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Home My WebLink About7831-zFOB~ NO. 4 TOWBI OF SOUTHOI,r) BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . D.e._q~?ar..D.r.$v.e. ............ Street Map No../,.au....q.ty..E~ock No ........... Lot No, . .8 .... .L.a.u.r..e.~...N. :.~., ............ conforms substantially to the Application for Building Permit heretofore fried in this office dated ............ Apl'II,. ] ~ 19.~.~. pursuant to which Building Pemit No. 7.8.~].Z... dated .... April. ]8.., 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.f.v.a.t..e.p.n.e...f.a.m.~..~y..d.v.e.l.1.~.n. g .................................... The certificate is issued to . .l~Qy~j~. ~r~. Irt.~ ........ .0w~z' ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ..D.e.c...] 9..197~.. by..R. :. V.~.~.~.~.. UNDERWRITERS CERTIFICATE No..N..2~.6.1+.0.~. ..... i.t.o.v....3.7...].77.~. .............. HOUSE NUMBER . . 1 1,.~ .... Street . .D.e.~..m~.~..D.~.~.v.e .......................... ......... Building Inspector ~ FOIL~ NO. 2 TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7831 Z Permission is hereby granted to: ~l~n3_,.Z.e rz~., 3;~ ............................................. .......... J~c~c..7.9~ ................................................... .................. ~,w ~-t~.~u~ ........................................ to ...~2~l...~,.ew...oz~e.. ~ a~i:L~.. ~t,:~!li~ ................................................................................. at premises located at ..... .].D.I:,..~....T,~U~',e~...Qo~.~.~..~...~,~J:,a.e.S ................................................... .............................................. Delm~..~. ......... La~el ....... ~..... ................................................... pursuant to application dated .......................~.~]-......1.J~ ........... , 19..~.~.., and approved by the Building Inspector. Fee $..Z1.,.~0 .......... FORM NO. $ TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLiCATiON FOR CERTIFICATE OF OCCUPANCY instructions A. This apphcat~on must be filled :n typewr,ter OR ~nk, and submitted in DUPLICATE to the Building Inspector with 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 certificate of Code compliance from the Architect or Engineer responsible for the building. $. Submit Planning Board approval of completed site 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 $§.00 3. Copy of certificate of occupancy $1.00 New BHilding Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Pro err //~/J'"- ~"~"~ P Y .................// /~ ~2/~'~':'"~ .......................... '/' .......... ~' ..... ~" .................................. ........... ,o, ...... ............. Permit No. 2~..~./.....~.~... Date Of Permit ...¥.°/...~..;Z.,.J._Applicant ................ ~..~....~ .................. Health Dept. Approval ../....~...f.~l..'.].~.~.. .................. Labor Dept. Approval .......... -~.....!...~.- ......................... Underwriters Approval ..:~....~...v4.r..~ .......................... Planning Board Approval ........................................ Request For Temporary C,ertificate ........................................ Fin~ Certificate ......................................... Fee Submitted $ ....~... ............................. Construction on above described building and/p~rmit~ meets all applic, gble codes and_r~ulation~. Sworn to before me this / -- ~: // .......... · /,..~. day of ...... ~~ ........ (...~...~..?~'-'~ (stamp or seal) Notary Public ........~///~ounty /mx= .18 -StFFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services j Reference Number~--S~ -~/J APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY · ," , ,C ~ ,~ Phone 1 Applicant .F~,., · ~ Address ,_ ~ 2.Property Lo~ation Vi 11 age Township 3. Public Water 'Company Name 4. Lot size: Width,, feet Length feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main 10. Sewage Disposal System: A. ~O~-gallon septic tank: Precast__~__Equivalent Block B. Leaching pools: Number of,~ools ~<~o Precast ~lock Special__ ll. If private well, fill in the fol- lowing blanks: A. Tank capacity B. Pump G.P.M. C. D. E. C~~ gallons lotal well depth Depth to ground water ~ount 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 Heal th 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 · ~ / ~ Signed FOR THE DEPARTMENT OF HEALTH SERVICESI 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 ~ ,~?/~/f~' ~ SIGNED ~_ ____~-- ,~-'-- - S-15 Rev. 4/1/73 TOWN OF ~UTHOLD BUIMNNe DEPARI'MINT TOWN GLIRK'$ Application NO...~(' .~,.~...~, ................ Disapproved a~ ........ ~ ......... ~ ................................................................................................... APPLICATION mR BUILDING I~RMIT Dote ~/'/~/ 19....~-,' INSTRUCTIONS o. This ol~lication must be completely filled in by typewriter De in ink and..s~brn~cl in triplicate to the Building Inspector, w,[th 3 sete of plans, accurate pla~:plan to ~cale. Fee according tO scheel[ale~ b Pl0t'~lc/h showina Iocotionbf lot and 6f buildings on premises, rei~tionshiP,t6 ndjoining premises or public streets o~ arec~s, and diving a detailed description of layout ofpraperty must be drawn on the diagram which Js part of this application. c. The work covered by this application may not be commenced before issuance of I~ilding Permit. d~ Ul~ri approval of this appllcatlOn,~yrte'Building Inspector will issue a Buikling Permit to the applicant. Such permit shall be k' ept bathe premises ovailab · for 'mpection throughout the work. ~ e. No building shall be occupied or used in whole or.in pa'rt for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPL CAT ON 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>bull.ding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for nac/~ry ,r-,~oections.