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Home My WebLink About9096-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...~. ~97.~.4 ........ Date .... 0. q .~.o.b.~.~.. ?.~. ~. ................ 19. ~0.. THIS CERTIFIES that the building ................................................ L ..... h105 reeo Hole Dz'tve, Mattt~:uok, New York ocauon o~ rroper~y ........... - ......... : ................. : .................. :..... House No. ~ ~eet 2- Ham/et ~5 3 County Tax ~ap No. ~ 000 S~cfion ............ B~ock Suhd~s~on Deen Hole Creek Estate con~or~ ~uh~anfiaHy ~o ~ Application ~or Building P~R here~o~or~ ~d An ~ o~ce da~ed 9096 dated .. ~..~7 ~ ............... 19 .~ ~, was issued, and conforms to afl of the requirements of the ~pp~cable provisions of the law. ~e occupancy for w~ch t~s ce~ificate is issued is ......... Private 0ne-Family ~welllng. ~e ce~ificate is issued to ....... ............... io~.~k, ~ ~ ..................... of the aforesaid b~d~g. Suffolk County DepaRment of Health Approv~ ~ERWRITERS CERTIFICATE NO. N ~97 1980 Building Inspector Rev 4/'/9 FORM NO. 2 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) N? 9096 Z Date ......................... t~'~r'"'l'7 .............. , 19'7~" Permission is hereby granted to: Fra~¢.~..~Q s~..J[Qz~ s...Inc ................................... ................ ~x...9~)~.. ......... Cu.t,e~9 ¢.ae ................ to ....tJ]zild...z~ew...o~e...£a~.l.~..~'~w~.L.:[~.§ ................................................................................. at premises located at ~D.~;...~;L,...[~.;b.t.;[,.~,Q~...,~S~;~.~S ............................................................... .............................................. ~,'~/$...D~.e ~.:...~o 3~ ..D ~.. ......... ~ ~.t, .~.tue~. ............................................ pursuant to opplication dated .......................~'~;~.~......1.[~ ................ , 10..?.~..., and approved by the Building Inspector. Fee $..~.3.,.1.0. .......... Bui ding' ]~spector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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-(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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. 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 . . . 7'~..~... / ,i ,~?.. New Building .~ ........ Old or Pre-existing Building .... , ........ Vacant Land ............. Location of Property/~c.u.:/N~... Owner or Owners of Property . .~...'~). ~ ........................... County Tax Map No. 10~0 Section J~ :-~,...~B ock ............... Lot..~... ...... ........... Health Dept. Approval ...~,~. ~-~0-~8~ .... Labor Dept. Approval Underwriters Approval ... ' ~ ,. ~??~:~ . .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate .. ~ ................ Fee Submitted $ ............. ~ ............... Construction on above described building and pe/mit meets all applicable cod~ and regulatio,~s. THE NEW YORK BOARD OF FIRE UNDERWRITERS J~ BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced bS~ tt~e applican~ /~r~ed q~ t~ aboyF_ a~pli~qtion ltumber in the premises~pf =~ Job#177 its the followiag location; ~Basement ~lst FI. w~s e~.mi,~ed o,,0CC6~ I6 ~ 1980 [] 2nd FI. Section Block Lot and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS DRYERS OTHER APPARATUS: E R I C AWG, AW.G AWG OF CC COND NO OF HI LEG NO Of NEUTRALS OF HI-LEG OF NEUTRAL 11907 GENERAl. MANAGER Per- , This certificate must not be altered in any manner; return to the office of th,e Board if i~co~r,rect. Inspectors may be identified by their credentiaJs. COPY FOR BUILDING DEPARTMENT. THIS COPY OF cERTIFICaTE!MUST NOT BI~]ALTERED IN ANY MANNER. -- FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor with the following; for new buildings or new use: 1. Final sur~ey of property with accurate location of all buildings, property lines, streets, and unusual natura~ 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" ~and uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion requ ired to prepare a certificate. 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. ..... New Building .f.~). ........ Old or Pre-existing Building . ,,. ......... Vacant Land ............. House No. / ~ f,..) f / Street ~amlet or Owners of Pro ert County Tax Map No. 1000~Section //~/~.~... Block ...' ............ Lot.~ ............. Health Dept. Approval .~ ~-SO-~ ~>~ .Labor Dept. Approval Unde~riters Approval .'K,~ ~,;[ ~7~2 .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate . .~ ................ Fee Submitted $ .... ~ ~. .................. Con,ruction on above described building and permit meets all applibable codes and regulations. Applicant ................................................... Rev. 10-I0-78 SUFFOLK COUNTY DEPA OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT, 1,.i A PRIVATE_ ~ __--y/SEWAGE DISPOSAL SYSTEM AND A WATER 'SUPPLY j!,~B~F~ 1. Appl i ca~t~ ~ ~' ~ P~ ~ ~ ~ ~ 5. Subdi v. ~'~ ~ Address~.a~'- ~ '' "~"' '~ '~'~ ~~ ~U~_~U~ ] ~. ~ . ~ 6. Section~ 2. Property Location'~ ~ ~ ~, ~ ~,~' 7. Lot Number ~ ~U~ ~ 8. Private Well~ Vi~lage'~ A~ Townshi~O~AO 9. Public Water 3. Public Watef'Company Name Distance to main 4. Lot size: Width ~ feet Length ~ feet 10. Sewage Disposal System: (For Health Services Dept. Use) 11. The D. E. undersigned CERTIFIES: A. 900-gallon septic tank: Precast .~ Equivalent Block B. Leaching pools: Number of pools Precast ~ Block Special__ If private well, fill in the fol- lowing blanks: A. Tank capacity ~. gallons B. Pump G.P.M. ~""~k,,,, Total well depth ~0 Depth to ground water If Amount of water in well "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. 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 .////x//?/ SIGNED S-15 Rev. 4/1/73 Lo/G8 Lot ~? Lot 50 . LOt51 ~ , Nor£; SU~OI¥1$10N MAP F/LEO IN I'N~ OFFI¢~ OF rNe CLime O~ SUF~LK county o~ YOUNO SURVEY FOR: LOT NO. ~I, "/PEEP HOLE CREEK ESTATES" ~ =~u .I~ :,, NOg , ' rs-SSa . Lot ~? Lot 5~ NOTE: SUBBIVISION MAP t~ILEO IN THE OFFICE 0~' THE CLERK OF SUFFOLK COUNTY ON JAN. 88~ TO I~E 'T~TLE ¢~PA~Y, GOV~JM~NyAL R~V~S~ONS ' YOUNG & YOUNG 400 0$TRANDER AVENUE4 ~RiVERHEAD, NEW YORK ALDEN W. ¥OU'NG HOWARD W, YOUNG FPANCES, ROS~ HOMES, )NC. /%': .... ',:-'~ ~ I I I 1' '1 ----,. ! i ~' ....... : .... ........ --I,- ' - '~, 'c'~h~' , C- ~,~-~.~ 1"/.t Os W A FId, AL : !