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Home My WebLink About8257-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at l~ria~;;y..Lan~ .............. Street Map No.. XX~. ....... Block No ..... X~...Lot No, Ya¢... ,g. ul;~lco, g~,e .... l.~.,X,. ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ 0c:.t; .. 23.,, 19.75'. pursuant to which Building Permit No. dated ........... 0¢i;...2:3 ...., 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;~'~.V.t~..o.~9..~L~...I.¥..d?~.]._~...~¢, ....................................... The certificate is issued to .]~r~r~d. ,j:,..liquidly%4;. ..... 0~r ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .l~t~...~0...~¢)~...by..ii,..V;13,~.~ .... UNDERWRITERS CERTIFICATE No...~I2~.~A30., .l~a~...30..~.97~ ................. HOUSE NUMBER .... 80~) ...... Street ..... l~ait, i;y. Lane ........................ ...... ..... Building Inspector FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING P*ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8257 Z Dote ........................................................ , 19 ........ Permission is hereby granted to: at premises located at ............................................................................................................................ 6~ CHOral: 0C'7J' ~-~ 19Z2., and approved by the pursuant to application dated ............... . ........................................ , Building Inspector. Fee $ ........................ --p--ERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT DRIVEWAY CONSTRUCTION CESSI~OOL CONS fRUCTiON '/' CELLAR CONSTRUCTION OTHER 'Building Inspector dl Date March NEW YORK BOARD OF FIRE UNDERWRITERS BOREAU OF ELECTRICITY 85 JOHN $TREE~T, NEW YORK, NEW YORK loo3a was exem~hed on March 25, ' ' 26 i ~ 28 26 FIXTURGS · " FUTURE APPLIANCE FEEDERS SYSTEMS MO. OF F~ET DIMMEI~J SERVICE DISCONNECT OTHER APPARATUS: S E R V I C E NO. OF HI-LEG A.W. G, 4/O 21o Motor/s: I-3/4hp, 2-Fr.hp 1-22.kw Elec. Fur., I Post light F.W. Brudi 1194 Waverly Ave. Holtsville, L.I. 11742 This certificate must not be altered in any manner; returr~ to the office of the Board if incorrect, inspectors may be LtC# 512 D credentials. Health Department Re~erence Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant *:~ ,,~ ,~ - ~,,,-,~'~ Phone ~, ,t'~,?<~_~ ,~ ~ ~/ ~ ~ .5. Subdiv. Address ,,. ,~ ~ ,- ~-'~' ~ '~ ~,~ ~,~, ~,, 6. Section 2. Property Location \ '~ ~ ~' · ~ '~ 7. Lot Number ~ Vil;l'age ~ ~ ~' ~ ~ ~ 8. Private Well ~9. Public Water 3. Public Water Company Name ~ ,, Distance to ~in 4. Lot size: Width ,~,~ feet Length ~'<- feet lO. Sewage Disposal System: A. 900-gallon septic tank: Precast ,~,,FEquivalent Block Bo Leaching pools: Number of pools Precast Block · Special 11. If private well, fill in the following blanks: A. Tank capacity B. ,Pump G.PTM. C. Total w~]~l depth D. Depth t~ground water __ E. ~Amount ~ water ~n well gal 1 OhS (For Health Dept. Use) The undersigned ~I~RTIFIES: "Construction of authorized installations will be in accordance with the,Suffol~County Depart~nt of Health's current standards thereto. This application will be valid f~%one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect° Date / ~ '; ~ ~ Signed ' ~ : , FOR HEALTH DEPARTMENT USE ONLY° Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE (/~/~"--~/~.Z SIGNED S-15 Rev. 4/1/73 (Building Inspector) APPLICATION FORBUILDING PERMIT ~/~. dj .dX(...:.>:, - ' - Date INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 a detailed description of layout of property must be drawn en 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 part for any purpose whatever until a Certificate of Occupancy shall hove 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 fbr removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildihg code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessa~,inspections., (Signature of applicgnt, or frame, if a corporation) ......... ! t/~aaress or app,manr] State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~:..p~.t..,,,....,,q.,f ....... ~ ....... y~,,.;....,-,.%....~.....:.~ .............................................................................. If applicant is o 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 proposed work will be done. Map No.: ~.L...~:~.~ .......................... Lot No: .'~.. ..................... Street and Number .................................... ~..[?..;,Z..~,:[..~.. ...... L..e~.(~.xl.!:.~. ............. d:t-'*.~..(.z~.~.r*..(-.~.~*tf: ................ ~ Municipality State existing use and occupancy of premises and intended use and c~ccupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................. L .. b. Intended use and occupancy .............................. :. .......................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. I:stimated Cost ........................... z .......... :: ................. 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 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 ............................ Depth ................................Height ............................ Nun~r(~of Stories ................................ L/, 8. Dimensions Cf ~ptire new construction: Front ,.i..!.1.?:: ....................... Rear ............................ Depth ........................ 10. Date of Purchase ........................................................Name of Former r~vner ........................................................ 11. Zone or use district in which premises are situated ...................................................................... !~'"'t't ...................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........ ~:~-; .......................................... ]3. Will lot be regraded . ........... i,.T,.f,WC.~,.r~/iII excess fiji be ~emoved frorrl D. rergiFesl~( .)/ Yes. ( ) No Nome of Contractor ............................................................ Address ................................Phon~ No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lat. STAT OF NEW' '6 i COUNTY OF ......................... ................................................................................................ bain9 duly sworn, deposes and says that he is the appiicanl (Nome of individual signing contrac0 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 all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set fo~h in t~ application filed the?with. Sworn to before me this .... ~%....: ......... :.. day of~,~,~ ............. ...... : ....................... :=. ............... ....... : ...................................... ~y ~ .... 1~ , ' ~ignature or appficant) le~m [~pires now NOTE: · = MONUMeNt ~MCOci~ UNAUTHORIZED ALTERAT[0N OR ADDITION TO TH~S SURVEY IS A VIOLATION OF SECTION 7200 OF THE NEW YORK STATE EDUCATION LAW StIOWN,HEEEIN A~E F~O~ FIELD OBSERVATION~ AND/OR FROM D~T~' OBTAIHED F~OM OTHE~$ YOUNG & YOUNG 400 OSTRANDER AVENUE, EIVERHEAD, NEW YORK AL~EN W. YOUNG HOWAR~ W. YOUNG SURVEY FOR: ^ T CU TCHOGUE ~'OWN- OF SOUTHOLD SUFFOLK CO,, N.Y. ; Sr'~ALE: I "= 50' . oA'rE. OCE 25, 19 /OB FBOM DATA now ~rc.. · -' MONUMeNt or formerly F Rogers MAIN ROAD I~. F.S Rte. 25 REVIffilON$ YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: EDMUND d. BARTLETT ~ ELEANOPt B. BARTLETT CUTCN~GUE ?OWN OF SOUTHOL~ ~UFFOLK :CO., N.Y, GUARANTEED TO: Building Inspector's Of/ice Town Clerk Buffdlng $oufhold, N.y. 765-2660 APPROVED AS, NOZ-ED ~ ~/.~/'~ i ' I ' ' I -I