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HomeMy WebLinkAbout6879-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .M.0 .o.l'.e.s...I~..n.e..~.o?..t~. ...... Street Map No.E~'~..~r..n...~.h.,. Block No ........... Lot No..9.'1: ....... G~'.e.e.z?.p.o.r.t....E.,.Y..., ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~.~p.t~...2.~. ..... , 1~.3.. pursuant to which Building Pemit No. 6.8.?9.g... dated ........ .3.s~.t....2.~ ..... , 1973.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...P.r.i.v.a..t.e..o..n.e..f..a~..$.l.y...d.w.~.l..1.i~. $ ...................................... The certificate is issued to .D.~lie.],. &..Se..~ck.e.r .... .0~lers. ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval F.e.b....2.!.. J.9.~.l~...b.y .R.,...V.i.l.!a. ..... UNDERWRITERS CERTIFICATE No. N..~ ~.2.0.7.3....Apr...~... J.~.?~ ................. HOUSE NUMBER ...~.7. ~ ........ Street .... .~.o. 9.r.e.s...L~..n.e...N.o.r.t..h ................. Building Inspector I~ORI~ NO. 2 ~ TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK',S OFFIGE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 6879 Z Permission is hereby granted to: .3.~.....t..~.....~ ................................................. ......... .~.~.~.~1~.~'~ .............................................. to ..~..~..?.....t. ~.,z.~...~.x.,~ ................................................................................... at premises located at . .~..~.~..~.1.....~i~.~.~'~..~.~..?.~. ..................................................................... ................................ .~.9.9.~.,e.~...~.?,~.e.....~?~.~. ............... ~..,.....~..o..~.t......~..,.~.:. ............................... pursuant to application dated .........................~..e..~ ....... ~ .......... , 19...?.~.., and approved by the Building Inspector. Fee $...~.~.,,.~ ......... FO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerli icate O[ OccUpancy No. Z~806 ..... Date ...... .F~b. 26. ............ , 19...~. THIS CERTIFIES that the building located at . .~4cor~ · La~e. ~¢or. th ..... Street Map No. ~as~ern. Sh Block No .......... Lot No...91 ...... Gr~aen~ orr.. I~ ~Y, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~ept.. 2~. , 19.?). pursuant to which Building Permit No. dated ..... Sept.. · 2~ , 19 7-3, 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 .. i'~'&.vage .o~e..f. ami.l.y, dwelling ............................... The certificate is issued to .-f~z~kf~.~- 6: ~ · .Tucker. .(~rners ....... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Fei) .2].. ]gY~.. bY .1~,, V.~l~a UNDERWRITERS CERTIFICATE No..pen~lfz~g ................................. HOUSE IqLriVlBER . t~y.~ ....... Street ....~ovr.es. La. ne. l~rt;h .................. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY * · ~[,rz*,--' 1 ~ ,~ l.O. Th 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CERTIFIES THAT o~ly the electrical .equi4~me_ nt as described helow and ~r~trod~ced hy the apl~llcant n~med o~ the abo~e a~l~pJieation ~umber i~ tl~ premises of Daniel Tucker, ~.!oeres Lane .No~th, Homestead Way, ~,reenport, inthefollorvlnglocation; [] Basement [] IztFI. [] 2nd Fl ut~ioe Section Block Lot was:examined on Ap ri i 1 ~ 1 ~ 7 ~ and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES DRYERS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF F~ST OT~R A~ARATUS: Special Receptacles: Water Heater: 1-~.SEW Elec. Room ~eater: E R V I C E NO. OF CC. COND. A.W.G. NO. OF HI-tEG A.W.G. NO. OF NEUTRALS A.W.G. F~R ,g OF CC. COt, ID. OF HI-LEG OF NEUTRAL 1 3/O 1 ~/O 1-50amp, 1-30amd 2-2.0KW, 2-1.5t9], 6-1.25KW, i-.75KW, 1 .5K Harold H. Haupt, Southold klec. Crlttens Lane Southold, New York llg?l Inc, COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FO~M NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A Th~s apphcation must be filled in typewriter OR ink, and submitted tn DUPLICATE to the Building Inspector w~th 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 d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4 Commermal buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate 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 praperty lines, streets, buddings and unusual natural or topographic features. 2. Swam statement of owner or previous awner as to use, occupancy and canditlon of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formatian required to prepare a certificate C. Fees: 1. Certificate of accupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $1.00 Date ......~..~.~.... ~...?~.:..../..~.. 7.../-~-.. ......... New Building ................ Addition ................ Old ar Pre-existing Budding ................ Vacant Land .............. Location Of Property ....bC.~.5......~...6/...'~.....~...[.~.......L...I.~..~.