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HomeMy WebLinkAbout5664-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ....... ~'..d.~I~-~.g, ......................... Location of Property ... 2~20 ................ $OYShq~O. ~.d., ............ .O.~.e.e.n. pp.~.~... House No. Street Ham/at County Tax Map No. 1000 Section . .. 5~. ..... ;Block ........ ~ ...... Lot .... ........ Subdivision..Pecanic. J~ay. ~T-~s.t at o$. ...... Filed Map No... ~..1~4:..Lot No...'1.'1.4-., ~.I~. :'1..16 conforms substantially to the Application for Building Permit heretofore filed in this office dated ...D.e.? .e.m.b.e.r.. ~?. ..... , 19.7..! pursuant to which Building Permit No ...... ~.6.6~..Z. ......... dated ... December ~ 71 ......................... 19..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Private one-family dwelling. I,TT,T,IAN CIACIA & OHA~'T,I~.8 CIOCEETTO The certificate is issued to ..................... ~o'~n~~) ...................... of the aforesaid building. Suffolk County Department of Health Approval .... B0-1009 ~o759~ UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rw. 1181 FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE i SOUTHOLD, N.Y. BUILDING PERMIT ~ (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 566~ Z Permission is hereby granted to: to pursuant to application dated ................................... Building Inspector. at promises located at .......... ~..~. .........:,..:~...j~r.,j~l~,~e~,,~li~elj~[~ .................... .................................. ~'-~'-~ ......... ,,~'~'"i '!':il'~'~,': ......... ................. i ............ Fee $..~)~ .......... J.,.., 19.,~.., and approved by the TOWN OF $OUTHOLD Btm.~qG DEPARTU~ To~n Clerk% OEee Somhold, ~. Y. Certificate Of Occupancy Tt~IPORARY No..Z.9.~..5.2 ...... Date .....A.u...E~..t.....~. ........... , 19...7.8 THIS CERTIFIES that the building located at . 2.320. Baysho=.e .Road .....Street Map No ............. Block No ...........Lot No, . ' ' conforms substantially to the Application for Buildlng Permit heretofore fried in this office dated ...D.e.c..e~..b.e.~... ?.~. ..... , 19.7.?. pursuant to which Building Permit No....5.6...6~Z. dated ...D.e?..e~..b.e.r...?~. ...... , 19.7.?., was issued, and conforms to all of the require- menta of the applicable previsions o/the law. The occupancy for which this certificate is ~sued ~ Private One Family Dwelling The certificate ~ ~sued to Theresa La Porta ....... of the a/ore~d Su~olk County Dep~-~en~ o! Health Approval ..... S. rg....~.0..O9. ................... UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER 2320 Street Bayshore Ro. ad , ..... Building TOWN OF $OUTHOLD! ~ Building Department : Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OP~ OCCUPANCY Instructions A. This opplicotio~ r~-~ust be filled in typewriter OP, ink, and s~lbmztted in DUPLICATE to the Building Inspector with the following; for new buildings or new ~se: l. Final survey of property with accurate location of oll 'buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sew..eroge disp0sol--(S-0 form or equal). 3. Approval of electrical installation from Board of Fire U~derwriters. 4. Commercial buildings, Industrial buildings, Multiple R~esidences and sim lot buildings and installations, o certificate of Code compliance from tJ~e Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site pIoh requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings end "pre-existing" land uses: l. Accurate survey.of property showing oil property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, ~0ccuponcy and condition of buildings. 3. Date of any housing code or safety inspection of buildihgs or premises, or other pertinent in- formation required fo prepare o 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 $1.00 D~te ..... e B ddmg ................ Ad&ht~on ................ Old or Pre-ex~stmg B~ddmg ................ Vacant Land .............. Subdivision ................................................................ Lot No ........ ,... Block No ............. House No...~'.~.~,.ff Health Dept. Approval ?. ........ ................... ! .¢~! Labor' ' Dept. '~pprovol ................................................ Underwriters Approval ........................................... Planning Bo~,'~rd Approval ........................................ ~equest For Temporary Certificote ........................................ Fin°J Certificote .......................................... Fee Submitted $ ........ Construction on above described building and permit meets all ~pplicable Codes and regulations. Sworn to before me this ................ day of ............................................ Notary Public .................................... County FORM NO, 6 TOWN OF $OUTHOLD Buiiding Department Town Hall Southold APP~IC,~T,ON FOR CERTIFICATE QF OCCUPANCY instructions A, This apofication must be filled in typewriter OR ink, and subh~itted in duplicate to the Building Inspec- tor win the following; for new buildings or net*/use: 1. Final sur*,,ey of property with accurate location of ail buildings, property lines, streets, and unusual natural or tomograohic features. 2.Final approve of Heaith Dept. of water supply and sewerag~e dispose --(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Unde~vriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architec~'o/ Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan re,~u rements where apphcab e. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildines and "pre-ex'st'rig' land uses: 1. /~ccurate 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. / C. Fees: 1. Certificate of occupancy 85.00 2. Certificate of occupancy on pre-existing dwelling or land usa $5.00 3. Copy of certificate of occupancy 81.00 Date New Building ............. Old or Pre-existing Building(*) .......... :/Vacant Land - . ..... County Tax Map No ,O00Secton ...... Block ..... ~ ....... Lot...¢~,~',,j ....... Subdivismn · ............................ Ftled Map No:¢ 7//. ....... Lot No .............. upt. Approva~ ,..a.././!...l. ........... LaborDept ~pprova . ............ ,.. UndarvMters Approval ~/ //~' ~. D~-.¢~,~ .............. Planning Boa~d Approval .................. Request for Temporary Certificate ..................... Final Certificate ................. Fee Submitted S ............................. Construction .... on above described building and~err~i(meets all app~'~ab e,%cod~s and ragu lations. 0.,uCcE./3qSq %/% , _ ~, ~, Applicant ~_ .4,. ~.X .~.~~ TOYJN OF SOU~OLD OFFICE OF BUILDING I~'SPECTOR ' P.O. BOX 728: TO~¥N HALL; SOUTHOLD, N.Y. 1"i971 TEL. 76d-1802 VL:ec Enclosures ~ ,~~T6~__ ~Pp!ican~t This is to ad,,ise vo .... ~ Permit No. ~, ~ ~;~ '== ~_~ ~=~ ~e~$oo under Bui!din~ a f~al ans~ect~on no~ ~~ ~ ~s COmp_e~eo and o [ / nas no~ oeea OO~e, In order to com~!e~ ~ ~ , . . ~ ~h_s fi!e, it ls necessary a Cerrifica5~ of cc,,~=n ..... ~ 0 ~..cy be zssued~. F!eas~ f~l out enclosed ~ ~ ~ ~ n same to tno} above rrq o.. -c~ wzth a check fo~ $5.00 payaole to the Town ~of Southo!d. ' '' , F--_se · nczcate to whom tDe Certificate of Dccupancy is to be mailed, and arrafge with th~s office for an inspection date. Thank you for your prompt a~ten,~ion. Very t~uly yours Victor ~Lessard; Adminis~tr~ tot SUFFOLK COUNTY DEPARTMENTI OF HEALTH EASTERN DISTRIc~ County Center, Riverhead~, New York PA 7-4700 H.D.Ref. No.~'c~ ~/OO~ APPLICATION FOR APPROVAL OF INSTALLED PRIVATE SEWAGE~ DISPOSAL AND WATER SUPPLY SYSTEMS Inspection for approval is requested, pertinent! installation data herewith. Address/~.~. /~4/4MMcTA'/~Phone~y3-2'aZ~4-Section No. ~ 2-Name of Builder ~(/~ ~. ~ ;~( Phone.T~f~--~5-Lot Number//~//~ Address ~'r ~ ~ . ~ ~ t /~ ~ Z~ ~'M~ .6-Bldg.Pe~ 7-Sewage System installed by ~- ~ fc ~C~ ~ Phone 7~ - 2 Address ~=~ ~ ~- ~ ~~ ~,/-' 8-(a)Deed location of property ~ ~ ~/*~ ~w~o~ ~ ' (b)H~let or Village ~/4 ~ o ~ ~m~_~ ~.'f. (c)T~w~'- 9-Septic tank-Gal 'L ft.W it.Liquid Depth'. lO-Cesspools-(a)No.pools ~ .(b)Blocks below inlet-l) 2)_ . (c)Block size-L in.W in.H in~ (d)Precast pool~(e)l (f)H.~ ft. ~ in; Pi~ ~t.~in.(g)Finished grade to cover (h)Backfill Material~t~ ~ ll-Water Supply: Public Syst~ ~W~.C~ Private Well If Private, the following questions are to be answered: 12-Private Water Supply System installed by ~ Phone Address 13(a)-Total Depth of Well ...(b)Dep~h to S~atic Water Level 14-Diameter of well pipe in. 15-Name of Laboratory 16-Method Of Disinfection 17-Date ready for inspection ~_ $ ~ ~ ~ The undersigned CERTIFIES: Above syst~s have been constructed and are in compliance with the Suffolk County Health Pepartmint's current Standards, Bulletins ~r - Builde~ ' ............ Z9-~nser~ sketch of ~ocat!on of ~r' & Sewerage F~c~$t~es ~th accurate d~ens~ons,~ STREET Inspected by ( .~/~_~_~,_~5 Date ~--~'- ~ {( . Based upo~ the i~for~ti6~tated above, i~atisfac~ory functioning of the above systems can be expect~with proper maintenanc~ and care, Ohief of~'~eneralW~;gineerin6 Serv~ ces S-Se lust.ructions for Submission of Installed Private SewaKe Disposal and Water System Application Applications are to be submitted in duplicate. Required information should be ~yped or legibly printed in ink. Inspectors are not permitted to make inspections of installations until applications have been submitted to and accepted by this de- partment. The item number on the application form ahd item number listed below are the /' 1. Owner's name and address - if owner and builder are same~ so indicate. 2. Builderts name and address - approvals will be mailed to this address. / 3. Give name of filed realty subdivision map. / 4. Section number of realty subdivision map. ~/5. Lot number of plot on which disposal unit is constructed. /6. Building permit number assigned by the Building Department. / 7. Name of person or firm who actually constructed the sewage disposal facilities. v 8. (a) For example: s/s Jones St., 100t e/o Smith St. (b) Hamlet. (unincorporated area in township), for example: East Moriches. Villase (incorporated area), for example: Northport. (c) Township, for example: Brookhaven, etc. w" 9. Give inside length and width in feet. Liquid depth is measured in feet from bottom of outlet pipe to bottom of tank. lO. ~ (a) State number of pools. (b) State number of blocks below inlet pipe for each pool. (c) State length, width, and height of cesspool blocks in inches. (d) Indicate by check if precast sections are used.' (e) Give number of leach- ing sections per pool. (f) Give height and diameter of each leaching section. ~/ 11. --- 12. ~-- 13. -- 14. -- 15. -- 16. 17. / 18. W (g) Give depth in feet from finished grade to cesspool cover. (h) Describe backfill material used. Indicate by check if water supply is public or private. Name of persoo or firm who actually installed the water supply facilities. (a) Give depth in feet from top of well pipe or casing to well point. (b) Depth in feet from top of well pipe or casing to water level in well. Inside diameter of well casing. Name of laboratory performing the examinations. Describe method of disinfection, for example: quart of laundry bleach in ten gallons of water poured into well and allowed to stand six hours. State date on which installation will be ready for inspection. Application must be signed by builder or owner. Signatures of subcontractor, superin~endent~ etc., will not be accepted. 19. Indicate location of Water & Sewerage Facilities with accurate dimensions on sketch. S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH · ~WAR ? ~974 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. Chief of General Engineering Services S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date i July 3~ 1978 Bldg. Permit No. H. O. Reference S0 1009 TO WHOM IT MAY CONCERN: The sewage .t__ ,Lois Ildr ] (tire dee~ ~ocat'io.): have been inspected by this department and found to be disposal facilities for a ............ ~ ....... satisfactory. ~ILDIHG DEP*RTMENT TOWN CLERK'S OFFICE ~TH~D, N. Y. Approved ........................................ , 19 ........ Pemit No ..................................... Disapproved a/c ........... ........... lnsp~tor. b. Plat plan s~owing I~ation of lot and of buildings areas, and giving a detailed description of layout ofpr~e~ must be drawn on the diagram which .is c. The work covered by this application may not be comme~ before issuance of ~uJlding Permit. d. Upon approval of this application, ~e Building Insp~r wiB issue a ~uiJdJng Permit te t~ ~l~a~. S~ ~Jt shaJl be kept on the premises available for Jnsp~tion throughout the pr~ress of the work. e. No building shaB be ~cupied or u~d in whole or in pa~ for any purpose whatever until a Ce~ificate of ~cupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o 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 nome, if a corporation) ( r ss of ap~l~l'cant) '" State w~ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buiJder. · e fownerof remses ~ r~am o p .................... ~ ...................... ~....