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HomeMy WebLinkAbout5536-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z~.9..~.6 ....... Date ............. Dec ..... 6 ..... , lg. 72 THIS CERTIFIES that the building located at . I~.S. l~th. Road..(.~11~7.).. Street Map No..XX ........ Block No .... ~ .... Lot No. xx~.. 01~.eellp.o~t.. N.~Y, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ul~r....8..., 19.71. pursuant to which Building Permit No .... 5~36~ i~~e~ :~. ,.~ted ......... Sept ..... .30., 1971.., was issued, and conforms to all of the require- nts of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pr.~.va.t.a .olae..£alu~,~. d~.~3.1~g ...................................... The certificate is issued to . .Prank. &. Clat.~, .Pa s~,o ....... 0vn®l~ ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .P.e.b. .2.2. ~..~.9.7.2..b.~.. R.~..v.~.l.l~.. ..... UNDERWRITERS CERTIFICATE No .... ~[ .12~.¢~ .... ~pr~.~l, .~,.."1.9.~..2 ................. HOUSE NUMBER ..... ~66.~.~..Street... ¢O~n. ty. l~&d. ~.~ · ~lo.~.th. Ro~d) .............. FORM NO. ~ TOWN OF SOUTtlOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 5536 Z Permission is hereby granted to: .......... ~,..Z~e't~,,e,~r~ ....,I,,~.. ~. ~~ & pursuar~ to ~pplication dated ............................... ~1~1~'"'-~ ........... , 19...~i, and approved by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTHENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) ~ have been inspected by this department and found to be satisfactory. SEP 5 197Z FO~t~I NO. $ TOWN OF SOUTHOLD Building Department Town Clerks Office Soutkold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUFANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ,n triplicate 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 d~sposal--(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 ~nstallations, 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 apphcable B For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-exist~ng" 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 condmon of buildings. 3. Date of any housing code or safety inspection of buddings or premises, or other pertinent in- formation required to prepare a certificate New Building ....~.'~...... ...... Old or Pre-existing Building ................... Vacant Land ........................ Location Of Property /.`~...~`~.t~...~..~/f./~...~.'~...~...~...'~~..~'...q/r...~.~.¥~r.`~'.~`~9~..~m~.~.~.~~ Owner Or Owners Of Property ...~..-/:7...X~zL~_'~. ...... l...J...£'~..~. ........................................................ Subdivision ................ i....~. ......................................... Lot No. ~ ...... Block No.....'~... ..... House No ....'~r.. .... Perm,t No ~..~.~...~. Date Of Permit ................... Applicant ................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all apphcable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Pubhc .................................... County ]t~OlT,~Vl ~0. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPAI~CY Instructions A. This application must be filled in typewriter OR ink, and submitted ~n triphcate to the Budding Inspector with the following; for new buddings or new use. 1. Final survey of property with accurate location of all buddings, property lines, streets, and unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electr,col ,nstallat,on from Board of Fire Underwriters 4. Commercial buddings, Industrial buildings, Multiple Residences and s,milar buddings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buddings 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 Date ............................................... New Building ..... ~ ....... Old or Pre-existing Budding ............................ Vacant Land .......................... Location Of Property .... ~..~..~....~......~...~. ~~."~q~.. ~..~....~.&.~. Owner Or Owners Of Property ..... ~ .(,~.. ................................................................ Subdivision .....% ...................................................... Lot No. ~ ....... Block No.~T.. .......... House No....-~.. ...... Permit No.~'.~..~...7' Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ....................................... Request For Temporary Certificate ........................................ Final Certificate ......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all apphcable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled ~n typewriter OR ink, and submitted in triplicate to the Building Inspector w~th the following, for new buildings or new use' 1. Final survey of property with accurate location of all buildings, property hnes, streets, aha unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and s~milar 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 hnes, 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 inspechon of buildings or premises, or other pertinent formation required to prepare a certificate. New Building ...... ~ ..... Old or Pre-ex~stmg Building ............................ Vacant Land ......................... Location /~ ' 0 ~'~ ' , ' , ~ 2 Of Property .~.~..I~.~-~..F'~-..~..4.~...~.....~..~.,~...~,.~.Z,~ .~.'..?:~.~'~..G~......~.~. Owner Or Owners Of Property ...~...,..(J~.'lr.t~.....~.Z.~.Cl~.~.(,Z,:..Ccd ........................................................... Subdivision .......~ ................................................... Lot No......'-'~. ...... Block No......-"'. ...... House No....'~.. ...... Permit No.~'..~.~...~..~......Z.. Date Of Permit .................... Applicant ................................................................ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. 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 ......................................................................................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County TOWN O F S E) UTH OLD OFFICE OF BUILDING INBPECTOR c~OUTHOLD, N, Y. Mr. ~, l,~z~e~'ol~' Commissioner of Public Works Suffolk County Yaphank Ave., Yaphank, hi. Y. Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated Laws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that ...................................... · .~:t~t~.-~l~..-.~/~.-.-.~'~-..~u~ ................................. ..... ~ ~tttm~'i' "~' ~'Z'~' ................................................................................. has applied to the Town of Southold for a permit to construct (~ building on '/~'/~6'"~,~"~"~="~ ~;~?'"