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HomeMy WebLinkAbout6609-zFOR~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at , ,B/~,, .N,ow , .8.~e, .f,o,.:..,, ,,I~, .... Street Map No. ~ ........ Block No, . ~ ..... Lot No, ...X~.....N.~.W...8.u~..f.o.~ :ir...N. :.Y.: ..... conforms substantially to the Application for Building Permit heretofore filed in this office 6609Z dated ...... .P~.~....2~..., 19 ~.~. pursuant to which Building Permit No. dated ........ . .Iei~......L~.. -, 19 7.3., was issued, and conforms to ~11 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P.I'..ly.a.t.?..o..n~...i'..a~.i..].~r..al. if..e.,~...i~, g..&..~.~.!v.a.t;.?..(.a.e.c.?.s.s.o.r..y.)..ia..l'.a~.? .... The certificate is issued to l..udrilat .l~, .(~Odali ..... .Oep_~.~. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.a..n..I..~...I9.7.6...blt. ~: .~i.l.3:a.... UNDERWRITERS CERTIFICATE No.1[26396.8.... Jan.l~..1.176 ..................... ~tOUSE NUMBER .. ~..i ?.~. .... Street ...~.~.'...s.~.r.~.e.~...~..~..d... f.~..~...s.t). ....... Xev S~lolk N.Y. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COJ~PLETION OF THE WORK AUTHORIZED) t N? 6609 Z Permission is hereby granted to: ........... ~ ...... .~:.,....<.~:...... ........... pursuant tO application dated , ~ /'~ ~.. 19'7-~, and approved by the Building Inspector. Fee $ ........................ Building Inspector TOWN OF SOUTHOLD Building Department Town Glerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled ~n 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 Iocahon 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 ar 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 Arch:tact ar Engineer respons:ble 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~sting" 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, ar 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 ...... .t.Q .~,.~..C~, ..'~. ~.., New Building .................... Old or Pre-existing Buffding ............................ Vaca~l~ Land ............................ Loca,,on of Prope ...... ....... Owner Or Owners Of Property ..... /~-~..~.~...b.'-~.,.....J~.-. ..... ..~..~..~.~.......'~.~. .................................... Subdivision ................................................................. Lot No ............. Block No ............. House No ............ Permit No.~..~.(~..~..~-.... Date Of Permit ~.~(~,~.Applicant ..~.~.~ ..... ~..~. .................... Health ~pt. Approva~ ............................... Labor Dept. Approval ................................................ ppro, ........................................ Request For Tempor~ Ce~i{icate ........................................ Final Certific~t~ ~ Fo, Submitted $ ...~,~ ......................... SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number .~,~4~-,..~-~) APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Appl icant O. ~one -_~1~[~__5. Subdiv. Address ~ kl~. ~ 6. Section 2. Property Location I~ ~ 7. Lot Number 8. Private Well Village [~m,~"',~',O~:'~l~ Tow.Dship '~o~) 9. Public Water 3. Public Water Company Name Distance to main 4. Lot size: Width~,~feet L~ngth~feet '~ 10. Sewage Disposal System: (For Health Dept. Use) 11. A. 900-gallon septic tank: Precast ~,,, Equivalent Block B. LeaeHing pools: 'i Nu r of pools ~ : ~ecas~Block Special If pri~a~e well, fill in the follow~n~ blanks: "A. Tan~apacity ~)~ gallons B. Pump G.P.M. ~k~ C. Total well depth D. Depth to ground water E. Amount of water in well The undersigned CERTIFIE~: "Construction of authorized installations will be in a~cordance 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. FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the ~Pn~n~aO~e~fstuhp~lyHe~latnhbDee~etdtho~tt~sadp~oq~a. te and s~ati~_~factory Sewage Disp.~o~?