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Home My WebLink About7826-zNO. ~ TOWN OF SOUTHOI.D BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~6.~. ~.~ ...... Date ............ .J .U~.9...2.3 .... , 19. ~.~ THIS CERTIFIES that the building located at . ~'].S. ¥iZ].ag.e .~.ar~e ....... Street Map No.V.~].:[.~g3..I,'..~r~lSck No ........... Lot No, .. 3....N,.~ .~.~.~.u.e..k...1! :.~.. ........ conforms substantially to the Application for Building Permit heretofore filed/n this office dated ........ Xpri:L .. 16, 19.7.~. pursuant to which Building Permit No..7.~2CZ.. dated ........... Apr,1....1.~ 19.?~., was issued, and conforms to ~11 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...Priva..~9..qn..e.f.a.~...J..~y...d¥.e.l.~..tl~.g .................................... The certificate is issued to ...Ro2~s. ~,. J~,:arm2.e]. ..... Ot~nex. ...................... (own. er, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~..l~..e....~ ~... 1. ~5...bit..~. :..V.~.i. 1..a... UNDERWRITERS CERTIFICATE No...t~. 22~70...,Iuna .L~..197.~ ................. HOUSE NUMBER ~2~ ....... Street ..V~.~q~qge..[:s~ ........................... ...... " .... "' :t ...... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7826 Z Permission is hereby granted to: ..... ~.~.~:~ ...... ../.!~.~::.~$. ...... ~.~ ........ ...~......~.~ ....... .~.:....~ ~.~.~...r..~.~.. ....................................................................... .~!.~. ~..L..,.-..~.~.!..~. ...................................................... ......... .&o...T. ..... ..3,.? ....... .t(..!.~.~.~..&: ...... ~?..~..~..o..~.....;~ .................................................................. %/' ................ ~..: ....... ~..?.~.!,.~. ........ /...~...., 19.'7....?.Tand approved by the pursuant to application dated Building Inspector. Fee $ ........................ Building Inspector TOWN OF $OUTHOt. O , Building Deportment Town Clerks Office Southold, 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: I. Final survey of property with accurate location of all buildings, property hnes, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage d~sposal--(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 s~te 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 .~...u:.~..e.....~...O..~.....3:.?.Z .5.. ................ New Building .... ~ ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~...:'..3:.-1..?:.g...e...~.e.x....~.~.~..u:.c..~..,.....~..*.~/.:. .............................................................. Owner Or Owners_Of Property .~...o..s...s....S..,.....~....~...~..z'...e...~. .................................................................................. Subdivision ...g~--~.~...~.~~ .......... Lot No.....3. ....... Block No ............. House Permit No .~..8..~...0....Z.. .... Date Of Permit ..~..T.~7...'.?...5...Applicant ...~.cl.....~...o..~..~..S.~ ..X~.C..t .................... Health Dept. Approval 6/'19/75 - 5-SO-37 Labor Dept. Approval Underwriters Approval ~../..~../..?..5.....N.~.~.8..?.?...0. ............ Planning Board Approval ...~.e...s. ............................. Request For Temporary Certificate ~o FinoJ Certificate yes Fee Sube,~4~d $ ,5..:..0..,0. .......................... Construction on above described building and permit meets all apphcoble codes~.and ,regu~tions. Applicant.~,.~~... -- Swan to before me this o, ........................... .......... .'. cou. / (stomp or seed FORM NO. G TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPAN( BLDG DEPT. y TOWN_ .O.F SOUTHOLD. .... Instructions This apphcat[on must be filled in typewriter OR ink, and subm!tted in duplicsta to the Budding Inspec- tor w~th the following; for new buddings or new use' 1. Final sun/ay of property with accurate location of ali buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and s6werage disposal-(S 9 form or equal). 3. Approval of electrical installauon from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buiMmgs and installa- tions, a certificate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planmng Board approval of completed s~te plan requirements where applicaDIe. For existing buildings (prior to April 1957), Non*conforming uses, or buildings and "pre-existing" land uses' l. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features 2. Swo;n statement of owner or previous owner as to use, occupancy and condition of buildings. 3. D~te of any housing code or safety inspection of buddings or premises, or other pertinent ,nforma- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certd~cate of occupancy on pre-existing dwelling o~r land use £15' 5.00 3. Copy of certificate of occupancy $1.00 Date.. Januany 16, 1985 , .. New Building ............. Old or Pre-existing Budding(*) ........ =/Vacant Land ............ ).no #) V~ttage Lane Mattituck, NY 11952 Location of Property ............................................ ~ ........ ~-. ......... House No. Street Ham/et Owner or Owners of Property ......... Lynn ~la0~eJ~ .................................... County Tax MapNo. 1000Section .. 'J'~8 ........ Block .6 .......... Lot ..... 8 .......... Subdivision ................................. Fhed Map No ........... Lot No .............. Perrnit r'~o ........... Date of Permit .......... Apphcant .................................. Health Dept. Approval ........................ Labor Dept. App¢oval ......................... Underwriters Approval ........................ Planning Board Approval .................. ~ '., Request for Temporary Certificate ..................... Final Certificate ................. Fee Subm,tted St.QQ ......................... Construction on above descmbed building and permit mee~;s all app~,cable~codes and regulations. Rev 10 10 78 THE NEW YORK BOARD OF FIRE UNDERWRITERS EiUREAU OF E[.ECTRIClTY 65 JOHN C:TREET, NEW YORK, NEW YORK 10038 2' N 228770 ,'~,~.. J~e ~, 1975 ~tpplicatlonNo. onfile 79897 ~oss Mana~el~ w/s Village L~e 472.14 n/o Main Rd., Matti~uck, L.I. 'xTU~[ : --' I' ~ ~ ] FIXTURES } RANGES ]~OKING DECKS I OVENS IOl SH WAS~X~-~ ~ * F~ure appliance feeders: 2-3#8, 1-2#12, 2-2#14. · Qeorge Zimlinghaus ' ~- Park Pl. :,' s cern~a,e must not be altered in any manner return to the office of the ~ard ~he sewage disposal and ~ate~ supply L EP/ RTMENT O? .H..E ALTH ' RiV E~[-~}, N.Y. facilities fcc this location have been '% ,' inspected by th~s d-D.~=~:-.,+ ~]: fo - / ~ ' to be satis.~ac~o:¥. ' ' .... dNAUTHo~IZE~JLTE ' I ' ........ ~ ' '" .............. ~ t~ SECTIorO THIS SURR~ IS A~ATIONvIOLATioNOR A~lro~ ~ '~ ~ EOU N 72~/0F THE NEW YORK STAT' SL~FOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY · Applicant. ~Obdne Address 2. P~'pP~'t.V. L_o,c, ation'~l~ Village: ......... 