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Home My WebLink About7940-zFOn. M NO. & TOWN OF SOUTHOLD BU~,DIN(~ DEPARTMENT Town (~lerk's Office Southold, N. Y. Certificete Of Occupnncy l~To. Z6.6~.O. ...... Date ............ .8.~.l~t .... O ...... , 19 ~.~. THIS CERTIFIES that the building located at ...:$$I~.C0.~.~.. ~)~. ......... Street Map No~..np~.e.o.~.~...P~Block No ........... Lot No, .. 52 ..... 8Oll~;hol~l.. N.,.~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... .~..~ . .~.~. .... , 19.7~. pursuant to which Building Permit No..~.~..0.Z.. dated ........... .1~....~.~, 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?.~.Y.~.~ .9.~.~..f.~._a~..~.~.~[..d.v.~.l..~:~g .................................... The certificate is issued to . .F.°..ulA~..9¥.~. .H.om.~.~...I.n.o. ..... . .Okr~$N ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .8ep.g . 8..~.97~..by. R, .¥~32 m ..... UNDERWRITERS CERTIFICATE No..I~.23~..~....~.u.~...29...1.97~. ............... HOUSE NU1ViBER .. 38.0 ........ Street ... ~r~.e.O~;];. D.:r ........................ ...... ....... Building Inspector YOR1~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) No. 794O Z Permission is hereby granted to: .F.~ ~u~,'l~=~..~.o~e S., _T,r~ ................................... .................. ~o~.~.~L- ........................................ ~o .~&1~. ~. ~r~ £~I.-~ ~q.~g .............................................................................. at premises located at ...L. cl:[;...~....~e~e.~o.l~,..~'~; .................................................................... ................................................................ ~ot~,..~.~,v~ ............ ~t~n~ ............................. pursuant to opplication dated .................... J4~.~......~J~) ................... 19..7[~.., and approved by the Building Inspector. Fee $..~.~.~.,.~1~ .......... FOKM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Soul'hold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Inltruction~ A. This apphcation must be filled ~n typewriter OR ink, and submitted m 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, aha 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 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 hnes, 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 ote ..... ..'bT. ......... New Building .... . ..~........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locat,on Of Property ..... ..~....~....~. ...... ..Y..l~....l~....i~......~..~...~..~.......~....~. ........ S.q.~...~.~/~..Jm..J.,). ............................... Owner Or Owners Of Property ....~.--~.q..~../~.~..~../~ .......~?...t~.....i.~..~ ..... j./~...~...;. ............................................ Subdivision ..~.~;.~..~1~.~...~.~....~...~,...,..~.,. ............. Lot No. Block No ............. House No.,.~..,~...,~.. Permit No .... Date Of Permit Health Dept. Approval ..,.~,. ...................................... Labar Dept. Approval ............................................... Underwriters Approval ...~...~....L...~.....~,,~..c~/...I.~.2~.. ..... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate ..... ~. ............................ Fee Submitted $ ..... ~.......--~... ................. Construction on above described building o~nd permit meets all applicable codes and regulations. Sworn to before me this ........... ,,.O~.. day of ~- Notary Pub,,c ..... (stamp or seal] SUFfOlK ~OUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~,;~ ~,~,.,~-.,~_, ~ ,j, Address ~,~ ~5~'~C'~ 2. Property ~o~ion ~/~ v V~llage ~..~,, . 3. Public Water Comfi~ Name 4. kot s~ze: ~dth /j~feet 10. Sewage Disposal System: 11. A.~gallon septic tank: Precast ,//Equivalent 5. Subdiv. 'f.= 6. Section ~ ~,~-~, 7. Lot Number , ¢,~ '~ - ' 8. Private Well .... Township .~_ ~-?~, ~.,~ 9. Public Water ~ .,,-,~ ~ ~.~ ~ ,..~i-~, Distance to main - Le~h .,9?,feet (For Health Services Dept. Use) Block B. Leaching pools: Number of pools '~ Precast ~ Block Special__ If private well, fill in the fol- lowing blanks: ~j~ allons A. Tank capacity C. Total well ~epth D. Depth to ground water E. Amount of water in well The undersigned CERTIFIES: "Construction of authorized 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. ate ~1~. ~q ~.~ b Signed ~,~ ~,-.,.~.~ ~ .... ,~ ,~_~ . ======================================================================================== 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. S-15 Rev. 4/1/73 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFI~ ....... ...... , ............... .......... L.Z ...... . . INSTRUCTIONS a. This applicahon must be completely fdled ~n 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 Iocahon of lot and of buildings on premises, relationship to adjoining premises or pubhc streets or areas, and giwng a detailed description of layout ofproperty must be drawn on the diagram which ~s part of this apphcation. c The work covered by th~s application may not be commenced before issuance of Building Permit. d Upon approval of th~s application, the Building Inspector wdl msue a Budding Permit to the apphcant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to the Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construchon of buildings, additions or alterations, or for removal or demolihon, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) · ..... (Address of applicant) State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electnc~an, plumber or builder. ....................................... .o...~.~.~. ~....--.... ~..~.~. ~.. ~.e. ~.....c,. ~. ~.--,',[.4. ~..~..'~.~ ................................................................... Name of owner of premises ....