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Home My WebLink About7861-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. $677.9 ...... Date .......... 1~0~' ... ~ ~ .... , 19.75. THIS CERTIFIES that the building located at .Ll~;.tle. N.eek R(~ad ........ Street Map NoJ~.n.n'~'. t~llore~lock No .......... Lot No, .18 .... gu~,hogu~ .. 1~.o.¥, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... &p~r~.l. 29, 19 ~.~ pursuant to which Building Permit No. dated ........ A]~]. 20.., 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~lva.te. one .f~ua~.ly. dwelltn~ ................................. The certificate is issued to . P,~er~;. &. Dol'oth~...~®a~ ..... O~n~.~ ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Noir. ~2. ~i9.7.~ . by R~..~:l. lla ... UNDERWRITERS CERTIFICATE No.. ~[~ .~.~)~?....~.o.~.,.. 2.. S9.~.~ ............... HOUSE NUMBER ~20 ...... Street · ~,tt~],®. Neak. Roa(i .................... ........ .... TOWN OF SOUTHOLD 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) Ne 7861 Z Dote ................... ..~.~..~. ~...~......] .0.. .............. , ~'~ 19...(.z'. Permission is hereby granted to: .~cr~.~.. ~,;pxL ~ .. A/. g...~Lqb ~.~...~.~.e. ........ ................ ~r. ze.~ ................................................. at premises located at ...,,I:g.~.....1..8. ....... ~...'~..-..~.~...~.~.~. 9.~.~..~ ...................................................................... ................................................. L~ ~t l~..12e Ck.. ir{oE.d .......... C~J~ho~gll~ ......................................... pursuant to application dated .............................. .K.~g.~.J...~ ..... ~.~...., 19..~..~., and approved by the Building Inspector. Fee $..2~...~.~. ......... FORM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ~nk, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use' 1. Fina~ survey of property with accurate Iocahon of oil buildings, property lines, streets, and V¢32 unusual natural or topographic features. · Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). · Approval of electrical mstallahon from Board of Fire Underwnters. 4. Commercial buildings, Industnal 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 s~te 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 inspechon of build,ngs or premises, or other pertinent |n- 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 ~te ....... ¢~ ................. .Z..~.Z~.:... New B~lilding .... ...~...' ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locat,on Of Property ..... .~..Z:..7~....~...~......~.~..C.~C~..../~..~..~..~, ......... I~.:...~...~...C...~.~,~..~.~: ......................... O~ner Or C~ners Of Property ......... ~.~.~.¢~'...~....~..~O.~.~..~..~...../...C~...C'~.e-- -- ---- Subd,vis~on ..~..'...~.~'~.~.....C~.~.~:~ ................ Lot ~o..../~...~'B,oc~ No ............. ~ouse ~o..Z...~.~ O Health Dept. Approval ..tJ./....M~..Z...:. ....................... Labor Dept Approval .............. ....................... Underwriters Approvol ....~..,...,~..~.../~..O.~Z .................. Planning Board Approvol ...... ,/~....~.,...:.~..~ ............. ~ '' F ' Cetf ate Request For Temporary ~.errizicate ........................................ JnaJ r i ic .......................................... Fee. Submitted $ ....,.0.~....~ .............. Construction on above described building and permit meets all applicable codes and regulations· Sworn to before me this ............ .~. day o ........ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services ~ Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Phone l. Applicant BOI~C, l~m~s® Address R,R, ! Box 37J~ Out~ho6ue, N, ~, 119~5 6. Section 2. Property Location...~ad~ ~t, ~ ~ae ~ ~ttle ~k ~,7. Lot Number I~' ~u~off~,, ~e, ~utho~ To~ 8. Private Well Village Cu~e Township ~U~Old 9. Public Water 3. Public Water Company Name ~ app~oab~e Distance to main 4. Lot size: Width 139 feet Length 1~ feet 5. Subdiv. Sunro, ~ho~es 7.8 lO. Sewage Disposal System: A. ~-gallon septic tank: Precast X Equivalent Block~ B.Leaching pools: Number of pools ~{~ ~ Precast~~0 Block Special__ 11. If private well, fill in the fol- lowing blanks: A. Tank capacity. ~2 gallons B. Pump G.P.M. 5 C. Total well depth ~0 ~, D. Depth to ground water 27t'~, E. Amount of water in well ~ i~t, (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordanc( 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 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/l/73 F. },. * ," l'rO,? pt'p~ ,L~OSEJ~.T C. ,,~o DOROT/-/k'/ ~Vi-ES' '-~ C, Un-C~OGLJ~, NJ.Y. Examined ......... ~. ........ , 19 .... Approved ................. LI. ...... ..~,...~? ....... 192~Z Permit No ~...(~,...~,.../....~... ................... BUILDIN DEPARTMENT~~7//~ - ~ r ~ ~ ~ Disapproved a/c ............................ Date ....... ..... INSTRUCTION$ o This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Bui|din. Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showing locatton of lot and of buddings on premises, relotlonsh,p to adiommg premises or public streets a areas, and giving a detaded description of layout ofproperty must be drawn on the d~agram which is part of this apphcatior c The work covered by th~s apphcation may not be commenced before ~ssuance of Building Permit d Upon approval of this application, the Budding Inspector wdl ~ssue a Building Permit to the applicant. Such permi shall be kept on the premises available for inspection throughout the work. e' e No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occup 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolihon, as herein described The applicant agrees to comply with all opphcabJe laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and i~ buildings for necessary inspections. (Address of apphcont) State whether applicant is o~wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder If apphcant is a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) Bu,lde,r's License No ...... .?