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Home My WebLink About7704-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Cerfi[icnte O[ Occupnncy THIS CERTIFIES that the building located at~O~l~ .~ .................. Street Map No. L?e.W .a.~.d. .AC Block No... ~ ..... Lot No..1.9 ..... t~0~I~I~OI~I...N ,Y.,. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .J.~.....2.~. ,, 19.7~. pursuant to which Building Permit No..?~O~Z · dated ............ .~.a~ .~.? .... , 197~.., 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 .[r.~.~.~..~...o~. ?..~...a~..~.~..~...6.~.~.1.1. ~.~$...~.l.~.~. ,~...~. ?.~..~.~?..~....~. ............. The certificate is issued to ...K?.~.,...P.~..t~...~.~.~.1..e.~.. ....... .0~. e~. ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .D(~.*. ~...~975~..~Y. 1~...¥i~la., .... HOUSE NUMBER .. ?.8?0. ...... Street ...~.~.qO.'.l~..~.r~. ...... .................... Bmlding Insp~ector FOR~ NO. ~ TOWN OF SOUTHO£D BUILOI~G DEFARX/~ENT TOWN CLERK'S OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 7704 Z Permission is hereby granted to! pursuant to application dated .................... ~.~D,....2.~. .................. , 1~.~[...., and approved by the Building Inspector. Fee ~x~., ~. ~i'. ............ Building Inspector / FO]aM NO. $ TOWN O~ $O~THOLD Building Delmd'menf Town Clerks Office Southold, No Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter aP, ink, and submitted in duplicate to the Building Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate location of ail buildings, property lines, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage dispasal--(S-9 form ar 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 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, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o 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 , ~_~.._.~..~.- ~,~ -~L~-'~ ~)..." .~.,..~ Date ............ 'e Buddm , ~O1' or Preex~ tm " I'n , V ' ' ~ w ' ' g ................... o - 's' g~ioi g ........................... ocgnt Land ............................ Location Of Property ....~X~~i. "~~'~' ~~ ~/ Owner Or ~ne,rs Of Prope,y ..... ~/~..~.~: ...................................................... Subdivision ~~.~4~ ............... Lot No..~.,. Black No ............. House No ............. Permit No..~--~Date Of Permit c...~,.,-..r.~.Appllcant ..................... ~..~.:.. Health Dept. Approval ...................................... ~J~abor Dept. Approval .................................. .: .......... ....................................... Request For Tempor~ Ce~i{icote ........................................ Final Cortiflcote .......................................... Fee Submitted $ ....~ ............................. Construction on above described building and permit .meets oil appl~le// c~es a~at~;;~~ 3 ............ ............................................ ~,~ :'""'~:'"T'"::~ ,,.: ~,,,,,~. 2..:L~..~...~:. ....... .................... ~ --'-'"r~"~'6~t' ............. : ................ ~. ,~~::.,.~:~...~,....: ....... ~: ~'~f'-' ~ ............... SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Heal th Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant~~~hone ~-:2~2/% .5. Subdi Address_~~~~~//¢~/ 6. Section 2. Propert~cat~~~~e~ ' 7. Lot Number~ 8. Private Well ~[~6] ~p_ ~m/~. Public Water 3. Public Water Company' Name__ f~-~ -- Distance to main__ ~. Lot size: Width~a~ feet Leng~ ~&feet 10. ll. Sewage Disposal System: B. Leaching pools: { · Number of pools ~ Precast ~ock ~pecial__ If private well, fill in the fol- lowing blanks: A. Tank capacity. ~"~,~,~__~allons B. Pump G.P.M. Z~ 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 b~l.~and may be renewed if a current local Building Department Pers~i~is in effect. ============================================================================== FOR THE DEPARTMENT OF HEALTH SERVICES' USE ONLY. Basedon the information presented here- with, it is the opinion of the Department of Health SerVices that an adequate ~nd satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE Z/~7~ SIGNED S-15 Rev. 4/1/73 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.'.~.Z: Permit No. :.~...i~....~...L/...,~ ........ APPLICATION FOR BUILDING PERMIT Date ....z ......... r~......~.. .................... 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 streets or areas, and giving o 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 O 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 port 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 ir~ buildings for necessary inSpections. ,-- ........ (/.. '" ~./(Signature of applicant, ~r ~, if a~orporation) (Address of o~plicont) State whether applicant is owner, lessee, ag~hf, ~r~hitect engineer general contractor, electr c an, p umber or bu der ................................. .:.. ........... . /?? ? _.. !/./., -/ ., ' .................................................... Name of owner of premises ....~.~:,,../.../..././~/~c- ~../..~,.~.....~.~...~...~ ~..: - / If appl~c~ont/is a corporete,~/iignat~e of dally authorized officer. Bu,ders Lic¼ No .......... ...... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done Mop No.: ..... ,~..-~.....'.~.... ,... Lot No.~....~.. .... ...~.'.~.~.~.,..~.~/_~.,~.~<~ , ~ ~: ~ /////'__~'~- ~/'~ .............. Street ond Number ........................................................... ~...~..~/~.~K', .~ .~...~. / .~..,... ..... - ~--'Municipality 2. State existing use and occupancy of promises on, al'intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............. .?~....d'~/.~'...~..~....~........, ................................................................ b. Intended use and occupancy ..... ./....~,-'~..~........./.~/./~...~........~../,:~,.: ............................... 3. Nature of work (check which applicable): New Building~· ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . ~,_:~ , / ~ ? ~ '~- (Description) 4. Estimated Cost ........... '..~..~..~..r....O....~... ........... Fee .....~..~'-...:~ .................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... g .............. 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 ................ ~7 ...... Depth ................................ Height ............................ Number of Stories ................................ Height ....... /~....~.~. Number of Stories .............Z ................................ ]j..: ................................ ; ....... ~.. ................... 9. Size bf lot' Front .~...~...~,.¢ Rear ..~....~.., ~;Z .......... i .......... ;' ....................................................................... J' . ............ 10. Date of Purchase .......... Z .~..~...,~ ........................... N~ Former Ow~ner ..~.~'i...../~..~'~-.-.~..~. ......... 11. Zone or use district in which premises are situated ...~¢..~.~..~.Z ................ 12. Does proposed construction~_.zviolate any zoning law, ordinance or regulation: ...~4b~.~.' .................... ~,. .............. 14. Name of Owner of premises ~.:...~W...~......~.~..~/~.....~Address .~,~Y' ~'.'~..~..~/.~.'.-..'¢TCPhone No..~..~..~...'~..~....~..J¥*.d~ Name of Architect ............... ~ ........... : .................................. Address ................................. Phone No ....................... ' ' Phone No. Name of Contractor .................................. Addres . .. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frore 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 Y.O,~fl~,~J~//_ [ c ¢ COUNTY OF ....... ........................... ~Z.~..~X~..~~ .......... being duly sworn, deposes and says that he is the applJcam (Name of individual signing contract) above named. He is the ........... ~..~4~~.~ ............................................................................ ~~ ..................... (Contractor, agent, corporate officer, etc.) of s~id owner or owners and is duly authorized to perform or have performed the ~id ~rk and to m~ke and file this application; that all statements contained in this application are true to the be~ of his knowledge an~ belief; and that the work will be performed in the manner set fo~h in the application filed therewith. , / Sworn to~ef~ me this , ~ / / / .......... o, ....... / Noto~ Public .~& Z...~~Coun~ .... ~~X~/~~: ....................... ~ .... ,// /(Signature of ap~ico~ ju ml]. / ? k O T LOC T N ~' LA L /~ N O 5 C k = f NO P L A N C,[ N E K A L N (~ T E 5. -, ~. 5I G,, :F-.I L O T L 0 C A l' I 0 t~ EaS I g rMCE FOK PAUL __! I ~ · STUDIO. I [,,[_B F- P-, A L N 0 T E 5 · '' A ,~. g E N R O 0 · b N J N O P,, 0 0 M. ROD' F J 1~ST FLO0~ PLAN' KE5 I D ~NG E FOk ELTON T BKOWN- DESIGNER. V A T I ~ N J U T H. ~'~ E V' I E L PAUL J~iTC. 14&I~ ~ L£VATI L~TkL f- · ST LIDY- Ro - //'?,CUT ~ ~<~-~ F~US~~ X, ~[CTI 0 ~4 / / ' LAIJH '. I~-E C P-.C. AT/I 0 h, () ' E t6C T IL { CA L P LA N- M R5 P A U L H E T 7 L F.. P~ EL'~OH T, IDLDNVN , DESIGNE~