HomeMy WebLinkAbout6387-zFORM NO. ~
TOWel OF $OUTHOLD
B[m.~)ING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at . 6~ee~wa.y · F~a®t. &. P. arkv~,~treet
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ...........l~al'o...6.., 19F3. pursuant to which Building Permit No.
dated .........~a~ ... 7. ..... , 19.7.3., was issued, and confoms to all of the require-
merits of the applicable provisions of the law. The occupancy for which this certificate is
The certificate is issued to . ~e~ry..&.'. ~rtl~, .Grelz, lich ..... 0wl~.e;r~ ...............
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . .~ep.t... ~ 3...19?3 .. by. .H. ;..v.~.~. !e..
UNDERWRITERS CERTIFICATE No...~.~ ~2.Q2.~ ...... A.u~ .30...~ 97~ .............
HOUSE NUMBER 830 ......... Street .. 6raenwa~..~as.t ........................ %70 Parkview La
Building Inspector
FORM NO. i~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 6387
Dote .................... J~Ja~b....~ ................. 19'73"
Permiss!6n is hereby granted to:
....... ¥..i~ee=.t,.. ~e;r~e ~.t.e ~a...
/ .............. st.-.t..~z..~ ..................................... .
.............. M~m~vv.~i~e ..........................................
to ...~t.lA..~.. o~...f.s~t.y.. ~ve~..~.~ ..................................................................................
at premises located at ..... [~ot,..~s.....Gj~ea..Aez, e.s .........................................................................
.............. ? ............. ~/~.1~ ..G =~e~w&J'..~aet~ ............... ~'.i~r+~ ...........................................................
pursuont to opplication dated ......................~,~ ............ ~. ............ 19.c/.~.., and approved by the
Building inspector.
Fee $..~.,~ ~:~0 ...........
Building Inspector J
PO~M NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
Sonthold, 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:
I. 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 dispasal--(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
3, Copy of certificate of occupancy $1,00
$5.00
Date November, 28,1973
New Building X Old or Pre-existing Building Vacant Land
E S Greenwa East Orient,
Location Of Property ..... ,~,~,~,, ............ /, ....................... ~'. ...............................................................................
Henry & Martin Gramlich
Owner Or Owners Of Property .......................................................................................................................
Green Acres at Orient -- 6
Subdivision ................................................................ ~.or No ............. Block No ............. House No .............
6387 Z ~ 3/7/73, , Vincent ~eLettera
Permit I',1o ..................... Date Of Permit .................... ~pplicant ..................................................................
S0-1292
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval ....N.....!..1..2.0.?..?. ....................... Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ........ ~, ...............................
$5.oo
Fee Submitted $ ....................................
Notary Public .................................... County
Construction on above described building and,permit meet~ al.I applicable codes and regulations.
Applicant ......../~.~...~..~.,.,~.,....~...~ ........ ~.. ~ .~,...0/., ,¢~..~. .......................
Sworn to before me this
........ J...~ day of ....... ~......~...~..~ .... (stamp or seal)
THE NEW YORK BOARD OF FIRE UNDERWRITERS
I~ BUREAU OF ELECTRICITY
[~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~'
THIS CE~IFIES THAT
o~y the e~t~ ~uipment ~ ~cdb~ ~ and int~ by t~ ap~li~nt ~ on the a~ ao~icat~ n~r in ~e ~r~es o~
in tae folmwiag mcatlon; ~ B~eme. r ~ ~st FI. ~ ~.a rt. out~ade s~tio. BI~
w~examlnedon AUi~ ~ ~7~ andfoundtobeincomplia~ewith~herequirementsofthisBoard.
DRYERs I FURNACE MOTORS I FUTURE APPUANCE FEEDERS
A~T. K.W, ~L H.P. GAS H.P. A~T. NO. A.W.G.
RANGES
SERVICE DISCONNECT I NO. OF
)THER APPARATUS:
TIME CLOCKS BELl. UNIT HEATERS MULTI-OUT/ET
SYSTEMS
A~ps., TRANS. NO. OF FEET
R I C
A. W.G. NO. Of HI-LEG A, W. O.
OF CC. COND. OF HJ4.EG
EXHAUST FANS
DIMMERS
NO. OF NEUTRALS A.W.G.
