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HomeMy WebLinkAbout6674-zTOWN OF SOUTHOLD B~m~nlNG DEPART~rf Town Clerk'e Office Southold, N. Y. Certificate Of Occupancy No. Z?80~ ..... Date ............. Au~ .... 3 ...... ,19.2~. THIS CER.TIFIES that the building located at R,0oW,. ~/S..~estphal~a .RdStreet Map No..:g~ ........ Block No...:~:g ...... Lot No... ~xx... i4atf~i, tuek..N,~, ...... conforms substantially to the Application for Building Permit heretofore filed in thi.~ office dated ............. june...18 19.?~. pursuant to which Building Permit No. ~6~Z · dated .............JB~.e.. ~9..., 197~.., was issued, and conforms to all of the requir~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Private..one. ~aml~,y .d~e~ng...¢2nd. ~1oo~..unf~n~sl~ad) .......... The certificate is issued to .S~dney. ~aastead .Jr. ..... 0~mer ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..,~. ~...1 ~.... bY..R..,..V.~.~.& .... UNDERWRITERS CERTIFICATE No..N~ 61~8 .~ ..... June. 12... 1 ~).~ .............. HOUSE NUMBER ... 130/2 ...... Street. t~astphalia, ltoad ..... ~iattl~aek ....... Building Instructor [ FORM NO. 6 TOWN OF SOUTHOLD Building Department 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, 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 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 ...... ...br. ...1.922. ........ New Building ..... ~[ .......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .... .l¢~OO..i~s.t]~hal/~.J~:~a~..~E[~..]~tO..W~). ................................................. Owner Or Owners Of Property ............ ~;;LC~et~r...0~fL~l;~. ......................................................................... Subclivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~6.~~' ....... Date Of Permit (~u/..1.C,~/..73...Applicant ..~rl~...~8.~.~, ............................. Health Dept. Approval 6~.~/.~...~4...T.t.1'1~. ....... Labor Dept. Approval ........ ~'./,~ ................................ Underwriters Approval ...1.~t'.~8~[ ............................. Planning Board Approval ..... ,~Z~ ........................... Request For Temporary Certificate ........................................ Final Certificate Z~[ Fee Submitted $ ...~[,.OO ........................ Construction on above described building and permit ~..ets all aa~licable codes and regulations. Applicant ............................................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County FORM NO. 2 TOWN 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? 6674 Z Date ......................... J~e ........$9 ........ , 19..73.. Permission is hereby granted to: ...ql&ue~...l~t ~ ,~...J~. .................................. ....... ~3,,;~O.....2.1.2.. ~ t, ......................................... ......... ~1.~ ;l,.¢e .......... 1[,.~., ................................... ~o ....~u,ll,~ ..~ze-,z...oz~e .. ~'~..t .~.. (~:.~. :,,£ng .................................................................................. at premises located at .~/,~,....~,~e,~t~8.'J,~-~i,..~a~. .......................................................................... ............................................... l~f..t.~.t.~ ......... lJ.~.. .................................................................... pursuant to application dated .................. ~U,~O ........ .~ ............... , 19...~.~., and approved by the Building Inspector. "00 Fee $...~.~'..~ ............... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Of[ice Southold, N. Y. ~I4PORkRY Certificate Of Occupancy No.. Z~.9~9 ..... Date June l? 1.q~ THIS CERTIFIES that the building located at ....R. :0 ~.: .~.~'..~.e..s.t.P..~..]'~.aStreet Map No...XX ........ Block No .... ~ ..... Lot No. Xz:x 14att~.tuek NoY, conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ,~un®...18., 19.~.3. pursuant to which Building Permit No.. ~..~. Z. dated ........... .J.u~e...