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Home My WebLink About8227-zFORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's O~ice Southold, N. Y. Certificate Of Occupancy No, Z.6.9.3~t ...... Date ............. 1/~.eh .... ~6..., 19.76. THIS CERTIFIES that the building located at .. Gi*~. Lane ................ Street Map No.B~Y. ~.~.V. 0~.. Block No ........... Lot No, 16 .... $Ou~hOl~,, .~,~ ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Oat.. 6 ..., 19.~.~. pursuant to which Building Permit No. 82272.. dated ........... .Q~$ ....6..., 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.~,l~r&te. o~e. fmnily. ~lw$]ELil~g ....................................... The certificate is issued to l~l,~k .P.i$.t~...~ ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .M.a.~'.. J.0...~.9.~..~...by. R..Villa .... UNDERWRITERS CERTIFICATE No.N~(~I}~. ...... J~.~...~ .~...~.~7.~. .............. HOUSE NUMBER .... ~0~ ..... Street ....~.J,r~. I.<a.~.e. ..... ~.oB..t.h.o..~. .............. Building InspeCtor FOE~ NO. ~ TOWN OF $OUYHOLD BUILDING DEPART,~ENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 8227 Z Permission is hereby granted to: at premises located at ............................................................................. 7 ............................................. .............. · ~.......: ............ 4 ..................................... .~ ............ t ...................................................................... pursuant to application dated ~'t")r "T ~ 19~... ~i and approved by the Building Inspector. Building Inspector TOWN OF $OUTHOLD , Building Deportment Yewn Clerks Office Seuthold, No Yo ]]971 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 disposoJ--(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: 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 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 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 New BHilding ......~.. ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ...... ]~a~..~.i~JTu~,~ ................................................................................... Subdivision ~'.Y.~f~.~...~T~T.~q,.~..~.~....~,~...~.0.1~.~.~.q~No. [~ ....... Block No ............. House No ....... .1.,,0.~' Permit No, .,.~.~..~ ...... Date Of Permit ...O..g.~.e.~....~.~/~plicant ....... ~D.~...~.Q.~.~(~.~. ......................... Underwriters Approval ..~[..2.~.br.~.):{-.~. ......................... Planning Board Approval ~./(.~ ................................ Request For Temporary Certificate ........................................ Fin~ Certificate ....... ~ .............................. Fee Submitted $ ~.~.O.q ........................... Construction on above described building and permit meets all o. pplica~e codes 9~d.[, regulations. App,,cant ...... ............................. Sworn to before me this /~- J /' ./' Z ~" /- ' '//'c~//~./7 ........... /,..O.. day of .....~..~..~.~ ....... /..?.. ............. (stamp or seal) x~ Notary Public ............ ~ ......County THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ dl 85 jOHN STREET, NEW YORK, NEW ~ORK 10038 described below and ;ntroduced by t~ aPPtlcant ~med on the above application numar the Ralph Pitman,' Gin Lane Main Bayvle~ ~est.~of~,' Southo!d,- ] F XTURES J RANGES coOKING, DECKS~ ~ DISH WASHERS EXHAUST FANS ~ O & S Contracting- ': ~ThJs certificate must ~ol be altered in any mannerj return to the dffice of the Boar8 if i~cor~ct. Inspectors may by 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 Phone Address " ~ ~ ' 2. Property Location ~/~ G'-,~ ~ ~,v,; ~ ~/~ Village l~J ~,,~ Township ~ 3. Publl? Water Comp§~ Name ~t,.~-~ _ 4. Lot s~ze: Width ~"~ feet Length 12~ feet 10. Sewage Disposal System: ~' 5. Subdiv. ~' '! 6. Section 7. Lot Number Private Well 8. g. Public Water Distance to main (For Health Services Dept. Use) A. 900-galJon septic tank: ./ Precast ¢ .Equivalent Block B. Leaching pools: Number of pools Precast Block Special__ 11. ~f p. riw~lre well, fill in the fol- ~.ow~ ng j~,anks: ~:: Tan~]?apac~ty_~. L~ ~--,~__ gallons "-C T~al well depth ~ D. DL~pth to ground water E. ~nount of water in well The undersigned CERTIFIES: "Construction o~f ~thorized 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 ~ind_.=ne~ ..... , 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 ,Syst? and Water ~~ Supply c~.' s lled.on ~:S P'q~ //y)/~, ^PPROVAL DATE S-lS Rev. 4/1/73 b .j ~ -.. . ...... ~ ~ ~' /~ I~ v ~ ................................................ ............................ ,...................-- .............. ,.~ ~ ~ ,~ ~ ~ - ................................ ~'~'f~'~¥~"i~;~ ...... ~ ........ 0'"'~'"'~ ~,~ ~ ~ - ~ . ,' j..,. ..... .:.-' ::, : --. .................................. ..... ............ a. This a~li~adon must be completely fill~ in by ~ewriter o~ in ink ~ ~mi~ i~ triplicate to ~e Bui~i~ ~ I~or, with 3 ~ of p~, ~u~ pl~ plan ~ ~le. ~ a~o~ing to ~h~ule. b. ~ot pl~ ~l~]~tion of lot and of building~ ~ premises, relationship to ~joining premiss or publi~ stree~ or a~as, ~d givi~ o ~ription o~ layout ofpr~e~ must be drawn on lhe diagram which is ~ o~ this appli~ati~. ~ c. ~e ~ ~~~ ~lication may n~ be commenc~ before issuance of Building Permit. d. U~ a~wl o~is ap~li~atien, the Building I~s~tor wil~ issue ~ Building Permit to the apph~ont. Such peril ~ shall ~ ~pt ~ the p~emises available ~r i~tion ~r~gh~t the work. e. No building shall be ~cupi~ or u~d in whole or in pa~ for any pa~e whmever u~til a Ce~ifi~ate oJ ~u~ncy shall have ~en g~nted ~ ~e Building Inme~or. APPLICATION IS HEREBY MADE to the Building Department for the issuance .of a Building Permit pursu.a, nt to the ,-~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applic.able Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for re .mov.al or demo!ibon, .as he.rei.n described. The applicant ~jlJJJlJJ~ comply with all applicable laws, ordinances, bull.ding coae, housing coae, aha regulCltJons, CIrK:I to..,.). admit authoHzJi~ an premises and in buildings for necessary inspections. · -~(~ignature 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. Name of o~ner of premises ............................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .......................................... Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which propose~Lwork will be done. Map No.: ......... ~ ' r ~....~ .~.." ................ Lot NO....'/'..'/'~'' ............. Street and Number ....................................................................................................... '~. ........................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................................................................. ,.~ ........................................................... b. Intended use and occupancy ....................................................... .~ ........................................................................ 3. Nature of work (check which applicable): New Building-. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ..................................................... (Description) 4. Estimated Cost ............. './.../..z...'.."..:.......~ ...................... Fee ............... ~..:i ....... ~ ............................................................. (to be paid on filing this application) / 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars 6. If business, commercial or mixed occupancy, specify r~ature 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 / - Number of Stories 9. Size of lot: Front / ' / / Rear ................... [ ...................... Depth / 10. Date of Purchase ........................................................Name of Former Owner 1 1. Zone or use district in wh'ich premises are situated ........................ ' ..................................... ;....? .................................. D 12. oes proposed construction violate any zoning law, ordinance or regulation: ................................. .._L~~ .............. 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes (~'C-, ,.) No 14. Nome of Owner of premises ' ' ' ' '' "" Address ............ PhoneNo/...x../.-/.~'~ - 'j.' '. Name of Architect .............................................................. Address ...........................~,,,,~le.iNa.~..._....~. Name of Contractor ....... ~..:.....' ............................................ Address ...,;.:..:.."~..?.,0..[..74~ I:~one No ...... 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 whether interior or corner lot. STATE OF NEW YORK, [c c COUNTY OF ................................ ~'~ ................................................................................................. being duly sworn, deposes and says that he is the applicon! (Name of individual signing contract0 above named. He is the ........................................................................ ~ ........................................................................................................ (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 oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to beta me this ~ ,. ........................ day of ............................................ , 19...~....' Notary Public, . ..............................~ .................... C°Unty~' ................................................................................................. · -7 ~, {~ ~ ' (Signature of applicant) T -I APPROVED , N'O...TED ~, ~-~'~ ,' ' : ~ ;' NOTIFY BUILDING DEPAR,TMENT ','- 765-2660 9AM TO 4PM FOR REQL 1, B~FORE BACKFILLING TION OR START FRAMING, 3. FIN.~£ WH£N JOB COM~FLET£D CPN~RETE ,/