HomeMy WebLinkAbout6253-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. J~21t~ ..... Date ......... '... J.ul~r .... ~ ...... , 1973.
THIS CERTIFIES that the building located at 1~o .O, oW., .$/,% .New. 5uf. fot~ ./O~eet
Map No. ~ ........ Block No..XX ....... Lot No. ~... Eatt&.tu~k...N,Y., ........
conforms substantially to the Application for ~Buildin~~ permit heretofore filed,in this office
dated ........... l~e~', · 13' ' 19. ?2- pursuant to/which Building Permit No. 62~1Z
" ,' ~;252Z' '
dated ..... N~ .... ~ ....... , 19. '7'2, was issue(i, and conforms to al~ of thel~/l~ellO~; ~lp~l~
,' ; rex'
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . P. rivato, ene..f, amtty, dwelling, with. acee seo~¥, buil~Li, ng. &..f.e~ee
The certificate is issUed~ to .. Ii....Alvi.n · ~mt. th · ...... Owne.l, ........................
of the aforesaid bulldog.
Suffolk C6unty Department of Health Approval
. (owner, lbssee or tenant)
UNDERWRITERS CERTIFICATE No..N. 'O9~61'9 ' ' · lc. ay.. 2' '~973 ....................
HOUSE NUMBER...7690 ...... Street .... ]~hitW' SI~;~O].~' 'AV~';i: ........................
Building Inspector
FOI~M NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.. Y.
BUILDING P, ERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
cOMPLETION OF THE WORK AUTHORIZED)
N? 6251 Z
Permission is hereby granted to:
Flo~el,.. ~i.~.l.t-..B~.!tt.~ag.- Co.rp..... A/(~.....1~ ~ · ..Alv~ 8m~h
'"'8~3'""'~i~h~"~l~ ..................................
........... Ym2dbur3r ......... ~.~. ..............................
to ....~uf~.~d...~.~.,.ol.~..T~/~j3.7..~,~,t~.~.~.~t~.....&...Ae~e~el,.~..~;L.l~.4~g.~.-Z~..ey,,4.-s~:J~tg
· ..aoeees olT..bul.l~ f~g.. ~ ..&ppt'oved.,..l~' ])o~,rfl~" cff":kppl'e~l:"lleV"2i'"~)~ ......
pursuant to application dated .,,~,,~,,..,~,~.~,,~.~.,...l~..,.~..,&[;)~,,~,a,~...., and approved by the
Building Inspector,
Fee $'"~'~'~0' .........
Building Inspec~r
(
FO~,M NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 6252 Z
Permission is hereby granted to:
......... .Sk~3.....,z.e~c~Q...T~ .............................
............ .U...o..o..d...b....u~ .................................................
to BuSed ne~ aecesso...~.. (
................ ~..~.~?.d.....b..~...~....,.~.~.?..,..Z...,......,..,.~..~ ............ .!..9.~ .............................................
at premises located at ...... ~.~.Q~[~...~£~..i~L/IL..~¥...31~£~3J:..A~I. ..........................................
.................................................... l~a.tt£tuek.....I¢,~.o ........................................................................
pursuant to application dated ................... ~ ........~ ................. , 19...~., and approved by the
Building Inspector.
Fee S.li~.e.(~ ............
Building Inspector
FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN C:LERK'S OFFICE
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 6253 Z
Date ................... ~i' .......... P~. .............. , 19.~2...
Permission is hereby granted to:
Fl~w.e~..~lll.~uil~ ~&..~ or~...A/.C..~.Al.v~n $~th
...... ~2~t....~.ericho...TT~k .................................
............. lloo~,~.~....l~o~.o .................................
to ...... ~. ~ I~,a. te...ez:J,e.ti~...~ue,~..oo~.~e ............................................................................
at premises located at ..... ~eO.,W...oJ'.~...~/~..l~ew..&~.z.~=Z-i~...~2~e ...................................
..................................................... ~.~tl.tu~k.....~to~:. .......................................................................
pursuant to application dated ............ ,11Jl~' ....... '%'3 ........................ , 19.~/~..., and approved by the
Building Inspector.
Fee $.~J~ieDO ...........
FOB, M NO. 6
TOWN OF SOUTHOLD
Building Depmtment
Town Glerks Office
Southold, N. Y. 11971
APPLIGATION FOR CERTiFiCATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building
Inspector with the following; for new buildings or new use:
I. 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 dwelJing or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date ......J..u..n..e.,, .! .2..,., .! ~..7] .................
