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Home My WebLink About7716-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certific.te Of Occupnncy No. Z6~8~ ...... Date ............. ~'my.... 28 ..... , lg. THIS CERTIFIES that the building located at . Pe~onic..i~ay. I~lvd ........ Street Map No. ~ ........ Block No... ~ .... Lot No, .~.. La~el...N ,Y., ............ conforms substantially to the Application for B~l~ng Permit heretofore filed in this office dated .............. Feb...5. , 19F.~ . p~suant to which Building Permit No. 7F.1.63.. dated ............ ~qb...1.0.., 19.~5., was issued, and conforms to all of the req~re- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ~ri~ate. one. ~'~l]-y..dwelling ...................................... The certificate is issued to Dominic..& ~rg~ta...~enat~ ..... ~s ........ (owner, lessee or ten~t) of the aforesaid building. Suffolk County Departmen~ of Health Approval - UNDERWRITERS CERTIFICATE No .... N. 22~.3~ .... ~Y... ] ]...] 9~.5 ............ HOUSE NUMBER ~.. 859~ ...... Street ... Pe~.on~c..Bay. ~i~vd .................... Bmlding Inspector TOWN OF SOUTHOI;D BUILDING DEPARTMENT TOWN CLERK'S oFFICE $OUTHOLD, N.. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7716 Z Date .......... ~..;...... ....................... ; ........... , ............ : ..................................... : ~"~ ..: ~~ ~' .......... o,,,~,,~,,~o,~o,~.~.;~..~ ......... : ........ ~./.... ~ .................................... .................................... :.....~...:. ....... ~..~.=~...~..?.....~.~.......:: ........................................ pursuant to application dated ................ .~.~..'7.::..~..........~...- .............. 19~..~.--~'...., and approved by the Building Inspector. Fee $..: .................... FOEM NO. t TOWN OF SOUTHOLD , Building Depertment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subm tted 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 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. 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 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: l. 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 New Building .......~... ..... Addition ................ Old or Pre-existing Building ................ Vacant/Land .............. Location Of Property ...~/~......~.. ....... ~..~/....~,,~....~:t./.~...~.....~]~..~.....~. ......... .~.....~...r~.../~..~....~... ............................ Owner Or ~ners Of Prope~y .~.~.~.-I~.~.~...~.1~...~.~.~....~.~i~..~.~ ............... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ~.~... Date Of Permit~.~..Applicant ~ ~/)~' ~ /~¢ ............ ................... ................. Underwriters Approval ....................... ..~ .................. Planning B~rd Approval ........................................ Request For Zempora~ Ce~ificate ........................................ Final Certificate ~ Fee Submitted $ ~ ~ Construction on above described building ~and p~.fmit meets all qPplic~l~le codes and regulations. Applicant Sworn to before me this ........ ... oyof ........ ....... Notary Public .....~.. ~.(.. ..... County / (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant PO c¢¢~;;~'~ ~L~ tA~ho_,ne Addresst~,~ ~,~ l~ ~ 2. Property Location~/~ P~,~,c ~-/ Village i_~ "~L Township 3. Public Wate~ Company Name 4. Lot size: Width_leO feet 10. 11. Length /~ feet Sewage Disposal System: A. O~-gallon septic tank: Precast ~Equivalent Block B. Leaching pools: Number of pools '~ Precast/'V/ Block Special__ 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 5. ~uoo~v. 6. Section 7. Lot Number --8. Private Well 9. Public Water DiStance to main (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. Date ,_Z~'- ,~ /f ~- Signe - ================================================================= ..... z.Z.__'- ..... ,' ..... 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. S-15 Rev. 4/1/73 it / t / ! ! 4O PF--'CONIC FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN? TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 192..~.... Pemit No..'2..~....../.....~......~'.~ ..... Applicotlon No. ~ ~ / (~ Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. 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 I~lan 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 of property must be drawn on 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. AI~PLICATION 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 inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................... .62..~..~..m &,~.l, ...... .~ .~...~.~.~ ~..~,.%., .& .............................................................................................. Name of owner of premises .~..~.J¢3.~..~..I.~.1~,.~....1'~.1.~...~.C~ .~...~...~..~..T..~......~..~....~...~...°..~.¢ ................................................ If ap~,~Lsignature of duly a~:z~horized officer. I Name and title of corporate officer) Builder's License No ........................ , ............................... , ,C Plumber s License No ...... .~..../t E ectr c an s L cense No...~.'.~.,~..'.] .......... Other Trade's License No ..................................................... /5 _ 1. Location of land on which proposed work will be done. Map No ......... ,,~....:.~'.:....~.-'~7,.,~....,~.. ....... Lot No,?..~./.~.(.7..:.?..~..(.~' Street and Number .J~5.t,,.6;.~...4.~......¢.~.~..~.7..~......~./~....~,~T.~..~.~.!...~.,....~.~.~....&~.~.J~,...~...~&e.~..~.¥.~.. I~ ~ ~, p~ ~ ~., Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....................................................................................... :. ........................................... b. Intended use and occupancy .~'..~.~....~..~..~.~./,..~.(. .......J).~-.~,:.~,£~.~..~ ................................................................ · ' v~ ition 3. Nature of work (check which applicable): New Braiding ....................... Add .....................Alteration ............... Flepair ......................... Removal ......................... Demolition ........................ Other Work (Description) 4, Est(~nated Cost ..... ,.~, ,~,,~ O O ~ ,.O O 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 o~ car~ ........................................................................................................ 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 ................... y .................... Number of Stories ................. ~ ...................... 8. Dimensions of ~n~ire new construction: Front ....... ~. ............ Rear ..~ ................. Depth ,.~ ......................... Height ...... ~ .................................... Number of Stories ...~../, ................................... t.~.-~ .................................. 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 reoraded ...... ~ ....................... Will excess fill b~removed fro~ p~emises: [ ] Yes ~ No 14, Name of Owner of premises .~.~),~/~.~.~..~.,~,~.~,{/.~..,,~,.{~.~,~ ..................................................... (Address) (Phone No.) , Name of Architect ..................................................................................................................................................... (Address~ (Phone No.) Name of Contractor ............................................................................................... ~ ......... ,~ ................................... (Address) (Phone 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 wheth- er interior or corner lot. (Contractor, agen t, corporate officer, etc.) of sa~d 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 [Jest of his knowledge and belief; and th~/h.~.~work wilt be perf~ in the mannem set forth in the application filed therewith. ~ll~l~l~ lt~II~ ~ ~ . ~ ~ ff ~ ~O~A~Y PUBLIC, S+a+o o~ Now Vor~' / - ~ ~otarg Public ...................................................................... Goun g '~'"~ ........ ~2[[Signature ........ of app}~''-~7'~tcanU ................................. _ ~-¥ tBU~NL, IN~ BEPAt~T~ENT