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HomeMy WebLinkAbout6855-zFOR~ NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No... Z~9~2' -- Date ........ Jt~e. 3 .... , 19.7~.~, THIS CERTIFIES that the buildix~g located at W/~' F£i'th ~t ........ Street Map No. ~ .... Block No. ~. Lot No. ~. ·. E~w ,~fo3~... E.,Y,... conforms substantially to the Application for Building Permit heretofore filed in this office dated . &ep%' 1-0. , 19 73 pursuant to which Building Permit No.. dated $~p.t .10. , 19.73 , 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 ...Fz'£~ate. ~ne. £amll~ d~eJ~iing .......................... The certificate is issued to . ~/'i~ce~% Ca. ppe:l-l.o ...... [,~e~ .................. (owner, lessee or tenant) o£ the aforesaid building. Suffolk County Department of Health Approve ~Y ' 3] .~ 97k: ............. UNDERWRITERS CERTIFICATE No.. ~I. ] ~.~3h 4 ........ ~ay. · .%~,. · · .~.97t~ .......... HOUSE NUMBER *- ~6~0 . Street . .Fi£.~h-~4;.~-~e~;. · (N~, .~..£o~lr..La) .... .i ............ .... ' ' FORi~I NO. 2 TOWN OF SOOTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPL~ION OF THE WORK AUTHORIZED) N? 6855 Z Date ....................... ~.p.~ ......... .1.(~ ........ , 19..7..~.. Permission is hereby granted to: · .~/J~m.a~,t .. i;a ~pe .l, io ...................................... .... .1.3 ~......~o~'~t ~u .. i~ oa~l ................................... .Y. all~..~t~zeam ......................................... to ...~.~ ]-..~....n.~ .~....~;~...;~1 Il]f_ .dw.~ !ling ................................................................................... at premises located at .....~../...~.......F.~.~...h...:.S..~. ......................................................................................... ........................... ~.~..~.~Xm;lt~ ....... ~t.,~., ......................................................................................... pursuant to application dated .................. ~11~. ....... 1D. ............... , l~..~...., and opproved by the , ~Building Inspector. Fee $, ..~.,~. ~ .~.~ .......... Building Inspector FOR~ NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil buildings, property I,nes, 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 cerhficate of Code comphance 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-ex~sting" 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. 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 occupancy $I 00 Date .....~Lay...2~ ^....].~.7..~ .............. New Building ....x..x...x..x...x..XAddition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... Owner Or Owners Of Property ..... .¥4.~g.~r~la..&~..~.pg.e,l, Jk~ ................................................................... Subdivision t2h~,lgjX,.~.l.t.b..t..d..i..y.,: ............................... Lot No ............. Block No ............. House No ............ 6855 Z 9-10-7.3A licant Vincent J. Cappella Permit No ..................... Date Of Permit .................... pp .................................................................. Health Dept. Approval ........................... ..1, ..... 2J ...... Labor Dept. Approval ................................................ Underwriters Approval ....~.......J...~...~..~..~..l...~. .............. Planning Board Aoproval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........x...x..x...x..x...x..x..x...x. ............. Fee Submitted $ .... .5..;..0..0.. ...................... Construction on above described building aj~/~ermit me,ts all xal~plicable codes and regulations. day ,'_ ....... (stamp or sea ) ( ~/ ~. ~--~/ ' ~,.,~'~ V/~,~r~..,~.~ JUDITH 1' BOKEN ~~ ~ ~ ' -- - ~::~ubhc, State of New York No 52-0344965 SuffoJk CourJatr~t.~'~' Comrmsston Expires March :30, 19.~ ~T~~)O~T¥'DEPARTMENT OF HEALTH Health Department ~ ~ ~ ~ Reference Number -.. APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant¥incent J, Cappello Phone825-7398 5. Subdiv. Address139 Gordon RoadV Valle~ Stream N,Y, 1t5~1 6. Section 2. Property Location~/ side of 5th ~t. 210~ s. JacksonT. Lot Number 8~ree~ 8. Private Well Village ~ew 8:~olk Township~ou~hold 9. Public Water 3. Public Water Company Na~ Distance to ~in 4. Lot size: Widt~O0 feet Length~50 feet 10. Sewage Disposal System: (For Health Dept. Use) A. 900-gallon septic tank: Precast ~Equivalent Block B. Leaching pools: Nu~er of pools ~ Precast~ Block ~pecial 11. If private well, fill in the following blanks: A. Tank capacity4~-- gallons B. Pump G.P.M. C. Total well depth D. Depth to ground water E. Amount of water in well~ The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County ~epartment of Health's current standards thereto. This application will be valid for one ye6r from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date ~~ /~ /~ Signed ~//~. ~-9. ~_~_~:i