OF NEUTRAL
Fut~naces: 1-]/Shp, 1-1/12bp
5~otars: l-1/2bp
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
H.D. Reference No, ~
APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM
Address #i O~ ~"' ~;l&~; ~ ' 6.
2. Propert~~ ~ ~-~;~ ~.
g~ P~ I P 9.
3.
4.
10.
Section
Lot No.
Private well
Public water
Public Water Company name -~,~ -,~ Distance to main -'"' ~--
Lot size: Width ;~ feet Length ~- feet (Enter on center plot below)
Sewage Dispos~ystem: Precast w E ivalent
~ ~ching pools: Number ~Precast ~lock Special
b Private well fill
lanks below:
Tank capacity ~als.
Pump G.P.M. ~
Total well depth~
Depth to G.W..
Amount of water in
well
Test Hole
Data
The undersigned CERTIFIES: "Construction of authorized installations will
be in accordance with the Suffolk County Department of Health's current stand-
ards thereto."
' ~r or 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 th~s plot.
Date ~ ~ Signed ~ --
S-15
Revised 4/]/7Z
' [,,. :~ J TOWN OF SOUTHOLE~ ~
BUILDING DEPARTMENT~¢'~-~/?~ /~"~'~'~'/ -//"~'~" O ,'~
TOWN CLERK'S OFFICE ~,~,~,/ /.~ ~, ~ ,~ ~,~
SOUTHOLD, N.Y. ~' --
£xomined ......~'~/~/f / - ""'] ./...~ ~r.,~....~...... ~ ............ 19..-'..../..""~ '~ ' Applicat'iort No ............... ~ ..............
19 ....... Pemit No ...................................
Di.pp,ov~ o/c .... ~ .............. .~'.- ~ ~-~
APPLICATION FOR BUILDING PE~rI'~ ~
Do,o .~.~%:.....~ .................... , ~9.~.~. ....
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the BuJlcling Inspector, wit
3 sets of plans, accurate plot plan to scale. Fee according to schedule. ·
b Pot p an show no location of lot and of bud ngs on premises, relationship to adjoining premises or public streets or a~ m
g v n'g a detailed description of layout of property must be drawn on diagram which is part of this application.
c The work covered by this appl ca~ On 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 or
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 bee,
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 Southoid, Suffotk 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 ~pplicant agrees to comply with all applicable lawl '
ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections.
.... .......................
~, ~,--~,,-ne:/rTT[~Ai__[~ig"~ture of applicant. Or name, ifa corporation)
VINCENT
~.~....~u~-.,
~ou~[ ~ ~ox 22s ............. .~ .~.-.--~...-.-.
MANORVILLE, N. ¥. H949 "'~"~"'" (Address of applicant)
.State-whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
· 'L. '~ ' ot,3~h-c~-o ~. . .........
...................................... .I~..~..%..~....~. ~.,.....~, ........... , ........ , ..................................................................
'~ ~,~o, ~-..~.c,,~..: .................
Name of owner of premises .~.~.-~.~...'~ ......... .~..~...,. ..................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name aOd title of corporate office~)
Builder's License No ..........................................................
Plumber,s ,License .No ......... c~.~..,,~,..../~j~.,,C~.~./.~.../.......~/c:~7-4~'/~' /J~ U~'~ ~'/e-~'/Z.~ --
Electrician's LiCense No .......~...~..~.....~.~.. ...............................
Other Trade's License No ....... ~...~ ........................
1. Location of land on which proposed work will be done. Map No.~.~.-E'...~.......~...~. ~..~...~".l~--~J~.-t~?ot'~o ...... G.:, ...........
Street and ' ~--
Number ....../~ . : . . . L ~. . .~. .'~, ~.I. X ~. ~.. . . . .~. ~, . . . . .~. . . .~:. .. .~ ....... U. . .~. . ~ .~. . .~.. . ~. .-'[. . . . ;. ........ .. . i. ._~ i ~ : ; ~ ?. ........ '
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
ao
Existing use and occupancy .................................... ., ............. ;~ ......... t ................ ; .................................................