New Building .........~( ......... Old or Pre-existing Building ............................ Vacant Land ............................
I~Z~..P.F. iy.~.~.e. Rla,..h.t of .~..a.y.a Vii l..a.9.e....o..f....H..e..t..t..[.t..u..c..k..,. Tow.n...o..f...S..o.u.thol~..
Location Of Property ...........................................................
Owner Or Owners Of Property .......... .A.!..v.!..n....S..m.!..t.,h. .......................................................................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No....6..2.~.!....7.. ...... Date Of Permit ..!.!./..2./.Z.2,....Applicant ..F..1...o~...qF....H..i.1..[...B..u..[.!.d..i.n.g...C.p..r.P..: .............
Health Dept. Approval ].r)./.].0./.7.Z...-...~;.~I.Z~.~ .......... Labor Dept. Approval ................................................
Underwriters Approval ..~;../..2..2../.7.~...-....N..0.~.!..6.!.~ .......... Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ........X.. ................................
Fee Submitted $ ~.....0..0. ............................
Construction on above described building and permi~codes and regulations.
~t=',e of tCew York
Sworn to before me ~'~'~'~ Applicant .................................... ~,.... ....... ~ .........................................
th~. ........ dJ~roq/n..t o..befo~e- s
............ .Lt day of .....
Notary Publi~~ounty
Yor~:
NOTARY pUBLtC, Sta~eT.~
New
SUFFOLK COUNTY DEPARTMENT OF HEALTH
APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM
Applicant Flor I~lll Buildln~ Cor'p.
1. Phone~92-%5%~. Subdiv.
Address 821~3 Jerl~ T~., W~bu~, Ne. Yo~ 6. Section
2. Property location E/$ Private Right of W~, 7. Lot No.
8. Private well
Village ~ttl~"¢k Township ~u~ho~d 9. Public water
3. Public Water Company name Distance to main
4. Lot size: Width ~}~ feet Length ~9~ feet (Enter on center
10. Sewage Disposal System:
A.
B.
×
plot below)
900 gallon septic tank: ~r, ecast ~' .E~valent Block__
Leaching pools: Number~l__Precast ~ Block Special
If private well fill
in blanks below:
Tank capacity~ Gals.
Pump G.P.M~6~
Total well depth 5~'
Depth to G.W.
Amount of water in
well /fO'
Test Hole
Data Feet
SANv ~ 0
L~ 2
~ 4
6
8
10
12
14
16
lB
The undersigned CERTIFIES: "Construction of authorized
be in accordance with the Suffolk County Department of Health's current stand-
ards thereto." i~'L0~BU~0]~-
Date Soptembar 20, ]972 Signed
~ or Builder
installations will
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 can be installed on th ts plot.Date ~0/~0/77__- S igned~~ ~_?/~
S-15
Revised 4/1/72
Pflu$T
TOWN OF SOUTHOLD , j . /' ~, F~ ~
BUILDING DEPARTMENT Y~P~..~; _ ~--(--~'~
TOWH CLERK'S oFFI~ i. ~ ~ '~ ,
~~t~n ~o .................................
........................ ............. - .
,&-It 1~ ~ *1 (Building Ins~tor) I ~ ~ t ....
t 0
~ ~~ APPLiCATiON FOR BUILDING P~lT ~ ~ ~~
~ ' Date ............ ~.,~.~ .............. , lg,~.~..
. ,sT.U O,S
~. lhi~ ~pplicofion must bo compl~t~l~ fill~ in b~ ~,writer or in ink *nd ~ubmitted in ~lie~ to Ih* Buildin~
In*p*ctor.
b. Plot plan sh~in~ Iocotio~ o{ lot ~nd o{ buildinO~ on pr*mi~*, relationship to odioinino pr~mi~e~ or public *tre*t~ or
ore,s, ~nd flivino ~ dot~il~ description o{ l~yout o~prop~ mu~ b~ drawn on ~he dio~ram which i~ ~d o{ thi~ ~pplieotion.
c. Th~ work cov~r*d by thi~ opplic~fion moy not b~ comme~ed b~fore i~uanc~ o{ Buildin~ P*rmit.
d. ~pon approval of thi~ ~pplic~tion, ~ Buildino Insp~tor will issue o Buildino P~rmit to ~ ~i~ont. ~h p~rmlt~
~h~ll b~ kept on th~ premi~ ovoil~ble {or inspection thr~hout th~ p~re~s o~ th. work.
