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HomeMy WebLinkAbout6104-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sonthold, N. Y. Cedi~icate O~ Occupancy No~16.6. ....... Date .............. .EAT...~9 ...... , 19. THIS CERTIFIES that the building located at . .'40;LX~.. 6.v~..~. p~lg. ?!~Ce Street Map No. i~arvo~t .l~a~lock No ........... Lot No..1.7.. · .Soul;ho'Lei.. I( ,Y.o .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Sept...8 ...... , 19..72 pursuant to which Building Permit No..610k, z. dated ........... l~pt.. 8 · ·., 19..7~, 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 . P. ri?~te, ona. family. ~welling ...................................... The certificate is issued to . Anthony .&. Anteinel;te. · .Ca**ie, h ..... O~ner~ ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .PAY...29...1975..b.y. fi.,...V.i.l.!At. ..... UNDERWRITERS CERTIFICATE No...Eay...'ltl. 19.73.. bT..J,. J~ubackl ............... [lOUSE NUMBER..1~O ...... Street .... ¥iS1]S..A,V~ ................................... ................. ~30 ..............p~.e. ls. p..24.,~e. .................................. Building Inspector I~OF,.M NO. '~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL CC~MPLETION OF THE WORK AUTHORIZED) N? 610~ Z Date ............................................... 19 Permission is hereby granted to: '~~~.~ ...... ~.~ ~.......~j~.~.......~.:. ....... ............................................................................. ................................... .................................. .......................... , ~nd opprov~ by the Building Inspector. UuHom~' Inspector FORM NO. $ TOWN OF SOUTHOLD Building Deportment Town Cleric* Office Southold, 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. New Building . ..~.. .............. Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...(~.~'.~....j....S.. ....... ~..~.J~........~.....~..~..C'.r~..........~..~:..~..~.~.~. .......... .~..~....~..~.../~...~.~ ........ Owner Or Owners Of Property ............. ://(. ......................................................................... Subdivision .~..~...~.~.~..~..,.-~.........~...o. ,/~../.,~...~. .............. Lot No...L~.. ..... Block No ............. House No.,/.~..~P Permit No...~..J...O../'~....Z Date Of Permit ..?.Z~/.~..~....Applicant ...~...~./..~...O.~.,~........~..'~..~....~'../.'...C-c.~L,~. ....... Health Dept. Approval ..:......J,,,~..... ........................... 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 a~d regulations. Applicant .. f)...cff~.......¢~'....~-- ................................ Sworn to before me this ...... otory TERRI LEE ~ pUBLiC, State of I~ew York (stamp or seal) Examined ........................................ , ............. lrOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 1~....~/. Pemit No...~.~.Z.i~..~.......~.. ...... Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT ,~ ote ............ ................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit¥. 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 giving a detailed description of layout of property must be drawn on diagram which is part of this application, i~ , c. The work covered by this aJ~plication 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 ke 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 b~er 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; .......................... .............................................................................................................................................. Name of owner of premises ..~.~..~L~.i.~.~.......~...~.~.~.~Z~/)./~...~..~. ........ ..~[.~.~...~.J..~.~. ................... If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) 1. ~rCe:~:~dOfNl2r~d~rn ...w~..i.l~.c..h;:/i~.~..~..~ ~k.~..w..i.l.l.~...~ ot No ...................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~..... .................................................................................................................... b. Intended use and occupancy ............ ~... ~....~--,~......~ .................................................................. o t Nature of work (check which applicable): New Building ..... ~ ............ Addition ..................... Alteratio~n.....~.....'. .... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~ t ~'~' O C/h¢,~ ~ (Description) Fee ,/.,~::3 ~'-' -~°C~' Estimated L. os .................. :-.~ ....................................... i~ ~ '1;'~ 'p'~ ~ ~' '~i'li;;~' ~'t; i;'~'l; ~;ii'~ ;:t'i~ ;ii ................................. 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 ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories .............. .~ c../ -~ ~;'7 ..................... mens ons of ent re new construct on: Front ........... .,~,,...~....... Rear ..... ~..,,~.. ............. Depth ..~...~,,...?;,,.~ .............. 8. D Height ................................................. Number of Stories .,,,.'. ................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............... ~ ....................................................... 11. Zone or use district in which premises are situated ........ ~ ......~;/~J~...~¢.....~.. ............................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .~...O.~ ............................................. 13, Will lot be regraded ................................... Will excess fill be removed from premises: [ ] Yes [ ] No /. ° ...................................... 14. Name of Owner of premises ..... .~... . ~/,/,¥.,~..~ddressiO.; (Phone No.) __ Name of Architect .......................................................................................................... ~., ~, ~.., .~'. ,~. ,. ,~., ~.., ........ (Address) (Phone No.') Name of Contractor ................................................................................................................................................... (Address) (Phone No.) 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 description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YO~, ~.,~. J- ) ............................ i ~ 'ndi idual s~ning contract) .......... being duly sworn, deposes and says that he is the applicant above named. He is the (Contractor, agen t. corporate officer, etc.) of said owner or owners, and is duly authorized to perform o? ,ha.v~op~.~rmed the said work and to make and file this application; that all ~tatements contained in this application are true to t~e besf_ 6f fi s kno~/ledg, e~l belief and that the work will be performed in the manner set forth in the application filed therewith. Ho 52-0344963 Suffolk Coun~ ............................... l,~....day of ..,.'~.......~.: .................................. 19 .....~...~..'~.. , Notary Publi ..~'... ounty ........ ~ ..... ...~.....~... ...... ~' (Signature t6f applicant) SUFFOLK COUNTY DEPARTMENT OF HEALTH N0 , .., , . ,,t ~ ,:,~ ~>c i ~-- H.D. Reference . APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Phone~ Address l~''~ /~ ~-~mz~tH~-IX /~/~ >~aa~~ 6. Section ' 2. Property locat~o~ ~f£~-, ~,~:--,-4 ~)c-~ I{ t~A~ 7. Lot No. 4. !O. 8. Private well Village%~:u~ ~'AO Township ~a'~/~L ~ 9. Public water Public Water Company name ,(~.i~'~'- Distance to main, , Lot size: Width /~,~ feet Length /7.~-- feet (Enter on center plot below) Sewage Disposal System: A. 900 gallon septic tank: Precast/ Equivalent Block B. Leaching pools: Number,~Precas~;'/Block Special If p~ivate well in blanks below: Tank capacity Pump G. P .M,. ~ Totals'well depth Depth to G.W. Amount of water in well TestHole Data,, Feet 0 2 4 6 8 10 12 14 16 18 The undersigned be in accordance ards thereto." fill Gals. CERTIFIES: "Construction of authorized installations will with the Suffolk County Department of Health's current stand- Date Signed ~'~ - ~7, '~ ;t~lC>© , Own e r/~/o r Builder ~OR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion DC the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date ~' Signed - 5-15 Revised 4/]/72 F 175,()0 .sar~ 04 c(_, ,~. SgYFO/~ fOrTY ltF~TH DEPARTI~ENT ~,~.z~ MAY 2 9 ~9~ The sewage disposal and ~mT. er sump].y fac~.l~t~es for %his location have been . ~ . ~ .... P~n~ ~d found Chief 0f General Engineerin¢ Services 't ,1 2~ '0