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Home My WebLink About7747-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~.~0 ...... Date ............ ~$p,t..,..8 ........, 19.?.~. THIS CERTIFIES that the building located at .. ~L],lar.d .&. P~$. ~.~ee. ~dStreet Map No. ~X ......... Block No.. ~ ...... Lot No, .. ~ ... C~teh~g~ .... N,~., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Ear.. ].0.., lg ~. pursuant to which Building Pemit No.. ~. ~TZ dated ............ ~ar.. A0.., 19.~., was issued, ~d conforms to ~1 of the require- ments of the applicable provisions of the law. The occupancy for Which this certificate is issued is ~rSy~e. 9~. ~%~. ~W~.~g ....................................... The certificate is issued to ~le~. ~,. ~ld~ .~. ~ .~ ..... ~e~ ............ (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval . .~8~..~.. ~.. ~. ~..~ .... UNDERWRITERS CERTIFICATE No.. ~...:..~g .5...~.~6 ............... HOUSE NUMBER ..... ! ]~ .... Street .... P~O. ~. ~ ....................... ]00 Blllard ~ ~ Bmlding Inspect~ ] FOF~M NO. 2 TOV/N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, H~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7747 Z ' Earch 10 ,_/5 Date ........................................................ , ly ........ Permission is hereby granted to: ulerm F, Haidtman~l o ~on Box E Jamesport one lamlly awe ~iing to BUild Dillard d Pine ~'~r~e hoad at premises located at ............................................................................................................................ p~r$~nt to ~pp~icatio~ dated ........................................................ , 19 .... a~d ~pprove~ by ~he Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~ Southold, N.Y. 11971' 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ,- ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2.Fina~ approval of Health Dept. of water supply and sewerage diSposa -(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 installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements wher~ app lc.ab e B. For existing building~ (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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 informa- tion required to prepare a certificate. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling $25.(10, A~ce~sory .,~ 10.00 Business $50.00 ..Certificate of occupancy on pre-existing dwelling $ 5 0-. 0 0 Copy of certificate of occupancy $ 5 00 over 5 years $10.00 4 Vacant Land C.O. $ 20.00 " ' 5.Updated C.O. $ 50.00 Date ..... NewC°nstructi°n Old or Pre-existing Building Vacant Land Location of Property ...... House No, Street /Yam/et Owner or Owners of Property ....................................... ; .................... County Tax Map No, 1000 Section ............... Block ............ · · Lot ................ Subdivision ............... ~/'~/'~ I~¢~?' ................ Filed Map No .......... ~ ~-~L°t No.., ........ ,... Permit No. J..'.:.:... Date of Permit .......... pp ................. Health Dept. Approva ........................ Labor Dapt. g~pproval ..................... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. ,~ es~and regulations. Construction on above described building and per s all app,~b~,~. Rev, 10-10-78 FO~M NO. 6 TOWN OF SOUTI~OLD , Building Department 'Town Clerks Office 5outhold, N. ¥. 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 all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposals(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, o 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 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 New BHilding ....,,~. ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ...,..~,~,~,i~,-mem,..~...~.....~.~J~Tt~. ...................................... Subdivision .......~ .................................... Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant ..~..~L.l,.~..~.,~_.~.~-~-~m~...~.....~.~ Health Dept. Approval ..... ?./..~../,.'.~-~.. ....................... Labor Dept. Approval ............................................... Underwriters Approval ,~,~,c,);.e~.,~,.~,~.~..-.....°~.~'..Z~...,,Planning Board Approvol ........... .~.......~.. .................. Request For Temporary ~L~ificate ........................................ Finctl Certificate .......... ~.. .......................... Fee Submitted $ .,...~,.~... ......................... Construction on above described building a~d~rmit meets all applicable codes and regulations. Sworn to before me this ~//(~//~ ........... ,~. day of ..... ~......~.2..~.~ ....... ~omp ~l~~ ~ ~0 Nato, Public ..........,~, Coun~ ~ t t~?O ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~r 85 JOHN STREET, NEW YORK, NEW YORK 10038 v,.,~. August 5, 1976 ,~.~,li,...,io,,~'o.o.I,l,~ 55349~' N296906 THiS CERTIFIEE~ THAT Glenn Heidtmann ~ Son, Builders, Pine Tree Rd. Luper Dr. ~ Red Wood Lane, FIXTURE SWITCHES OUTLETS 17 20 DRYERS FIXTURES 17 [] ~.d rL outside Section Block Lot and.found to be in cornpllance with the r~qulre.~ents of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS MULTi-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: Hotor/s: 1-5/4bp. GFCI Special receptacles: 1-50, E R V I 'C E 1 1- 30 amp. OF NEUTRAL 4 Robert Goodale RR1 Box 1SA Mattituck, L.I. 11952 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentiaJs. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant' ""' ~'' ~ "'"~ Phone '_]~ /~ ,~ -~(~,,,~, 5. Subdiv. Address -~,' ~ ,,'i,~- ~ ~ · ..... ~,q?~ 6. Section Property Location ~ ~ ~ "< .... ~.~-~t 7,. Lot Number ~1 ....... ~' 8, Private Well Vi age . '~ ToWnship,~,,, ~,~, ,,~,,,,.,~'-,, 9. Public Water Public Water Company Name__ %~,:~? Distance to main Lot size: Width ~,l,~ feet 10. Sewage Disposal System: A. (//~O~allon septic tank: Precast_ ~, Equivalent. Block B. Leaching pools: Number of pools ~ Precast ~OBlock --Special ll. If private well, fill in the fol- lowing blanks: A. Tank capacity, "l~ gallons B. Pump G.P.M. ~, C. Total well depth ,<~' D. Depth to ground water ~"~ Eo Amount of water in well Length ,~(~(~mfeet (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 ~h~ Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot· APPROVAL DATE ~y(~?~ SIGNED , ~ ~ S-15 Rev. 4/1/73