HomeMy WebLinkAbout7009-zTOWN OF SOUTHOLD
BUtlJHNG DEPARTI~-~IT
Town Clerk's Otfiee
$outhold, N. Y.
Certificate Of Occupancy
No. Z~9OcJ Date ~ 1~ 19.?1~
THIS CERTIFIES that the building located at ~d&~ i~ Street
Map No. x.X Block No. ~v .Lot No. F~st ~al'iol~ l~.l~.
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............ .N.o.~.....3.0, 19. ?.~. pursuant to which. Building permit No. ~.0~...~...
dated ............ .N.o.?... ~0., 19..7.~, was issued, and conforms to all. of the require-
ments of the applicable provisions of the law. The Occupancy for which this certificate is
issued is P.I~..v.a.t.? .o..n.e..f'..n~..~y...d.??.l..1.~..[i ................... i ....................
The certificate is issued to Thos & P&t~'tel~ (~OVio ora
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ~.~. J.0....l~.....~...R:. ?.$.l.l.a....
UNDERWRITERS CERTIFICATE No..~..!'f.$.~}. ....... .~...~..~...~...9'~.. ...........
HOUSE NUMBER . .~.~. ........ SWeet Ced&l' Ave
Building Inlpector
FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
N? 7009 Z
Permission is hereby granted to:
. ~.a..~ ..t~...~ .. ~ .?.~..s...~...?...hg..J.....&....r..a.~.z,i, ia Cx.o~ley
Box336 · l{.1{.I:
Co!onial I~oad Sot~thold
to k~l~. ~iaw.. ~n-.. fa~t', ~...d~e~f~ ......................................................................................
at premises located at .]J~.~,..Cll.~l,~...J~.J'~l.'~e .......................................................................................
............................................ /~..~.....~rJ,.9~ ~,.~., ...............................
pursuant to application dated .......................J~(Q.~. ....... ~O ............. , 19..~'.~., and approved by the
Building Inspector. JJ'C~l f~r~t £1oor ox~l. TI check a~e set;b&ek
Fee $.. ~,~.{~ ..........
J :
FORM NO. 6
TOWN OF SOUTHOLD
Building Deportment
Town Clerks Office
Southo~d, ~1. Y. 11971
APPLICATION FGR CERTIFICATE OF OCCUPANCY
Instructions
A. This application 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 all buildings, property lines, streets, an6
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 complicnce 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:
I. 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 in-
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 $1.00
Date .......~.. . .~... ..........
New Building ...~.. .......... Addition ................ Old or Pre-existing Building ................ Vocont Lond ..............
Location Of Property ....... C~.~.~ ....... ,~./;.~.~ ............... ~....~:'~..O..~,~: ............
Owner Or Owners Of Property ...... ~......../.~...........~....,'~.~.~:~...',~. ........ C/~..GE~'.~.~.. ........
Subdivision ............................................................... Lot No ........... ~ock No ............. House No .............
Permit No..Z~... Date Of Permit ~(~.Applicant ~~.....~..~.~ ........
~/ /~_~
Underwrters A r val ~-/~.~ '
ppo .......... ............. Planning Board Approval ....... ~ .................
Request For Temporary Certificate ........................................ Final Certi~ ........ ~ .................
Fee Submitted $ .......... ~..~.~ ................ //x / ~
Construction on above described building~ermit meets all ~licab~es
.......... ..........
Swornj~to befOreofme~~ / /~>'/~ ~ ~ ~
........ ............... ........
Notary Public .................................... County ~~
1~0~ NO. 6
TOWN OF SOUTHOLD
Building Depo~tment
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 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 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:
I. Accurate survey of property showing all property lines, streets, buildings end 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 $1.00 Date ......~ ~'./ ,~ 7
New Building ..... ..~'... ..... Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property..~.~::~-/~-....O,~,~/..~.. ..................... ~..~.~..2~.....~ ..................................
