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HomeMy WebLinkAbout5975-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~[O~8 ...... Date .......... AI~:I.1 ....9 ....... , 19 73. THIS CERTIFIES that the building located at Ma~n..Road. & .Ced&r-. I.~ ... Street Map No.. XX ........ Block No..~ ..... Lot No .... ~ ...]~ast. ~a~.loa...N,~'..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ J~me.. 28, 19.72 pursuant to which Building Permit No..~97~Z · dated .......... June.. 2~ ..., 1972., 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~.~,va$~. one..family, dw~llin~ .... (. &ppro.vad. by. ~1. Appeals } ...... The certificate is issued to .. Edgar. & .Itel®ri. lt&wkin~ ...Owns.8 .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . No.~.. 9..%972...by. R, .ViLla ...... UNDERWRITERS CERTIFICATE No.. J~ .bt6935 .... Oct,. 5....~972 .................... HOUSE NUMBER. J;~:)O ....... Street.. ]qail2. Bd. ...................................... 55 Cedar La Building Inspector ~ ~OE..~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5975 Z Permission is hereby granted to: to ~11~ new ~ .~.~.~ clWellin~ ..................................................................... A roved by. ~d Ap.p.e&ls) at premises located at ....... ~-~..~..a..~1~..~.~.d....~..~..~.~..~...~...?....~#..~.~..~...~).~....$.~..~.~..~..~ ....................................................... ~..a.~.~..~ ............ ~.,..z...,. ......................................................... pursuant to application dated ........................... ~.lj~..e.......~..~. ......... , 19..~....., and approved by the Building Inspector. Fee $.~/~ .~ ~.~'. ........... [,:,::.'l~ iNCLUDES AppROVAL ?,'~ RE.~OVE ExcESS FiLL F~'.,Oi',,, ABO',/E pREMISES BY · , ~ REGJl ~D[ xtG U-'T ~ D~tVEWAy ~oN~,TKuCT~ON ~ CEssPOOL CxJblS, ~LJcTION ~ cELLA~ cONSI ~OcIION ~ FORM NO. ~ TOWN OF SOUTHOLD Building Depo~tment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfructions 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. C. Fees: 1. Certificate of occupancy $~5.00 2. Certificate of occupancy on pre-exis'~ing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ................................................ New Building ...//~'..~. .......... Old or Pre-existing Building ............................ Vacant Land ............................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Health Dept. Approval .... , ....................................... Labor Dept. Approval ................................................ Underwriters Approval ....~....~/..(~.....J...'~...). ............. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and p, et~it meets all applicable codes and regulations· Apphcant .~. ....................... ,.~ .............................................. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference NoJ~J"7//~ ~' Date ~//~ Co ~~- APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Approval to construct said systems is requested,pertinent data herewith: 1-Applicant ~ ~ ~¢z~'/f~ ~ ~'~ g_- Phone 4z77-! ~6-Sub div Address ~z~-~-z~/ ~b~ ~./oe~, 7-Section 2-Detailed propert% locatlo,n f~v ~ ~ 8-Lot No. Hamlet .f~.~-~ ~f ~ ~ To~ ~O ~' ~ ~ ~ 9-Private well? ~ ~ 3-~blic ~ter supply name Distance to nearest ~in / 4-Lot Size: Width ft. Length ft. (also enter on center plot plan below:) 5-~elling: Singl~ Family f~ T~ Family? ~ /Cellar? ~lab? ~ fCrawl S~ce? f~ lO-Pro~s~ system. Septic tank ~Precast y~yCesspool~ / /Shallow pools / /Other ~ 11-Septic ta~ inside dimensions. Vol~e~ Ga~s.Length ft. Width ft. Liquid depth ft. 12-Precast sections: //yNumber/~Square Ft. Cesspools: Block sizeL incs.D ins. H ins. Total block~ below inlet: ~1 ~2 ~ ~OT PLAN ~ ~ Street __ ~ ~ ~ Ind5 ~ate ~ ~ ~ ' No 'th The Undersign~ CERTIF~S: "Constmction of authorized installations will be in accordance ~5~h ghe SufgoIk Coung7 Healgh De~r~men~s~ eurren~ Sganda~s~ Bul[e~Sns, and amendmengs ~here~o, eoverSng P~5~ag~ S~ge DSs~sal FOR ~ALTH DEPART~NT USE ONLY. Based on the infomation presented hero.th, it is the opinion of the Health De~rtment~ that an adequate and satisfacto~ Se~ge Dis~sal System can bo ~nsgallod on gh~s Date r/Y~ Signed (10/65 Revis.) S-15 BUILDING D E PA RTM E N T~*i -),~..'~x~ -~,-~ TOWN CLERK" 'FFI';'/ /~/~ ~ ~ SOUTHOL,D, N.Y. , ~'~ '~ - ~.e~/~ ~/~' · ~1~ * '-'~ ~(~' 19..