~·~...('....h/..O..) ...... .~.t..~.~.-~..'.~....O...~.i.~.....~:.~. ........................ Owner Or Owners Of Property ..~ .............................................. JZ.. ................................................................. Subdivision .L~.~..~...~.~.'~...~......c~.~.(~.~.. ....................... Lot No.....~..L .... Block No ............. House No ~..~5.-~.. Permit No, ..,~,..~..~..,~...Z-~.. Date Of Permit ...~.(.~,l]~..Applicant ...~.I]~H~..c~......b......~?..~..L.!5..~..~/~.,~ .................... Health Dept. Approval .... .~.~.~...~...!..i..~...c! ............ Labor Dept. Approval .............../~...:.!.~.. ........................ Underwriters Approval ...... ~...-~...h/...b..!...~.....~. ................ Planning Baard Appraval ....... ./~...~..!.~.. ...................... Request For Temporary Certificate ........................................ Final Certificate ........... ~ ............................. Fee Submitted $ .~ ................................. Construction on above described building and permit'"f~eets all gpp~icable codes and regulations. (gr/~, C4;'/,/ ~ Apphcant .................... ~;~.....,.~.~. ~ ......................................................... wor. *o .fo e me 77 Notary Public .................................... County (stamp or seal) LOT - 5'2 -'::21- 4 i,.,,.,.,,,,,,' ~Q~ -,4 Or" '1 LOT " LOT - '9'2 SUFFOLK COUNTY MEALTH DEPARTMENT D*TE FEB 21 1974 ~. D. REF. ~J~/~/c~ The sewage disposal and water supply facilities for this location have been inspected by this department and found %0 be s~tisfactory ~ ~ Chief of General Engineeri~ Services SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address g~.~ /'//~//~' g/-- 6. Section 2. Prop~erty location ~z-~j/-~f~f'_/_~-~.Z~-3' ~¢~-7. Lot No. ~,,V,~%a~ _~c~,~p~.f-Township _~,/-/f'f~ ~, 9 Public water ~ ~~Water ComPany,name_ Distance to main~ ~ 4. Lot size: Width /,~ fee't Length /~ feet (Enter on center plot below) 10. Sewage Disposal System: A. 900 gallon septic tank: ~recast~Eq~valent Block T~2~ 'Special '_ B. Leaching pools: Number~Prec~ .... in blanks below: N Tank capacity Pump G.P.M. Gal Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet 0 8 10 12 14 16 18 ~T'I~e u~ersigned CERTIFIES: "Construction of authorized installations will be ~ acco/,~dance with the Suffolk County Departmentz~f-xHealth's current stand- ards there." ~/~/~.k~,~ ~ , .~ Date ~~ 2 ~ /~2 Signmd ~ ~~~ Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, is the opinion of the Health Department, that an~equate ¢~n~ satisfactory Sew~ Disposal System ca~ be~nstalled on this plot. ~___~ . x..___~ , Date Signed ~ ~~ 4~, ,,,, ~ S-15 Revised 4/1/72 TOWN'CLERK'S OFFICE /2-/~g ~' .~ ~ ~UTHOLD, N. Y. ,~._~ Examined .......... ~ ....... ~..~ ......... , ,9 ........ / ~ Z~ ~plicotion No..~.L..(../.. ....... ., ..... ~proved ........................................ , 19 ........ Permit' No....~....~......~/ ...... Disoppro~ed o/c ........................ ~ ................... ~,,,~ .................~ ...:: .............................................................. ....... ,_ :~ ~; :~ ~ ~ ................... ~..~..-.-~../ ..... ["~4 ................................ , Date ~~.~ .................... 19~ .... 3 ~,~ ~-/~ INSTRU~IONS a. This application must be completely filled in by,pewriter o¢in ink and s~mitt~ ~rt· .' Inspector, with 3 ~ts of plans, accurate plot plan to ~ale. Fee acco~ing to ~hedule. b. ~lot plon showin~ I~fion of lot ond o{ buildin~ on premis~*, relationship to odioinin ore~*, ond ~ivino ~ det~ilod description o{ I~out ofpr~*~ mu~t be drown on the di~omm which i, ~ of thi~ ~ppllcation. c. lb* work coy*md by thi~ o~lic~tion mo~ not be comm~ before i~uoec~ o{ 8uildih~ ~rmit. d. Upon ~pproval of thi~ opplication, th* Bui[din0 Inspector will issue o Buildin~ ~rmit to shoal be kept on th~ premi*o~ ~wil~bl* for inspection throughout tho work. e. No buildino ~holl be ~cupiod or u~d in whol~ or in part for ~n~ purpos~ sholl how been omnted by th~ Buildin~ Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Bud ng Perm t pursuant to the\ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordnances or~" Regulations, for the construction of buildings, additions or alterations, or for removal or demo t on, as here n described. The applicant agrees to comply with all applicable laws, ~rdinances, building code,' housing code, and ragu ations, and admit authorized inspectors on premises and in buildings for necessary (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lesse.e, agent, architect, engineer, general contractor, electrician, ptumber or builder. .............................. ............. , ....... i ............................................................................................................... Name of owner of premises ....