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:
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NOTE
DO NOT SCALE
USE DIMENSIONS
ON PLAN
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FAIRFIELD, CO NI~..
SHOWN
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CEIL. JOISTS
RAFTERS
ROOF
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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
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7'-
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