<.~'"..2c...~..~...~,..../~......'~... .............. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No. M~ ~'o ,~2~.~ / Lot ~'^ I Locohon of land on which proposed work will be done p xi .................................... ,~ ..~ .................... Street and Number ......... ---- -- -- ---- .~../..~...4.,.~....~..I/.~..Q~.,......~..¢~.,. ............. ~,~.~...~ ............. (,,~:..'~..~-~/~-~-.~'..~.~...t~/~,..J4'.... Mt~nicipality/ 2. State existing use and occupancy of premises and m,~ended use and occupancy of proposed construction: a Exisiting use and occupancy . · 3. Nature of work (check which applicable) New Building .................. Addition .................. Alteration ............... Repair .................. Removal ................. Demoht~on ....... Other Work .............................................. ~ ~ (Description) ............................................................ 4.Estimated Cost ......... ~'~- --~..~_~.~..~..~/....--. ..................... Fee . (to be paid on filing this application) 5 If dwelling, number of dwelhng units .................... Number of dwelhng 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 ex~stmg structures, if any' Front ........................... Rear ................................Depth .................... Height ........................ Number of Stories ........................................................................................................ Dimensions of same structure with alterations or addmons Front .................................... Rear ...................... Depth ................................Height ...................... Number of Stones ................................ 8 Dimensions of entire new construction- Front .... ~..~....~...~... ............... Rear .... .~...~....r_:....~....¢.. ..... Depth .....~...~...q..~_ .... Height ..... .~.~. ........Number of Stones ..... ./. .............................................................................................. 9 S,ze of lot: Front ...................................................... *-~ _ ./.' .~..~?. ? Rear ..........~.~¢~.~. ..................... ' .Depth ..... .4/~..~ ................ 10. Date of Purchase .... /...~......~..C:..../l...../..~..t.~...../...~..~...~..... Name of Former Owner .4~..~.~.~:.~.~:..~'..,.~..,.../.?...~..?...~.~ 11. Zone or use district in which premises are situated ............ ~..: ........................................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation ..... ...~..(~ ............................................ 13. Will lot be regraded .... ..~..~..~. .............. Will excess fill be removed from premises: ( ) Yes ( 14 Name of Owner of premise/s .~..q.~.~.~..~ ..... ./.~...~...~.S .~. ........... Address ~.~c~t~,U.~......~..~.,.. Phone No. Name of Arch,tect ..~..~. ~...~?..~...~.~...~. ............ , ............Address/~.~.e.,s. rZ~-.~.....'~./.'././..~,,'Z/(./~'Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions froF property lines. Give street and block number or description according to deed, and show street names and indlcat whether interior or corner lot .J STATE OF NEW,Y-O~,//~' COUNTY OF ..t~.~~ ........ ....................... ~/~~....~.~.~ ................. being duly sworn, deposes and says that he ~s the apphca (Na~6f (nd~vid~l signing contracO above named He ~s the ......................................... ~~....z ......................................................................................... (Contractor, agent, corparate officer, etc.) of said owner or owners, and is duly authorized to perfarm ar have performed the sa~d work and to make and f this application; that alt statements contained m th,s apphcation are true to the best af his knowledge and behef, that the work will be performed in the manner set fo~h in the apphcation filed therewith Sworn to before me this ............... ..... Noto~ Public,. ................ ...... ..................... Carfare,ss,un ['r'~res Ma~ch ~0, 19~/ NOTIFY BUILDING DEPARTMENT, AT' 765-26'~0 9AM TO 4PM FOR REQUII~. i. BEFORE BACKFL(.[NG FOUNDA- TION OR START FRAMING . - 2, BEFOR~ COVERING PIPELIN~ 3. FINAL WHEN .~OB COMPLETED NOT' RESPONSrBLE FOR DESIGN OR COi~l. 5TRUCTION ERRORS · I J '11 j- - -LF_~-/- 5 IDE_ .FL_ 74,,= ~'_o,, ~,z~. __ ....__.~y~. ~ ~, ~, 2L~"xG'.~"x I~" E~ N~~z5~ p~' W,~.~, Lo~ ~L~"xGLS"~ 1~/4'~r F~EP~O~F ~ ..... ~-~ ~ ' ILG"x CLS'x 15/5" ;, , ,, , GLo" ' " " - I ~'_0" x ~L ~" ~ I ~',, ~ ' '~ ' I 4'.o'~ GLS" x 15/~, . , ,, ir ?__=tgA~oV': r-. , ! ~LS' q'- 5" UT/Z / ,4.L ~," ri B~TH 0 FOLLOW DIMENSIONS-- DO NOT SCALE DRAWINGS* 4 C F L L ,/X'F_.Z eu LU/~LL. , - Y4 '~' g I'_ o" MOTE: l 0" /-' 6£o" Cio" 17 '--o" ('~L. II '.'0" [!Oi 0 7~ O' F" L O0 r'2_ ~L~J FOLLOW DIMENSIONS-- DO NOT SCALE DRAWINGS, 9.71o" -J -13 C I°"^w""'"~' IS'AMUEL P,AUL,ARCHIT J c.~c,~0.¥ E C T ~' T J DATE 9.G.'74 , I07-40 QUEENS BL.¥D.' FOREST HILLS, N.Y, 1 ~ALL //. LL~ LL_~' ~"'24",,"~4"x ,~" FTC. c ,, - ?,t" .--ILo" U':" O.C., '2.2~4 IZ I I ~E1=, 17& J 4,-" VEOT ~tT , 12'i, ,,:?: ' FL, 'TO c EZZ ~ ,~ 'D~TA(L5 o~ kC~TCU I""'""""'~'""'l SAMUEL PAU,-L, ARCHITECT ' =o...,..., 197~ =*~ 9. G-7~ '10~[40 QUEENS BLVD, FOREST H L:LS N.Y 11'37'5