~) ........... FORM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This applicahon must be filled in typewriter OR ink, and submitted in DUPLICATE to the Buddm§ Inspector with the following; for new buddings or new use' 1. Final survey of property with accurate location of all buddings, property hnes, streets, aha unusual natural or topographic features. 2 Final approval of Health Dept of water supply and sewerage dmposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters 4 Commercial buildings, Industrial buddings, Multiple Remdences and similar buddings and installations, a cerhficate of Code comphance from the Architect or Engineer responsible for the building. .5. Submit Planning Board approval of completed site plan requirements where applicable. B For exist,ng 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, buddings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings 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. 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 Rte ....... New B~tilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....... ~.~..~.~l:~.R..~.~.~t~'~..e.~.~.~.~..~.~'~..~.~.~..]:.~.~z~.~...~..~..~..~ ............................................ Owner Or Owners Of Property }/,z'. & ~s. O/z~a3cles Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No..Z.8..]-...]: ......... Date Of Permit ...~./..?./.7...5...Applicant ...~t...~.e..Q.e.....O..*....~.9.~..t:..°.D....SF.....~.9..q]....Z..!!.~o Health Dept. Approval ..... ...~... ................................. Labor Dept. Approval ............................................... Underwriters Approval ............ Iz~{. ............................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate ........ ~ ........................... Fee Submitted $ ....5...,..Q.0.. ....................... Construction on above described building ~,~mit meets al~ppl~.~l~ and regulations. Applicant . .~~.....'~.. ...... 1...~..g..~.~ ~/~/~/ ............................../~ ~ Sworn to before me this ~/~_~ ./~ / ~.... ................ day of ............................................ Notary Public .................................... County (stamp °r sea~/,~6 oc ~ ITl U SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1 Applicant " 72 - .~ x.f.,,.'~Fv ~'~ hone ~'/~I ¥ ~' 5. Subdiv. Address ~ , ~-, ~J 2. Property Location ~q/j. / ~'~ ~j ~ "~- V~llage '~ ,) ~.,~'~ -.~ Township ~ '~ .-, 3. Public Water Company Name 4. Lot size: Width ~ -' feet Length, \~ " feet 10. ll. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main Sewage Disposal System: A. ~]lon septic tank: Precast" Equivalent Block B. Leaching pools: Number of pools Precast~a°Block ~pecial If private well, fill in the following blanks: A. Tank capacity "~ ~ gallons -? B. Pump G.P.M. , C. Total well depth D. Depth to ground water E. Amount of water in well (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's 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 HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. S-15 Rev, 4/1/73 ~°4~0~ SURVEY FOR CHARLES A. ~ MILDRED MAG/LC ,~T NEW SUFFOLK TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. SCALE: ,4t~FtlL 4, 1975 ,.I, ZIIV.. 7, 197,~ REFERENCE 4~JAIIANTEIED Ali dlstances fo wells and cesspools are by Iocahcn fror~ house owne's and field Fools ore not w'~ble these &mens~ons c.~,,vt ~e cc,h;,ed Unauthorized ollerahon or addH~on to lh~s survey is a violation of sechon 72O9 of th~ Flew York State Educahon Law. Copies er lbs :urvey mep not bzarmg the land surveyor's inked seal or embe',,~r-~ ~:el thall not be cer:,d:r~d to bo a vahd copy , , - - ~', c- , ',' ~t,~s r'~,,cated h; con :he 'J run only to th~ ~ ~ s r, ;c, ~,~-m the 'urvay b prcp~r:,l, an-J on h~s behalf lo the hd~ corn: ~ey, goverrme~da[ ~ncy ~r,d ~¢~dm~ mshtuhon hst~ hereon, an~ to the assignees of the bndmg rash uhon. Guarantees or cerhfic~hans are not transferabb 1o ad&honaJ Institul~ons or subsequent SURVEY FOR CHARLES 4. MILDRED MA Git L · T NLmW SUFFOLK TOWN OF $OUTHOLD SUFFOLK COUNTY~ N.Y. SCALE: 1'~.:7,0' APRIL 4, 1975 ~Yt L~C. NO. BUlLDiH6 DEP~RTME~T Z~ ~ ~ ~ ~ (~ TOW~ CLERK'S OmCE ~ ~ /~' ~ o ~ ~UTHOLD, ~, Y. ~[~h ~ ~ ~ ~ ~ ~ ~' ~ ....................... ApplicatiOn No ..... ~_~..L.~ ............. . ' "~'~~r) ~ ............ ~ ................ x~~~~/.._.____._ ~ APPLICATION FOR BUILOlNG PE~IT 19~..~ ~,e ................ :.~.......... ............. I NSTRU~IONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildi[ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets, areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatio, c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Budding Permit to the applicant. Such perm 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 Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, 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. ~ c~fu _ ~f_~ ............ ~...N~...~.....~......~...:~ ...... /..~., .............. ~ ' ~(~--~-&~ ..... o (Signature of applicant, or name, if a corporation) /o/~/';:~ .......... ~,..~,~~,.....~.:.~/..: ...... LL.~.s..~:.'- (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bulldel Name of owner of premises ...~.'..;~X~ ........... ~'~..~ ................................................................................ ..licant is a .corporate_, signatur~te of duly authorized officer. ............. ( alt~e and title of corporate officer) Burlder's Lfcense No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. "~/..~"-.~ Other Zrade's License No ............................................... /X~ X Location of land on whicJ.h prop9sed w~ork will be done. Map No ' . .................................... Lot,-~[o .~..~. .............. Street and Number ....~.~...1C'....~.:~' ........~ ............................................................ L~,,.~4J......'~..'.~...'~3~.~,,. ..... Municipality State ex~shng use and occupancy of premises and intended use and occupancy of proposed construction o Exisiting use and occupancy ............... 3. Nature of work (check which applicable) New Budding ............... Addition ................. Alteration ........... Repair ................Removal .................. Demohttor. ................Other Work .................................................. . ~ (Description) 4 Es,imotedCost .... .:.....~..~..~.~ ......................... ~ee..~.~ ...... ~ .......................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ /{. .............. Number of dwelling units on each floor ...... .J. ................ If garage, number of cars .............. .J. ................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ....................... 7 Dimensions of exmtlng structures, if any' Front ................... Rear ................................ Depth .................... Hmght ........................ Number of Stories ............................................................................................................ D~mensions of same structure with alterations or add,hans. Front ................................... Rear ...................... Depth ............................... Height ...................... Number of Stories ................................ 8. Dimensions of ent,re new construction: Front ..... ~ ...................... Rear......~....C~'.. ................ Depth ......~...~... ...... Height ....J.~../. ........ Number of Stories ..... 2/.. .................................................................................................... 9 S,ze of lot. Front ............ ,~.l~l~..~. .............................. Rear ...... /..0Z~.i .......................... Depth ..../..~--O.(D. ............... 10. Date of Purchase .................................................... Narn.e of Former Owner ...................................................... 11. Zone or use district Jn wbch premises are s~tuated ....... ~....) ............................................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation' ........~.....~)... ...................................... 13 W, II lot be regraded ....L~ .............. Will excess f,II be removed from premises: ( ) Yes (~'No 14 Name of Owner of prem,ses ..... ..Ch..:....~.......~N.. k~ ................. Address .~..~..~..q_....v~.. ............ Phone No...~.9...~.....'~..im..-<. Name of Architect ........................................................ Address ................................ Phone No .................... Nome of Contractor ..... .~....~. ~ ..... .~... ~:..~. ........... Address .~.g.~...~.o.t.~¢q'hon, No.q..?~..q:....%,9..t..~ PLOT DIAGRAM Locate clearly and dmtmctly all buddings, whether ex~st~ng or proposed, and re&cate all set-back dimensions fro property hnes Gtve street and block number or description according to deed, and show street names and indica whether interior or corner lot /C° ~^~ OF NEW~.R~/.Z, ~_ ,~ '~ COUNTY o~,....~:.,r/.~z...r~-~ ................ .~.~...~.~ ............................... being duly sworn, deposes end s~ys that he is the ~pphco (N~me ~¢/indiv~duQI s~gning contmcO above named ~~{ He ~s the ................. ~ ........... .9..~ ......................................................................................... (Contractor, agent, corporate 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 this application; that all statements contained ~n th~s apphcatJon are true to the best of his knowledge and behef; a that the work will be performed ~n the manner set fo~h in the apphcation filed therewith. Sworn to before me this ................. ~. ~o~ o~ ....... ~~.,., ..... , ~ ~ ~ ~t~ ~o~,.~,,c.. .............. ~~~ co~ ..~.~~..L%~ ....................... ~~ Z~'~ W~.~ ~ ' - ~S,gnature of applicant, ;-NM ~...LE VA7 IOk[ '~_ L._'F' VA: ! IC3¥3