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HomeMy WebLinkAbout6916-zFOILM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ottice Southold, N. Y. Cerfificnle Of Occupnncy No. z. 6p.93. ...... ~ Date ....... Sept...9. ...., 19.7.~. THIS CERTIFIES that the building located at o./~ Glenn .£~oad Street Map No.;',.e.s.t; C.k ~.st;Bloek No .......... Lot No.? . 3.o.~thold..I! :.Y.. ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ .0.¢$ .11, 197~.. pursuant to which Building Permit No. 691 dated ......... .0.at...] 1 , 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 P~.~¥at.e ,o~.e. ~'.a.ml. ly d.we.~. ~[;L.n.g ............................. The certifieate is issued to of the aforesaid building. Suffolk County Department of Health Approval Se. Dr 8 UNDERWRITERS CERTIFICATE No..I( .1.6.1.0.6.~. .... .l::a.y..2.2. HOUSE NUMBER 500 .~lind$. ~ay Building..Comp ..... (owner, lessee or tenant) Street .fi.~.e. 1.:.n..i~. 9.a.d.. ............................. B,,ilding InspectOr ~0~,~ NO. ~ TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHOR]ZED) N°. 6916 ' Z Date ...................... ~$, ....... J'l ............... , 19~... Permission is hereby granted to: li;L~da~a;g... I~ ~,3, d,i,r~...Co~ .......................... ..... · .,~,,boz.-.~-3,8 ................................................ ..... ~t,., ..,t'~ s.....N. ,T~., ..................................... / to ...~,~, ~..d.....n.~.',i...9.~..~... f~.~_~.). ~-...d~.e ?!_1. ~z~ g. ...... :. ......................................................................... at premises located at ~.Q~...~. ....... /~es.J;..Cme~.£~ta.te~ ............................................................. .......................... /~t~r~.~ad ......... :$~v..thml. d ......... ~,.Y., .............................................................. pursuant to application dated ................... ~.~ .......... 'J--1 ................ 19...~/~, and approved by the Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Bull&lng Department Town Clerks Office Sou~hold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ~nk, and submitted m DUPLICATE 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 hnes, streets, aha 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 F~re Underwriters. 4. Commercial buddings, Industrial buddings, Multiple Residences and similar buddings and installations, a certificate of Code compliance from the Archaect 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 hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or prewous 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 Fees: 1. Certificate of occupancy $5.00 2 Certificate of occupancy on pre-existing dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00 .......... .............. New Building ................ Addit,on ................ Old or Pre-existing Building ................ Vacant Land .............. kocat,on Of Property ...~.~....~.. ....... ...~.....~....~'.......~...~..~......~.....~..~...L~... ........ .~...!..?..~...~.........~....:....~...~..~....~...~/.. ~ Owner Or Owners,~ __ ~,¢.Of Property .... "~'"'~'~' ~ ~'"'"/~"/D ~"r~; ........... !~'~'i")'?"'"~"'~' '""(;~'"'~'": ......................................... ..... ...... ............. ............ Perm,rNa ~/~Z Date Of Permit ...~....C~....!.L ...... Applicant J,,~l~4~.f/,~J ~¢ ~L~/~,~ o - Health Dept. Approval ~ ~' ~' / I ....... ~ ................................... Labor Dept. Approval ............................ , 4_. Underwriters Approval .t..~.~...~...~ ......................... Planning Board Approval ...... .......................... Request For Temporary Certificate ....................................... Final Certificate ............ .~.. ....................... Fee Submitted $ ~...T~ ................ Construction on above described building and~p/ermjt ~me~t~ all appli,cable cod~s and regulations. Applicant ......................... .~, ........ :~-... ~,.~-~.~,.;... :.~ ../.....~m~,-, ........... Sworn to before me this (stamp or seal) ~Z"~' ~'~.U NEW YORK BOARD OF FIRE~.UNDERWRITERS THE SW BUREAU OF ELEcTRIC~ ~ ~ '" J--- 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..,~ ~ ~..~ ~.,.,~.~o.o.~ ~ , 161065 THIS CE~IFIES THAT WXndsway Inc., Glenn Rd., off ~Xn BayvXew, Southold, L.I. FIXTURE ~BPTA I IT I EXTURES I 21 I 36 2~ 6 DRYERS I FURNACE MOTORS I~ITUR~ Jdq~UANCE IlBE)~eS AN.T. ' K.W. fL H*P. GAS H.P. :T. NO. A,w,G, SERVICE mSCQNNECT I f~K). OF I S 1 150 CB x I 30 OVENS OF CC, COHO, 1/o *Furnaces: 1-1/8bp, 1-1/15bp EFuture ApP. Feeder/s: 1-2~10, 1-2#12, Motor/s: 1-3/qhp C isH wm MUtTI-Ot~T EXHAUST FANS 1/o Robert A. Goodale 525 Orchard St. New Suffolk, New York 11956 TOWN OF SOUTHOLD ..... BUILDING DEPARTMENT '~///'~' ~ ''('' ' TOWN CLERK'S OFFICE ~. _~..~ / . SOUTHOLD, N.Y. _ .,, ~ '~ ~ ..~'~"~%-¢~"J/_ ~ ~-' ':xam~,ed ............ ~E ........ L/'...., ~.../.~ ,, '"'""" "" Ap¢~cat~on Na?...(./....% .................. sopproved a/c .................................................................... ........................................................... ................ ................. ................................. (Building Insl~:tor~ APPLICATION FOR BUILDING PERMIT /, ~ ./././ Date ............................................... 