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HomeMy WebLinkAbout6311-z FORM NO. TOWN BUILDING DEPARTMENT Town Clerk's Office · $outhold, N. Y. Certificate Of Occupancy No ....Z 369' Date ............Aug~; .10t .... ,197.3. THIS CERTIFIES that the building located at . ~e~ee -~X, al3, ............. Street Map No.. 5;~L26 ...... Block No..XX ....... Lot No.. '~'9 ...... ~ol~t, hol.d,t .][,~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 'D~',' '27~' ', 19.72. pursuant to which Building Permit No.. dated ........... Dee'.' '27F- -, 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 'PI'~.' ...... ~e' fmatty 'dw~ '~illg ....................................... The certificate is issued to 'Rob~.;' ga~n~l' ...................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No ..................................... / ........ HOUSE NUMBER .............. Street ...... ~. ~'~r~.l ........................... Building Inspector [ FOR~[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6311 Z Date ....................... ,,~e,C.....2~ ............... , 19~.2 .... Permission is hereby granted to: Ge~..~Ll~le~s...~i~ e.r...~.~,~..... ~/.C.....~ebe ~t I(assner · .~.~O..(~...t,a. ..................................................... ....... g-u~eheg~ ................................................... to .. ~u~l d...r~w.. ~ne...t~ ~£ .t.~ .. d.w ~t- .t&.n~ ................................................................................... at premises located at ...... .~o~C..,j~) ....... ~;u.~k~)~a...,,e~e~,s ............................................................ ................................... · e~pee..T.~a.~.t ............... ~ot~h, ,:~d.....'....., .,.~ ................................................ .... ~{&~F.~...¢~eek...f.,p..evePa~e...se~.ee~,...~ ............................................................................. pursuant to application dated ........................D~(~.....~..~I ............... , 19.~'.:~..., and approved by the Building Inspector. Fee $ [~.~ ,.~Q ............ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OGCUPANCY 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, Industriai 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 appllcable. B. For existing buildings (prior to April 1957), No~-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 safe~ 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 $5.00 // / Date ............................................. ~...~ New Building ...... ~ ........... Old or Pre-existing Building ............................ Vacant Lond ............................ ,ocatlon Of .............. Owner Or Owners Of Property ...'..~..~./,/,~:....~.~..~.~ ............................................. Subdivision ......... ~....O..../~..~...~J~.~.~.,..~..?.~....~...l-ot-- No...../..~..... Block No ............. House No ............. Permit No...~....~..LI....~... Date Of Permit/..~.~..~..?:/~: .~...Applicant ~.....~..~~.. ...................... Health Dept. Approval ....~;~.~...~.,~..~...¥..~...?.Z~/...~bor Dept. Approval ......... ..~.......~..: .......................... ~- ' - .... ..F...:..~ ..................... Underwriters Approval ~.......~ ............................. Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate ......~...i ............................... Fee Submitted $ .....~. ~...O.- ..................... Construction on above described building and permit meets all applicable codes and regulations. App,ica.t ~~...~..~ ................ .~.~...~.~.~ Sworn to before me ~ ............ /.Odo~ of ....~..-.~-~7.....Z.~.~..>~ ~ ~ ~ Notary Public, Sta~e ot N~ Y~ ~ (stamp or seal) -/of ~7, P' ~oT ~o /-o? .2_0 \ A//~ ~ o' z'" ,LDp,. o,c:, ~--.c<~ ~-- ©6/T.'-fOZ_~ A] SUFFOLK COUNTY DEPARTMENT OF HEALTH EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval tn construct said Sy,~tems~ iS regueste~.epertinent~da%a herewith: 1-Applicant '5' I ~,, ,~ , , -~ ~ ~ho~e 6-Sub div Address .~ , 3.. 7-Section 2-Detailed property location 8-Lot No. Hamlet 'Town 9-Private well? 3-Public water supply name Distance to nearest main 4-Lot Size: Width ft. Length. ft. (al~o' 'enter on cepter plot plan below:) 5-Dwelling: Singl.e Family 10-Proposed system. Septic tank .~Precas~ ~._./Cesspools J /Shallow pools / /Other / / 11-Septic tank inside dimensionsk'~olume(~_~_Gals.Length ft. Width ft. Liquid. depth ft. 12-Precast sections: ~/Number~/Square Ft. Cesspools: Block sizeL incs.D.__ins. H~-~ns. Total blocks below inlet: PLOT PLAN Date Capa city_~_-'G'als. G.P.M. ,~ 'ad~ , G .W.L. The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments t~eret~o, covering Private Sewage Disposal Systems". Date , Signed Own.er~°r Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the mnforma~lon .presented herewith, it is the opinion of the Health Department, that an adequate a~d satmsfactory Sewage Disposal System can be installed on this Plot. Date (10/65 Revis.) Signed Indi e No ~th Data ?eet 0 2 6 8 10 12 ~6 18 . TOWN OF SOUTHOLD ' BUILDING DEPARTMENT~::~/¥ TOWH CLERIC'S OFFICE SOUTHOLD, N. Y. ~,~ ..................... ~.~ ................ , ~ ........ ~z~ No..~.L.~.~ Disapproved o/c ............ ~ ............... APPLICATION FOR BUILDING PERMIT Date ......................... ~'~..q..~.Z ........ .'~..?.....~....