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HomeMy WebLinkAbout6298-zFORM NO. 4 TOWN OF $OUTHOLD BUII.I)ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupancy No.Z~2.~ ....... Date ................. $~t...~..., 19..~.'~ THIS CERTIFIES that the building located at l~_ .m~. ~[~ .l)r~v.e ............. Street __.~._-~P N~Cap$, .K:l. dd..Ed~lock No ........... Lot No. 82 .... l~;~;~,~;l~Ck..N,¥.,. ....... -~,,con~orms substantially to the Application for Building Permit heretofore fried in this office dated .......... .Dee ..... 48, 19-72. pursuant to which Building Permit No..62.~7,. dated ........... Dec .... 1 ~..., 19.72, 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.r~Y.~..o.n.e...ff..a~.~..ly..d.¥e.l.]...~.~ ................................... The certificate is issued to ... Ha~ry. O-onsf, antLue ....... .0~rne~. ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. Aug...~ ~.. 19.7.~. b~'R,. ¥;l,l~,a ..... UNDERWRITERS CERTIFICATE No..N..0~1~99~ ..... J.~u~...7...1973 ............ HOUSE NUMBER . .670. ........ Street. ~il..~ .I~'ii,'~ .......................... g P~¢ FOR~ 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? 6298 Z Permission is hereby granted to: ........... Ilatt~tu~....llo~:o ................................ at premises located at ...... ~t...-~....~,~Ft..~..~,~tr ................................................................ ..................................... S~eatt ..i~.. ~.. II,aaa .Jla .............. Ilatt:~*,uok .................................... pursuant to application dated .......................... ~1~. ....... ~1~ .......... , 19..~., and approved by the Building Inspector. Fee $..~1~,.$~ ......... Building 'l~spector ( FOBM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerk~ Office Southold, N. ¥. 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 dispcsol--(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 $5.00 Date ..../~....~.! .(..'~..~..~..... ~..,..../.,~...~'.~' New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~.~....l~....~..~...~.....~...~.~.. ....... ..u~...~...~.?..........l~...~..~.$..~...~..~........~:....(~...; ........................ Owner Or Owners Of Property ......~....~...(~..Z'.~..:.I. ...... .~..~..~Z..~[.~....~....~.'...~..~...~?.~i.~..~.. ................................................. Subdivision ...~....~.....~...:...~...:t.~...~........~..~.~..!]...~..~ ...... Lot No.....~...~ Block No .............House No ............. Permit No. ~.~..~. Date Of PermitJ~^../.~.2.~licant /:~,~ .~.Z........~.~D,~.~ .Z~.~..~.~...."~.;..'.A/....~..~. ......... Health Dept. Approval .:.~.:.O.....'T./...'~..'..~..~.. ................ Labor Dept. Approval .............. .~....~. ...................... Underwriters Approval ,~,.~...,O..~,,.~,,Z,~.. ................ Planning Board Approval ...... ,/~.,'....!,,~.,.: ................... Request For Temporary Certificate ........................................ Final Certificate !/ Fee Submitted $ ..~. .............. i .............. Construction on above described building and permit meets all applicable codes and regulations. App cant ..~.~-~../ ~ ~..~..:..~,~,~.. . . , Sworn to before me this ..... .~, ...... day of ...~.....' ........... ~,... Notary Public .................................... County (stamp or seal) .~,~ -~'/ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.P. Reference No. ~J'/~ ~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM APplicant J~ ~ tam Ph~___4_J~_5. Subdiv. Address ~e~ J~ ~tt~ #.To 119J2 6. Section 2. Property location ~Outh ~. Village NItt~JlJ~.J~ Township~D~th~l~ 3. Public Water Company 4. Lot size: Width lOO feet Length~feet ~O.-tem~ge Disposa/~..~ystem: k ........ ) A, /9'00~gallon septic tank: Precast__~_Equivalent Block__ B. L~ching pools: Number__J~Precast~Block Special 7. Lot No. ~2 8. Private well I~ 9. Public water~.l[Jdd ~&~(~ Distance to main~*. (Enter on center plot below) The undersigned CERTIFIES: "Construction be mn accordance with the Suffolk ards thereto." If private well fill in blanks below: PumpTan~' Gals. Total~well depth Depth ~'o ~.W._ Amount. o~i~,wat~r in well Test Hol~ Data Feet ~ 0 . C'~ 2 C~ 4 6 8 10 12 14 16 18 of authorized installations will County Department of Health's current stand- Dee. ~1, Z973 Date FOR HEALTH DEPARTMENT USE ONLY, Based on is the opinion of the Health Department, Disposal System can be installed on this Date ~ O~r'~o'r ~i~er the informat~'dn presented herewith, it that an adequate and satisfactory Sewage plot. Signed S-15 Revised 4/]/72 LOt 82 ' ~ LOt 94 LOt 95,' NOTE: · -' MONUMENT SU~OIVI$10# &~AP F~ ~D IN ~"HE OFFI~m OF TH~ C~£~K OFSUFFO~ K COUNT YON dAN. I~ 19~gASFI££NO, R~V,S~ONS YOUNG & YOUNG AUG. IO~1973 400 OSTRANDER AVENUE, RIVERHEAD, N~'W YORK ALDEN W. YOUNG HOWARD W. YOUNG HARRY CONSTATINE . ~, LOT NO. 82," CAPTAIN KIDD ESTAT ut .,~ ~.