1¢.2~... ..... INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public 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 permi shall be kept on the premises available for inspection throughout 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of ap~pii~ant, '~r nan(e, if a'Eorporation) · (Address of aPplicant) State whether applicant is , agent, - : ..... ' "2 .... "~ ' ' ' ~ , ------;: I~. I --, 'r'' or builder. ..................................." ............................ ........... :: ............................................... .._:.. ................... Name of owner of premises .....~...!.~..D...~........~......~......~..U.~.t..P..~.&/.<~.....~.....~...".(..O...~...~...~..~. ~..~...~..~.~.~......~....;~.~...~...L...?.,... If applican~ is a corporate, /sign/~re of duly~t,~orized x/ (Name and title of corporate office~' Builder's License No ..................................................... ,-,z ..~._,/,, Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.:...~JL'£~' ............... O~'i'J(......................~ s'~'~'/,, Lot No ...... 2 ................ Street and Number ,.~ ~ .~Aa~ fi~....~. ~..uj. i o' ~..~.~ ,~' ~.~. h~.~..~/ ~ u~ ~12~, ~...,..~...~...R~.~ ......... '~' ........................................................................... '~ .................... '~'~nicipality 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 3. Nature'~f worlr, (check which applicable): New Building..................t/ Addition .................. Alteration Repair .................. Removal .................. Demoliticm .................... Other Work ................................................... f~ ~>~ c)~ ~ · *-~ (_~ '7 ~ (Description) 4. Estimated Cost ...... ,~,...., ............................................. Fee ........... i~;"l~'~"~;~"~'~"~'i'l'i~'~"~i';"~ii;;;~i~]~i .................. 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 ...... .~.,..~......o. ........ Depth Height . .I~ Number of Stories ....... !. ......... 9. Size of lot: Front .................[..O...C) ................................ Rear ............. .~..~,,~.~ .................... Depth .~..,..,~...~.). ................ 10. Date of Purchase ........................................................ Nome of Former Owner .~....l~,.....~.~...~....~.~..~../../.~.....~....~....~c/ ! 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .../:~...D. ................................................. 13. Will lot be regraded ' Will excess fill be removed from premises: ( ~/Yes ( ) No 14. NameofOwnerofpremises ......................... .~ ............... ...i....r Address ................................ Phone No. Name of Architect .............................................................. Address .............................. .! Phone No ....................... . ....%.. Name of Contractor ~.J..~...~...,~... -¥.'.!~..'-~ ..... Address .... . ......... 1 ..................... Phone No. ~ .................... 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 corner lot. STATE OF NEW YI;~,K,,-- ~ [ c c COUNTY OF ..... ~...J' ~"~ . ............................................ ~ ........ .~. ...................................... bem~ duly sworn, deposes and says thot he is the applicam (Name of individual signing contractO - above named. He is the .~,..~,.v~.....~... (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 end belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to_before me this ~'~ ~,~ ~ ...... · ....... day of ..... .................. Notary RUTH M, MYERS a_ma!~ PUBUC, St~ et New SUFFOL~D~I~}~E~(~T~)]I~F HEALTH Health Department ~IV£RHEAD, N.Y. Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT S W k( .DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant Address ~ 2. Property ocat o~, .... L,,~ ~,. ~ ~ 7. LO~ Nu~~ ,~ ~_,_, V~a~~' ...... I 3. Public ~ 4. Lot size: Width JOe feet Length, ~*feet lO. Sewage Disposal System: (For Health Dept. Use) A. gOO-gallon septic tank: Precast_L~quivalent Block__ B. Leaching pools: Number of pools ~" Precast ~ock ~pecial ll. If private well, fill .in the following blanks: A. Tank capacity B. C. D. E. ~ gallons Pump G.P.M. ~ Total well depth. Depth to ground water ~ Amount of water in well + The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. 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 i)ista?lgd on this p$ot. ,'~ ~ APPROVAL DATE SIGNED / S-15 /'~/ Rev. 4/1/73 Chief of General EnEineerXn Services / / ° I ~.'~p~l~at;~n and building per- ¢ from Stale of New York L-v,~o,,,ler, lol Agency, per ~aw el- Sept. 1, 1973, ~.~ 0 U THO I.. ~ C[,[:~- C,F BUILDIr~G IN~PEC-'On o:meMol A§ency, per Iow 'F kONT LLWAT I.ON ELF_VAT OFFICE OF BUILDING INSPECTOR TOWN OF $OUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N. Y. This application and building per- mit is subject to review dnd possi- ble permit from Stale of New York Eng~ronmental A§~ncy, per law ef- fective Sepl, 1~, /973; APR~OVED AS IN'OTED NOTIF~ BgJLDING DEPAKTMENT ~T 1, B~OR~ BACKFilLING FOUNDA- FOP, ~Z4~ ~. C Ol~, %LOo~~ u1 ?,L.'A N T-LOON "PLAN I~EAM i' 41' 2.", 8'~ P-, A F i'Er, S ON'J5' ~:' E Lff' SiLL ~koc~ ~NALL J blAGKAFI ~ .¥F_. CY /0 ,. FT E LEVATi 0 tXl,. GHT itLLYATION '