3, Public Water COm4~)FLV Name 4. Lot size: Width'--''~ feet Length ~ feet 10. Sewage Disposal System: A. ~lallon septic t~nk: Precast Equivalent Block B. Leaching pools: Number of pools Precas'~ Block S~cial ' ll. If private well, fill in the following blanks: ~ A. Tank capacity ~ B. Pump G.P.M. C. Total well depth D. E. Depth to ground water gallons Amount of water in well 5. 3UDOIV. ], 6. Section ~ 7. Lot Number ¥~m 8. Private Wel~-~ 9. Public Water Distance to main (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 Signed(~_ ~~ 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 insta~l~d on this pl,ot. S-15 Rev. 4/1/73 / ..... ....... .................. APPLI TI FOR BUILDING PE IT ~-~ ~ ~e .~..~ ........................... , 19...~ .... INSTRUCTIONS o. This application muSt be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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 st.ree?, or areas, and giving a detailed description of layout ofproparty 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 will 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 !S 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, a~tl other ppplic.oble Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal' or demolihon, 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. U. lit, - & (Sg a of app 'ca t, or name, 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 applicant is a corporate, signature of duly authorized officer. L mL Ze imml me (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. EleCtrician's License No ............................................. ~ Other Trade's License No ............................................... Location of land on whic. h propor~cl work will be done. N~ap No.: ........................................ Lat No. · Street and Number ..~....~......~.....~..~L.~~ ........................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed conStruction: a. ExJsiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ~ e3., ,l~ture of work (check which applicable): New Building.. ....... ..~... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition. .................... Other Work ..................................................... ~ (Description) ....... .7...(. ............................................................................ 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 ........................ ; .................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions 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 ..... ~.e. ........................ Rear ........ ~ .............. Depth ..;m.e. .............. Height ..~....I. ............ Number of Stories ........ ~..~*.~ ................................................................................................. 9. SiZe of lot: Front .......... .~...., ................................. Rear ....... ~ ............................ Depth ...~,~ ..................... 10. Date of Purchase .......................................... ~ ............. Name of Former Owner ...~ ...................................... 1 I. 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 ...~llll~ ......... ~.....;... Will excess fill be removed from premises: ( ) Yes (Ill) No 14. Name of Owner of premises ...~11~1~-..~.~..~1#111#1~ ............ Address ........ .?. ..................... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor .....~J~...~...~ ............. Address .~;~llJ~lll~.e.~l~hone No..~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ S S COUNTY OF ................................ ~' ' be ng duly swam, deposes and says that he is the applicam (Name of individual signing contracf) above named. He is the .............................................. '~Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me thiSof 19 ........~~ij~L~~~~ ........................ day ............................................ , ~;...~ Notary Public, . ................................................... County ............. (Sign" ' ')' ........................... FO~M' ~0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT~, TOWN CLERK S OFFICE MUTHOLD, N.Y. ~ ~o~ed.. ~ . ~v .> .................. 7 ~wo~ed ..................... ~fY=...LL., ~...~.~. ~ ~o .......... .:.. ....................... isopprovea o/c ......................................... ).. .......................................... .~,.'~T~g Zl. ~ K_~ ~/'~ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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 or areas, and 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 will 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 i~pections. (Signature of applicant, ar me, ifa carpara.an) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) $17-P Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... '4:[11J~J ~ 3 Locotion of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ~./..?...,?~......¥.~...~JL..-.~.-?-~.~ .......................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ................................................................................................................................ ,3.., lX~ature of work (check which applicable): New Bui)ding · ....... ~... Addition .................. Alteration Repair .................. Removal .................. Demolitior ..................... Other Work ................................................ ~_ ~-~ (3 ~D L) -~( ~ (Description) 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 ....................... .Z. .................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions 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 ..... ~t .......................... Rear ........ .~ ............... Depth ...~1~ .............. Height ...~1~....I. ............ Number of Stories ........ .~..~.~I ................................................................................................. 9. Size of lot: Front .......... ~ ...................................... Rear ....... ~ ............................ Depth ....~-~ ..................... 10. Date of Purchase ........................................................ 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 ...~'11~ .................. Will excess fill be removed from premises: ( ) Yes (X) No 14. Name of Owner of premises ...~...~..~......l~l!~llll,~,. ............ Address ......... .'. ..................... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ....~...~...~.~ ............. Address .ll~l~.~.l~,~.~l~J~.~.~'~hone No..~.~..~...~..~.IL~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, I ¢ ¢ COUNTY OF ................................ ' ................................................................................................ being du[y sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this %~"~ ~ '~'q-~ '~t')' ........................ day of ............................................ , 19 ........ Notary Public,. ................................................... County ...........................i~'i~ .............................. .I