~. ~o buildin~ ~hall be ~cupi~d or u~d in whol~ or in pa~ {or ~ny pu~o*~ whatever until ~ ~i{icot~ of
~hall h~v~ be~ oranted by th~ Buildin~ In~p~tor.
APPklC~TIO~ ~S H[~fi~Y ~D[ to th~ Buildino Dopo~m*nt {or tho i*~uanc~ of ~ Buildin~ ~it pu~uonI
Buildin~ Zon~ O~inonc~ o{ lh~ Town o{ ~utho~d, Suffolk Count, ~w York, ond other ~plic~bl* ~w*, O~in~nc~ or
Regulation*, for th~ comtrucfion o~ buildings, ~iti~ or a~t~ration~, or for removal or d~moliti~, ~ h~in
~ opplic,nt ~Ore,~ to comply with ~11 ~pplic~bl~ l~w~ ordinances, bu~ldln~ c~e, housln~ c~ ond r~ul~ion~.
.................... .........................
82~,3 JERICHO TPKE., W0ODBURY, NEW YORK
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general, contractor, electrician, plumber or builder.
Name of owner of premises ........................... A.l..y.).n...s. ml. h ....................................................................................................
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 ........................... .E../.~S~.~.P..r.~..v..a.~t.e....R..[..[....R.!.c~.h..t..~f..~.a.y.x~.~.t.~t`~..t.~...~R[~.~..~...
2. State existing use and occUPancy of premises and intended use and occupar~rc'y bf'prop~edr'c'onstmction?
a. Exisiting use and occupancy ........................V..a...c..a..n..t....~.s~nd ...................................................................................
b. Intended use and occupancy ....................... ?..r..l.v..a.t..e....r...e.s..!.~e.n..c..e. ......................................................................
3. Nature of work (check which applicable): New Building ...... .X. .......... Addition .................. Alteration ..................
Repair .................. Removal .................. Demalition .................. Other Work (Describe) ........................................
4. Estimated Cost $/~b~t000,00 Fee .
(to be paid on filing this application)
5. If dwelling, number of dwelling units ...... .0..n..e ................. Number of dwelling units on each floor ............................
If garage, number of cars detached two car garage and detached guest cottage
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 ................................
6.zt,8 ' , ,,
8. Dimensions of entire new construction: Front .............................. Rear ....... 6./{..{~ ............. Depth ....~.~:..8.'.'. ..........
Height ......... ].P~! ...... Number of Stories ..............~nf~ .............. ..
9. Size of lot: ~ ..~D.,DDDD...s.q.....f. tpdl~Let..I.r.£egtll~r. ................ I~,pt~. ...............................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated I{es Ident la i
12. Does proposed construction violate any zoning law, ordinance or regulation> No
13. Name of Owner of premises ...A..I..v..I..n....S..m..I..t..h. ................ Address ............................................ Phone No .....................
Name of Architect Flower Hill Bulidlng Cbrp. A,~,~ 82b'3 Jericho Tpke. .
..............................................................,, ,, ,, ,, ~{fSb. fH,~, .,. · .N ~;dily~ t,k ...... Phone No.69 ;t.~ .Zt5./t5 ......
Name of Contractor .................................................... Address ............................................ Phone No. ~' ~'
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck 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.
,NO'fART' PUBLIC~, State of New Yo~k
No. 30-2622700
Qualified in Na~au County
Tm*m Expires M~:ach ~0, 1973
STATE OF NEW YORK, ~- c c
COUNTY OF ........... ~li~e~ ......... $~'~
THOHAS E, UHL- i : .
............. ~: ............ .................................................................. :..being duly sworn, deposes and says that he is the applicant
(Name of individual signing application)
above named. He is the ............ P.r. MJ.d~nLgf...F..tg~.~.r..H..! ~ ~ ~J ~.g,..~.~.F.R~..Vi~l.i..qh..J. li...~l~..~FJ.1;£~.~.l~g~ ...................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the sgid Work and to make and file
this application; that all statements contained in this application are true to the be~f~f his knowledge and belief; and
thc~ the work ~will be performed in the manner set forth i~ the application file~.
Swam to before me this ~
.............................................