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Home My WebLink About7970-zPORM NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z6669 ....... Date ............. Sel~.~ .... ~8..., 19.~.~. THIS CERTIFIES that the building located at . Cox. & .l~a~;thewa .La ...... S~eet Map No~Om~vOO~S. Block No .......... Lot No...lO .... C~g~ho~m... N,Y, ..... confor~ substanti~ly to the Application for B~ld~g Petit heretofore filed ~ ~s office dated ........ .~y .... 30.. , 19.75. p~su~t to which B~g Pemit No. ~ated ....... ~9 .... ~ .... , 19. ~, was issued, ~d co,ores to ~ of ~e req~,ir~ ments of the applicable pro~io~ of ~e law. The occup~cy for w~ch ~s certificate ~ issued ~ .. FR~.~. O~ .fa~Y. ~ll~g .................................. ~e ce~ificate is i~ued ~ .. ~h. ~.a ..... ~ ............................ (owner, lessee or ten.t) of ~e ~ores~d b~ld~g. S~olk Co~ty Dep~tment of He~ Approv~ ,,, Salt., ,9.,, ~.97~., .by, R, .V~,]a U~ER~I~RS CER~ICA~ No..]2~ ..... ~.- 2~.. 197.~ .............. HOUSE N~ER ,..695~ ..... Street ....Cox. ~ ............................... ~0 ~tthews ~ B _' ~g Impe~or ~ FORH NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~T? ,~,o z ~o,~ ~_~~/ ........... ......... ~'="~ ....................................... .............. :::: ...... : ......... '.:... ....... ........ ...: ................. : ...... ............... .......... ......................................................................... :::....::~ .................................................. .~ ~,,~, ,~,~ ~ ..~...~..: ......... ~ ................ :,..__.,.~ .......................................... ............................................ ~:.~.....:....:::~, ..... :..~ ................... ...................................................................... ~ ........ ~~~> .............................. Building In~ector. ~,e,.~..~...:: ......... ' SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number ~'--~or'~ -~'~., . ~..~'~., ~ ~ APPLICATION FOR APPROVAL TO CONSTRUCT .... ~j 1. Appl icant~'z~'l>,i-~/~=-~,~ Phone ?~ J -m~, J 5. Subdiv. ~V/~/~ ~~o 6. Section Address YG' /&//~y~k~ ~a 2. Property Location ~,/~/~ ~_~/ Village ~t~/~/~:- Township 3. Public Water Company Name 4. Lot size: Width/~S~feet Length /~feet Sewage Disposal System: A. ~)~gallon septic tank: Precast~ Equivalent B. Leaching pools: Number of pools / Precast~i~d%~Block Block Speci al__ lO. ll. 7. Lot Number 8. Private Well 9. Public Water Distance to main (For Health Services Dept. Use) If private well, fill in the fol- lowing blanks: A. Tank capacity, cT/o) .gallons B. Pump G.P.M. ~ C. Total well depth D. Depth to ground water E. Amount of water in well ll~e 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~J~,~nlj~s, jp^~j~c~e.~ Date ~ ~-' 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 FORM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerics Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicahon 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. Fmal survey of property with accurate Iocahon of all buildings, property lines, streets, and unusual natural or topographic features. 