Loading...
HomeMy WebLinkAbout5791-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate OI Occupancy No...Z~..~..~ ...... Date .............. 6*pt.. $3 .... , 19.~2. THIS CERTIFIES that the building located at .. fl~x, clinerl-/~ne ......... Street Map No..~01k ....... Block No .... lot .....Lot No. ~ ...8OItt~O].~!..N,][, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... bpr~,~,..~,., 19..~ pursuant to which Building Permit No. dated .......... &pr~,~....~'.., 19..~ 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 .Fray&re. _~n~ ®. fara$1y .dv®Ll.~ng ....................................... The certificate is issued to . .Founderl~. ltome~. Ine ........ 0,¢ne~ ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Seltt..~.~.l 9.~.. bl~..it...V$lla ...... UNDERWRITERS CERTIFICATE No..~1..lt.~.~ ........................................ ttOUSI~ N UMBER.. ~ ....... Street .... G&rd~er.~..I~Z~ ............................. Building Inspector FO~ NO. ~ TO~N OF SOUTSOLD 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) 5791 Z Permission is hereby granted to: ...... /.J~Jl~tlra ..1/,~ml...I~....,l~l .................. at premises located at ........ J, ql~'-~'""~&Jr, F~"'P&'~JK ................................................................. ...................................................... ~.s,~l,t..~e,J-.t~, ................... ~o~a~l~ ....................................... pursuant to application dated ................................. A~..-.~..., 19..{~1~., and approved by the Building Inspector. Fee $..~.~ iT. ......... I~ORM NO. 6 TOWN OF SOUTHOLD Building Depo~tment Town Clerics 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 dispcsal--(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 aT 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 $5.00 3. Copy of certificate of accupancy $1.00 D te ......... New Building ..... ~ ......... Old ar Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of Property ..?.~.~,..z~.J~.~.~.~.......~-~e..t~.~.-,~......I.~L..~. ................................................... Subdivision ...?...~...t...R....V...t...~...l~.......~..~....~..t~ ................... Lot No ............. Block No ............. House No ............. Nc~...~...~ J....~.... ...I Permit Date Of Permit/d~'~,..~.~^pplicant ...... .... Underwriters Approval .............................................. nning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes _and regulations. Sworn to before me this ..... !.~. ...... day of ...~.~.'~.~,?~...~. 9~...~..~.~.,,,~,. Notary Public ................. ~s~,~'~. County TERRI L[[ ELAK ~OTARY pUBMC, State 0f New York No. 52-6168295 Qua i[ied in Suffolk Commission Expires Marcl, (stamp or seal) S-9 SCHD SUFFOLK COUNTY DEPAHTHENT OF HEALTH Date ,.~CF ; 1972 Bldg. Permit No. TO WHOM IT at MAY CONCERN: The sewage disposal facilities (Give deed location) for a structure located have been inspected by this department and found to be satisfactory. 1972 Chief of General Eng:ineer~g Serv~ ce~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.DoReference No ~'-/d~ APPLICATION FOR APPR0~J~ TO CONSTRUCT PRIVATE SEWAGE DISPOSAL $YSTF~S Date~ Approval to cor~truct said systems is requested,pertinent data here~lth: Address~''~e~ ~ ~~ ~,~ ?-Section ~ ~ 2-Detail~ p~pe~y locationW/~ ~,~ ~. 3KO'~ t,~. 8-Lot No. q~ ~mlet &~ ~ To~ ~W~-~ '-- ~9-Private well? 3-~blic ~ter supply ~me -- Dis~nce to nearest ~in 4-~t Size: Width IO~ ft. Leggth~O~ ft. (also enter on,enter plot plan below:) 5-~elli~: Single Family ~ T~ Fa~ly? ~ /Cellar? ~l~b? ~ ~Crawl S~ce? lO-~o~s~ ~st~: Septic tank ~ /Precast ~Cess~ols ~S~llow ~ols ~ /Other il-Septic tank inside dimensions: Volume 12-Precast sections: / /Number~Square Total blocks below inlet.-~ PLOT PLAN Gals.Length. ft. Width' ft. Liquid depth___ft. Ft. Cesspools'~lock sizeL~_incs. D ~ ins. H~_4ins. Capacity ~ 'G%ls. O.P.M. Street [ The Undersigned CERTIFIES: Indi No "Construction of authorized installation ;ate ~th Data Feet 0 2 6 8 10 12 will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Date~ m~;~ Signed~er FOR HEALTH DEPART~E~NT 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 this Plot. Date ~/,~7 )-'~ (10/65 Revis.) S-15 TOWN OF SOUTHOLD ~ ;-4 .o · n ,~. ~'~ /.,~ TOWN CLERK'S OFFICE ~ ~ v~ ~,.~ ~ S~THOLD, N.Y. ~ ~.0 ~ ............... , Applicati~ ~6.' ................................ ........................................ , ]9 ........ Pemit ~o ..................................... INSTRUCTIONS o. This.application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plon showing location of lot on.d of buildings on premises, relationship to adjoining premises or public streets or or~s, and giving a detoiled description of layout otpraperb/must be drown on the diogram which is p~rt of this opplication. c. The work covered by this application may not be commenced before issuance of Building Permit. · d. Upon approval of this appJ]cation, the Building Inspector will issue a Building Permit to the applicant. Such perm t shall be kept on the premises 69ailable for.in~pection throughout the progress of 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 hove been 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, buil~.ng ;-ode, housing code, and regulations. (Signature of applicant, or name, if a corporation) , .(Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,, ge, neral contractor, electrician, plumber or builder. Name of owner of premi~e~ ..... .~..?..Y..~..P.~.~.~...~.e .~-....~....~.....)..1~...~-.: .... . ..... ........ .......... :, --f (Name c~d title of Vorporate officer) 1. LOCation of land on which p.rpposed work wifl be done. Map NO.: ........ ; ............................... lot Ne.....~.~: ............... Street and Number :C?..e.A.I~.~ i~ ~8...,.~/~ ,....~'.~..i ~..~..1 ..~.......~..~...&....~. ..... .3..~...~ :...~,~., .~/,i~l..m.-..~..~....~. ~: ........ 2: 'State existing use and'~u~nW of p~is~ and intended use ~d ~cuponcy of p~o~d ¢onsfmction: a. Exisiting use and OCcupancy ................................................................................................................................ b. Intended use and OCcupancy ........ ~....~...l~.......~.~j~ .~..!.~....~'. ...... ~..~...~....Lt..~....~...~..: .................................................... 3.* NatUre of work (check which applicable): New Building ........... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 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 ..~-.~.~9..~...~. ....... If garage, number of cars ...........J. ................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each h/pe 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 ............. ~ .................. I 8. Dimensions of entire new construction: Front ...... .~....~. ...................... Rear ..~'.0. .................... Depth ...~...~. ................ · ,.ti ~'o~__ _ Height ....I ........ ~ Number of Stories ...... ~. ................................................. ~ ....................................................... ...~ 9. Size of lot: Front ........ /.§.0. ............ Rear ...... /.~.~. ...................... Depth .....~.O....O. .................. 10. Date of Purchase ........ ................. Nome of Former Owner ,~.e..~..'T'..~.....°....~..A~.'.~.....~/~...~....~.....c~....~* 11. Zone or use district !n which premises are situated ..................................................................................................... 12. :Does proposed construction violate any zoning law, ordinance or regulation? ..... .~...0.. ............................................... 13. Name of Owner of premises .~...".l~J~,,~.$...J~.e.s...IN¢.Address ~e~-~-(-I?~...-.~..--.~v~'/---Mqt~ Phone No.~.~..~..'.~...,~...~.... Name of Architect ................... .~..~ ................................ Address .............. .~..~. .......................... Phone No...~..! ............... Name of Contractor .................... k...~ ...................... ~ ...... Address .......... .~..~. .............................. Phone No..L..k. .............. P~OT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back 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. ~'nt&,l~ ~P,~.e~. STATE OF ~" u/s , .3So' !being auty swo~oses and says t~t he is the applicant ( , a~lication) ~ above named. He is the C*~.~.~ ..~ ~L~.- ~.~,~..~.iF (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the applicatJ~ filed therewith~ Swomt~ me this . ~ ...... o, ....................... Nota~ Pu~..~.~~oun~~~r~ ~[;; ) Notary Pub[iq Sia~e of New ~a~k No, 52-0344963 Suffolk County ~ Commission Expirei March 30, 19~ W 5.'75 O0 ~D E.. 'FHI E/ .ii Z CLJSTE~ /~VE. m iI:~N PiPE ~ IvIONLIMEPIT MAP OF PP._OPF_P. TY surVEYED FOq,. FOUHDE1E,~ HOI~E,8, AT. ~THOLP TOWN Ol::~SOJmOLP.N.¥ ING. CTli~EI:) TO TI4.~ O4~ T'IT'LF-, VaN TOYL,,,f:ot!.. : ;,,',, ., ./.