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Home My WebLink About8305-zTOWN OF $OIJTHOLD BUILDING DEPARTMENT Town Ckrk', O~ie~ ~outhold, N. Y. CertifiCate Of Occul ncy No.. ~. :~27.... Date ...Decem'oe~. ·.. b~ .......... ,19. -78 THIS CERTIFIES that the building located at ... ~.~0 .Gr~onI~ .P~th .... ~ Map No ....5~7. .... Block No ...........Lot No...4 .............................. conforms substantially to the Application for Building Pemmit heretofore filed in this office dated .....Mov~mber...9 ...., 19.7.~ pursuant to which Building Permit No ..... ~5(~5Z dated .....l~ov~ml~er. · · ~9 .... , 19..7.5, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~sued ~ ...... ~i. vate .O~e..~am~Lt.y .F~elt..~ng ........................ ,. ......... o! the aforesaid buildh~. Suffolk County Department of Health Approval ........ ~-30-.178 ................. UNDERWRITERS CERTIFICATE No ................. NJ412.~2 ................... HOUSE NUMBER ...1~0 ........ Street ........C,z, lEo~-s · Path .................. ............................................· -~,ut;h~.d~- ~¢Y~ ................. FOI~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8305 Z Building Inspector. Fee $.~'.~ ............ Permission is hereby granted to: .M.~.e. ~....e...~ .~. J,~ ....................... ~. .................. ........... ~..o..Z.~ ............................................ . ..... ~o ...~..a..t.~..~.e.~.,~?...~.t...z~...~..e.:z...z..t.~.~ ................ : ................................................................... at premises located at ....~...~....~.....~.......~...~...t~....e.~.t.....~..~...i~....~.. ........ : ........ ~ ................................................... ............................................ .~.~.e.~...~.e.e..4....~.~.t ......... ~.~l~e3,~ ................................................ pursuant to application dated .........................~..,.I~... ........... ~..,......;., 19~.~...., and approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Delm~tmeht Town Clerkc Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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-ex'st'ng ' 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. Dote 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 ........ ....... New Building .......~.,.. Old or Pre-existing Building ............................Vacant Land ............................ Location Of Property ....... ~..~:~.*Z'2 ........ ~/.~.,~.~,~4~2.~.~ ........ ..~.~.,,~../ ......................................................... Owner Or Owners Of Property .../...~.~..~.~X.~Z/c,,~'..,..ZT,/~..C~=r.~'. ....../'t4.,',,.,~r.~.(-..¢.4~.~.~.~'./4./. ............ Subdivision .///~ff~,~./~"~.~'....../~.,¢~.~.'.,~. ................ Lot No, ...~.. ..... Block No ............. House No..../.~.~..... / Permit No. Date Of Permit,~.~...~,,,,.~..,~pplicant .... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ..... .~../~.2~.~..~.'..'.%~'... ................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ...~..~.. ................................. Fee Submitted $ ......~.~..~ ........................ Construction on above described building and permit meets all applicable codes and regulations. ^pp, con, ............................. Sworn to before me this ................ day of ............................................ (stamp or seal) Nota~ Public .................................... Coun~ THE NEW YORK BOARD OF FIRE UNDERWRITERS i) ~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK. NEW YORK 10038 N4! 342 " t ~ /lppllcation No, on file ~ ~ ~ ~ 6 ~ Date THIS CE~IFIES THAT o~y the e~t~a~ ~quip~e~t ~.~scd~ ~ i~t~ ~ ~ ~l~n~ ~ ~ t~ a~ ~/~pt~p num~r in t~p~p of in the followlng location; ~ B~em~t ~ ~ FI. ~ction Bilk ~t w~ exam~d on ' and found ~o be in compliance ~ith the requirements of this B~rd. RXTURE EPT I I RXTURES DRYERS FURNACE MOTORS FUTURE AP'FLIANCE FEEDERS AMT. K.W. OIL H.P. GAS H, P. AMT. NO, A.W.G. RANGES SPECIAL REC'PT, I !.2 TIME CLOCKS BELL UNIT HEATERS MULTI~T~ EXHAUST FANS 2 r DIMMERS SERVICE DISCONNECT NO. OF S E f 2~~ METER. J,-,t.SR'4 Hot '~'ater' Heeler R V I C E A. W.G. NO. OF HI-LEG A.W.O. A.W.G. ?/n NO. OF NEUTRALS ! 21o This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their't:mdentials. P~u! E~u rns $oufhol d, L.I. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY ViTl~e ", ~ ~,,~ ~ Township 3. Public Wat'~"C~Name ~ ~~ 4. Lot size: Width_x~;~ feet ...... Length Applicant?~y,/_],,?;? ('~i,~.~.~ ~..~,~ Phone ?~'*~. Address <>, ~ ,??,,.~ ,~ Property Locatio~ '~]~-] ,.".~' ~,~. ~ ~ ~ ~e feet 10. Sewage Disposal System: A. 900-gallon septic tank: (~"t(~'~cast 'v~ Equivalent Block Bo Leaching pools: Number of pools ! ~recastTj?~ock Special If private well, fill in the following blanks: A. Tank capac~ty, allons C. Total w~i'l d~pth , D. ~Depth tJ.-~round water E. Amount df:water in well 11. 