Loading...
HomeMy WebLinkAbout5663-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. certificate Of Occupancy No~76~ ....... Date ............ ~k~l~ .... ~9 ...... ' 19'~A THIS CERTIFIES that the building located at B/'~' Wi.l~d~ ~ ............ Street Map No.. ~ ........ Block No..~ ...... Lot No...~... ~12~ ' 'H~T4 ....... conforms substantially to the Applicatidn for Building Permit heretofore filed in this office dated .Dee. '¶3' 19. ~ pursuant to which Building Permit No ............. , ~663Z' dated .......... ]~eo ..- ~-~, ..., 19..Tt, 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 · ~,riva~e' ~'e 'fa~'~Iy' I~,tell~' ...................................... The certificate is ~sued to .... IMi'b¥~ 'BbYg&~l ...... i ol~r~, i~s's~' ~ 't~'a~t') ......... of the aforesaid building. Suffolk County Department of Health Approval "'~ul)" · '%8' ~ 972" b~ 'R~' ~&'- UNDERWRITERS CERTIFICATENo... ']I~'3~D' ' 1~' 'eT'*' ]~'b~ .................... HOUSE NUMBER..~.. ~.~ll~re,~ ................................................ BttiRling Inspector FORi~ NO. ~ ~ TOWN O~ SO~TSO~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5663 Z Permission is hereby granted toi ........ .i~&..~.~..~ .............. ~ ................. to ...... ~,.~ ..I~...e.,e., £e.~t,,~'. ~,'lt'~ .................... ....................................................... :., pursuan¢ to application doted Del ~..i 19....L~.., and approved by the Building Inspector. ' Fee $"~J~JJi~l~ ......... pERMIT [NCLUDES APPROVAL TO REMOVE £XCESS FiLL FROM~,.ABovE P~EMISES ~Y ~RAD~NG LOT ,F~WAY CONSTRUCTION F ' ~$POOL CONSFRUCTION .... F~ . LLAR CONSTP, OCTION / S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH JUL 1 8 1972 Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at ~ / /./ (Give deed loc4t!on) ~' J have been inspected by this department and found to be satisfactory. Chief of General Engineering Services JUL 1 8 1972 FOIr, M NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerics Office Sonthold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR, ink, and submitted in 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 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 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: 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 ...7~'~. .........Old or Pre-existing Building ............................ Vacant Land ............................ L~.,~t ,,.. Of P,,~rt7 ~..~.. ................................ /. ........................................ C~ ........ '~ ......................... ~' ......... Owner Or Owners Of Property ..~...~...~...~..~'.../~'....~.......~..... ...... ...~..~..'~.-..~...~.....'~... ............................................... Subdivision ..~....~...?...~.....~;.. ....... .~....~....[/......~'~2... .................. Lot No..~.~ ..... Block No ............. House No ............. Permit No~...~...~...~..,..~.... Date Of Perrni~/t~.,..,c.;./~/.?.?/.Applicont .~...~..~,.~./Z.~...~ ....... ..,~...;.........~....~,,,/¢,~...~....'~J' Health Dept. Approval .....~....~L......~...?..~ ................ Labor Dept. Approval ......... .../~...~.~.. ............................ Underwriters Approval ..~....~.~..~.?.~.'...~. .............P ann ng Board Approval ..... /...~..~.~',. ........................ Request For Temporary Certificate ..~..~...~..Z......./~...~-/.~.~. ......... Final Certificate .......................................... Fee Submitted $ .....~.....~ .............. Construction on above described building and permit meets all applicable code~,s and Applicant.. ~-- ~. ..~.... '~ Sworn to before me this ........ .~..~.'[ day of ..... ~....~-...~..~..~ (stamp or seal) Not,c~y-)Public "-'",~"'"':;~z'".~:~-/l'"~ County JUDITH T. I~@KEIq ~ata~/ Public, $~ole cf New Yor~ No. 52-0344963 Suffolk Countlfdl~ Commission Expires Mo~ch 30, t SUFFOLK COUNTY DEPARTMENT OF HEALTH I ~ H.D.Reference No .~O-/~ ~- APPLICATION FOR ~PPROFAL TO ~ONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date ~ ~-~, 7,9- Approval to construct said systems is requested,pertinent data herewith: i-Applicant ~ M. 'YFe ~'~- Phone ~Sy-&L~/6-Sub div ~ ~ ~ P~ Address ~ ~ z&7-c~ ~ ok ~ ~_ ~ ~ 7-Section , 2-Detailedproperty ~ocation,~n,~ ~H~ ~;~ ~ ~.. 8-Lo% No. ~ Hamlet ~ ~ ~.