:" Z ' ' ~ ' ce--- ' ·
Intended use and occupancy ...............
'
3. Nature of work (check which applicable): New Building ..~.,...~ ............ Addition .......i ............. Alteration...~ ..........
Repair ............ Removal ............... Demolition ........................ Other Work '
(Description)
4. Est, ma,d ............ ............................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ....... ~ ........ Number of dwelling un, its on each floor ..............~ .................
If garage, number of cars .......................... ~ ........................................................................................... ~ ....................
6. If business, commercial or mixed occuoancy, specify nature and extent of each type of usa .......... ~ ................
7. Dimensions of existing structures, if any: Front ll~..-&~.... Rear ..... ~i~..~ ............. Depth ..~.~.....~l.-,,~j~!~...
Height .................. ~J{~.~. ................................. NUmber of Stories .. ......... 't'~.",'~.~77~'"' .......................
Dimensions of same structure with alterations or additions: Front ......... ~ .......... Rear ....... ~ ............................
Depth ..................... ~ .................. Height .............. ~ ................... Number of Stories ...... ~ ..........................
8. D mensions of entire new construction:,Front~.. ....... 41~'.~, ...... Rear ... . ~ ~ ........ Depth. '..~u~i~ '~:-"~:..
Height .............. ~..~ ............................. Number of Stones ...................... ~ ...........................................
9. Size of lot: Front ......... ~{1~ ..................... # Rear ............ ~1~ ............... ~ ...... Depth ............. ~1.~t1~.". ........................
10. Date of Purchase .......... ~ .................... ~.... Name of
Former Owner ......... ~ .................................................................
11. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed conStructi0n'vi01a~e any zoning law, ordinance or regulation: ............... ~..". ....................... : ..........
13. Will lot be regraded ~___ J~'.~. ................... Will excess fill be removed from premises: [ ] Yes [~[ No
14. Name of Owner of premises
Name of Architect ................. ~,.-~ .............. ,.~;.~;;;; ......................................... ~: .................................................
(Address) (Phone No.)
Name of Contractor ~ ........... ~~....i~t~ll~....~t~....i~."9~N~.i~' ....
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-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.
STAT .i.Ji
COUNTY OF ..-~..~....~.~.~.. ................ ~, ........ )
............. ~...~...?~"~.'~.~ ..~.,~...i....~.'."~%'.~.. ~..~.~ i ........... being duly sworn, deposes and says that he is the applicant above named.
(Name of individt4al Signing contract).
,He is the ........................... l~.,,f,.~.,.',',',',',',',',~%.."~,..~...,.~.. ?,,.~.~ ....................... ' ........................... '.....' .................................................................................
f Contractor, agent, corporate o/I~cer, etc.)
of said owner or owners, and is duly authorized Io perform or have performed the said work and to make and fll~ this a~lieation; that ell
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. TE~RI LEE
~ ~ ,(.,,C~% c.~,. Ir~ No. 52.6~.68295 ~._1 ,~[~TARY PUBLIC., State of',New York1 , , '
,. .................. / .............. .nn,,,,
~, tary Public... ~...~..-~._.~i~:i~'~O::~ 30. tS....~....../.~.~.~~.~~.....: ..........................
1
/
/
:1
APPROVED A,S NOTED
DATE: /~/~ ('-~"' ~ ~ 7 ~?~'
NOTIFY BUILDING DEPARTMEN~r /~ F
76S-2660 9AM TO 4PM FOR REQUiR-
ED INEI~CTfON$:
1. BE~RE BRCKFILLING ~UNDA-
TION OR ~ART F~NG
2. BEFORE C~RING PI~LINE
3. FINAL WHEN JOB C~LETED
NOT ~S~NSIiE ~on DESIGN OR GON~
OPGEN'~ PT. ~Y
0 ce/L, ~ ~rim.,,-' ~r' Re. w.s-oo I~
1
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