~..~..~..L~'"-.~.. ........ Z...4~.......~I.......~....~...~.~.~ ............ '. ..................................... 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 ......................................... Other Trade's License No ............................................... ~'~-~_,.~/~¢' ~'~ Location of land on whichDropased work will be done. ,L~Ai:ko~No/ ....... ..~...?....~..7....~..'~.. ....... Lot No .~.~ .............. Street and Number ...... ~.~....L.....c~........~...~:~...~..~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ' . ........................................................................................................ b. Intended use and occupancy ..... ~ ............................................................................................. 10. 11. 12. 13. 14. wheth~ Nature of work (check which applicable): New Building ....... Addition .................. Alteration ................ Repair ~ ..............Removal ..~ Demolition.....:= .......... ..--~ther Work ....~ ............................ '...~ ........ .*,.... (Description) Estimated Cost .....~.~.~..~ ...............................Fee ~ ~ ~.~.. (to be paid on filing this application) If dwelling, number of dwelling units ........... /. .............. Number of dwelling units on each floor ........................... If garage, number of cars ..~..... ~.~..~.~ ............................................................. If business, commercial or mixed occupancy, ..~cify nature and extent of each type of use ............................ D~mens~ons of ex sting structures, ,f any. Front ...~ .................... Rear ...................... ; ......... Depth .................... Height ........................ Number of Stories ............... ~ ............................................ ; ...................... : ......................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................. Height ............................ ~.~...Nu'rr/ber of Stories ............... Dimensions of entire new construction: Front ........ .................. Rear ...~-~. ................. Depth ........................ Height.................... Number of Stories ........ ~ ............................................................................................. S ze of ot' Frontt~ ......~....~; . ..... /~...4~.. ' ' Rear /~....~... . Denth ~"~-'~ Date of P'urchase~;iii'/"~"~""~"'iiiiiil;iil;i;iiilName°~;°rm"-~"~v'~;"~;~'~ Zone or use district in which premises are situated .............. .~...~-,f..~.~...~'.~.~.../.,~J~....~=... ..................... Does proposed construction violate any zoning law, ordinance or regulation: .....~'...~.. ............................................ Will lot be regraded ............. ~ ............. Will excess fill be removed from premises: ( ) Yes ~ No Name of Owner of premises ..~.~....~..~..~.~....../.--~..~f~........ Address ~./~,~'...4/~.....~.~h~n'e No..~..~..?...'~....~..~...~'..~' Name of Architect ............ ~ .......................................... Address ................................ Phone No ....................... Name of Contract/~.~..~.~...~ ........................ Address~..~..~"~hone No.~...~-...~..~....~ PLOT DIAGRAM locate clearly and distinctly all buildings, whether existin~ or proposed, and indicate all set-bock dimensions from lines. Give street and block number or description according to deed, and show street names and indicate · corner Iai. ! STATE OF NEm'W ~1:~ ~ ~ S S COUNTY OFi;,~.,~~ y. ................ ~~ ..................... being duly sworn, deposes and soys that he is the applicam (Name of individual signing contraclg above named. ~. He is the ............................................................................................................................................ (Contractor, , ' , 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 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 applicatiorl-f~ed th, P, dLewith. Sworn to before, me this ~ ! _ ?.~ ~ 'x %._~ .............. ...... ........... Notary Publi~, . ................................................... County ....................~t~'.O~,,~..~...~ ................................... (Signature of applicant) , APPRI~yE~) AS NOT~ED~. ~NOTIFY BUILDING DEPARTMENT AT 765~2660. ~AMTO 4PM FOE : ~D INSPE~IONS: ' TION OK STAKT FETING ' / 3. RNAL WHEN JOB~OMFLETED NOTE DO NOT SCALE USE DIMENSIONS ON PLAN ELD HOMES FAIRFIELD, CO NI~.. SHOWN Z FLR. JOGTS CEIL. JOISTS RAFTERS ROOF SIDEWALL W I I',1 DG\,Y S FIN WALLS LOUVERS ROOF SHINGLES RAKE O/H COR?!ER- F~t"~, -- I I¢~A i'£ R IA L _~. N L--J L 20' NJ. 7'- t4'- J 1 L__J ..... I~EA Iv. ' F~&iRF!ELD ~ DO USE NOTE NOT SOALE DIMENSIONS ON PLAN. DWG. S H OW h! FAIRF~,ELD HOMES''~ 'Iii:ILl).