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Home My WebLink About8254-zFOKM NO. 4 TOWN OF SOUTHOLD BUll.DING DEPARTMI~,NT Town Clerk's Office Southold, N. Y. Certificete Of Occupnncy No. Z588~ ...... Date ............. F.e.l~....~. ......, 19.7.6. THIS CERTIFIES that the building located at .. J~nn~r..Lane .............. Street Map No..x~ ......... Block No.. x.z ...... Lot No.. XX... ]~.e.~r. 3.u~.f..o.l)c.. ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. .0C.~... 2.~., 19.~.~. pursuant to which Building Permit No.. dated ........ Oct.. 22. ...... , 19.7.~., 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.t.vate..one..faml.~.y .dwelling ....................................... The certificate is issued to .Rlch~l. ~ch~. & .1g01~le:~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .FeB..1~...1.976...by. f~ .V:LJ,~,a ..... UNDERWRITERS CERTIFICATE No. N266.1~6... ~al~...21...%976 ................. HOUSE NUMBER ..... .320 ..... Street .. Bt~,~,~r..Lar~ ........................... ....... ........... lrOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 825~ Z Permission is hereby granted to: George A~er~ ........... .A~.~...ft.~b.~=~... ~r~ ................. ............ ~ .~......C..o.;~..~ ....................................... ............ ~At cJo~o~'ua ~...~ ,.. ~,' .............................. to ....... a~a~;~'.u~l;. · & ..l~,.~at~e .. ~te .. ~mi. ty. · M]~t.~, ~g ....................................................... at premises located at ...~./~...~)~'...~....-..?..]JI~C..J~U~.~D,~k.~..N.A...,~ .................................... (House number to be assigned) pursuant to application dated ....... 0~.1~1~1'...~ ......................... , 19..~.~., and approved by the Building Inspector. Fee $ ........................ Building Inspector ~1 THE,,NEWIYORK BOARD Of FIRE UNDERWRITERS ! ' BUREAU OF ELECTRICITY ..... h ~.. ~,, :~ imll~ I I ]~1~i~ SU f f O 1~~ L.~ql i ~ .... I OTHER APPARATUS: Moco=e: 227 E.~reak~a=er Rd. Ma CtiCuck. L. ~. 119~2 Lic #1529 B D This certificate must not De a~tered in any manner; return to the office of the Board :~ incorrect. Insoectors may De identified ~v FORM NO. 6 TOWN OF SOUTHOLD 0 Building Depmtment Town Clerks Office Southold, N. ¥. 1197! APPLIGATION FOR CERTIFICATE OF OCGUPAHG¥ Inltructionl 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 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: 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 Dote .. ~'.~]~.~,~...~.,... ~..cj.~.~ ....... New B~ilding x Addition Old or Pre-existing Building Vacant Land Location Of Property .... ..~./..~..~.....~....8~...e..,.....~..e...~...S..u.~..~..o...~..~..,...~..e.~...~..o...~..~.. ...................................... Owner Or Owners Of Property R~..C.~D, Tt~I. {~3.~..~e.~.l;~,..~C~u.[2J~n.~ ......... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~..~...~. ......... Date Of Permit .~..O./..~..~/..7..~Applicant ..G...e..o..~.~.e....~Z..e...~..s..,....~...u.~..Z.~..e.~.t....Z...n..c.. Health Dept. Approval ........ ~0~.~,~..~ ................... Labor Dept. Approval ................................................ Underwriters Approval ....~..~...~..~...1..~..~. ........................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate ~ Fee Submitted $ ...~.... ........................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... George Ahlers, Sworn to before me ~ / (~ ........... ...ff. o, ......... Notary Public ............,/~//~..... County (stamp or seal)/~'~ ~'(~ (~-/ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number,S APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant (,d~ , ~ /J~z~-~'.~ Phone Address ~,-o ,~ ~ .~xx:- 2. Property Location ~/~.f ~/ ~ ~ ~ ~ ~ Village 3. Public Water Company Name 4. Lot size: Width/~m feet 10. Sewage Disposal System: A. 900-gallon septic tank: Precast ~"~Equivalent Block B~ Leac~g pools: Numb~ of pools / Precast ' ~ Sp -~ Block ecial If privadse well, fill in the fol- 1 owing b~l_anks: A. Tank capacity ~/~ gallons B. Pump G.P.M. J C. Total well depth. D. Depth to ground water 5. Subdiv. 6. Section 7. Lot Number 8. Private Wel] 9. Public Water Distance to main 11. E. Amount of water in well ~. Township Length I??,~ feet (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. 