~.9.., 1~..., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pr:l.~tate..one. f.~$~[, d..wg.l. 1..~.g ...................................... The certificate is issued to . .8~.dney 0~$te.d&..J~. ..... . .0~..e.l* ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~'un® 3 197t~ by Ro Villa UNDERWRITERS CERTIFICATE No .... N..1..(~..~.~.~. ..... J...u~., .~.2 ...... ??..~. ....... HOUSE NUMBER ....... ~.~.O0.... Street ...~.e.s..tp..h~..1.~.a..R..~..d. ..................... Building Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- ?~C BB JOHN STREET, NEW YORK, NEW YORK 10038 ,ate 12.1 .74 App,ie.t,o. o. on,,,e '7."-"7 N 164585 THIS CERTIFIES THAT only the e~ectri~d equipment as descrlbmt belo~ and introduced by th~ ~pplicant named on th~ above epplicatlon number in the premises of ~idny Olmsted, 1~00 West Phalia Rd t:./, Hattituck. L.I. in the followlng location; [] Basement ~ 1st FI. X [] 2nd FI. ()ti ts ide S~ction Block rot was examined on ,.TLIR ~ 0 · ~. ~ ? ~i and found to be in compliance with the requirements of this Board. ~)~TT LUEI~5 [ECEPTACLES~0 SWITCHESll[,NCANDE$CEN?[,~ ,FLIuXoIEUs~REtST [ ~v~C~r~ ~T"ANG~.Sw. DR¥~=RS FURNACE MOTORS FUTUEE APPLIANCE FEED~ES AMT. K,W, OIL H.P. GAS H.P. AMT. NO, A.W. G, EXHAUST FANS SPECIAL REC'PT. i.~T.~ AMp. SERVICE DISCONNECT [NO. OF [ S E R cc. COND. 1 10 (iB x ] 2 OTHER APPARATUS: Special l~eceptazle/s; 1-3Oamp, 1-50anp. l;'ater heater/z; 1-4.5T.W. · ",Yot or s/; 1- 1/2III'. Panelt~oard/s; 1-12cir,, I00amp. V I C NO. OFHFLEG A,W.G. MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET A~T, WATTS NO OF NEUTRAL OF NEUTRAL 1 4 Sidny nl~;~s ted 53-20 212 St. 11364 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF $OUTHOLD Building Department 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 fram the Architect ar 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-ex'st'ng ' 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 premises, or other pertinent in- formation required to prepare a certificate. .._...~,_~.. 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 lA ~,e .......... ~.....I.~.:/~..Z.~. New Building ................ddition ................ Old or Pre-existing Building ................ Vacont Lend .............. 1.o...o...W....,, ~. /. ' ~...4. ~.,,Z..~. ~ .~.. Location Of Property .J...i .I. ,,.. /.&... . ~ ........................ ~ ..,... Owner Or Owners Of Property ...... I.,,~.~..~. .... ,f. .................................................................. Subdivision ....................... ~ .................................. Lot No.............~ Block No. ............-'---- .ouse Uo.J.512.O Perm,t No....d~.7..Y. 2Date Of Permit t~..~.&pp,icont ..~:&~...~./~..~..27.~...4 ..................... Request For Temporary Cert' f cate .................. ..~......... ........... P ne Cert ficote .......................................... Fee Submitted $ ....... ~ ............... Construction on above described building and permit meets all applicable codes and regulations. Applicant .................................................................... Sworn to before me this DE?~,~F ~)L~T~(L~PARTMENT OF HEALTH Heal th Department Reference Number 2. ,Pr.o,per, ty L~ation/~ c/O '~T~/~:~ '~ ~ ~ ~ Village~ ~e:~ ' Township ~ [~ 3. Public Water Company Na~ ~ 4. Lot size: Width2~d~ feet Length ~ APPLICATION FOR APPROVAL TO CONSTRUCT '73 JUN 7 PM AIPJ~I~TE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant ~/~Au (~/yw,']--~/ Phone2/~-J2~-/~FJ' 5. Subdiv~ 6. Section 7. Lot Number 8. Private Well ~ 9. Public Water /~/~ Distance to main feet 10. ll. Sewa~isposal System: . A. ~_~O/-gallon septic tank. Precast Equivalent Block B. Leaching pools: Nun~ber of pools~ Precast~OBlock ~.