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Home My WebLink About7959-ZFOB, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z6~ ...... Date ............ llo~ ....? ........ , 19.7.~. THIS CERTIFIES that the building located at . .. i~m .¥&y ............ Street Map No~l~l~e~ro~. ¥ff~;~pck No ........... Lot No.. ~1~ .... 8outhold. · Il. ¥, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... May.. 29.., 19..7.~ pursuant to which Building Permit No.. 7-9~Z. dated .......... !~ .... 29.., 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. or~. far~:~.ly. ,'~e: ;'~.~.n~ ...................................... The certificate is issued to . Fl~.alakl,/~u. ~ear ....... .~na~r .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. Nov...~...~.qT~.. ~y. R., .Villa. ·. UNDERWRITERS CERTIFICATE No.. P.®~din~ .................................. HOUSE NUiVIBER .... .~?~ ...... Street . ¥&~i~m. ~y ............................ Building Inspector FOBM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT Ct'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7959 Z Date ....................... ~ ......... ~T~. ........... 19..~.~.. Permission is hereby granted to: I~att/~uek at premises located at ..Jdlt~.~, ......Ifl~..ilg&"k4k~& .................................................................. pursuant to application dQted ............................. ~ ......... ,~J~. ..... 19~.~'..., ,',nd ,',ppreYed by the Building Inspector.~ Fee $3~? ~. ........... ............ Buill~i~'~ In~ector ~ ............... FOIL~Yi NO. 6 TOWN OF SOUTHOLD ~ Boilding Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in 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, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(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-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 inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: ]. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $!.00 /- New Building ........... ~..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Of Property ~.~...~ .~.../~/YI.~../~./~ ~V"4)')~' I 50~J~'/~o.~..~. , Location Owner Or Owners Of Property ..... .~.~..~. 4°~../~....1~...J:~..L..~.......~..~...~/../~ ......................................................... Subdivision ................................................................ Lot No.~...-...~.... Block No ............. House No ............. Date Of Permit ........ Permit No. Uea,th D pt. ................... b:,ba, pt. Approval ................................................ Underwriters Approval ....~...~'..~.,).~.~. .................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate ........ ~ ......................... Fee Submitted $ ......~.~..~.~?. ................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ...~...~.~...~..... ~. :....~.,...~.....~rfr~... ....................... Sworn to before me this ............ . dayof ....... Notary Public e~JZ~./. County (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES H ea 1 th Services~7~/~-/~-~ Reference Number 3. 4. 10. 11. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address )~ ~-~4v~o~,~ ~v~,.A~ Property Locatio~ ~Y'~ ~-~-~ ~'~ 6/°/ Village Township Public Water Company Name Lot size: Width__feet Length· Sewagq D~Iposal System: . A.~llon septic tank. Precastl./~Equivalent Block B. Leaching pools: Number of pools Precas~'0 Block If private well, lowing:~anks: A. Tank~capacity. B. Pump'G.P.M. Special the f( .gal 1 ons fill in the fol- C. Total well depth. D. Depth to ground water E. Amount of water in well 5. Subdiv.Hm~ff~'~ 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main feet. (For Health Services Dept. Use) 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~. Date~( ' ~L/I~ ~~-~ { ~__g-~ ,~ ~/~/~/ Signed X ~'~/*~'J .',"~'~ 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~S~vstem and Water Supply can be installed on this plot· APPROVAL DATE ~'~'v~7~ SIGNED~________~ ~ S-15 Rev. 4/1/73 APPLIGATIOfl FOR BUILDING PERMIT 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 o detailed description of layout ofpropart~ must be drawn on the diagram which is part of this application. c. The work covered by this application may nat 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 a Certificate of Occupancy_~ shall have been granted by the Building Inspector. APPL CAT ON S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Build ng Zone Ord nonce of ~.he Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regu orions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and ragu atlom, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicont, o~ name, if a ¢6rparotion) (Address of applicant)~/ /'~ ~' ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ --------~-- -- .~,.,,~.. ,~., ,~..,.,,~,,..,~,,.,J,.,.~,.. ....... d~..,~.~.~..~ ................................................................... If applicant is a corporate, signature of duly authorized officer. ......... Builder's License No ..................................................... Plumber's License No ..... ~...:.~?. ........ (~)../-.-~.....~..~'~. Electrician's License No ...... ~.~.....~.....~.-.~-.~.~....:.. ~ ~r- Other Trade's License No ............................................... ~' ~,~tT'e'4',J'" ~7 1. Location of land on which proposed work will be done. Mop No.: ~..~...'~....~..~'..~....~...~. ..... Lot No......~.. ................. Street and Number ..~..~....~.....~...~......~.. .......... .~......~y: ................................ ~, ......... ~'. ...... '~"...~.--.~ .......... ~" ...... Munl¢lpali~ 2. 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 ................................... 7' ................................................. ~'"'"". ............................. 3. Nature of work (check which applicable): New Building' / Azklition Alteration Repair .................. Removal .................. Demolition .................... Other Work .......................... : .......................... (Description) 4. Estimated Cost ......... .~...~.,~ ,0.~..0.. ............. Fee .......................................................................................... -'~ ~ ~ (to be paid on filing this application) §. 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, Jf 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 ........... 3..~.. ......... Depth ........................ Height ...~..~. ......... Number of Stories ...................................................................................................................... 9. S ze of lot: Front ..................................... Rear ......... ........ ........ Depth 10~ Date of Purchase ...... .~...~..i..~ ..................................... Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Jaw, ordinance or regulation: ...... .~...?. .......................................... 13. Will lot be regraded ....,~...q. .............. Will eXCess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .~.~.~;'..Z'.../...~'.. ....... ~...~.~..~.... Address ...~. ............ b4~. ~/~hone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..~..:./~:..~.,/.~.~.f.....-~...~...e....~...~. ....... Address ......~?....~..~./...-...)~C~one No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and nd cate whether interior or corner lot. ,~ STATE OF NE'W_YO~J]~,. ~ [ c c COUNTY OF .~.~ ........... ........... .~....'...~.~;/~..~...~_..~.....~..~.. ................. : .................. being duly sworn, d~oses and says t~' he is the applicon, (Name of individual ~gning contract~ above nam~. ~ ~ ~ , ' He is the ........................................... ~...--.............. .............................................................................................. (Contractor, agent, co.rate officer, etc.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; that all statements contained Jn this application are true to the best of his knowledge and belief; and tha~ the work will be perfor~d in the manner set fo~h in the application filed ther~ith. Swam to before me this ~.. _ ~ ................ ....... ............ , .... Noto~ Public,' ~~Z ...... C~n~ ~----~ ~- ""~~....~....-.~~ ............ ~~'"'~' (Signature of applicant) ~7~v~u '/I~ -- ' ~eto~ ~ubl~c, state ~f N~ ~o. 52~034496~ Suffolk Coun~ Cbm~ltsi~h E~lres March 80~ 19~ ~-- well ,-- 4"r'_t ----.'., rE"'P-.ANKLIN ,,~ JOY ~,EAt~ - ' ,~OIJTHOLD SuMF-ogt~ COLjI'CT¥, N,'I~. ~ C I N h- l-JI 12_ f NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM TO 4P~ FOR REQUIR- 05 t L D ~ :0 - L ?,, N