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HomeMy WebLinkAbout5730-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~1~ ..... Date ............ &~g .... '$0 ..... , 19.~,~. THIS CERTIFIES that the building located at . 1[,0.¥., .... 14&~L~ .11~, · Street Map No. ~[ ......... Block No..~[1~ ....... Lot No. ~... ~S~-I~l*~ ...1~.~., .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... M&I*~I~' ' ' 6' 19.~. pursuant to which Building Permit No. dated ............ 14&l'al~ .... 6' 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 · l~l'~m~ 'Olx~' fa~.ly 'Sw~]:l~l~g ....................................... The certificate is issued to ' '1}1%' '¢!~1'];S~' · ~a~l~ll ....... ~n~l* ................ (6wner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ' '&~ig '~' 1 ~/2' ' · l~/' ' R',' '~'~X].~ .... UNDERWRITERS CERTIFICATE No. ....................................... HOUSE NUMBER.. 3~ ....... Street ....l~'g~t&t~ 'P~II~.' ~[' ~ .......................... TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) i 5730 Z D~, ~ ~ ~...~ Permission is hereby granted to: .............. · ~ee~l~ ...... ~.~.. ........................... to .... ~..~....~..~.~..~...~.e.~ ............................................................................. at premises located at ........... ~,Oell.~..e~..~l~.~l~..~l~lil~ ....... f~...~..~.,..~$11 ~II:~ILJI~ ~llJt) ........................................................ ~I~O.~..~....II,Z, ............................................................ pursuan4' to application dated ................................... JJil~....~t. ......... , 19...~., and approved by the Building Inspector. F~ .,. J Ihi,.'i! .......APPROVAL TO F:.E ~:!O'VE c .-... ,~ ,'~S FILL FROM ASOVE PREMISES BY REGRADING LOT DRIVEWAY CONSTRUCTION CES£P,.)OL CONSTRUCTION CELLAR CONSTRUCTION OTHER FO~M NO. $ TOWN OF SOUTHOLD Building Depoltment Town Clerks Office Southold, N. Y. 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 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 formation required to prepare a certificate. New Building .......~..... ....... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...,~.~.r...~..? ...... ...~/~.......~,e~/..~........./~...~. ............... .~.~.../'~',',~,~..~./.'~...~. ............... Owner Or Owners Of Property ..../,~.~ ....... ~.,,....([?~.~.,/.Z. ................................................................ Subdivision .~....~.~F..~..~,~--~y.~...~.i~.,,s~....~.......~'~... ........... Lot No....~...... Block No ............. House No ............. Permit No.....~...~?'..?. ....... Date Of Permit ~/.~./~...~':.......Applicant ..~...~.~...~.. ~ .~....'~.~,..../'/,,~, Health Dept. Approval ............................................ Labor Dept. Approval .....~.?.~. ..................................... Underwriters Approval .............................................. Planning Board Approval ..~.~. ................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ~/~/~(~ ................ day of ............................................ (stamp or seal) ~/~:~? ~'! Notary Public .................................... County ~/~ ~/~1 S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH AU6 8 Date ~ldg. Fermit No. -~?~,,~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (C.~i"~ deed location) J~ ~ ) ,/~-s~-~--. ~' , have been inspected by this department and found to be satisfactory. ghief of General Engineer~ r,~ Services AU~ 8 1972 THE NEW YORK BOARD OF FIRE UNDERWRITERS a~ BUREAU OF ELECTRICII'Y ' 85 JOHN STREET, NEW YORK, NEW YORK lO038 ,.,~y ,. ~97~ ~,,.,,~.,~.~.,,. ~7o~ N 31854 THIS CERTIFIES THAT Charles Campbell, n/s Maid Road, Rt.25, East Marion, L.Z. Water heater: 1-4.5kw Elec.room heater/s: 3-2.Ckw, 4-1.5kw, Motor/s: I-1/2hp 1-1.25kw, 2-1.0kw, 5-.75~v' "! R APR i i TP - APPRUV4[ [XPlR[ ~"~"d0~'~/"'~EPART~NT OF HEALTH HoDoReferenoe NO~ 0 -/~.~o2-- PLOT PI~N Capacity_~AGals. G.P.M. b' Street No~th Data Feet 2 1~2 The 'Undersigned CERTIFIES: "Construction of authorized installations will be in accordance'with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposal Systems". Signed ate.. · c ~ Uw~e~- 'or -~ Bu~Yder FOR HEALTH DEPART~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. ([0/65 evis.) EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPRO~ALTO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date' Approval t~ construct said systems is requested,pertinent data herewith: 1.Applicant ~,'=~., .~% L~=ol,~, ~.~,- Phone_F.~6-Sub div Address ~ 1~... ~ ~,~;...~.