~,_ *T MATT;TUCK ~ .L.. ~'~ -- TOW'O' SCALE: I" : 40' DATE:DEC. 1~,1972 i.D. 72-1013 10 THIS SU[V[Y IS A VIOLATION OF LOt ~ ~ 94 ~--~ NOTE: · = MONUMENT SUBDIVISION MAP FILED IN I'HE OFfiCE OF THE CL ~1( OFSUFFO~ t( ~OUN?' Y ON dAN. I~ 1949ASFILENQ REV:S~ONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W . YOUNG HOWARD W. YOUNG SURVEY FOR: HARRY CONSTATINE TA~ LOT NO. 82," CAPTAIN KIDD ES G:JA ANTEI~ AT MATT[TUCK { JA~ ANTEi~ SCALE: I" = 40' DATE:DEC. 13~1972 TOWN OF sOuTHOLD ~ BUILDING DEPARTMENT TOWH CLERK'S OFFICE ~ ~UTHOLD, N. Y. Examin~ ...~ .......... G ............... , 19...L... , ............................... :. ............. ............... ......................... - ' APPLICATION FOR ,UILDIHG ,,,MI, 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, an~_ giving a detailed description of layout of property must be drawn on 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 shall be kept or~, the promises ~lvailable for inspection throughout the work. ~ e, No buildin~q shall be. occupied or used ~in whole or in pert f~r any purpose whatever until a Certificate of Occupancy shall have beeq~ §ran~cl by the Building In~pect6r. 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) Inlet l rive, M&ttituck, lq. Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ Otmer Name of owner of premises H&c~']r..~.t.a~t.J.lte ........................................................................................................ 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 I~..~..~.A~..~.~..~s~t.~ No...$1 ...................................... Street and Number ............................... 2 ......................................... 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 .~u~,l.e. ~____;. · a]al~l~ .............................................................................. · ~ ~ ~ 3. Nature of wor,k (check which applicable): New Building ...~[ ................. Addition .................. :.. Alteration ............... · Repair Remo al De olition Other Work (Description) 4. Estimated Cost ....... .3....8./. ~e....(~... .................. Fee .....~...~......./..?.Z ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ..Z.. ............. Number of dwelling units on each floor ..,...1~... ..................... ~ ........ If garage, number of cars ...... ..~...~. .................................................................. i ............................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of usa ..... I~/Jb ........................ 7. Dimensions of existing structures, if any: Front .~13.e .......... Rear ........................... Depth ................................... Height ............. .l~...a..e. ..................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .~.I~, ............... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..4.~....f...t.a .......... Rear ...4~...f. to ............ Depth ...~..J[.t:.~, ................ Height ................................................. Number of Stories .~.~,~l~3~e ......................................................................... 9. ' Size of lot: Frdnt ....~I,~.~..EJ;' .................. Rear .113~1..~.t., ........................ Depth ~./aS..~.:l;o.~.eg&ge.) ............ Height ............................................. Number of Stories 10. Date of Purchase ......][~.~, ........................ Name of Former Owner ............................................................................ · ....... ~ Res~dent~a! ........ 11. Zone or usa district in which prem~sas are muamu ............................................................................................. 12. Does proposad construction violate any zoning law, ordinance or regulation: ~ ....................................................... 13. Will lot beregraded.__.?_e,~. .......................... Will excess fill be removed from premisas: [ ] Yes [~] No 14. Name of Owner of premisas .~...~..~.....~a.t~tiTzee...Z~te~,:.~Ft?,~r..h~ti.~e~,v..~q~:..~a,::3~..4.3~ . t,o,a.a ress) /Fnone mo.~ Name of Architect .....l~....a..e. ......................................................................................................................................... (Address) (Phone No.) Name of Contractor ~..e.[.f. .......................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposad, and indicate all sat-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. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform ~Dl~,~eT~r~J~ed the said work and to make and file this application; that all statements contained in this application are true to the ~f~J~:,k~'~l~¢!~Jorl~elief; and that the work will be performed in the manner No 52 03449 set forth in the application filed therewith. ~ - - 63 Suffolk Counf~ (/ - ~ (Signature of app ' ) STATE OF NEW YORJ~r~ COUNTY OF .................................. ) {~ame of indivi~l si~ing con~ ................................ .....................................................................................................................