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. APPROVAL DATE SIGNED S-15 Rev. 4/1/73 INS I IU,ICTIONS a. This ap~cation mustbe completely filled in by typewriter o~. in ink and submitted in triplicate to the Building inspector, with 3 set~ of pkms, accurate plat plan to scale. Fee according to schedule. b. Plat plan showing location of I&t and of buildings on premises, relationship to adjoining premises or public streets or areas, and giVing a detailed description of layout ofpraporty must be drawn on the diagram which is part of this application. c. The work covered by this application may nat be commenced before issuance of Building Permit. d. Upon approval c~ thk application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on tfm premises available for irmpactlan throughout the work. e. No btiliding shall~ble occt/pied or used in whole or in part for any purpase 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 applicabte Laws, Ordinances o_r Regulations, for the construction of buildings, addltlem .or alterations, or for removal or demolition, cm herein describeoT~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing cnde, and regulatlans, and to admit authorized inspectors on premises and In buildlngl for nacess~ry 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. Name of owner of premises ...... ~I~II~IE~..~ .................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......... i ............ "l~LIl~..Irl', ............... Plumber's License No. ................................................ Electrician's License No. ............................................ Other Trade's License No ............................................... 1. Location of land on which proposed work will be dorm. Map No.: ........................................ Lot No ......................... Street and Number ............. · ..................................................... Municipality State existing use and occupancy of premises and intended u. se and occupancy of proposed construction: a. Exisiting use and occupancy ........... i~,U~l~.....~~.~......~.d~g.'.~....: .............................................. b. Intended use and occupancy .................... [ ......... ..~,~L~..,II~I~J~L~f.~..~IIR ................................ ; ...... 3. Nature of work (check which applicable): New Building.......~- ......... Addition .................. Alteration ..... Repair .................. Removal .................. Demolition .................... Other Wor~ (Description) 4. Estimated Cost ............. ~*-~ ....................... Fee~.. ~ .................. 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 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..................,.......,.~' 'i, Depth ................................ Height .................¢;~...~,.. Number of Stories ................................ I ~: ~ 8. Dimensions of entire new construction: Front ;/lO~ ............ Rear ~0.I. . ~.~ Depth .......~.. ................ ~ Height .................... Number Of Stories ..... 41~.~/~: ................................................................................................. :. · oo,' 0o, 9. -Size df Iot~ Front ...................... ~ ............................ P, ear ............................ ~ ...... Depth .~ ......................... 10. Date of Purchase ......... e~ ...... ~...7,m~ ............. Name of Former Owner ....................... . 1 1. Zone or use district in which premises are situated ............. A ..................................................................................... .~: '12. Does proposed construction violate any zoning law, ordinance or regulation: .... ,~4~...-* ....................................... 13. Will lot be regraded ......... ~ .............. Will excess fill be removed from premises: ( ) Yes (~) No 1 4. Name of Owner of premises ............................................... Address ................................Phone No ....................... Name of Architect .............................................................. Address ................................Phone No ....................... PLOT DIAGRAM ...... Locate clearly and distinctly oil 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, Icc ~ )~)'(,/NN~/ L/~/V/~' ~' ~*uP~'~eV~" COUN~ O~ .......................... w;~~'~ ~ ~ ~ ~~ ~ ~ o ~"~ ~ ~ ..... be n du y sworn, d~oses and soys t~t he is the applicom (~ ~i~ividual s,gnmg contmc~ above nom~. ~ . He is the ...................................................................................................................................................... (Contractor, ~ent, co~orate officer, etc.) of seid owner or ~ners, and is duly authorized to perform or have performed the said work and to ~ke o~ file this application; that all stoteme~t~ dontained in this application are tree to the best of his know~dge and belief; and that the work will be performed in the manner set fo~h in the application f~ed ther~ith. ~ Swam to before me this ~ ~ _~/ ~~ ....... ....................... , .................. BRUS~~ NOTARY PUBLIC. S+afe of New Yor} No. 52.~S22026 -Suffoik Coun~ ~/ Gemmlt~en i~iree Mereh 30, ~9..~