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HomeMy WebLinkAbout6489-zFORM NO* 4 TOWN OF $OUTHOLD BUUDING DEPARTMI~.NT Town Clerk's (~ttice $outhold, N. Y. Certificate Of Occupancy No. Z6.1.~8 ...... Date ..............8al~t .... ~{~..., 19.7~.. THIS CERTIFIES that the building located at .. Lakeside. I)rlve .........Street Map No. 2edar. ]~eaCBloc~ No ........... Lot No. 62 ...... ~uthol. d. · I~,¥o ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated ...........Apr$.l...1G 1~.~.. pursuant to which Building Permit No, 61~89Z.. dated ........April. · .~8 .... , 19 '?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 .Private. one. f~lly, dwel~LinS ....................................... The certificate is issued to J~ea &. L~na. O~ts ..... Ov~0~.8 ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..~epf~.. 1 l...19%~...by..t~,. UNDERWRITERS CERTIFICATE No...N. ~ ~% ~ 9.~. .... Oat. 17... ~ 97~ ............. HOUSE NUMBER . 2~[ ......... Street .. L~es~.cte .Dr.~,v®. ,, .South ............. ...... ..... TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ; BUILD]~NG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL P,[JLL COMPLETION OF THE WORK AUTHORIZED) N°. 6489 Z 'Dote ................. Pem~ission is hereby granted to: **a:.~.~...~..~.~..~ ......................... ~ .......... .......... 22~....~.1~,~.~1~r/~..~ ....... ................. i~.~:~l!!e..~ .................................... ~o ,.t~tl~...~...~...~tl~...~!~t ...... '. ........................................................................... at premises located at ]a~l.l;..!~ ......... Cae!. a_?,.]~t~al~..t~8.?..~ ............................................................ ........................... t~Ir~sid~. ~r/~re (tlout]~) ......... ,~u.~!l~14 ....... t~.~, ..................................... pur,%uont to opplicotion doted ......................... Ap,~l[~l, ....... -l~ ...... , 19..~.~.., and approved by the Building Inspector. Fee ~ .......... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 BLDG DEPT TO¢,~ OF SOUT~CL~ APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Aa This application must be filled in typewriter OR ink, and submitted m ~mmmm~m to the Building Inspec- tor with the following; for new buildings or new use: ~. 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 installa- tions, 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. For ex~sting buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~-"operty showing all property hnes, 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy~ /' $1.B0 t~, p ?,l~, _~ 4.Vacant Land C.O. $5.00 Date .................... New Building ...~.. ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property-- ' ' '~'~' ~' ' ~ ' '/"t ~,~, ~., '~ ...... Hou~ No, ~ Ham/et Owner or Owners of Property .~..~;~..~-~-~%"~ cou,,., ,,,o. ,ooo s,.t,on .... ....... i i i i ........ ,_o, ..... '..'. ........ .... Flied Map No . ?..~....Lot No .... ~.~,- ...... PermitNo..~.~,g.~. Date of Permit .......... Applicant...'.~, Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final CertificateX Fee Submitted $. I...O. Q ....................... Construction on above described budding anj;bl~rm~t meets all applicable codes and regulations. ~ LO ~t~ Applicant ................... Rev 10-10-78 .' THE NEW YORK BOARD OF FIRE UNDERWRITERS I~ [~ .~, BUREAU OF ELECTRICITY' 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the abo~e application number in the premises of James Conte, 255 Lakeside Prive, Southold, L.I. inthefollowinglocatiofl; ~] Basement ~ lstFI. [] 2nd Fl. Outside s~ction l~lock ~ot was examined on ~ ~. t Ob er 1 ~ · 1 ~ 7 3 arld found to be in compliance with the requirements of this Board. ,.XTU. I ' ."X'U"ES ' ""ES'U--CE"O'O" ,UTU. ~T. K.W. OIL H.P. OAS H.P. ~T. NO. A.W.G. ~T-- ~P*! ~ 0 SERVICE DI~ONNECT J NO. OF J S R [ ~/o COOKING DECKS OVENS DISH WASHERS TIME CROCKS ~ELL UNIT HEATERS AM~:, ~.* TRANS. H.P. C MULTI-OUTLET SYSTEMS NO. OF FEET EXHAUST FANS DIMMERS NO. OF HI,LEG NO. OF NEUTRALS OF NEUTRAL 4/0 "/~er heater: 1-4.5kw ~otor/s: 1-3/4bp Pane!board/st!-13cir. 200amps. . room heaters: 1-1~. Ok~4 k2- 2.5~'~ ~ 4-1.0~, 10-.75~w, 3-.Skw Ton AC Unit 3-2. Okw, 3-1.Skw, 2-1.25k'~, 33 Willow Park Center, Faz~inf~dale, L.I. 11735 G~N~I~AL MANA~ill I COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN OF SOUTHOLD -, ~ BUILDING DEPARTMEHT TowN CLERK'S OFF .1~.~. /~,:~/'7:~ '~./~.~_, £xamin~ ,~. I~! f ~ -~ ' ~ ................................. L...~.. ........ ;.~ ........ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicQte te the Building ,, Insl:~"tor. i~ce~..on~. ~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public areas, and giving a detailed description of layout ofpraperty must be drawn on th· diagram wl~ich is part of'this al . 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 te~ne gpplk;ent. ~ch laermit~ shall be kept on the promises crvoilable for inspection throughout the progress of the work. e. No building shall b~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. described!