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Home My WebLink About7828-zFO~M NO. · TOWN OF SOUTHOLD BU~,r~INC, DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificnte Of Occupnncy Z,6721 Oct 2 75' ~To ............ Date ........................... , 19 .... Horshoe Drive THIS CERTTFTES that the b~lding located a~ ......................... S~ree~ Map No. 0~g'Vw'~S~lock~ No. .Lot No, 22 Cuteho~ confoms subs~ti~ly to the Application for B~]ding Permit heretofore fried ~ this office dated ......... ~.. ~, 10.~., was ~sued, ~d eonfoms ~o ~ of ~he req~ men~s of Private ~e f~ily dwelli~ ~ssued L~is Hodo~ The c~tfficate (owner, ~essee or ten.t)~ o~ ~e a~oresaid h~g. S~o~k County Dep~ment of He~th Approva~ .~P~..~...~.~...~. ~}.~ .... ~'~OP~f NO. ~ 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? 7828 Z :::::::::::::::::::::::::::::::::::::::::::::: :::::~2t itr~p::~Pol:Cati°n dated~ ...... ~./....~... .......... ,19~,and approved by the ~.~~. ~ n ector FORM TOWN OF $~)UTHOLD , Buil'ding D~portment 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: 1. Final survey of property with accurate location of a{I buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal (5-9 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. B. For existing buildtngs (prior to April 19§7), 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 a~ 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 blew Building ......~... ...... ^dBition ................ Old or Pre-existing Building ................ Yac~nt kand .............. · o o,,on o, .......... Owner Or ~ers Of Prope,rt7 ....................................................................................................................... Subdivision .~..~.C.~..~..~....~.....~../~..~./.....~..~..~..~.....~...~....Lot No. ~... Bilk No ............. House No..~r~~ Permit No. ~.~.~. Date ~ Pe[mit .~~pplicant .................................................................. Hea{th ~pt. Approval .......... .~.~;~ ........ ~bor ~pt. Appr~al .............. .~..~ .................... Unde~riters Approval ......... ~.)~. ............ Planning B~rd Approval ......... ~..~ ................... Request For Tempora~ Ce~ificate ........................................ Fin~ Ce~ificate ..~. ................................. Fee Submi~ed $ .~..~ .................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ..Z..~.. ~¢ ~.... ~..a.,~.. ~..~ ...... ..~... ~.//.~...~...~..~. ~~: .,..~ _ ......... .~. day of ..~...;..(..~..7..~. ............ -~ (stamp or seal~ ' _ /~i~¥'~ Notary Public .... ~~... .... County SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services y! ~ Reference Number,-~f~ ~-~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1 Appl i can t ~ ) s :~:.~ j, Z; " Phone" · Address 'i~.-,, ,~.,, ,.~ ~ 2. Property Location~/.. rye, Villageq~ :,,.~ A..G Township 3. Public Water Company Name 4. Lot size: Width.,~. feet Length2]~ feet 5. Subdiv.~t":,'-~ 6. Section 7. Lot Number 8. Private Well g. Public Water~,m Distance to main 10. Sewage Disposal System: A. ~allon septic tank: Precast / Equivalent ~'~Block__ B. Leaching pools: Number of pools / PrecastQom Block Special 11. If private well, fill in the fol- lowing 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 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. FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- 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?~ SIGNED S-15 Rev. 4/1/73 ,n't-z,~'/ /THE~, NEW YORK ~UREAuBOARDoF ELECTRICIT¥OF FIRE UNDERWRITERS ' ~ ~ ,~, 85 JOHN STREET, NEW YORK, NEW YORK 10038 , ,. ?o,.e,~ AuEuzt 'THIS CERTIFIES THAT .... , , only th~ electrtcal eqt~ipment as described below and introduced by the apphcant named on the above applicatton n~mber in the premises of "~, , ,: . Allstuct, Ho~9., e/s Horseshoe D~. O~e~on View Es~a~es, 12~ ,~n theJollo~alng locut~on; ~ ~ Basement OU~ S ~e ,o.,.~.