__Special If private well, fill in the following blanks: A. Tank capacity ~ gallons B. Pump G.P.M. C. Total well depth D. Depth to ground water E. Amount of water in well (For Health Dept. Use) 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. Date ~- 7 ~/~ 7-~ Signed ~/~~ 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 installed on this plot. APPROVAL DATE ~//{/~ SIGNED ~' ~ ~ S-15 Rev, 4/1/73 TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFI~E'~ ~, SOUTHOLD, N. Y. ~.* o inod ......... {.: ....... ' .. Approved ...................................... . Disopproved a/c .................................. ~ ....................... ......................... ............... :T ...... ~-;~:'.~' APPLICATION FOR BUILDING PERMIT Do,, ...5.: / ~ ....... .. ................ , ,,....,.~..> INSTRUCTIONS a. This epplimfion must be completely filled in by typewriter or in ink and submitted in triplipat~ to the Building Inspector, :$ ~ts o~ plans, e~urete plot plen to scele. Fee according to schedule. b. ~lot p~en showing Iocetion o~ lot end of buildings on pmmisa~, relationship to adioining premiss or public str~et~ or crees, en~ giving a deteilad description of layout of ~oper~ must be drewn on diagram which is pert of this applicetion. ¢. Tbe wo*k covered t~ this epplicetion may not I~ comm~ne~l before i~suen~ of Building ~ermit. d. Ul~n el~roval of this i~li~tion, the Building inspector will i~sue e Building ~armit to the applicent. Such I:~rmit the ~emises eveilable for ins~¢tion throu§hout Ibc work. e. No building shell be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have bee~ granted by the Building InsPector. AP~LICATION 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, ~uffo~k County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or elteretions, or for removal or demolition, as herein described. The applicant agrees to comply with ell applicable laws, ordinances, building code, housing code, end regulations, and to admit authorized inspectors on premises and in buildings for necessary insPection;~, i ..... ..................................... (Signature of applicant, or neme, if a corporation) ,..~ ...................... (.~;~';;';; ~;;';p~ic;;,';)'"" 7'~:~"~"~/''' , State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................ O~.~.~.....>:... .................................. Name of owner of premises .... .~../. ..... ; ................................................................................................. 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 I-icense No ..................................................... Other Trade's License No ................................................... !.. Location of land on which proposed work will be dgne. Map N.o .............................................. Lot No ....... ;. ................. Street and r * ~ R'/ R. .~, ~.~.. ~ ~ Numbe .................................... .~..~.....~.~...~ ....... ( ...... ~. ....................................... .~, ......:........~.... -- ' Mumc~pahty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................... b. Intended use and occupancy .................. .~.. Z~...~......./~...~....~..!: L~......./~....{~..~.~.~ ./.?.~. ................................. ~ ...... ,; ...... · Nature of work (check which applicable): New Building ....................... Addition ............ Alteration ........ ,~:... Repair ......................... Removal ......................... Demolition ........................ Other Work ............................... : .... (Description) ....... ........................................................................... 4. Est,mated Coac-4f..4...~[ .................................... (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 occuoancv, spec_Ltl/nature .an, d ext~nt of qach type of usa ..~....~.. ........ .._o ........... .~ .... 7. Dimensio~ns of existing structures, if any: Front ..(~....3..~...~...!~. Rear .~.~{~Z.....(~.......~=~:....Depth .(~....~.~......(~.....~..~. ....... · _ (~ '~C* ~ /~" ,, ._k.. A~ e.