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HomeMy WebLinkAbout6512-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .Gr.ee..n..Hi. 1..1. ~ .......... Street Map No. Easte. r.~.. ~ Block No. Se.e.V. ...... Lot No..~.~ .... .QI'. e.e.nD, gr.%. N,.~.,. .... conforms substantially to the Application for Building Permit heretofore filed in this office ___.~_..~ated ........ Ap.r.$1..2~; , 19.~.3 pursuant to which Building Permit No. 6%12~ __....._._---dated ....... .A~.r..il..~.~., 19 73 , 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. riYate..one, family .dwet!~n_g.. The certificate is issued to Goo.l'ge..W..e.~.~lo.x,.e..,/..~-. of the aforesaid building. (owner, lessee or tenant) Suffolk County Department of Health Approval Atlg. 28 . 1.973 . by R. Villa. UNDERWRITERS CERTIFICATE No...~.. ].]2i ~ 0... A~g..30..197~ ............. HOUSE NUMBER . .21 g ...... Street ...DR~L .HI J41..~a~. ................... Building Inspector FORM NO. 2 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6512 Z Permission is hereby granted to: · ~e~,.-.A]~:~e¢*s..-]~-.3~e.~,..-~-ne- A-/~..Ge~).~. [4e~,,ntore .................. ~u-~e~gue ....................................... to ...B.1J,~;l~..I~.~'...C~n~.. Z~ r~ ~l~...l,t~t ~'~ r~g ................................................................................... · t premises loc~ted at' ..... .L~t~...'l.~....tga~,~.~...~ol~.Olt ............................... .: .............................. ................................................... i~,~a ..It;~..1... l,ar~-o ................. O~,eong, o~,~...-: ............................. pursuant to application dated ..................... ~r~,.~.....12.~ ............ '., 197.3 ..... and approved by the Building Inspector. Fee $..8.~.70 .......... ,. , ~ !'--' Bu~ilding In'sjSector / Z~OZtM NO. 6 TOWN OF SOUTHOLD Building Delmr~mnnt 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 triplicate 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, 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 buildings, Mulhple 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: 1. Accurate survey of property 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 buddings 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 .... t ......... Old or Pre-existing Building ......................... Vacant Land ............................ Owner Or Owners Of Property .~..~...~...~..~'..~...:..~.~.....~~.~...4~,~ ..................... Subdivis,on ....~...~.~...~ .................. Lot No.//,~. .... Block No ............. House No ............. Permit No ~....~./,~...~.. Date Of Permit ~.....~..CApplicant ~7'~....~"¢.~'J~.~. ................. Health Dept. Approval .....................:.~ ................... Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....V~.... ................................ Fee Submitted $ .....~...-.~ .................... Construction on above described building and permit meets all applicable codes a_~nd regulations. Applicant ~.~....~.~.~' .................. ,?...~ ...~.~.~g~x Sworn to before me this ......... ...y... o, ...... Notary Public .................................... County (stamp or seal) ~/~ ~-~<~/~ FOI{M NO. $ TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 AFPLICATION FOR CERTIFICATE OF OCCUPANCY Instruct;on= A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 farm or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commercial buddings, Industrial buildings, Multiple Residences and simi[ar buildm~ and t~e building. 5. Submit Planning ~o~r~ cpprovol of completed site pl~a requirements where ~pplicoble. B. For existing buildings (prior to April 19~7), ~on-conforming uses, or buildings ~nd "pre-existing" I~nd uses: 1. Accurate su~ey of property s~owing o11 property lines, streets, buildings ond unusual n~tuml or topographic feotures. 2. Sworn statement of owner or previous owner ~s to use, occupcncy ~nd condition of buildings. ~. D~te of any ~ousing co~e or sofe~ inspect;on of buildings or premises, or ot~er pe~inent 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 3. Copy of cert,[,cate of octupancy $1.00 $5.00 New Building ..~ .......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...... 2.9~.~......(~~ ....... .~.....~.. ......... .,~.~..c..¢...~.~..~..Z:.../,D. ........ ~¢~.~...~. ............... Owner Or Owners Of Property .... ~./.~..6,.J.~.6~..../~ ....... 4~..W.~ ....... .~.~..~..~..~.....~../..~...~.../..C...,'.r~...~.../..~.r. ........... Subdivision ....... .~...O..f..C....7~..~.......~?..~..,~. .................. Lot No...~...~. .... Block No ............. House No.. ,~.~,,..~. Permit No....~,....~.../...,~. .... Date Of Permit ....Z~...~..2.2?'...Applicant .~'.~,~..(~.~r~..~¢. ~ ..................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ ~ ~uc',w,,~,a /~F,p,Ovu, .............................................. rtu,,,,,,,td ~GGrC~ Appi'ovGl ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ .................................... Construction on above described building and permit meets all appl~icoble codes and regulations. /~F'I-'* ~ ~.'-', ,~ ..... . .'T:'./~..: ................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notory, Public .................................... County a~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ J~U~USt 30, 197 385 JOHN STREET. NEW YORK. NEW YORK 10038 .,,re ~p..c..o.:~o.o./.,, *>9)13 N 112110 THIS CERTIFIES THAT George Wetmore, Jr., w/side Green Hill Lane,300' n/o tlomesgead ¥lay, Ea Eastern Shore, Greenport_L.I. in the following l~a~ion; ~ B~ement ~ lst FI, ~ Z.d rt. outside S~tlon Bilk ~t ,~e~amin~on AuMust 27, 1973 and found to be in compliance ~vlth the requirements of this Board. RXTURE t EXTURES OUTLETS IECEPTACLES SWITCHES INCANDESCENT FLUORESCENT 27 [ 27' 17 DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS ;PECIAL REt'PT .. 3 0 SERVICE DISCONNECT [ NO. OF [ S R 0 C~ x METER, 1 15 ]. 