~i,,~,~o. jul~ 31', 1975 andfoundtobelttco.tphutweuffthfhereqtdremearsofth~sBoard. RXTURE ~ FIXTURES __ OUTLETS SWITCHES FLUORESCENT :i6 ,, ~ , DRYERS FURNACE MOTORS FUTURE OVENS DISH WASHER EXHAUST FANS i TIME CLOCKS ' MULTI-OUTLET DIMMERS SYSTEMS NO OF FE~T OTHER 1 301 I ~ SERVICE DISCONNECT ' ~' ~ S ' E R V I PER ~' OF CC COND Motor/s :'~ 1-.]]~/2hp ~:' ' ,~ u ' ~ 2hp.[ · 51~ Staller Dr. ' 'C E East Quogue, L.I. 11942 ,, , ,,,, 6ENERAt'~ANi~C;E~ This cerhficate must nbt be altered in any 'manner, return to the office of the Board ~f tncorrect Inspectors may be ~denhfmd by trois facilities f~r this location have ~esu~ ~o~o~ inspected by this depar~ NOTE" · -- MONUMENT SUBDIVISION MAP FI£HD IAI TN~' OFFIG6' OF TN~ C'/.EB/¢ 6~ SU~n'OL.K COUNTY ON APtW£4, 1975 AS FI~ NQ 6241 T~ ~O~T~O~ ~ ~E~ A~D C~PO0~ ~W~ B~R~IN ~E FEOM FIELD O~SE~VATIO~ Ai~D/O.~ R~OM DATA OBT~HED .£V,S,ONS YOUNG & YOUNG /975 400 OSTRANDER AVENUE, RIVERHEAD, HEW YORK ~OT N~ 22,"OREGON WEW ESTA ~E~'~, · ow. o~ SOUTHOLD ~cA~. i ,, = ~, .~ o~*~. ,,.AUG I~ 1974 TOWN OF SOU?HOLD 0 ~ BUILDING DEPARTMENT ~'~ C L C'S OmCE ~D, N.Y. ~_ [xamin~ ...... ~ ....... 1 ~ ~pplicafion ........................................................................................ !1 , ._ ~e~c ~ ' Date , -f..., ................ ,~ INSTRU~IONS a. Thi~ ~pplimtion mu~t ~ completel~ fill~d in b~ t~writ~r or in ink and submitted in triplicate to tbe 8uildin~ 3 ~t~ of pl~n~, accurst* ~lot plan to *cal~. F~ aceordin~ to *ebedul~. b. Plot ~lan ~ho~in~ Io~tion of lot and of buildings on premi*~, rel~fion*hi~ to ad~oinin~ ~i~in~ a d~tail~d d0~eri~tion of la, out of ~ro~rW mu~t be dra~n on diagram ~hich is part of this application. e. Tbe ~o~ ~ered b~ thi~ a~plication ma~ not be commenmd ~for~ issuance of Buildin~ Permit. d. ~n a~ro~l of thi~ a~lie~tion, tbe 8uildin~ In*p~ctor will i*~u~ a Buildin~ P~rmit to the a~lieant. Such th~ pr~mi~ ~il~ble for in~ction throughout the ~ork. · . ~o buildi~ *hall ~ oceu~i~d or u~*d in whol* or in pe~ for ~n~ purpose what~*r until a ~rtificete of Oeco~an~ ~r~n~ b~ tbe Buildin~ In~ctor. ! APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zon~ Ordinance of the-Town of Southold, Suffolk County, New York, and other appliCable Laws Ordinances or Regulations, for the construct on ~ buildings, additions or alterations, or for removal or demolition as herein described. The applicant agrees to comp y with all app cab e la~J ord nancea, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections.'~ _. ~lSjaf~atur~ot.~oplicant, or name, it a eorporation~ lqon~auk Highway. Hamptea Bays ........................... .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; ~uilde~ louis Roeo~ Name of owner of premises ........................................................................................ ; ....................................................... If applicao[ is a corporate, signature of~dul¥ apthoriz, e,d officer. ...... .......... (Name and titffi-of corporate officer) O~eAon View ~teteo r 1. Location of land on wt-~ch proposed work will be done. Map No.: .4...-~.....~../...... Lot No..~,:.....,.; ............................. I' ..... c lle sestme o ave 7- ' / 5treer ana mum~ ............................. ; ............................. ......................... ~..,,~,~...~,,~ ................ ~Municipali~ 2. State exi~ing u~ and o~upancy of premiss and intended u~ and ~cupancy of propo~ con~mction: E ' v.eent ln~ a. x ~ing u~ and ~cupancy ....... , ............................................................................................................................ b. Intended o~ anti o~upancy ............................................................................................................... ~'~' ............. ~ 3. Nature of work (check which applicable): New Build, lng ........ ~ Addition ..................... Altera~on...