Owner Or Owners Of Property ........................ ./. .....................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Dept. Approval ..~.I./..~./..~...~.......~..~.~...:/.../T'..~'.Labor Dept. Approval .......... ~('..~.? ........................
Health
n r Approval ................. Planning
U derw iters ~../..-["~....~...~. Board App?~v~.......~7.
Request For Tempora~ry Certificate ........................................ Final Certif)~'ate ...1 ....... · .J~...~..~.
Fee Submitted $ ..... .ff...~..[. ~. ~ .............. ..~.. /'/-..
Construction on above described building a0d~ermit meets ,q~l agpl~c~3ble,/~odes and r~g,,lations.
Sworn to before me th,s. day of' ' ......
Notary Public .................................... County
THE
NEW YORK BOARD OF FIRE UNDERWRITERS
SW BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK, NEW YORK 10038
N 56553
THIS CERTIFIES THAT
o~ly the electrical equipment as described below and introduced by the applicant named on the abo~e application number in the premises of
Thomas Crowley, e/s Cedar Dr., 500' n/o Southern Dlvd., East Marion,
L.I.
in the following locatlon; [] Basement [] Is}Fl. [] 2nd FI. outside ~ct;o. mo.~ Lot
was examlned on [~r~ 25, 197~ andfoundtobeincompliancewiththerequirementsofthisRoard.
FIXTURE FIXTURES RANGES OVENS DISH WASHERS
OUTLETS SWITCHES
15 21 12 15
DRYERS FURNACE FUTURE APPLIANCE F~EOERS
TIME CLOCKS MULTI.OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT S E R V I C
OTHER APPARATUS:
Water }{eater: 1-a.5K'W
>lo}or/s: 1-1/2bp
Flee. I{oom }{eaters: 2-1.75KW,
NO, OF CC. COND. A.W.G. NO. OF HI4EG A.W.G. NO. Of:NEUTRAL A.W.G.
1 3/o 1 1/0
3-1.25KW,
2-1.0KW, 1-.75KW
W.L. Ruland
Mattituek, New York
Per
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Health Department
Reference Number
APPLICATION FOR APPROVAL TO CONSTRUCT
A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY
1. Applicant ~b,)l*J~
Address q~r I ~
2. property Location
Village ~~j~9 Township
3. Public Water Company Na~
4. Lot size: Width )o~' feet Length.
10. Sewage Disposal System:
A. gOO-gallon septic tank:
Precast ~ Equivalent Block
B. Leaching pools:
Number of pools .~,
Precastx Block ~pecial
11. If~j~riv. ate well, fill in the
~ fol.l~wl ng blanks:
A. Tank capacity ~ gallons
B. Pump G.P.M.
5. Subdiv.
6. Section
7. Lot Number
8. Private Well
9. Public Water
Distance to ma!F-
feet
(For Health Dept. Use)
;'~! C. Total well depth
:i:' D. ~-~pth to ground water
~ E. ~ount of water in well
The undersigned CERTIFIES: "Construction o~authorized installations will
with the Suffolk County Department of Health's current standards thereto. Th,
will be valid for one year from the date of approval indicated below and may
a current local Building Department Permit is in effect.
FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it i~, r~
opinion of the Health Department that an adequate and s~tisfactory Sewag~ ~' ~'
and Water Supply can be in$talled on this pl~ot.
APPROVAL DATE /~/-~/'~ SIGNED
S-15
Rev. 4/: ~ ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN ~ERK'S ~FICE I~
~OLD, N. Y: ~
.
pp,ov .............. ...................... , ....................................
Di~ppr~ed ~/c ~~ ............ ~
............................
........................ .....
,~/ ~Z-'7 ~ APPLICAT!ON FOR BUILDING PERMIT ,~ · ~
......... '
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 sh0wiri~ 'locatiOn Of 10t 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 Permit.
d. Upon approval o'f this application, the Building Inspector Will issue a Building Pe-i'mit to the aPPlicant Such permitf
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 Deportment for the issuance of o Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 I~vs, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
State whether applicant is owner, lessee, ag~Rt, architect, engineer, general contractor, electrician, 'plumber or builder.
