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Home My WebLink About9060-z1~0~ NO. 6 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z7785 ...... Date ............ J-uty ....21 ..... , 19~,~ . THIS CERTIFIES that the building located at N./,%. Ma'in- Re,ad ............ Street Map No.. ~:~ ........ Block No..::<r~ ....... Lot No, ~ ' ' ' L'c~u~e'~' ' 'N~f'~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .................. Y,a.rt 1~ .?.~. pursuant to which Building Permit No.. dated ........... ~lar.- .~ ....., 19.-7'7., 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 B~s:~n'. ,~" ..... .~.lcting.' ' ~.~ith' atter~t,f~o~' ok, -dwel'~i~'~g' unit' ' -~Ap:c~'oved' by Bd Appeals) The certificate is issued to . .t.~,. ~haekr~an. & .~e.- Owners..(. 'Dan'~el' J~eoby) ...... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .May-. '9" '1977' ' .by.John. Bredemeyer UNDERWRITERS CERTIFICATE No, .pen~ling-, (. 'T'nspoeted' 'by' 'Jubaek~') ..... HOUSE NUMBER ...1.1+~. ...... Street ... ~l.aim ~oa~ ..... Laurel ................ Building Inspector FORM NO. 2 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) N? 9060 Z Permission is hereby granted to: W~....J..~ .~9.b~..... ~/.C... ~: ,....S~ackman.. ~...C.o.. &.. Dan I e 1 Jacobi ............. .G.utchog~ ............................................. ~o ....~ .e..m..9..d..e...Z.....e..x...f..s..t...i..n. E ...b...u..t...1.~.~..n. ~ ..W..i.-th..ll~i~a ..~l ~... £ AP.t )... ~.. s ~o.=e ................. ......................................................... (.Ap.l~r.~.v.e d...by...Bd...AppmalsJ .............................................. at premises located at .....~./...~......}~i~.~L..~.Qa~ ...................................................................................... Laurel N.Y. pursuant to application dated ..........................~..a..~......! ................ , 19..~.~1.., and approved by the Building Inspector. Fee $...'1[ ~..-..0, .~. .......... SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Riverhead, New York Building Permit No. TYPE OR PRINT LEGIBLY IN INK Health Services Department Plan No. Application for Approval of Commercial Sewage Disposal System TO: The Suffolk County Department of Health Services Date Village Application for approval of commercial sewage disposal system is hereby requested. Location: (Name, side of street, name and distance to nearest intersecting street) (Builder - Owner) Ready for inspection FOR USE OF HEALTH SERVICES DEPARTMENT ONLY Based on the information stated hereon by the applicant and other information made available, it is the option of this Department that this system with proper maintenance can be expected to function satisfactorily and is not likely to cause a nuisance, provided designed sewage flow is not exceeded. Structural features are not included. Date "AY 09 ~9~7 ~'~ .j~.~,~.~- ~. Chief of General ~ineering SCHD - 8-13 FOR~ NO. S TOWN OF $OUTHOLD , Building Department Town Clerks Office 5outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicotioa must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--($-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 19,57), No~-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: 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 $1.00Date .,.~,,.,.~., ..~../,, ~ .~.../x77 New BLIJldJng ................ Addition ................ Old or Pre-existing Building ....~ ........... Vacant Land .............. ocat on Of Pr erty ........... ................... ...................... _..::..... .................. Owner Or Owners Of Propert~~"'Z~..~./'.....~...'.~..'....~../.~)..../~.~.A/...:....'J..'/'~'""~"cP~..'~:.' ......... Subdivision ................................................................ Lot No ............. Block, No ............. House No ............. Perm Ho. ,/.> ............... ate O Per t ..:.'.~...~...App ,cat ..~/...~..?', ............................. .~..~... ....... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~J Certificate .............. ~ ................. Fee Submitted $ Sworn to before me this c ~x// ~ ....... · ,,~,,~. day of ...~,.,.,.~...... ['~ l. (stamp or seal~ TOWN OF $OUTHOLD ~///'~-- '~, ~"/'~ TOWN CLERK S OFFICE ~_ ~_/.~ SOUTHOLD, N.-Y. ~ ~/ /.~.~ ~.. ~".-.....' ............ ,~'.~.z.. ~ ~ ~ Examined / ' ~ppdcation No....(.t .......... % ........ Approved ....... 'f / '~Z. ~ ~ ~ ~ ........................................ , Permit No ......... -............~ 'sapproved a/c..~ .m /~ ..................................... ~..c ....... ~. ....... ~.....