~ B .A.P,.PLI _CATION .IS HEREBY N~ADE to the B.uilding Dep.a. rt_ment for. the issuance of a Building Permit pu_raua~ nt to the mlmng /.one uramanae at the Town of Southold, Suffolk Coug. ty, New York, and other applicable Laws, On:tfrmnces or Regulations, for the comtruction of buildings, additions or alterahons, or for removal or demolition, as heroin c~ The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulation~ ~~(S g ature at app~icantj or name, it a corporation) ' u~mress or applicant; A/. ~. /17ol State whether ~plicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... ................................................................... * ....................................................... Name of owner of premises ...~.s~1~..C..'~.......~.....~..../~..~.. ........ ~:.A.~..T..g~.....: ................................................... If applicant is a corporate, signature of duly authorized officer. ~ .................. N;;;;;;' ';;~' ';i;'i;' '~;i,' ';:;'~';;'~;';~i i;:';';~ ......... ~, 1. Location of land on which proposed work w be done Map NO ..... ..~....0... ........... Lot Mo .~.., ..~... '~ s,,ot and ............ ................ ....., ........ :::::::: ............ : ...... :.,.L:::::::::::: Municilaallty 2.State exLetingla~se and occupancy of premises and intended use and occupancy of preposect constmttie~: a. Exisiting use and occupancy ................................................................................................................................ ........... o/ e b. Intended use and occupcm~/ ................................................ .../~..... ...................................... ,.......~ ............ 3. Nature of work (check which applicable): New Building. [:..:......? ....... Addition .................. Altemti6n .... .'..'~ ......... Repair .................. Removal .................. Demolition ......... '.~.;.[~.~ Other Work (Describe) 4. Estimated Cost .....'~,~..o....O.....o. ................................... Fee ,/..~....0...:..~.~.?...'~.. .................................................... (to be paid on filing this applicatiOn) 5. If dwelling, number of dwelling units ..... ..J. .................... 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, Jf 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 ............................ Depth ........................ Height .................... Number of Stories .................................................................................................................... 9. Size of lot: Front ..... L/../..~'.. .............. Rear ........................ ,.. Depth ......................... 10. Date of Purchase ...... ..~..~..~.~...J......!.~.~.~.. ................... Nome of Former Owner ............. 1 i. Zone or use district in which premises are situated ..................................................................................................... 12. Does propOsed construction violate any zoning law, ordinance or regu at on.;> ................................................. 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ............................................ Address)..~..~.......~ ...... ]~. ...... Le~. .......... Phone Name of Contractor .................................................... Address ............................................ Phone No ..................... 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 comer lot. STATE OF NEW YORK, ~ ¢ ~ COUNTY OF ...... ~ ......................... )' ~"~ ...... ~.~..~....~.....~ ...................................................................... being duly sworn, deposes and says thor he is the applicant (Name of individual signing application) above named. He is. the...., ............... ~ ....... ......... ~ ................................................................. (Contractor, agent, co~orote officer, etc.) of said ~ner or ~ners, and is duly authorized to perform or have performed the Said work an~ to ~ke ~nd file this application; that all statements contained in this application are true to ~e b~t of his knowledge and belief; and that tho.work,will be performed in the ~nner set fo~h in the ~pti~ti~ filed thereWith; ' Sworn to before me this ...... .......... ................ "' Publi ~ . , ~ ~R~E C. ~ANKE~H . ~a~ c~-.J.~ ........... ~ .......... ~mu~'~-~f~ (Signa~re of applicant) .~* - I ~a, ~ I ~ ~ No. 30-3807858 SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL,SYSTEM Address,~ 3o~'~ ~yw;"~, .1~: ~l%/~,l/e I/l?o~ 6. Section 2. Property location feR~-~eacA ~rl~. 7. Lot No., , 8. Private well Village ~oo~/.~ Township ~C~t~j~ _ 9. Public water 3. Public Water Company nature /F~/~. Distance to main 4. Lot size: WidthH~g~f~et Length/f~ ~.~'feet .... (Enter on center plot below) 10. Sewage Disposal System: A. 900 gallon septic tank: Precast~'' Equivalent.. Block B. Leaching pools: Number. ~.~ Precaat ~' Block .... Special__ Street If private well fi in blanks below: Tank capa ci ty.~/D-Ga Pump G.P.M. Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet -r~ 0 '~ 2 4 5~ 6 8 12 16 18 The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto," Date ,~///.~--~ Signed~~,~ ~ ~~ c__~- Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, is the opinion of the Health Department, that an adequate_an, d_ f~s~fa~tory Sewa Disposal System can be installed on this plot. ~./(.F-~'.'~ ~ S-15 Revised 4/]/72 DI2E-DG&D - ,T ? OP 50UTHOLD lOYN OF 60OTUaLP, N.¥, 5£ALr~. 50'= i'' B = I~OWutA~NT t 't ................ ~ ........... Il?iV: .......... ~,w L-I ~,ra. Oi rl¢ :]