1/O OTHER APPARATUS: RANGES K.w. 1 1~.: COOKING DECKS OVENS DISH WASHERS K.W. [ AMT. K.W. ~T. K, W, TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET V I C EXHAUST FANS AMT~ H.e.F DIMMERS NO. OF NEUTRALS A.W.G. OF NEUTRAL i 2 *~urnaces: Oil i-1/Shp, 1-1/12bp l-lO amp. Garbage Compactor W. B. Ruland, Mattitt~ck, I,.I. Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SCALE · 4.0'= I" ~,~ Ill, ON PIP£ TITLE SUFFOLK COUNTy HEALTH DEPARTMENT The sewage disposal and ~?~*ne supply facilities for this locat, io~ have been inspe¢teO by this department and found SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No EASTERN DISTRICT, RIVERHEAD,N.Y. Approval to construct said systems is requested,pertinent data herewith: - Hamlet ~f;~~ Town3~;/~ ~/9~f/~ 9-Private weli?-/~g3 ~x ~ 3-Public water supply name ~.]~/. _~. ,/ ~/~,~/y~stance to nearest ~in % 4-Lot Size:. Width~TOft.-Le~tH~ft. (al~o enter on center plot plan below.) ~ 5-~elling. Single Family ~X~ T~ Family? / /Cellar? /~/~lab? ~T lO-Pro~s~ syst~: Septic tank ~/Precast y~/Cesspools / /Shallow pools / /Other ~ / ~ l 1-Septic ta~ inside d~mensions~ Vol~e~Gals.Length ft. Width ft. Liquid. depth., ft. 12-Precast sections: ~Number/ /Sq~re Mt'. Cesspools: Block sizeL, incs.D ins. H.. ins. ~ Total blocks below inlet: *i .~3~ ~T P~N  ~city Gals. Street ~M Y~.-~- ~! Data Fee~ '0 2 4 6 8 lO 12 14 16 ~ ~ Indi The Undersign~ CERT~S: "Const~ction of authorized installations will be in accordance with the Suffolk County Health De~rtments' current Standa~s, Bulletins, and amendmentSDate~//~/~_~l , thereto, covering SignedPrivate Se~geowner~oDiSposal~~r Builder 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 can be installed on this Plot. Date ~-7F~->~ Signed,. ,~ EXCAVATION DtSPECRON REQUIRED s-~5 Examined . ~* ~' ApproYed ........................................ ~ BUILDING DEPAItTMENT,~,,~/,~ ,,~o~ TOWN CLERK,S OFFi~ Application No~....~ ......... ..... Disapproved o/c ........... ~ ...................... ~ ~spectorl L ~ ~/'~ ~ APPLICATION FOR BUILDING PERMIT aa,. INSTRUC'I'ION$ a. This application must t:~ completely filled in by t¥~writer or in ink and submitted in triplicate to the Building Inspector, wi 3sets of plans, accurate plot plan to scale. Fee according to schedule. ,4.% b. Plot plan showing location of lot and of buildings on premises relationship t6 adjoining premises or public streets or areas, a giving a detailed descri~ion of layout of property must be drawn on diagram which is part of this application. c. The work cowred 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 permit shall be kept on'~ the premises avai|able for inspection throughout the work. e. No building ~hall 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. .A. PPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zoni Ordinance o/~ the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction 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 applicant, or name, if a corporation) (Address of applicant) v State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. v If applicant is a corporate, signature of duly authorized officer. ......... ........ .............. (Name- "~and title or corporate officer) Municipality 2, State existing use and occupancy of premises and intended use and occupancy Of proposed constructiOn: a. Existing use and occupancy ...... ~....~..~.~ .................................... , ................................................................ b. Intand~d use and o~upanc¥ ............................................................... 2 .................. y ......... :. ..... 3. Nature of work (check which applicable): New Building ............... Addition ..................... Alteration .......... Repair ................ ~ ....... Remova ............ ~ .... Demolition ..., .................... Other Work ......................... : .......... ~ --^ C~-~'~ 7 0 (Descriptionl 4. Estimated Cost ..~...~'~..~.,,~.~Z~.. ............. ~..~ 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, commemial 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 ...... ~,IT....,~.. ...... Rear ....~.' .................... Depth ..~?~. ...................... Height ...... ~. ...................................... Number of Stories ..... ~. ................................................................................. ....... /....~.... ........................ Depth .................................................. 9. Size of lot: Front ............. ~......~... ........ Rear ~ 10. Date of Pumhase ..................................... Name of Former Owner ............................................................................ 11. Zone or usa district in which premises are situated ..................................................................................................... 12. Does proposad construction violate any zoning law, ordinance or regulation: ...................................... '"7 ............... 13. Will lot be regraded .... (-/,~. ...................... Will excess fill be removed from premises: [ ] Yes __[~ No. 14. Nam, e of Owner of premises ,.~.~X~:~. dr~ess~,....,.~f~?~~.~C~, Name of Architect ....................................................................................................................................... ~ ............. , A dres (P ne o.) Name of ContractOr ....~...e~. ........ ~....~.[~.~4~.. .............. ~..,,12..~.)/..¢~:~ .......... PLOT DIAG RAM -- .... I.ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-beck dimen'sion~'f?om-- property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot .... STATE OF NEW YORICk,. /,/_ /,~ ) COUNTY OF ......... ................................ Ol~nd~v~dO~l ~n~n~ contract} "~"'~3larrte ............ heing duly sworn,~~...d~o~s and ~¥s that ha is the applimnt aho~ named. {Contractor, agent, corporate office~ eib.) . 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 he performed in th~. manner set forth in the application filed therewith. ...................... ......... ....................... ......... i/ APPROVED AS NOTEL.