~....~ Applicotion No. ~'~' '/ '~ Examined ......... C/..~..~.~ ............ ~....., ,, ~?- ? ~ 2-- ~ /~' ~ ~ ~prov~ ........................................ , ~ ........ Pem~t ~o ............................... *~'~ ~ ~ /~/~', ~sopproved a/c ............................................ ...~ ............................................ ~ _ ¢'~ ~_~ '~ - T-~ ~o' ~- APPLICATION FOR BUILDING FERMIT ~:~ ~ ~,~.d o. This application must be completely filled in by typewriter or in ink and submitted n dup cote to the Build~ Inspector. . b. Plot plan showing location of lot and of buildings on premises, relationship to odioining premises or pub ic streets areas, and giving a detailed description of layout ofproperty must be drawn on the 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 perm t~ shall be kept on the premises available for inspection 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 have been granted by the Building Inspector. APPLICATION IS HEREBY/v~ADE 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 applicob · 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 cede, and regulations. .~' ~/~'~ / '~/ /2_ ............. ....... ...... ~ (Address of applicant) NamEof owner of premiSes ...~...~'~..~..x......*~..~.~'.R.~..~.x....~../9:(-~.~..~.~ .............................................. ~. If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) ~ 1. Location of and onTz~/~owh ch proposed. ~ork w be done. ~OP No.: ...................... ~ ............ , . Lo~/ No ........................ .~ Street and Number ...... ~.f~J.~.~?..~.~/. ........................................ ~.,,,~.[..~.~..~.,~.tr~./.~..,q~. ................................ /.~ ~'~ ~-~' ~//t ~ ~ Municipality ~ , 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy . ~ ~ A,' ~ b. Intended use and occupancy ........ ~.~..-~..~....~.~. ................................................. · ........ 3. Nature'of work (check which applicable): New Building .... A~dditJon .................. 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 ............................ garage, number of cars .................. ~.~..:~,,~. ............................................................................................................... If 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 ................................ 8. Dimensions of entire new construction: Front ............ /. ...................... Rear ..... ..~7...(...~ .............. Depth ...~.~'.. ............... Height .....~..~....~. ...... Number of Stories .............~ .............................................................................................. 9. Size of lot: Front ...... ~....~..I.../.~ ....... Rear ...... ..~...~...~..~..~. ........... Depth ..... '~.~..~.....'~.....~.....-~.. 10. Date of Purchase ....... ...~/.:.~./~/..~- ......................... N~ne of Former Owner ...... ~. .............................................. 1 1. Zone or use district in wl~ich_Dj~,,mises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ....../~..~...~..~4...~.~...s?. .......... Address ...~,~.c.Z~.~.~,~;I(.~.~.. ..... Phone No ..................... Name of Architect ...... ~'~"'~'"~'V~"~'~""/~'/'d"'~""-~'""Addressv~.,~. ~/ ~ ~-. iiiii.~iiiiiiiiiiiiiiiiiiiiii~ Phone No.~'.ZT..~.~..q.~'.. ~x -- ..~.~. ........ Address Phone N o. ~'~..-. ,/.. ~. ~. ~. · Nam, of Cont ctor PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or pr. oposed, and indicate all set-back dimensions from proper'n/ lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW"I(.QRK,/./ ~j. COUNTY OF .................................. ~..~'.~...r....~.~......?:~,. ................... being duly sworn, deposes and says that he ~s the opphcont (Name of 'mdigi~l signing applicatit:ln) above named. He ~s the ...................................... ~ ................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that oil 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 forth in the application filed therewith. Swam to before me this .................... of ...... ....... , /) ~otary Public, State of New york V No. 52-0344963 SuffoJk Count~.~ Commission Expires March 30, 19.~-~ Z IN,4~'P O~ L. Ar, I~ ~D~.R W. 4~ HE:LIN t-.,L HAWKi NS 9 b M~p op' ~ 3~+ ,© F_DGA~ - } ......... 7 ..... r ('Z'.O'OP tlr?5 A. T ' 0 N, ¢/'7 ;o 'ZT- 0 h I !