.................................. .........................................................................................
Name of owner of pre~t~'~..""'~/~..~....~.....~"~' "A?"/~/~'.... ~.....,~..~../~..l.~... .................... ................................
/
/
If a~icant is a c~o~e, s~ure of d~ au[~riz~ officer.
(N e and title~f co~orate offic&r)
Build~r'~ [ic~se ~o ............................... ; ..................... ~ ~& - ~ --
~lumber'~ kic~nm ~o .................................................
[lec/ricion's License ~o.
Other Trade's License No ...............................................
1. Location of land on which______ __,,Prop°se~ work wLII be.done. Map No.: ........................ t. .............. Lot No .........................
Street and Number ...... ~...~.....~..~..x~..~../...~..~..."..."~.~i~..~..~...~lf~..~.~.~,.,~f-~.~. ................................
Municipality
2. State existing use and occupancy of premises and in,~ended use and occupancy of proposed construction:
o. Exisiting use and occupancy t~/'R~'~ ~'~-~
b. Intended use and occupancy ........ ~(~/~..~.~. .......................................................................................
3. Nature of work (check which applicable): New Building ............ Addition .................. Alteration
Repair .................. Removal .................. Demolition .................... Other Work ......................................................
(Description)
4. Estimated Cost ....~.....~.1..~ .................................... Fee
(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 ...... ,~.,,~...t. .................. Rear ....... .~1~....~ .......... Depth ......~...:.~ ...........
Height ..... ........ Number of S~ries .......... I..~/..'~.. ........................ v ......................................................................
' Depth J'2-o i
9. Size of lat: Front ...............I......~.. ................................. Rear ..... !..?....~. ............................................................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ..1~.....O.. ......................................
13. Will lot be regraded'. ........~...'~..~. ......... Will excess fill be removed from premises: (,~ Yes ( ) No
14. Name of Owner of Premises ~.~.~....~.. ......................... Addre~~.t~::-~l:.. Phone No.l~[Z..-t.~..~..~...
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor .~....v~....~..~!~-~ .......... Address ~:/......~...~...'~.....~..... Phone No. -~l'.~'.'.J..'['~..~
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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~'O__I~_
COUNTY OF ~.~.~...... ~ ~
...................... ~..~~ ................. being duly sworn, d~mes and says t~t he is the applicant
(~e of i~id~signing c~mc~
above name.
He is the ..................... ~~-~~~ ............................................................................. ~ .................
(Contractor, agent, co~orate officer, etc.)
of said ~ner or ~nem, and is duly authorized to pe~orm or have performed the said w~ ~ke and file
this apphcation; that all statements contained in this ~plication are true to the best of ~ledg~and belief; and
~ar ~e work will'~ perfo~ed in the manner set fo~h' in the applicati~ fil~ ther~ith./ /
Swam to ~fom me this · . ~ / /
Nota~ ~ublic~~.; .... n~ ...... ~ ~ ~...~......~ ........................................
'
Nota~ Public, Slate of New York / r
No. 52-0344963' Suffolk Coun~y~,,,,~
Commission Expires March 30, ~9'~
!
THOS.
~T I~T14
~. ~'1~' O~"L -
t
%_ ~t-'.q,
5. '[)'
l'/.O. 0
SITUATE
[fiST IA~IOS
TOtVH OF ~OUIbI~LO, N.Y.
N
0
5C~L:.
' ' /?"
APPROVED AS NO1ED
NOTIFY BUILDING DEPARTMENT AT
765-2&60 9AM TO 4PM FOR REC~ifi-
ED INSPECTIONS:
t BEFORE BACKFILLING FOUNDA-
TION OR START FRAMING
z. BEFORE COVERING PIPhLINE
~, FINAL WHEN JOB COMPEJTED
.