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HomeMy WebLinkAbout6535-zFORM NO. ~1 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~2t ....... Date ............. 0~t ..... ¶:~. ...., 19.7.3· THIS CERTIFIES that the building located at .Y.o'~I[.S .&- Oak ............. Stree~ Map No. Yo~ ...... Block No..~ ....... Lot No.a... ~tti~u~. · .i .Y.. .......... conforms subst~tially to the Application for Building Pe~it heretofore filed ~ t~s office dated ......... 'lpri'l'' ~? ', 19.~3. pursuant to which Building Permit No. -6~3.~. dated ............ ~..~ .... , 19. ~.3, was issued, ~d eo~orms to all of the req~re- ments of the applicable pro~sions of the law. The occup~cy for which this certificate is issued is . P~$va~ .o~. Sa~$~y. d~ llt~g ....................................... The certificate is issued to .. ~o .-& .~-~ ...... ~PS ................. (owner, lessee or ten,t) '' ~ the afores~d build~g. Suffolk Co~ty Department of He~th Approval . ~.t.12...l~... bi .B~. ~ill~ ... UNDERWRITERS CERTIFICATE No.. ~.l.~l ..... 8ep~. · .~...~.97~ ............. HOUSE NUMBER .9~ .......... Street .. -YO~gS. ~ ........................... 6~ O~ ~ ......... B~i~' i~;~;c[;~ ..... FOR~ NO. 2 TO%VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 'N°. 6535 Z D~te ......................... ~ ......... ,~ ........... , ~9.~'3.. Permission is hereby gronted to: ............ .~. ~..,~....1~tb..... ~z~r~ .................... ................ ~at~.tuck ....................................... ~o ..~_ ~l~..a~w...~a~.. ~I~....~wellin~ ..................................................................................... at premises located at ...... ~QtqJ~g...~..(~aJ~..J~; .................................................................................... ...................................................... F~.tt £tuck ..... ~.~ .................................................................. pursuant to cpplicctlon d~ted ............................... ~...L..~,~.., 19..~,~., end cpproved by the Building Inspector. Fee $-.8'~,M;)0. ......... uilding I lvO~,M NO. ~ TOWN OF SOUTHOLD Building Depaffment Tmyn 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: 1. 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 premlses, or other pertinent in- formation required to prepare a certificate. C. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 / Rte ...... ...... New Building ...~ ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..... ..~.~...~. ~....~'~--....~m~,e...i~,,e-;~..Z ................... Owner Or Owners Of Property ..... ":' '~...~,a.,-~ ,e Subdivision .................... ,.~ .................................... Lot No. ,,'~ .....~BIock No. ,,,,,~,, ,,,, House No...~.A~... PermitNo .~..~.~S DateOf Permt~[~i~/.!?A~p cant . . Hea th Dept Approva .~...'~......'?~. Labor t A royal ~ Underwriters Approval .... .~....J..L.LJ.~...~....~ ........ i ...... Planning Board Approval ..... .~....~....~...}. ................ Request For Temporary Certificate ........................................ Final Certificate .......~ ............................. Fee Submitted $~.. ................................ Notary Public .................................... County Construction on above described building and permit meets all~gpplicable codes and regulations. Sworn to before me this ~"t~,/~' ......... · .~... day of ........................... .~...~. ....... (stamp or seal) /~/~. SUFFOLK COUNTY DEPARTMENT OF HEALTH H,D. Reference No. APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant ~~.~i~~ Ph?n~. Subdiv. Address -~o,~(~. '~7~F--~7~,~ ~,~, 6. Section 2. Property l~catlon :7~_ ~.f j-~. ~. 7. Lot No. ~ /- 8. Private well Village ~~,~) Township ~~, 9. Public water 3. Public Water Company name ~ Distance to main 4. Lot size: Width/~ feet Length /~ feet (Enter on center plot below) 10. Sewage Dispos~ystem: ' Precast ~Equ'/ivalent A. ~O~gallon septic tank: Block B. ~aching pools: Number ~reca's~lock 'Special If private well'il in blanks below~. Tank capaeity~Gal: Pump G.P.H. ~ Total well de~pth ' Depth to G.W~ ~ Amount of water in well Test Hole Data I ~ee~-- I° 2 6 8 I lO 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~,5~' ~g~ ~.3~ ' ' Owner ~r~uilder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewa Disposal System can be installed on this plot. Date ./f b7 Signed '"' $-15 Revised 4/1/72 THIS CEKTIFIES THAT only tl~ e~tr~ ~lu~nl~nt G~ d~eri~ed ~1o~ and int~ by tile ~idi~G~t nGm~d on tl~ al)o~e 41%olR~t~on number ~ tl~ pr~r4~ of Ted Rayburn, s/s Youn~ St., 200' w/o West Phalea Ave,, MattStuck, L.I. in thefotloFing Io~.tion; ~ B~ement ~ 1st FI. w~e~'"i,,~uo. September 6' 1973 OUTLETS ECEPTACEES SWITCHIS INCANDESCENT 18 2.