~"~rt"~Z'",~t~- as shown on the otteched plot plan, submitted in triplicate, do,Ced ....... ~t~.. ............................................ and titled ..... ~';a~ ~...¢~.. ,1~,~...~...~.7/~ We shall withhold further action on this application for ten days or as otherwise provided in the aforementioned Section 23gK. Very truly yours, Building Inspector Town of Southold, N. Y. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Fq] 2 2 i972 Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed lo'cation) have been inspected by this department and found to be satisfactory. SUFFOLK COUN?£ DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SEWAGE DISPOSAL AND WATER SUPPLY SYSTEMS Inspection for approval is requested, pertinent installation data herewith, Address~.%~ ,r 5&~ ~ ,.0~,~-~.-~3 Phone 4-Section No. 2-Name of Builder~L~ ~ 2~2~o ~ Phone7~-~ 5-Lot N~ber 7-Sewage System installed by f~'..~' P'~o~.~ ' Phone. 7[-'~.~7 Address ~%...~L.~l. ~2~ ,~ ' , - ~ ' ' (b)~mlet or Village ~,:~6~'' ' . ..... (c)To~n 9-Septic tank-Oal__L__ft.W ft.Liquld Depth__ft. ...... ~ ~ (~)~l~ks below iniet-!)/~% 2)~,~0 3)__ (c)Block stze-L ~& in.W .~ in,H ~ in.(d)Precast pool , (e)l (f)~__ft. in; Di~__ft.__in.(E)Fintshed Erode to cover (h)Backfill Material~3 ~/ · ll~Wa~er Supply: Public Syst~J~u ~,~,~,'~,~ ~, ; Private Well If Private, the followinS questions are to be answered: 12-Private Water Supply System installed by Phone Address ft. 13(a)-Total Depth of Well ~ (b)Depth to Static Water Level 14-Diameter of well pip~ ~ in. 15-Name of Laboratory -- 16-Method of Dis~nfection ..... l?-Date ready for inspection 3~%/ The undersigned CERTIFIES: Above systems have been constructed and are in compliance with the Suffolk County Health Department's current Standards, Bulletins ; .... Ow~'~ - Builder" ' 19-Insert sketch of location of Water & Sewerage Facilities with accurate dimensions, ¢ , Inspected by ( . ~~e Based upon the info~ation p~ted abo~e, satisfactory ~unctt" '9~,~g of the above syst~s can be expected with proper mainte~andVcaC~ Date ~Cn O C' ~,~7~ Approved TOWN OF SOUTHOLD DFFIOE OF BUILDING INSPEiq. TOR TE]WN CLERK'S EIFFIEIE SIniIJTHEILD, N, Y. Mr, R. ~ammerer Commissioner of Public Works Suffolk County Yaphank Ave., Yaphank, N. Y. September 16 ~ 1971 Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated Laws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that ...................................... ...~..~... ~.~.s... ~ .e. ~.~.o...s.~.%.... ~/...q.....~...~.....~..~..s..s..~ K.o. ................................. has applied to the Town of Southold for a permit to construct a building as shown on the attached plot plan, submitted in triplicate, dated ....... ~.~.,~.. 1 0 19~1 ............................................ and titled ..... Clair Passaro We shall withhold further action on this application for ten days or as otherwise provided in the aforementioned Section 239K. 9/27/71: A~proved to the Town of Southold, pursuant to See. 239K of the General Veto/ truly you~. Municipal Law; as per revised plot plan. A permit is required under See. 136 of the Hilghway Law for access to C.R.27. t~'l~'x'~'~t~ ~ _ l SUFFOLK COUNTY DEPT. PUBLIC WORKS R. M. KAMMERER, COMMISSIONER Buildin~ In%oector TOWN OF SouTHOIJD/7' /-/ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined~ --~ .......................... , ]9 ........ pemit D,,~pproved o/c ....~ ~... ~.~..~.~..~.~~- ~ ' ........................................................................................................ g ........... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 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. S~ch permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or Jn part for any purpose whatever until a Certificate of Occupancy shall 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, housi~ code, a)~ regulations. a corporation) ....................... ( ress o d'pplicantT- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................ ............................................................................................................................................ Name of owner of premises ....... ../~...~....~...~..../..~. ....... .~.........~....L.../?/....~. .......... ..7~..~...~..~.....~.....~.. ...................................... : ............. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .......................................................................................... ............................. ' ........ 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 .~.j~..~.-.~ .~...~....~. / L.~.. .~..(4/J?,LJ././'q~... . . 3. Nature of work (check which applicable): New Buiiding .................. Addition .................. Alterotio~ .................. Repair .................. Removal .................. Demolition .................. Oth~roWork (Describe) .................... 4. Est mated Cost ........... Fee ...... .............................................. '.'"'"'"'"'"'"' (to be paid on filing this application) .5. If dwelling, number of dwelling u~its ........ .~..../~....~...~. ....... Number of dwelling units on each floor ............................ 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 .... ..~ Height ....... /...~.. ....... Number of Stories . ..~....~....~..."~.. ........... 11. Zone or use district in which premises are situated .............. ~ ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation;> 13. Name of Owner of premises ./c-...')~'....~.........~.~../t....'}~....0....Address ~OO/~.¥/V" Phone No ..................... Name of Architect ~(~'I~o~IAI~ t'tel~tE$ ~°~ddress ............................................ Phone No ..................... Name of Contractor ~)~'E"J'b~/'/c~ Address '-.'eOI'/TH~I"D Phone r~o ..................... 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 desc/!pti_~.on according to deed, and show street names and indicate whether interiOr or comer lot. % . STATE OF N EWe. ~l,Jt~, ~ ~/, ~ e e COUNTY OF ...~......J'~'~ ................................................................................................. being duly ~om, deposes and soys t~t he is the applicant (Name of individual signing application) above named. He is the ~..~-LU--/V7 (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 application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the alzo, licatlot~,,filed therewith ~ /) Sworn to before me this .~ \ ~ /' / ~ / / .// Nota- Public ............. .................. *~ , - ........................................................... county ~/ [:~ignatur~ of applicant) z$'