~.-., fl) 2 0-2 / ................... Dimensions of same structure with alterations or additions: Front ...... ~ ............... Rear .....~ .................................. Depth ................ .~. .......................... Height ......................................... Number of Stories ........................................ 8, Dimens,ons of entire new construction: Front ~..C ................. Rear ...~...(....~.. .............. Depth .,)..~......~. ................... Height ..2J.L..~...~/. ................................. Number of Stories .....[....'.~.. ............................................................................. 9. Size of lot: Front ..~.~.~..,J. ............... · ....... Rear ...2..O...°.'....O.. ........................ Depth ...~...~.~.s..~ ............................... 10. Date of Purchase ..... J.~...:....: .................. N.a_me of Form,§r ~ ~wner ............................................................................ · 11. Zone or use district in which premises are s~tuated ......... ~... ....................................................................................... 12. Does propoesd construction viotate any zoning law, ordinance or regulation: ....//Z..~. .............................................. ~q3. Will lot be re~lraded __~,~_.a. ............... ; ....... ~:.,. Wil.[I exf~ss fill be__ re~o,,v,ed,~roel:[n pre ,misses!, [ ] Y.es_ , _ _~.o,, _ . - - / ,-- :e z.z ~ R~..~ ...... 14~ Name of Owner ofpremtsas., ...~.,..l.~l/~...~./,~i~.[~..~.~ ...... * ~'~";~'l~'"~"A'"'"L('d(Address)_ ~.~4~.Y......2../.// .~u ........ (Pho.e:'~':'g'No.) ~ ¢ ~RJ' (.~bL ...~....~.../.~..a..~. /~..~ LdZ .~' .Zv...,.~: .................................. Name of Architect .....~..! ...... : ............ ~.. .............................................. ' iPhone No ) (Address) . Name of ContraCtor ........ ..~....b~....~..~ .................................................................................................................. (Address) (Phone No.) PLOT DIAGRAM Locate clearlY and distinctly all buildings, whether existing or proposed, and indicate all sat~oack dirne~ions from property lines. Give street and block number or description according to deed, and show street names an? Indlcate whath- er interior or corner lot. STATE OF NE~.,~'OR~K~ ) G u ~'14 ~- : COUNTY OF .....~...~f~,~.~.~ .......................... ) ............... ~..~.~ ~~ ~,ng duly sworn, de,,s and says that be ,, the ,ppli~nt above named. ' He is the ................. ~.~%~ ......................................................................................................................................................................... ( Con~ctor, a~nt. coyote o[~r, etc. _ of said owner or owners, and is duly authorized to ~rform or ha~ ~dormed the said wo~ and m make and file this appli~tion; ~ all state,nrc ~n~ined in this appli~tion are true to t~ ~st of his knowled~ and ~lief; and that t~ work will ~ ~or~ in ~ ~n~r ~t fo~h in the ap~i~tion filed t~mwith. da Of ~ ~ PUBLIC ~'=..~w York ...................................... Y ......................................RE."52:~5' ...... Notaw Public, .~...~.~~ar:h 3~,.~.~,~~.~,.;.:_...7;~~ .................................... ,~ N. ~7' 072 ~0" ~:. - :. ~3,,r~' t ~TY ~LTB DE~T~T The sewage disposal ~d water suppl~ facilities for this location have been inspected by this ~epartment ~d fo~d IAAP OF LAND SCALE- 50'= !" tn = /^OKIU/AI;ldT SIDNY iX/. OL/ASTF--D. JE. ",. 20BE P_.T \V. OL!ASTF___ D :~""'" " .... iA A T T I T U C E Ror)s~,.ICK VANTUYL, Li CEW$'ED LAN-D °F I'2 © I,.J.'T- EALE--x,/~-TIOLIo 1: ° ° ~1 ~.~I~T- Oil:Dr=-- r ..... ""l L ...... J I. J :tX8 FLoor ~.,'~T o# 3,~';IZ,,a,,e,," III ~ OY 2¥ x2'f ti3, C~c.£oo'/T, vq, '"J]J "1 t I I Jill t , , , ~,; ! L- ..... _ 5~51 ± COUNTY HEALTH DEFAET~EN~ EOBEET \¥. OL/^ST[ O /^ATT I TUC~ SCALE, 50'= I" B = /AOMU/AEMT