2. Fmal approval of Health Dept. of water supply and sewerage d~spasal (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 requ,rements 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, buddings 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 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 3. Copy of certificate of occupancy $1.00 $5.00 Date .9./..8./..7..5,, .................................... New Buildmg .......... ~¢ ........ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~.S../~./~.C.~.~..~..x.~.a.~.e.~..a.~.d.~.~..a..~..~.?:.e.~.s.~.a.~.e.~.C.~.t..c..h..~.~ ............................................ Owner Or Owners Of Property ......... ~9,~,f,~b,..,~,...~RT~l~,~ .............................................................................. Subdivision ..M.a..p....o..f....N..o..z'..l:..h....W..o..o..d..s. ........................... Lot No ..... .1.9. .... Block No ............. House No....5..0. ...... Permit No ....7.9.7. QZ ....... Date Of Permit .JU~,~,..?,,...lC)~lSplicant ...... J~4M;k.k,..D~Lu~l=/U..wmr-~£xle..I-lomes, I 5S072 Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approvol ..... .N..2..4..2..0..3..3. ........................... Planning Board ,~pprovol ........................................ Request For Temporary Certificate ........................................ Final Certificate × Fee Submitted $ ........... .5.:..0..0. ................. Construction on above described building and permit meets all applicable codes and regulations. .... Sworn to before me this ~pp,,canr .... .~.~.z. ~...~:~~ ..... ~h ..... day of ....... ~9.P.~.,...~.~Z.f. ................. (stamp or seal) 75 -5o'? SHOWN HEREON FRO~ THE SHALL RUN ONLY TO THE PERSON JOE3 NO ~-- STEUCTU~E$ 10 THE PROPERTY ~OR WHOM THE SURVEY tS LINES ARE ~OR A SPEC~FIC PUR- PARED, AND ON HIS BEHALF TO PROPERTY OF ~/~ POSE AND USE AND THEREFORE THE 1~TLE CO~PANY~ GOVERH~EN ~ ARE NOT INTENDED TO GUI~E THE TAL AGENCY AND LENDING IHSTI ~ ~ - /~ INSTITUTIONS OR SUB~EQUEN1 ~ITU ATE AT V[~L~IfON OF SEtT~ON /~ Of (OPIE5 OF 1H~S SURVEY ~P NOT SUFFOLK COUNTY, N, Y LAW, ~INKED SEAL O" E~BOSS~O 5EAt SCALD / /~- ...... ~' DATE ~/~ LID 1RUF COPY FILED MAP NO ~F~ DATE FILED __- GU~~~ BOOK & Page ............ FDN .... UND CONST .... DINAr - .... ~ ~ k~/~ / ..... , ........ ~AWKINS BY ./~~_ ~~~ ....... ~' SURVEYING a ENGINEERING WILLIAM ~ JAE~~ NO 046148 P ~, L,S, 941 4~36 HAROLL~ F ]RAN(~u~Y~, ~C NO O489D2 L $ THE OFFS! TS (OR DIME~LSIONS) LINES AR~ FOg A SPECIFIC PUR- POSE ~ USE ~D THEREFORE ~E NOT IJ~EN~D TO GUIDE THE ~ECTt0N 0T FENCES, RETAINING WALLS, POOLS, PAT~OS, PLATING ~EAS, ~O~Ti0H TO BU~HGS ~ ANY DINER CONSTRUCT~0H ~O~lON T0 ~B ~RVEY 15 A VtO~T~ON 0f SEO~0H 72~ OF ~E N~W Y0~ ~TA E EDUCTION GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE FOR WHOM THE SURVEY IS PRE, PARED, AND ON HIS BEHALF TO THE TITLE COMPANy, GOVERNh~EN- TAL AGENCY AND LENDING TUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING ~NSTITUTJON GUARANTEES NOT TRANSFERABLE TO ADDITIONAL ~NSTJTUTIONS OR SUBSEQUENT OWNERS COPIES OF THIS ,~dJRVEY ~LI~P NOT BEARING THE LAN0 SURVEYOR'S INKED SEAL OR E~/iBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY SUFFOLK CO'!NTY, N Y FILED ~AP NO. ~ F ~TE FILED B~ ~ PAG~ GONSTRUCTION DATES FDN, __ UNO CONST .... FINAL HAWKINS. WEBD JAEGf ~, ASSOCIATES, P C, ~%URVEY~NG & [ ~IGINEERING PORT JEFFERSON, N Y I 473-04&9 [ SOUTHAMPTON. N Y 94p433e (~t6~ 283 8~11 TION OR S'~ART FRAMING BEFORE COVERING FINAL WHJ~N STRUCT~ON ERRORS NOTIFY BUILDING D£EARTJ'4E'N:T 1 ;: BEEORE BACKFILLING t