~ ? ( ............................. ................................. APPLICATION FOR BUILDING PERMIT D~te ..................... I~STR~CTIO~S o. This ~pplicmion must be completely filled in by typewritor or.' in ink ~nd submitted Inspector, with 3 set~ o~ plans, ~ccur~to plot plon to sc~lo. Foe occordino to schedulo. b. Plo~ plon showin~ location of lot ond o{ buildings on premises~ relot~onship to od~oinin~ premises or public streots or ~re~s, ond oivin0 o detailed descdption of Ioyout ofproperty must be drown on tho dioorom which c. The work covered by this opplic~tion moy not bo comme~cod beforo issuonce o{ Bui~din~ Permit. d. Upon opproval of this opplicotion, the Buildin~ Inspector will issue o Buildin~ Permit to the opplic~nt. Such permit shall be kept on the premises ovoil~ble for inspection throughout the work. e. ~o buildin0 sholl bo occupied or used in whole or in port for ony purpose whatever until sh~ll hove been 0ronted by the Buildin~ Inspector. APPklCATION IS HEREBY ~ADE to tine Buildin~ Department for the issuonce of ~ Buildinfl ~ormit pursuont to the~ Buffdin~ Zone Ordinance of the Town of Southold, Suffolk County, ~ew Yark, ~nd other oppHc~ble kows, Ordinonces or Re~ulotions, for the construction o{ buildings, oddffions or oltorations~ or {or removol or demolition, os herein describod. The ~ppliccnt o~rees to comply with ~1~ opplicoblo l~ws~ ordinances, buildino codo, housin~ code~ *nd reoul~tions, ond odmit omhorized inspectors on premises ~nd in. buildin0s for necessory inspections. ..... .... ....... : .................... (Signature of ~licaaEor name, if a corp~ratig~i' '" · .~.~ .......... 1. ...................... .}. ............. I.../. ................ -- (Address of oppl~ont) / State whether ap, pJ~jcant is O/Whet, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... ~.~zi.L.~..~. .................................................................................................................... Nome of owner of premises If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... Plumber's License Other Trade's License No. 1. Location of land on wh cb proposed work Street and Number ' .......... :.~ ............................................ &! ......... , ,..~,~.;~.~....,~ ............. ~. ................ Munlcipality 2. State existing use and occupancy of premises and intended use and oqcupancy of proposed construction: a. Exisiting use and occupancy ...... ~Z~:.f.~...~?..~.. ........... 3. Nature of work (check which applicable): New BuilcJiRg Addition .................. Alteration .................. Repair .................. Removal ...... : ........... Demolition .................... Other Work ...................................................... ' , .... ~ ~. _ (Description) ,) ~, .'m,,, ~ .......... 4. Estimated Cost ..... ':....:.~ ....... ' ........................................ 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 .............................................................................................................................. · ............... 6. If business, commercial or mixed occupancy, specify~ture and extent of each type of use .../.?,/~,,~,c,~-_~,, ........... 7. D mensions of exi~dtTg structures, if any: Front ..........~.k¢ ............. Rear .....~,-.:~.~. ............... Depth -~L:~ ....... Height ~2-. ~ Number of Stories D mansions o:Ls, ame structure w th aiteration~or additions: Front .................................... Rear ..~?~.,~... ................ · ~ . Z,,-J tr' Depth ......~....' .................... Height ............................ Number of S o les ................................ 8. Dimensions of ,~+re new construction' Front .... ./,~.,~.~.. ..... Rear :~..~..'~ Depth .Z.'\ ~...~... ... Height....................~' ') Number of Stories ........................................ .~,...~,~ ..................................................................... /" . ........................................ Depth ................................ 9. Size of lot: Front .............. :..../..0. ............................... Rear ./.5 J 10. Date of Purchase ...... /...:.~T:....;..,:...../. .......................... Ngme of Former Owner ...... ~,~ ...... , ....... ~..,.; ........................... 1 1. Zone or use d str ct n wh ch prem ses are situated .......... C.~¥ ....... /.,, .:.:. ...... ,....*...:',f...~':;,..~4..;: ...f/;,.....L)...,,.,~,.~...t.-.. 12. Does proposed construction, yiolate any zoning law, ordinance or regulation: ....... <~}.~..,,~.,.../.. .................................. Will lot be regraded, .'...:...: ...... ~,.''~''..': ...... Will excess fill be removed from remises: ( ) Yes (~) No 13. ,/r? ~,~.... ,P ,, , 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect ............/~J/.~4~ 0 (~ . ~'~"~'~"~ ....................................... Address ................................ Phone No. Name of Controctor ....~..~...'n. 7~..~ ....... Address ..~;~Fd,~,.~'/,Z,i,."tt. Phone No. ~,,~,.?,~.~ ~/' ~" PLOT DIAGRAM -- Locate clearly 'and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines· Give street and block number or description gcqording to deed, and J~how street names and indicate whether interior or corner lot. ' ' STATE OF NEW YORK~ COUNTY OF ...... .~,,~g..~.~ ......... ', ............................... .~..~.~..~.~f6..~....~..~ ....................... being duly sworn, deposes and says that he is the applicom (Nome of individual signing contract) above named, He is the ............................................... ~g~.[ .......................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make ~nd file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ........ ......... do, ........... ..................... ................................. co ............................. .................. TOWN Or SOUT.OLD BUILDING TOWN OmC SOUTHOLD, N. Y. Examined ...... ~.~ ....... c.~ ........ 19.}.~. ~0 ~Z Z '( ~pplication Disapprove~~.: ............ (Building Inspector) APPLICATION FOR BUIIL. DJNG PEP,,t~JT 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 o~ areas, and giving a detailed description 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 a Certificate of Occupancy shah have been granted 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 laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. .................. ............. (Signature of applic..o~t-, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder · ...................Nome of owner" ............ of rem'"" ................... ses ~..~":'"'":~...~'~'/~///~'% ............. '"' ................ ,,~_,~"'"' ......... '"'""'"''"'"" ........... ""* ....... "' ...... "'"' .... If applier is a corporate, signart~re of dul¥~authorized oJ~Lcer. (Nar~7and title of,c'orporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which ar~ooosed work will be dpne. Map No.: ............... /.....: ................. Lot No ......................... Street and Number ...~.......~...?....~....(~.....~...~...~.~...~..~. ......... ..~...i.~ ............................................ ~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: ......................... ............................................ a. Exisiting use and occupancy .........../4~ ,,~, ~/~,~ ~,' b. Intended use and occupancy ........ ~../...'~(.~,...~.t:..~. .............. /....¥..'~..... .......... ./...J...'(..~ ...................... 3. Nature of work (check which applicable): New Building.. ................. Addition Alteratio Repair .................. Removal .................. Demolition .................... Other Work ................................... (Description) 4. Fstimated Cost ............................... 1 ............................ tee FT,.m.~;.,G.n .......................................................................... ~/ (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 ............................................................................................................................................. 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 .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will Iot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises .................................................... Address ................................ Phone No. ...................... Nome of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existin¢ or proposed, and indicate all set-back dimensions from ion according to deed, and show street names and indicate property lines. Give street and block number or descripl whether interior or corner Iol. STA-FE OF NEW YORK, COUNTY OF ...... .fl... ~ .x. · ... ~/.. :f _._~ ~_'~.~.~ ........... 'z ....... .~ ,.,, be ng duly above named. sworn, deposes and says that he is the opplicom (C6r~,}~6~'~r, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all stmements contained in this applicction 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 application filed therewith. Sworn to before me this ............. q ......... day of ............ ~,.,..~..w..:...~ ......... , 1 ...~.~ ~ ~ ~ Ptres March ~n ~ Lond of ~ 5 ~o~- / / / / / formerl~ or oDW D. cotOlO~° Mop I '= I00 ' of FINISHED GRADE TYPICAL SEWAGE DISPOSAL SYSTEM SEWAGE DISPOSAL DESIGN TYPICAL WELL !! DETAIL SI TE PLAN - RETAIL STORE ~ APARTMENT PLAN SHACKMAN 8 CO. 1"=40' TOWN OF SOUTHOLD SUFF CO., NY FEB. 24, 1977