~...?...~....~....~...~...~...~....~.~...~....~t..~....~. ..... I .J~..~ ................................................................. If applicant ts a corporate, signature of duly authonzed officer. (Name and tit e o corporate officer) Builder's License No .... ~..~..~.....~.....~-,~ .......................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ..................................... ... ........ 1. Locahon of land on which proposed work will be done Map No' ..~.~.~.U.~ .¢.~..{.-~....~.~..t~Lot No..~.-7..~.. .......... Street and Number ......... ..~..~...tg...~..~-.~.~..i."~'.......~...~ ....................... .~....~....l~....-'~...~...~..~.....~. ........ [,,~...~.../. .................... Municipality State existing 'use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and ~ccupancy ...... ..~....~...?...~....~...-~.k.. ................................................................................................ b Intended use and occupancy ....... ..O....1~.....~.......~....~../-~ ~...~..~..¢'.......~...1~....~../.~.(..~..~ ..................................................... 3. Nature of work (check which applicable). New Budd~r)g _...v'._... ....... Addition .................. Alteration Repair .............. Removal ............... Demoht~on ........ Other Work ........................................... 4 Estimated Cost ...... .~.~.0. O.~ ............................... Fee. /'~ ~' ?~D.. (Description) (to be pa,d on filing th~s apphcat~on) 5. If dwelling, number of dwelhng umts ....... ~. ................. Number of dwelhng units on each floor .~. ,.s;..~.?...~...V.. ...... If garage, number of oars ...... ,/....c,/~/'~. ................................................................................................. 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use ......................... 7. Dimensmns of exmtmg structures, if any: Front ....................... Rear ................................Depth .................... Hmght ........................ Number of Stones ................................................................................................... Dimensions of same structure with alterations or addmons: Front .................................... Rear .......................... Depth ............................. Height .................... Number of Stories ............................... 8 D,mensions of ent,re new construction: Front ....... .~..~. ..................... Rear ...~...?...~ ..............Depth .~..~.f ......... Height ..... /..~.~ .......Number of Star,es .... ./....~....~.~..?....~ ........................................................................ 9 S~ze of lot Front ..... /c~..~--../. ................................Rear /.~ ................................ Depth ../..~...~..I .............. 10. Date of Purchase ..... .*~.~..~. .......~.~..-)..~'~.. ................... Name of Former Owner ~.9.1~..W~.~.....-~?..'['~I~....~, ................ 11. Zone or use distnct m which premises are situated .......................................................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulation ...~.~ ........................................ 13. Will lot be regraded ....... ,,'~ ..............Wdl excess fill be removed from premises: ( ) Yes (~/~ No 14. Name of Owner of prem,ses ~..m?...N..9~./~.,~...~..~.~'. ~.././b/..~... Address ~t.$.~.~-.~.M..',~.~.~.FJ~l~hone No.'~.~.~.'.~..~.?'.,~. Name of Architect ~ ~' · · Address ' ~ Phone No. ~ Nome of Contractor ................................................. Address ................................Phone No .................... PLOT DIAGRAM Locate clearly and d~shnctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fro property lines Give street and block number or descnphon according to deed, and show street names and indica whether interior or corner lot STATE OF NEW h/xOP, n~.//,, // cOUNTY:: ....... L~I~.~Z.i~.~J~¢,,~.....~.~..~,.O......~i..~.. ............................ being duly sworn, deposes and soys that he ts the apph. (Name of individual signing contract) above named. He ~s the ................................0~...~...~.0....~......¢':.. ~...~..-~.1~.~.~-~. ~:t~· ............................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and ta make and this application; that all statements contained m th~s apphcat~on are true to the best of his knowledge and belief; thor the work will be performed in the manner set forth m the applioat~on filed therewith. Sworn t~J99j[ore me this '~".~., ~ ~'Z-~. ~ 19 .x~ . ~-- ....... ..... ....... Notary P u b I ic, ~;Z2~z:~..~,~,,~.~~ou n~ .,.~;:~...~.~~..; ...... ~,. ..... (~ (Signature of a~{blicant) JUDITH T BOKEN Nc~tary Public, State of ]'4ew York No 52-0344903 Suffolk County. Commlssmn Exp~re~ March 30, b, ED R~.* '1 I~ED LAV, Id:o" RM,~3 FAMILY LIVIMG RAA, (qb '?-~-,joG- ONE FAMILY RESIDENCE' N I.I. YORK ARCHITECT I01 3'AMAICA 32~ NEW YORK. 4.4~- o FLOOR PLAH~~ SCALE: ~/¢.'-= ILo" DATE: REVISIONCJ: PLAN N 0....S'.?.. D"AW~NG No.J..~.L.~ 4J- o" I t~l ¢ o ,8 o X 0 ?'- STORAGE A~,EA coL'I, an ,z,C'x,'z.&' UER 90 ~0 ONE FAMILY RESIDENCE U. YORK ARCUITECT CA 3'2, NEW YORK. FOUNDATIO/q P LAH., SCALE: ~/~" ~ I)-o" DATE: REVISIONS: PLAN Nu ................ DRAWIN( ~ o~ ~ lie 90- I ONE FAMILY RESIDENCE Il. YORK ARCNITECT SCALE DATE: REVISIONS: PLAN MO,.. DRAWING NO..~ or5 [~\ J~l~j~ j,g/I ONE FAMILY ~ESIDENCE- MAN H. YORK ARCHIIECT 90 I01 AMAICA $9.~ NEW YOR~ V+"= SCALE: DATE: REVISIONS: P-LEV,All 0 k..!S ONE FAMILY RESIDENCE. NE N H. YORK ARCNITECT I~,1 'AMAICA $2, NEW YOP, K. LIVIMC/ 12,~¢ M SCALE: .W I:Z. 055 G~4TIOM DATE: REVISIONS,' PLAN b 0.....~.. ,~.,.~~ DRAWINe NO...?..?..~...?'