~ o~ ~ ~ To~ ~/~ 9-Private well? ~f 3-~blic ~ter suppl~ ~me Dis%%nce to nearest ~in 4-Lot Size: Width~ft. Length ~q~ft. (also enter on center plot plan below:) 5-~elli~: Single Family ;~T~ Family? ~Cellar? ~lab? ; ~Crawl S~ce? / / lO-~o~s~ syst~: Septic tank ~ /Precast ~Cess~ols ~Shallow ~ols / /Other / / il-Septic ~ inside dimensions: Vol~e Gals.LenEth ft. Width ft. Liquid depth ft. 12-~ecast sections: /~Number/~Square Ft. Cesspools: Block sizeL incs. D ins. H ins. Total blocks below i~et: ~1 ~2 ~3 Street PLOT PLAN rade Capacity_._Gals. o.p... /at- The Undersigned CERTIFIES: -/ 7 ;ate ,th T,~t 5~15 Data ~eet ~ ~, 0 ~ 6 ~ '12 Indi No "Construction of authorized installations will be in can be installed on this Plot. ( 10/65 Revis. ) S-15 accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date ~1017~'-- Signed ~/~ //~6~A~ Owner or ~ilde~ FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System FORUM NO. 1 TOWN OF SOUTHOLD BUIL~DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. Examined ...... D~.ce~ b,~l;, ........ 1..~.,,, 19...~.,L. Approved " " 19.....'.'.. Pemit No...~5.65...Z .................... Disapproved a/c ..... ~. ~.,~.= .~.= ~.,~. =..-.= .m=..m= = .~..~ .-...-..~ .~,.~.~..-..~ .~..~ .-r.= =,= = m ~ m Application No ........ .5...6..6..~. ............... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date Dec 1 _% 71 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plat 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. Such permit ~J 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 in port 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, housing code, and regulations. (Signature of applicant, or name, if a corporation) Bridge La Nass. Pt. Cutchogue ............................... ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Mrs Barbra P. Bergen Name of owner of premises ........... ; ........................................................................................... ~ ........................................ If applicant is a corporate, signature of duly authorized officer. .................. ......... 1. Location of land on which proposed work will be done. Map No,: ,..~ii~c~32...~,llb,..~,~.~.~,~. Street and Number Z~/S~..~(i3.soz~..~oa.d ............ g.ul~cho~ue.....N~Z ................................................................. ,~,~,'7 ~ / Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......... .~..a...c..~...~..~....~.~...~.~ ............................................................................................ b. Intended use and occupancy ....... ~3TLe...fP~EL~.'I,.~...C].1g.e],~,;[12.~ ........................................................................... 3. Nature of work (check which applicable): New Building ~ ........ Addition .................. ~,lteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...D~f~ .................. Number of dwelling units on each ~loor ............................ If garage, number of cars ..................... On~, .............................................................. i ................. :...., ............................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... ~..~.~.:L~.f~J~.~l 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ..~ ................. Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... R~ar ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front .......... J.]..~ .......... Rear ......... ].]..~ .................... Depth ..... ]i..9.0 .................... 10. Date of Purchase ........................................................ Name of Former Owner .~..e..e..~..e....~..~.U~.~ ......................... 11. Zone or use district in which premises are situated ...~.!,~,!!..~.:D~.t, ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. ~ .......................................... 13. Name of Owner of premises .....~.l~zn~...~e.~.~....Address ...~?.~..~§..,....~.~.~....C...~.~..o..~...o.~.L~none No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ..~/J~o...~.e. fl~e ............................ Address .....C..~.t~..C.~..Q[.~,.e. .................. Phone No ..................... PLOT DIAGRAJ~ 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 according to deed, and show street names and indicate whether interior or comer lot. (,/,J I L- ~ ~ (~) ~'? '~ STATE OF NE)tV ~(~)R~, ~ ~ ¢ COUNTY OF: 9..~..~..-T..O.J,~ ............... $'~'~ .............................. .~...~..z'...~...z'..~.....?..;....~...e..~.~..e..~.. ......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .............................. .O..'Vf.~.~' ............................................................................................................... (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 application filed therewith. Swam to before me this ............... ....... ....... .................... Term Expires March 30, S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH JUL ~ 8 1972 Date ~, .~ Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located / /,~ (Give deed loc~t.ion) have been inspected, by this department and found to be satisfactory.