-- INSTRUCTIONS a, This applicetion must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspectu~, 3 sets of pans accurate plot plan to scale, Fee according to schedule. b. Plot plan showing location of lot and of buildings on prem ses, relationship to adjoining premises or public streets or areas, anl31 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 al~proval of this application, the Building Inspector will issue a Building Permit to the applicant, Such permit shall be I )t on 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~k 'been grant~d by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Buildi Z Ordinance of the Town of Southold, Suffo[l~ 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. ...... i~;~';~r'e ~)f applicant, or name, ifa corporation) ........................... ........................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ Name of owner of premises ...~!(/~....../~ .............................................................................................. If applicant is a corp~,,signature of J;tuly authorized officer. v ~/~Name and title of corporate officer) · / 1. Location of land on which proposed work will be done. Map No: ~.~.a~..'.... Lot No ........... .~... ............................. Street and Number ..............~l~.~J~.,l~......~./..'.'~.. ........................................... ~~ ....................... Municipality 2. State existing use and occupancy of premises and intended u~e and occupancy of proposed construction: a. Existing use and occupancy //'/~"-"-~' b. Intended use and occupancy ................. . ..~....../~. · ~ .~....~. ............................................................. ~*"~;'~ ........ ~ -, Natur~ of work (check which applicable): New Building Addition ..................... Alteratkm...':.~, ........ Repair ......................... Removal Demolition ........................ Other Work .................................... ......................... (Description) 4. Estimated Cost ..... ~...~./~..~'~. ..................... Fee ................................................................................. · '"' (to be paid on filing this application) 5. 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 ...... ~ ............ Depth ................................... Height ........................................................... Number of Stories ............................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ S. Dimensions of entire new construction: Front ...... ~... ....... Rear ........ ~ ............ Depth ................................. Height .................. ~ ........................ Number of Stories ........................... ../..~ .......................... 9. Size of lot: Front ......... -~;..~;. .................. Rear . ?~.~..O ........ Depth ......... ~....~ ................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ............................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation ............ x'/,...,~. ...................................... 13. Will lot be regraded ........ ~"~.,_ ~ ~..- ~2- .~,_____Will excess fill be removed from premises: [ ] Yes ~'~,] No ~..~ ~ 14. Name of Owner of premises .~,~....x~'~...z~.~.~....-./-.~....~/.~;~z..~.-.~"~-'"' '~"/'~'~'i~h"2~-e~o'~.'~:~ {Address) Name of Architect ...........;; ..................... ;;..;..; ............................ ~;~;i ............................ ';'""~'~ ~ ............... Name OT ~ .... ac[or ~.e~ ~:'~=' '-'""- ~ {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. O" VO.", ) SS COUNTY~ ................. ~/)"~['s'J~-~ingcontr'~) .................... being duly.,~A/) ~'7,~.~.~- ~sw°rn' deposes and says that he is the applicant above named. He is the ......................................................................................... ~~'"'"~'~'~"~'" .................................... (Contractor, agent, corporate~rr~r~te officer, etc.)offic r, ~ .] ~ ! o{ said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that a :;tatements contained in this application are true to the best of his knowledge and belief; and that the work wil~ be performed in the mann( set forth in the application filed therewith. Notary PubLic, County .......................... ; ........................ : .......................................... ..................................................................... ($~,~t~r¢ of THE NEW YORK BOARD OF FIRE UNDERWRITERS ~.k BUREAU OF ELECTRICITY r- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only th~ el~ctrlcai equiprnsnt as d~scrib~d b~lo~ and introduced by the app/icant named on th~ abo~ app/ication flumb~r in th~ premiss of ~ober~ Kaa~ner~ w/a~cte ~ Pee T~,ai~ ~000~ w/o?£ ~lnn~haha Blvd. ~ou~hold, inthefollowinglocation; [] Basement ~IstFI. ~2nd FI. Otl~B~ S~ction Block Lot ~ .o~.~d o. ~ UgU 5 ~ ~ ~ ~ 973 ~d ;o~.d to b~ ~ ~o=p.o.. ~th tn~ ~q~.t~ o! thh ~d. 16 32 17 16 I DRYERS { FURNACE MOTORS I FUTURE &ppuANCE FEEDERS AMT. ' K.W, O~L H.P. GAS H,P. ~v~lT, NO. A.W. ~. RANGES K.w. COOKING DECKS OVENS DiSH WASHERS FI I I I ILl TIMECLOCKSt BELL~UNITHEATERS MULTI-OUTLET / SERVICE DISCONNECT I NO. O~ I S E ,~T. AWL ~ EQUIP. ~#~v ~,~3w 3,f3w ~w O.~c~co o. 1 20 CB x R V I C EXHAUST FANS AMT. H, P, DiMMERS A.W.G. NO, O¢ HI-LEG A.W.G. NO. OFNEUTRALS A.W.G. OF CC, COND. OF HI-LEG OF NEUTRAL ~oto~/sz 1-3/~hp Elec.room hea~er: 2-2.0kw, 2-1.25kw, 3-1.0kw, 7-.75kw, 5-.Skw W.B. Ruland, Mattituek, L.I. m ~ARA~W~ Per ':' ~, COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~L / t / / / I I I I