~..~ .............. ..~-...~...~ ........................................... ~.... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Locat on of and on wh ch osed work be done Ma No ..~...! · ..~. Lot //~ 2. State exi~,ing use and oc~_.~, p~se~s 3d~d use and occupancy ~, praposed construction: a. Exisitin' use ond ~'~uponc;t ,~,,,...~~ ................................................................................ b. Intended use an/occupancy_.~, ....... ~ 3. Nature of work (check which ck~plicable): New Building ......... Addition .................. Alteration ......... .~.....j, Repair ................. .~emoval .................. Demolition ............ .......~her Work (Describe)~ .......~ ................................ 4. Estmatedcost..~...~....7~.~.~) Fee ,.~...~..~... ~'..' .~."~". ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... ./.i ............. 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, Jf any: Front ............................ Rear ................................ Depth .................... Height ............... ;,... ..... Number of Stories ................................................................................................................. Dimehsi0ns' of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Num-bef of Stories ................................ 8. Dimensions of entire new construction: Front ..... ..~..~......'. ............... Rear .....~....~'.. ................ Depth ...,~..,.~'. ................ Height ..../..~,. ........... Number of Stories ........... /.. ................................................... je .................................................. 9. Size of lot: Front ....... ~.....~...~.. ......... Rear ........ ../....'~...~. .................. Depth ..../.~.....~.... ............ 10. Date of Purchase ......... ~...~...~ ........................ Name of Former Owner -- 1 1. Zone or use district in which premises are situated .......... 4~. ..................................................................................... 12. Does proposed construction~,, - ,,- ~.~, ~. - A -viql°-te any zonine la~, ordinance or regulation.;> ........ ~......o. ........................................ 13. Name of Owner of premise~..../~...~....~...~/~Address~..~....~..'~..'. Phone No ..................... Name of Architect ............................ .~....~ ........ ~, ........ ^dd'res~...~..~.,.~....'..: ........... v.. Phone No ......... ~7'""'" Nome of Contracto~.~..~ ......... ^ddress/e~~~/.~ Phone No~.~..~..~.....v~..v PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from 'operty lines. Give street and block number or description according to deed, and show street names and indicate ~ether i,nterior or corner lot. , No. 52-8125850, Suffolk Count~ Term Expires March 30, 19~ OF ...... rd~lame ot InOlVlOUal signing oppllCOtlOn) above named. He is the ................................................"----- ~--~ -'- '"..~,....0....,~..1....1..../..~.....~....?.,].~..1...~.. ......................................................... (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 contoined 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. .S..w..o...m...t..o..l~..C~; ~eytho~S .......... ~....,,.~C~........=.....I 19.7/. Z~..~....~.~ .............. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY [---~? 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~ October ~ · ~ 8702~u THIS CERTIFIES THAT o~y t~ ~t~ ~u~t ~ ~ ~ ~ int~ ~y t~ ~t ~ ~ t~ ~ ~a~n ~m~r ~ t~ ~m~s of ~,,ere~ ~.,a ~orta~ay Shore f(d.~G~enpo~L.~. ~ in the foll~ing ~ation; ~ B~e~nt ~ 1st FL ~ 2nd Fl. S~tion Bilk ~t ~ ,, * ~) a~found ~ ~ in ~mplia~e with the r~ui~nts of th~ ~. RXTURE [ I I RXTURES RANGES ICOOKING DECKS I OUTLETS IECEPTAC"Sl SWITCHES.I,~^~,~iFL~E~Ti ~. r.I K.w, i ~T.l~.w. i, DRYERS J FURNACE MOTORS I FUTURE AP~JANCE FEEDERS ECIALREC'PT TIMECLOCKS I DELL ~ F i 30 ! , SET~~ I-o,~'1 :,: s ~e R~/,,~ v ITHER APPARATUS: OVENS 1DISH WASHERS UNIT HEATRES MULTI'OUTE-S'T EXHAUST FANS i -i/(; Peter* OaZlawu Ave. · %outho] :~, ',. Y. 11)71 Per_ This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified by their credentia s. coPY FOR BUILDING DEPARTMEHT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.