~System S-15 Rev, 4/1/73 THE NEW YORK BOARD OF FIRE UNDERWRITE:RS, I BUREAU OF ELECTRICiYY THIS CERTIFIES THAT Andre~ E. ~oo~ale, New Suffolk Ro~d~ ~6175, Ne~ Suffoik~ L.I. FIXTURE RXTURE$ ~ -~G DECKS L O~N~ [ I~WA~ER$ aPurnaces: 0~ 1-1/8hp~ 2-1/12bp ~Speclal receptacles: 1-50~ps., 1-30~ps., 2-20amps. Panelbo~d/s: 1-qc&r. 125amps, Robert A. Goodale, RR #1, Box 15A Mattituck, L.I. 11956 , This cerfificote must not be ~ltered in ~ny m~nnar; return ~o the office o~ the Boerd i~ incorrect. Ifispec~rs moy ~ identified ~ [i~S OF ThIS S JY\'£~ MAP NOT BEARING :t ,? S.8~ lid CD E. JAN 1 g 1976 ~. D. KEF. ~~1 DATE~ - ~o~31 and water supply ~=~ect~d by i' 5 ,~partment ~d found. ~ ~ General ~gineeri~ ~rvice$ 160.71 7~ ,SCA_E-20 _0, ! 12ON PI PE rq ,t~.ONUt,,tENT FOSTEr, HaP OF PP..OPE2¥Y SUP-VEYED . FO_~_~ ANDPuW GCOD .LF_ ^.T' NEW' 5UF'F'OL~ TOW ,.,r 50U. NO,..,,u N,Y. TOWN OF SOUTHOLD B~ING DEPARTM~T UT. D, . .......... ..................... l~Tl~ FOR BUI~ING PE~IT Dote : INSTRUCTIONS', ~ a. Thi~-ipplication mus~ be completely filied in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas ~ giving a detailed description of layout of property must be drawn on diagram which is part of this application. ~.~ o. The work covered by this application may not be commenced before issuance of Building Permit. ~'-4.'~, d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ,shall be kept o~* 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 Department for the issuance of a Building Permit pursuant to the Building Z Ordinance of the Town of Southold~ Suffolk County, New York, and 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 and in buildings for necassery inspectionL (Signature of applicant, or name, if · corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 License No ....... :.'~, ....... ~.~, ........ Other Trade's License No ................................................... 1. Location of land on which propmed work will be done. Map No .................................... v ....... Lot No ......................... Street and Number ....6ZT. J~..iqe~.,~t'/'~lic.~,~ed~..~letr..~££oZkr.~[e~r..~c...3,19~;~ ............................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................ *..~aGeZtt,.T, asC[ ........................................................................................... b. Intended use and occupancy ................. 0~a./~.~m~..~iKe/2/z~ ........................................................................... 3. ~Jat~t~'of work (check Which apl)licable): New Buildinga,.;~ ............. Addition ..................... AIteration...~,,.,.,,.',~. Repair ......................... Removal ........ ................. Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ..~3.~eJ~D~l~ ......................... Fee .......... ".....~.,,. .............................. : ......... ; ................................. (to be paid on filing this app~icationt 5, If dwelling, number of dwelling units ,..,me ....... Number of dwelling units on each floor ......................................... If garage, number of cars ........... t~ ................... ~ .................................. ..................................................................... 6, If business, commercial or mixed occuoancy,%pecify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Del)th ................. ;~,,,,,,,,,,,,,~,. 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 ...... [t~.i...~.~. .......... Depth .;;....3.~.!.,;~ .............. 2 t Height .................. .J~ ............................ Number of Stories ...... ~ .............................................................................. 9. Size of lot: Front ........ J~5,35 .................... Rear .......... J~33. ...................... Depth ......... ;1~3,o3,3 ............................. 10, Date of Purchase ...... ~,~, ...................... Name of Former Owner ,.~agez~..J~--n~!~.,~a+-a;b~ ............ ' ..................... 11. Zone or use district in whiqh premises are situated ......... ~,e~sS.~,e~..~.'1- ................... '['~ ............ ; ................................... 12. Does proposed construction v olate any zon ng aw, ordinance or regulation: ..... ~O. .................................................. 13. Will lot be regraded ~---.~.. ................. ~ ..... Will excess fill be removed from premises: [ ] Yes [:l[IJ No 14. Name of Owner of premises ................ jada,~a~.~o..G~odaAe....l~eet..~,~,~l,g~.3ta~z.Zt~=l~......'/3~..-..-,~[Q ............... (Address) {Phone No.) Name of Architect ..................... Ha3:~at~..TJ;~. ................. ,90.-.0~.10].s%..~t,~,ee~t~>.~a..~ ~2~ph2o),~e-~N~:~-Q~ .... (Address) · Name of ContraCtor . . .~ .......................................................... ! ......... (Address) (Phone No.) PLOT DIAGRAM i :: Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions fror~.~ property lines· Give street and block number or description according to deed, and show street names and indicate wheth~'~ er interior or corner lot. SEE ATTAOHED PIDT PLAN STATE OF NEW YORK, ) COUNTY OF ............. ~J~)~,~ ......................... ) ................................... J~....C~.. ,e~/.....~......,.~....o..d. ,~...e. ............................... being duly sworn, deposes and says that he is the applicant above named· (Name of individual~signing co~ttracO~ ~ . . · ', ~ . · Ha ia the ................................................................................................................................................................................................................. (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 best of his knowledge and belief; and that the work will be performed in the nmnner set forth in the application filed therewith. / ,:~ ,o o ~t~ ~,,nn,NA W. JACOBS -'"~ .,'~ ............... ~..Z.. ............. day of .._Jll~fll~.ln,,~a~e. ef..'~lew.y, er~9 .(.....-5'. ..... ~, , · (, ~EC~._PATfON 19"-o' TWO GAr'4AG~ 19Lo" DINETTE -{- 4- KITCHEN .~ ..+ ,, ?, . /" 12'-4" · " "o" FOY ~ ,I ~ '- LIVING r2~'. , - D!NING 2M 9!4-" -FIRST FLOOP. PLAN SCALE.: I/¢"~ i Lc;," '~P~VED AS NOTED FEE: I' BY NOTIFY BUILDING DEPARTMENT ~,T 765-2660 9AM TO 4PM FOR REQUIR- ED INSPECTIONS: 1. BEFORE BACKFILLING FOUNDA-' TION OR 2. BEFORE PIPELINE 3. FINAL ~ JOB COMFLETED i RESPO ~IBLE FOR DESIGN OR COI~I- ~ ONE FAMILY RESIDENCE RMAN H. YORK ARCHITECT PLAN HO...~..!f'~O IGI 3~, NEW YORK DRAWING NO ,! ..°.. J- t4-6,'D" ,c-,z'z~,o CH.:.) ;', , FOUNDATIONPLAN ONE FAMILY RE~, I P E N C.E. N~RMAN H. YORK ARCHITECT 90~o4 IGI ST. 3'AMAICA 52, NEW DATE ......... ~EVISION$ , ~COt"ID FLOOR. PLAIN '- HE 90- ONE. FAMILY RE. 51DENt' E H. YORK ARCHITECT 161 ~TAMAICA 3~-, NEW yO R.~L I' H' 4%-~'' C-Z~4e (..~.) DRAWING m.,, ............. 1 ~ F,.qON T I-IE.I~,I '90- ONE FAMILY REsIDENcE. H, YORK, ARCHITECT I~l 3'AMAICA. ~.~ NEW YO RI4, 1' t4'6~ C - ~.'Z~.e (N.:.) .o...'D I ~ o 4 )IIAWING NO I ONE RMAN 90.04. IGI 'FAMILY RE$1D£NCE H. YORK ARCHITECT ,.TAMA ICA :~., NEW YORJ~ JqO -, >~w~NG NO....~.?.f..e:.. , LE:FT TM 3, D~ EL ~'ATION ~ $CAL~.t ?~": '-O~ ONE HERMAN 90-tl4 IGI FAMILY RESIDENCE H. YORK. ARCHITECT r 3,?.~ NEW YOR~ /'_L_d.~J~ c-z~,~e (N.~'.) p,.^, ,o.. 5 1 °t 0 WOOD ONF FAMILY RESIDENCE ~C~,~ EL~¥AT/O~~ MAN H. YORK ARCHITECT SCALE: l/4-'" I-0 90-~ IGI ST, ~AMAICA 3~, NEW YOR~ I-)4-~ C-~e (N.~.) PL~,..o .51 q 0 c~w~,o ,o..7..~.~.a/... TOE ~ PAO~ E CAB/HET5 ,.SCNF:MATIC PLUMSINGDI~,G~AM" ONE FAMILY RE$11DENCE ,~;;;;~" ,C~_05~ :S~C_TION, H~RMAN N. YORK ,ARCHITECT i [..L E\/AT i ON L L F T E_ L EVATtO tx, t- H T ELLS/A'T I ON h L BEAI'q~ ~' O.C. %'~8" R A F l'r-&S qlYWOoD PLUMBiNg b 'Ck055 YEOTIOIXlo F 0 U kl I) &TI 0 N ?L iN o ...U ~'- lC::, T- U 0'0' E FY L E V A ¥ t0 P-,I GH'I: AT ION - C" F~,~VED AS NOTED._, ,i'~O_ FY BUILDING DEPARTMENT A'I' ,,,,5-266D 9AM ~O 4PM ~O& REQUIR- ,, , "B:FORE 'BACKFILLING FOUNDA- · ' 'i' ,,~N '~R START FRAMING ' 'A BEFORE'COVERiNG PIPELINE . 3, FIN,~L WHEN JOB COMPLETED - STRUCTIOi~ ERROR~ r -,' 'FkONT L:EWAT I0 N r FOU klI) ATiON PLAN CE C T T-LOON