5. Subdiv.?~.~,y~:_~y" 6. Section / 7. Lot Number 8. Private Well 9. Public Water Distance to main (For Health Dept. Use) The undersigned ~ERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's 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 HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Departm6nt that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot· APPROVAL DATE ~(~ ~}iF SIGNED ~-- __ S-15 Rev. 4/1/73 UILDING DEPARTMENT //.~,. ,~'"-,~,,~ . ~,/.~..~' ~,r'~ fO~,-,,, TOWN CLERK'S OFFICE . . ' / ' --; ~"~ ' t...~ SOUTHOLD, .. Y. Exam,ned .......... ,,,,,,rove,, ' ........ ...................................... Disapproved o/c ........................................ ................... iia ., i ;:, ..................... 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 plan showing location of lot and of buildings on premises relationsh p to ocljo n ng premises or public streets o~ areas, and giving a detailed descr pt on of layout ofproperty must be drawn on 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 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 o Certificate of Occupancy shall have been grianted 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 for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, arid regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~Signature of applicant, or name, if a corporation) ,J ........... ........................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ~:~,~:'..--.~.........~?..~.~::;t:~/~.~f~. ............................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Liconse No ........ ~...-..~..~..~m~ ......................... 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.'~.'/'il~'e4~-~'~- J~'~'/~""~' - ........................................ Lot No ....... ~ ............. Street and Number ....... ~.~C,~.&;~.....,~J~ ...................................................................................................... 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 ............ .~"~.~. ~".'.'.'.'.'.'.'./~..C~.."~... 3. Nature of work (check which applicable): New"lJuil~'ng......~. ......... ' Addition .....~ .......... :: 'Alterafioo ...... ,~,.,%...~ Repair .................. Removal .................. Demolition ....... ~ ........... Other Work ................................................ . .... ~ .~_ ~ ~ (Description) 4. Estimated Cost ............ .~...~.....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 of cars ......~......~49:..~..........,~.~-~c,~-,~,~:~"~ ..................................................................................... 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 ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... ~. .................... Rear ....... ~..~. ............... Depth ...~'...~...~ ............. Height ..... L~.. ......... Number of Stories ...... /. .............................................................................................................. Size of lot: Front /.'Y'O ~' ~ ....................................................... Rear ........... /..~.~ ...................... Depth...../..~..~. x..~....~. ......... Date of Purchase ....~.~..-.~...-....~.~..'~...: ............. ~ ............ Nome of Former ,Owner ..l~'; .~,..~.4[~A4...~.Z..~.:~,, ........ Zone ar use district in which premises are situated ........ .~....~.~.~4~-",~'/.~4~.~, ....................................................... Does proposed construction violate any zoning law, ordinance or regulation: ...... ~.~. ........................................... Will lot be regraded :.....~.~....-~... ........ Will excess fill be removed from premises: ('~) Yes ( ) No Name of Owner of premises ..~....~-~.~,~.~/4~,~7'~... Address ~.,~.~..:..~,~.~F,~ ......... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ....~.Z~./'~4~... ..................................... Address ...... ' .......................... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bo4:k 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. ' 10~ 11. 12. 13. 14. STATE OF NEW YORK, ~ ¢ c COUNTY OF ................................ ['~'"' ' ..~.~....~.,~....~.~.~..~...../.1~'.~.. .......................... being duly sworn, deposes and says t~t he is the applicant (Name of individual signing contrac~ above name. He is the .......... ~.~ .......................................................................................................................................... ; ..... (Contractor, ag~t, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; t~t all 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 fo~h in the a~plicotron filed therewith. Swam to before me this · ..... ...... .................. , , ,, Nota~ Public,. .................. '""'~'[~'w C~-~ .,..~.~.....~~.~ .............................. ~ ~ {~i~noture o{ ~pplic~nt) I' t