~..r ...... Demolition Other Work ' Repair . . Removal ................................. e (Description) 4. Estimated Cost ...... $.;~{}.,.Q.Q.Q^.QQ ............. ;... Fee ..././,,/.~. ................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....1 ............ Number of dwelling units on each floor ......................................... If garage, number of cars ....1 ....................................................................................................................................... 6. If business, commercial or mixed occupancy, speci~ 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' 26' 8. Dimensions of entire new construction: Front ...... ./A,~...~ ............. Rear ....... .~. .................. Depth ................................. Height ..... ~,Q ....................................... Number of Stories .....2.. .................................................................................. ~ 1~.1 t Depth ........ 7.~......, ............................... 9. Size of lot: Front .....~Q ........................... Rear ........................................ 2 f Height.................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 1 1. Zone or use district in which premises are situated ....~, .............................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .....~..o.. ............................ '~;r~ ............... 13. Will lot be regraded ._ ye,~ ......................... Will excess fill be removed from premises: ~rI'~''ses [ ] No 14. Name of Owner of premises ... I~auS. a..~[oc~a~. .......................................................... 2~1,,.7.~.1.1 .............. (Phone No.) (Address) Name of Architect ....................... (Address) (Phone No.) All~t~uot Co · 728-22 0 Name of Contractor .................................. ...~. .................................................................. ~. ....... (Address) (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 corner lot. STATE OF NEW YORK, ) COUNTY OF ....~..0.~ ............................... ) ~ ......... ~Z~I,~..~...]~.~...I~[~I,.~I~.~.~,.Q ................................................ being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) lie is the ........ ]~t.'l.~t..~. .......................................... ~ .......................................................................................................................................... {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 b~.~/~[~j~i~j~e and belief; and that the work will be performed in the manner set forth in the application filed there~yith. ~IOTARY PUBLIC; State of New Yor~ _ , · ~ , -- No. 52-8125850. Suffolk C0uatv, / / ....... ............. o, ...... ..... _ Notary Public,~-~ Coun~.../~~ ........... ~ - '7 p fly ' --'"~ tSignature of'applicant] UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION Or'SECTION 7209 OF THE NEW YORK STATE EDUCATION COPIES OF THiS SURVEY MAP NOT gEARING THE LAND SURVEYOR'S INKED SEAL OR EMaOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPy GUARANTEES INDICATED HEREON SHALL RUN ONLy TO THE PERSON FOR WHOM THE /YORE: ~ = MONUM~NI' SU~OIVISION MAP/rILeD IN THE OFF/CE OF YHE CLERK ~SU~OLK C~NT~ ON .EVSS'ONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAO, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG lOUIS HODOR TOWN OF SOUTHOLD , co., APPROVED AS NOTED DATE: *!Il-l/75' ' NOTIFY BUiLDiNG DEPARTMENT AT 765-'Z660 9AM TO 4PM FOP, P-.EQUIP,.- ED INSPECTIONS: 1, BEFOBE BACKFILLING FOUNDA- TiON OP, STABT FRAMING 2, BEFORE COyER[NG PIPELINE 3. FINAL WPJEN JOB COMPLETED NOT RESPONSIBLE ,FOR D~ES[GN OR CON- STRUCTION ERROr5 D.I N, II iq,.q. L ,,J C) Ltl4, BD_? .R M. '~1 /~,-7 lq F~Y_~ 1o # BD B D_, gM. /o'-/' ~2 MAIN FLOOR Be 7 L NDRY. QA_RADE_ .DEN /,2 /3¸ ....... L.O_WE_R _ F L_O0 R ~_o"~ 6'-~ O.H.D. o~ COUNTRY ,UI RE .S.E C T_ I_O N 3" P~L ~._M. BING t C o,u¢, Foo'T l ^it:~ /',k, I 0 FOUNDATION EAgT V00D BUILDERS L. SIDE R. SIDE