~ 18 [] ~t~ ~. outside s~,~o,, and found to be in compliance with the requirements of this Board. DI,,,,Rs I FURNACE MOTORS FUTURE AI~LIAN(~ FEEDERS ~,. K.w. O,'. H.P. ~ ,.P. .~T. ,,,O. . RANGES a*. ~. w. COOKING 0r~KS 0VEHS DISH WASHERS ~T. ~.w.l.~T. ~.w. ~T. ~.w. TIMECLOCKs BELL UNITHEATBES MULTi-OUTLET ' NO. OF FEET SERVICE DISCONNECT I ~.OF MITER 1 200 ~B S R V I C E EXHAUST FANS DIMMERS OF CC. COND. OF NEUTRAL 2/0 *Furnaces: Oil 1-1/Shp, 2-1/12bp 227 Waverly Ave., - ~2,~ B Medford, L.I. 11763 "'""~ .T-'~=/ ~ 11 ~ / " ~" copy FOB ~l~e DEPA~T~IS COPY OF CERTIFI~TI ~ NOT BE ALTER~ mN ~ ~m~ Exom~ed Approved ........................................ , 1 SOUTHOLD, N. Y~/~(/~r ,~--- ~ ~ ........... Application .......................... APPLICATION FOR BUILDING FERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 3 sets of pi,ns, accurate plot plan to scale. Fee according to scbedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, adq giving a detailed description of layout of property must be drawn on 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 permit ,shall be kept on the premises available for inspection throughout the work. a. No building shell be occupied or used in whole or in part for any purpose whatever until a Ce.rtificate of Occupancy shell 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, end 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 end in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ........ g,. .................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ......................... ' .... .V, .... Str and N,mber ....... · .. Munteipality' 2.State existing use end occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ .~/2~.a~'d..-~.....~f:~.~.. ............................................................................... b. Intended use and occupancy ...~2A~. ........................................................................................ ~ ....................... 3.~'~re of work (check which applicable): New Building ....................... Addition ..................... Alteration ........ Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ~;::3' 7 ~ (Description) 4. Estimated Cost ..... ~...qt/../...~...c(. t. ~'.' .............. 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: Frent .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ e. Dimensions of entire new construction: Front .....~teL~ .......... Reer ......~..~.. ................ Depth..~...'~....~.. ................... Height ................................................. Number of Stories ....et~. ................................................................................ 9. Size of lot: Front ............... ,, .................... Rear .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ....,d~-.~;/~....~'.~.~'.&~. 11. Zone or use district in which premises are situated ............. ~; ....................................................................... 12. Does proposed construction violate any ~oning law, ordinance or regulation: ............ ~ ................ [~:,, .............. 13. Will lot be re{Faded .................................... Will excess fill be removed from premises: [ ] Yes [t-] No Name of t3wner of ,,remises .... ..-~...~..~'06~)..l~E*"7~A~ ¥/~/,/~:'A/ o~c/?' 14. " " ...................................................... t ......................................................... "/' .......... (Address) (Phone No.) Name of Architect ......~..~.,r'~,,..D.~.~,. ,~,,.,,/-?,.,L,,...E.,....~_..,,_~. .................................................................................................. ~, , , ,, __ ~-* (Address) (Phone No.) Name of r¥,ne,~¥or ~ /L'~/-)A//_3E~'~ 22'-A/ . ...... ........................................................ 7' ....... ................................... ............... 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 wheth- er interior or corner lot. STATE OF NEW YORK, OF ) COUNTY ............................................... ...~.. )SS ............................ ~'J~'~Z*~'~?'t:Jl'~i~'~t~'~i~ .................... being duly sworn', deposes and says that he is the applicant above named. H~ ~ *~ ~ (~V lV ~-- ................................................................ {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 all statements contained in this application are true to the {~n~,~ f~i~ledg~and be ef; and that the work will be performed in the manner set forth in the application filed therewith. Natal/ pu~,[ic, State of New 3urn No 5~ee'~l''~63 Sut~k C°unt~-a/ ............................ 7..dayo, ..................... ,.., ry c .... (--e~'../. ~,adl¥... ~.. County / t~..-,w,,~.-~- z_ ~ · _ (Signature bf applicant} J, __ F-.. P 'T 1 ~ L~VATION I .s ~LAN ' ,, / SE-CONE) ~ LOO~_ :A A PLA N ' SHEEI 5 °~5 Sc a/e : .~,a '~ /"