~ 7-Section ~ 2-Detailed propert~ ~oca%ion ~f~g=~,~ ~$ .... ~ 8-Lot No. ' ~ Hamlet FT~,~,,,~ T6wn ~:~A~A/ 19-Private well?' ~ 3.BAblic water supply name Distance to nearest main ' ,,,, 4-Lot Size: Width_x.~ft. Length_~.x.ft. (also enter on center plot plan below:) 5.Dwelling: Single Family~Two F~amily? ~_.~Cellar? ~lab? ~ ~ Crawl Sp?ce? ~ ~ ~ 10-Proposed system: Septic tank ~ YPrecast ~ ~Cesspools/w~Shallowpools ~ YOther ! / il-Septic tank inside dimensions: Volume Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: ~ ~Number~.~Square Ft. Cesspools: Block sizeL_~y, incs.D_~_ins.H,~ins. Total blocks below inlet. ~1_~$2 ~2~$3 SOUTHOLD, N. Y. ........................................ , 19 ........ PeTit No .......... Disapproved a/c ...... ~'-'~r~''' 'r"~ ............ ........................ .................. ............ ........ ...................... ................................. TOWN OF SOUTHOLD BuiLDING DEPARTMENT/O. TOWN CLERK'S OFFICE Application No. ~'' APPLICATION FOR BUILDING PERMIT Date ........ INSTRUCTIONS o. This applica~!on mus. t 'b~ comptetely filled in by typewriter or in ink and submitted in duplicate to the Building~ Inspector. .], .'~ b. PI0t Plon~shoWing Ioca~tion of lot and of buildings on premises, relationship to adjoining premises or public streets or~ 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 Permih d. Upon"appmval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit 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 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, (Signature Vf applicant, or name, if a corporation) ............ ........ ...... ............. (Address of applicant) V . State whether applicant is owner, lessee, og~t, are~/~)ct, engineer, general contractor, electrician, plumber or bu. ilder. Name of owner of premises]~'/. ................ ~~-~,,d~...~.~-~7...~....-.~:~.- ............................................................................... ¥ If applicant is a co~ora~n signature of du~ authorized officer. ~ame and title of corporate officer) i. L~ation of land on which pr~osed work will be done. MUP No.: ~...~~..~.~. LOt No ....... ~ ............ Street and Nu~er .... ~..~Z ........ ~ ...... ~.....~ ......................................................................................... Municipali~ 2. State existing use and ~ou~ncy of premises a'nd intended use and occupancy of pr~osed construction: Exisiting use ar~l occupancy ................................................................................................................................ Intended use ond occapency ........................................................................................ ~i ................. 3. Nature of work (check which applicable): New Building..................~ Addition ,................. Alteration .................. ', Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .......... ..~...~ .......................................... Fee ~...O. ~'.! 5(..O. .................................. (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 ...........~ ................ 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 ........... .~..~ .......... Depth ......~..~. ............. Height ~' Number of Stories ~- 9. Size of lot: Front ........ ./...~..~. ............. Rear ............ ..~...~..~. ............... Depth ........ .~...~'..~.. .......... ;... ,~ ................... · /-~x~/. ............................ Name of Former Owner ...~..~'...~ ............ 10. Date of Purchase 11. Zone or use district in which premises are situated /~ 12. Does proposed construction violate any zoning law, ordinance or regulation.;> .y.~.6 ....... ~..~..t'J..~.~5~..~.~.~...~.~.~..~.~.~...,~ of · ~l~/..Add ress 13. Name Owner of premises .~,.,~.~'..,¢.A..,.,..¥.~....-~.,../~..,;.. Phone No. ~.......~...~.~.~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .-~..---.~..q:......~....~/~..~.....~..~.!.,,~.,f.....Address .g..~?....Ceo..~..~...~....C..o..'~..~?.0q~..¢phone No. ~...~..~...7.~..~..0. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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. STATE OF NEW.~YO~ I ~ S (Na;~;;~'f'?r;~]~ll~ual signing opphcatlon) .{~ . /~j/~ ' above named. He is 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 n~ke and file this application; that all statements contained in thi~ 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 f ed therewith. Swan3 tg,before me this ..... ........ ..... ............ ELIZABETH ANN NEVIJ. LI~ NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk County Term Expires March 3~, ....al. ~© I" CD = d ~'~~, o¢> { 0 ~. u,¢-~/I ,, tI