FOR HEALTH DEPARTMENT USE ONLY. Based on the' information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. EXCAVA TIOK PECTION R[QUIRED Rev. 411/73 INSTRUCTIONS ~ in by o~ in a. This application must be completely filled to le.t~F~iter ink and submitted in triplicate to the Buildi Inspector, with 3 set~ of Plans, accurate plot plan sca . according to schedule. b.. Plat. Plan shOWing Ioc~ier~ of lot.and of buildings an premiSes, relati6nshij> to adjoin, ing premiSes or public streets ol~ areas, and:giving a detailed dascriptJon of layout ofpreperty must be drawn on tffe diagram Which is part o~ th,s application~---~- c. The W0~rk cOVered by this appl'icc~ti0n 'may no~ be COmmenced before issuance of Building Permit. '~ d. Upon apprOVal of. this.epplication, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. ~ e. No building sha~ be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted' by the Building Inspector. " APPLICATION I~ HEREBY MADE to the Building Department for the issuance of a Building Permit pursu.a, nt to the~ Building Zone ~inance of the Town of Southol,d., Suffolk County, New York, and other applicable laws, Ordinances or Regulations,. fo~ 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 nocessary~jnspecNons. .... ............ (Address of epplicanO State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · V~n©ent J. Canne~lo ~me of OWner of premtses .................................. m~.,v ........................................................................................................... ~:" If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ....... Electrician's License No .............. : ............... 1. Location of land on ' ' · . .................. N u mbe rW.h. i~~~. 4~....'~ ........ Street and ....... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... ~............~.~ ........~...L~........~.......................'~ ................................... b. Intended use and occupancy ............ ~. ...... .~. .............................. ;1 .................................. 3. Nature of work (check which applicar:de): New Building .... ~.. Addition .................. Alteration .................. Repair .................. Removal .................. Demolitio~ .................... Other Work ...................................................... 4.' Estimated Cost ...~.25~ 0.0...0..%.0..0. - ...~.....0~.. ~ (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ..~. .................. Number of dwelling units on each floor .a~ ................... 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 wit~ alterations or ~dditions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire rmw construction: Front ..~:..~/. ......... Rear ..... .~...~.....:..*~....~... Depth ..~.~.~..-..8.~ ........ Height 2,0 £t, Number of Stories oz~e ............... 9. Size of lot: Froot ..... ~.~...~tA, .................................. Rear .2~4,o.5~ .......................... Depth .LOO..~ .................. 10. Date of Purchase ~A~g. 18 ~973 Hame of Former Owner G&z'~' Ol~ea 11 Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~..o. .............................................. 13. Wil lot be regradec~............................~ Will excess fill be removed from premises: ( ) Yes (~r) No · ¥~Lncent, 3. Ca lo l,~. gox'don ltd Phone No..8..:~5.'.-.~.~.9.~... 14. Name of Owner of premises ............................... ~ .~J~...~. ........... Address ............................. Name of Architect ¥:Lmeont, Sot;ira -.. 640 Fttlt*on fit,, ,. CH 9-O0.SS ~aaress ................................ Phone Nome of Contractor ............................................................ Address ................................ Phone No ........................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or descriot,on according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW. Y~_I~/~ ,~/ [-SS - COUNTY OF .~,jf~,eeC..~ ' / ', ............................................. ............................................. ,i;....being dui% sworn, deposes ~nd soys that he is the applicanl (Name of individual signing contracf) 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 make and file this application; that all statements contaioed in this qpplication are true to the best of his knowledge and belief; and that the work will be perforfne<J in the manrier set forth ih the application filed therewith. ' Sworn to befor~ ~e this / _/ Notary Pub c 'u~ntv ty ..... ............................................. ~" // (Signature of applicant) JUDm. I T. BOKEN Notary Public, SPate o~ New York N~, 52-0344963 SUffolk Coun-- C~mrni~ion EXpires March 30, F APPROVED AS NO:ED j l ~be~__W(az~'o G c_9ofi~ A.I.A. II RTE. 109 FARMINGOAL~, NEW J4J* I~I,ION sTI~EET ' RI[, 109 FA~MINGDA~F,~ h~ll~ ~JJJl~