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Home My WebLink About9859-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy THIS CERTIFIES that the building located at 2.3.7.5..H..a.r..bp.r...L.a.n.e. ......... Street Map No. "~ ~ Block No. XXX .Lot No. XXX conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Yul. y.. ~., .......... , 19.7.a. pursuant to which Building Permit No985..~.~... dated ...Ju;kY.. 2~4., ........... , 19.7.8., 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 ~.RI.VATE. ONE-.FAmILY. DWI~LL~NG ....................................... The certificate is issued to . ~QI~F~,gT.. ~.IA~J~ ....................................... (owner~]t~x~k) of the aforesaid building. Suffolk County Department of Health Approval . .8.-..S97.7.7. .......................... UNDERWRITERS CERTIFICATE No..N.4.97..6.1.0. ................................... HOUSE NUMBER , .2.3.7.5~ ........ Street ..... .H.a,r..bg.~' .L. ,a.n.e. :..C.u.t,q .h.o.g.u.e.; ......... New York 1000-136-1-18 ~g I{~s~ector l~OE]~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT' TOWN CLERK'S OFFICE SOUTI'~OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 9859 Z gore .... ....~ ...... ~...Y.. ................. , 19./_¢.. ~t premises ,~oted et ....~.~.~Z~ ...... Z~Z~'"~*~";:~'r~~':Si~' -- ................................................................................................ ;;.;,~ ....... : ....... t.J .................... ;.....: ...... z ...... Building Inspector. ; : , r : B~lding Ih~ector 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 survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2. Fina[ 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 ail 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 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 Z/. ~.'~.../: ,~.' .~..~'. ~.~. .......... New Building ...J~/... ...... Old or Pre-existing Building ............ Vacant Land ............. 7 /._/].az//,:- y Lo~atioa of ProparW . ~/~ ~ House No, Street Ham/et Owner or Owners of Property . ~ .~ J~,'~'.~. · ~ ..... t~ ~.~.4'. ~.~. ......................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Map No ............... Lot No ............... Permit No..c/:,~..,/.). ?.. Date of Permit '~..~.~. ?..~.~".~A'pplicant, J.~ ............................... Health Dept. Approval...~'?. :~ .Z.). i~ ..~ .......... Labor Dept. Approval ........................ Underwriters Approval .A~./.~f..U.. 3..~'./..~ .......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .(~. .......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant, ;,~. '.~, .~.'~...~., .~.,'~' '~.~..~..'~,, ................... Rev. 10-10-78 TEL. 765-266[] TOWN OF SOUTHOLD nFFICE r]F I~UILDING INSPECTOR TOWN EiLERK'S I-IFFIOE SE]UTHI3LD, N. ¥. 11971 Memorandum from... BUILDING INSPECTORS OFFICE TOWNOFSOUTHOLD TOWN IqALL, P, OX ?28, SOOTHOLD, N.Y. 11971 765-1802 UNDERWRITERS ' - ..... - ...... --THE~NEW-:YORK BOARD OF'FIRE --=~ .... RANG~ C~KI~ DECKS OVENS- DISH WASHERS ~HAUST FANS - , - .,SurdL ~tec. C . : _ .:~ Th& ~erfiilcate musf hot b~ alt&ie~:in-bn¢ manner; return to ~e office of the Board if incorrect, tnspe~ors Li:c.421E - : - 'tl BUILDING DEPARTMENT TOWN CLERK'S OFFICE · SOUTHOLD, N. Y. ,, ........ ,orm,t ....... Disapproved a/c .......................... .~..:;..........~ .................. ./ .............. (Buildi~l Inspector) ~ APPLICATION FOR BUILDING PERMIT Date ...~...' .~../ .............. 6~ / .................... ?~ ,1' ............ INSTRUCTIONS a. This application must be comPletely filled in by typewriter ac 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 a detailed description of layout ofpraperty 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 shall have been granted by the Building !nspector~ 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. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildere~. .:., If applicant is a .corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No Electrician's License No...~...~-.../.......~'.~... ................... Other Trade's License No ............................................... 1. Location of land on whichproposed work will be done. Map N.o ............... LoLNo'_4~.;..~...._~. Street and Number ~/~-~;'~~`~v~?~~;~(~ ......... -~ ~ 7~'- Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy' ..... i i..~i.~ ...... ..~..~..~.~ ......... , ...... 3. Nature of work (check which applicable): New Building.. ..... Addition .~ ................. Alteration ............... Repair .................. Removal .................. Demoiitior. ............, ....... Other Work ................................................ . .... · ~/ x ,.~ ~'~_ (Description) 4. Estimated Cost ....... ~.~....~.~ ............................... Fee?--.~..-Z..~ ................................................................ (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 .......o~.....~.. .................. Depth,~....~. .......... V ' Height ...Z ................... 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 ....~M.%~...~. ............. Depth ~:~ ~ Height ...,/....z?~ ........ Number of Stories ../. ................................................................................................................. 9. Size of lot: Front ...... .~..,(d..'...C:/. ...... ..~....../.,.~....~.-~.. ........... Rear ..... .,~....¢....¢2~ ......................... Depth ..... ./...'~.. ..................... 10. Date of Purchase ........ .7,..~.. ........................................ 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 lot be regraded . ....... ~ ......... ,Will excess fill be removed from premises: ( )Xes- (~No · ~ zz ~/. ....... ] 4. I',ome of Owner of premises ................. ,'~,..~../~,..k .... Address ................. ~ Ph6~e No ....................... Name ofArch,tact ._~:_......~/...,..~ ~-.....~' . ........................................................... Address ................ ~;~,/,~o ....................... o, o,,,oc,o ........ PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate oil set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ ~'¢'¢ ....... i ........................................................................... being duly sworn, deposes and says that he is the applicam nam~igning contract) above He is the ~~ .............................................................................................................. ~ (Contractor, 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 statements contained in this applicadon are true to the best of his knowledge and beUef; and tha'r the work will be performe~ in the manner set fo~h in the application filed therewith· Sworn to before me this Not~ Public, . ........ ~~ ............... Coun~ ~ ..... ._. : .................................................. , ~. ~..- ~ --(SignatuF~licant) 7.5 76 DWELLIiq G,$ (WELLS') 77 HARBOR LANE SUFFOLK COUNTY DEPT HEALTH SERVICES FOR APPROVAL OF CONST. ONLY DATE I I '" HS REE NO --kJ~-.'~O" '77 . kPPROVED BY -GUA RAN TE -FD ONLY OF ~THE WATER SUPPLY a I ~ ~ WAC S DISPOSAL FOR THIS RESIDENCE WILL CONFORM TO THE S~ANO- ARDS OF THE SUFFOLK C~NTY DEPT OF HEALTH sERv(c:ES JOB NO. 7a-2~o SUEVEYED FOR N Y L C. .048, HA,~OLD F.,T~ANCHON JR. ~ {.lC NO PE . . NAME ADDRESS aa00 Route 112 Medford, L. I, N. ¥. 1176.3 FILE NO, ~)G£NE TO:WU C~F SO//T~OZZ~- ,.gUF'~O/.A" COUNTY, Pg.Y, SCALE 17 :~ $0' DATE FILED ~A~ NO. ~56 DATE /0'2~/-1~t2~ BOOK NO. Z.Z. PAGE HAROLD K TRANCHON JR. PC. LAND SURYEYOR SUCCESSOR TO WILLIAM G MEIER NORT~ COUNTRy ROAD- WADING RIVER NEW YORK 11792 I75 DWELLINGS (WELLS') ~rr ~. AZ. 07°5E50'W. DATU~W ,4PP, qOX/A4ATE 'FAX AdAP DIST. ~ooo .SEC./-% ~iK. / 1ct /8, 'o ' HARBOR LANE SUFFOLK COUNTY DEPT· OF HEALTH SERVICES FOR APPROVAL OF CONST. ONLY DATE .... HS REF. NO I,A P PR OVED F~Y GuARANTEeD oNLy TO THE WATER suPPLY & SE,WAGE DISPOSAL FOR THIS RESIO~ENCE WILL CONFORM TO THE STAND- ARDS OF THE SUFFOLK C(DUNTY DEPT. OF HEALTH SERVICES NO. SURVEYED· FOR NAME ADDRESS ~ELEPHONE NORT;H ,COUNTRY ROAD- WADING RIVER ] NEW YORK 11792 (;~ :' i LT. 473- 3626 ~ ........ ON JR N.Y/LIC. N . 048~g2 HAROLD F. tKANC'H PEN' ~C,N~D 2111D~E LOT NOS. ~/,~-//6 //,/Cz. mAP OF: El~GENE SITUATEO ~T SCALE 1~' = ~¢' DATE FILEO MAD.NO. ~6 DATE BOOK N~. Z,Z. PAGE HAROLD'F TRANcHON JR PC. L~ND SURVEYOR SUCCESSOR TO WILLIA~ G. ~EIER £OT HU/W~ER, S 77 /00. 00' s~ Dy'4 ELLI NG~, (WELL$$ 8;$o- /778 D¥4ELLH'4G UNDEP. CoNST /0- %- 1~7~ HIt/AL SUFFOLK COUNTY DEPT OF HEALTH SERVICES FOR APPROVAL OF CONST ONLY DATE --- HS KEF NO APPROVED f,SY .......... THE WATER SUPPLY & SEWAGE DISPOSAL FOR THIS RESIDENCE WILL CONFORM TO THE STANO- ARD$ OF THE SUFFOLK COUNTY DEPT OF HEALTH SERVICES A VALID TRUE DOPY. N Y LIC NO 048, 2 H,~ROLD F TRANCHON JRPENN. LiCN0. 21'~15- E. NAME AE)ORESS TEL E PH ONE JOB NO, 78-2~1o FILE NO.~'UGENE SURVEYED FOR LOT NOS. 7/~-I/~ MAP OF ~UGHNE SITUATED AT OUTCHOQUE TOWN OF ~OUTNOZD- 3UF~OLK OOUNTY. SCALE 1¢ = BO' OATE FILED MAP NO. ~56 DATE ~OOK NO. Z,A. PAGE HAROLD ¢: TRANCHON JR PC, LAND SURVEYOR SUCCESSOR TO WILLIAM G MEIER NORTH 'COUNTRy ROAD- WADING RIVER NEW YORK 11 792 (516)!g29-4G95 ALT 473- 362~, n I ll d .4- t %1 ~,]" I rI I I -I-,I -- I ~-- L. ~T-T '5 ;4" ~ ,z:,,I,4 C It mOUSE, g Cb ~ ~ R U t4 I L L_ CCbl,.L%T. CQ. [ ~C.