~ ,.~~ .... (S gnature of applicon, or name, if a coq~oration) ...................... ' ' -- ----' ' d o appl nt) State wl~nerja,l~plicant is owner, lessee, agent, architect, engineer, general contractor, electriolran, p~mber or builder. ......... ................................... ........................................................................... , ......................... If applicfnt is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...................................... e ............. Plumber's License No ................................................. Electrician's License No ............................................. ' Other Trade's License No ............................................... ..,t"~J~/~.z ~' ~.~ ' 1. Location of land on whirl prapo~e~vork_~ll ~ Map~,,~.~,~.,...,......~' ' ~ .'..~ .................... ,.~ No. :~T~......" ........... Street and Number~~~.....~.ecJ4%..-. ............... ~ ...................... Municipality 2. State existing use and occupancy of premis~nde~upancy of proposed construction: .. a. Exisiting use and occupancy ............ ,~...w..~=..,.;~/ .................................................................. b. Intended use and occupancy ................................................................................................................................ / 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... 4. ~fimated Cost .... ~..,.:.,.....~....~. .................................... Fee (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 .......................... ...~.. .............................................................................................................. 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 ...... './../...~...~.,... ............. Rear ............................ Depth ~...~.. ....... Height ..e~..~.'~-- ........... Number of Stories ............../. ...................................................................................................... Size of lot: Front ............ ''J~.~.... ............................... Rear ........... --A,--/..e~..,i.... ....... ~ ....... Depth .... Z .~..?..~.. .............. Date of Purchase ........ ././..-..i-./..~. ................................ Name of Former Owner ~1:1¢/'):e~..~ ......... Zone or use district in which premises are situated .................................................................................................... ...~/~_. Does proposed construction violate any zoning law, ordinance or regulation: ..... .~../'..~.. ........................................... Will lot be regraded' ........~...~. ............... Will excess fill be removed from premises: ( ) Yes (~K~' No Name of Owner of premises ..,~..'..~.~.~ ...................... Address ..?...~..~......~.......,... Phone No...~...~...~...~...~... Name of Architect ............ ................................................ Address ............... .~ .............. Phone No.' .....:..... ........... Name of Contractor ...... ~..~.... ........................... Address .~...~..~....~ ......... Phone No.,~...'.~...~..~. 10~ ll. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from praperh/ lines. Give street and black number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK~ /?/;//~¢ c ' ........................ ~..~.f,,~x~~ .~.......~..-.':T ....... i .......... being duly sworn, deposes and soys that he is the applicant (Name of individual ~igning contracf) above named. ~, ,. ,,~ ~ -- He is the .................... ~~ ..~...~..-~. ...... ~.~/~.i~..~......~./~, ...c.~ .............................. (Contractor,. agent, ~cotporate officer, etc.) /~' · of said owner or owners, and is duly authorized to perform or ha~'? performed the said work and to make and file this application; that all statements contained in this application 6~e true to the best of his knowledge and belief; and thru the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ ............ ./Z.....Public,.day of .................. ('~ ~"'~ ~' '~'~'"/'"'~" ........ County' 19'"~'J'"'. ................... Notary ........................ -,./~.~.... ............................................................................ (Signature of, applicant) ~= Lot sq./t. - ~ ,< Area ~ ~ ~,~1~ ~ O0 ~'X LOt J~INE ~2~ I~ AS 1.0t The ~e disposal a~.:d ~ilf. ttes for t. bis ]mc?~.io~ late been ~ected by thi~ d,~r and OF WELLS IND CESSpOOl3 '/'HE LOC)ITIOH ...... · ~',rlD OBS[BVA~O~ sHOWN HEREIN A~ ~.~ .,z - AND/OR FROM DATA OBTAINED FROM OTHERS $U~011115101~ #lip FILE~ IAI FI~ OFFICE J~ ~, 19;"0 AS AIAI° ~ ~4~O$. ..v..,o.. ,. YOU.° · ',ou, e~°e, ,oo O,T...oE, ^,,u~. A~[N W. YOUNG ' -- LOT ~O, "L~RFL COUNTRY e · o~ o, SOUTHOLD ~r~ ~v/~ C-':: ,-' '. -~ ! ";'~'~ -,, :' - . ..... · , ,, 3. FINAL WHEN JOB COMPLETS=D 16'0 I !,