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HomeMy WebLinkAbout6391-zFOEM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ...~.r. Sr..o~...s..P.a..t.h..&., .Pg.o.k Ma~ N .~.~.*:.~. . .~?'~ock No ........... Z~ot Z~o. *~ Sout~o~d ~ .~. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~.~.~.1'.... 7., 197.~. pursuant to which Building Permit No..6.].9.~.Z.. ~.~.~_.~ed ....................... , 19..7.~., 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 ...~..~y.a..t.e...o~..e..f..a~...]..y...~.w.e.l.~..~. $ ...................................... The certificate is issued to . .A~.t..o~e.. $..~..1,..a..&...ht.i.f.e.....0~1..e.~.l. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~..o~.....~...~.9..7~...b.y..R.:..V~.i..1~. .... UNDERWRITERS CERTIFICATE No. N.. ~..~ ~.0.7.~ ....8. e. p.t....~...~. ~.~. .............. HOUSE NUMBER . .2.~..~ ......... Street ...O.r.~.g.op.~.s...P.a.t.h. ........................ Peek Place ...... .... ..... Building Inspector ~ FO~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE 5OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6391 Z Date ....................... J4n~l~ ....... 5' .......... , 19..~.. Permission is hereby granted to: ...~.~.~.~.~....~,..~...;,J,£~ .............................. .............. ~,een.~e ................................................. to ~.LL_..~'...oz~...£a~:~--:~L~..~w~.~r~g ............................................ ;. ........................................ at premises located at ....]~:...1.~. ......... F.,~.V.e&l;..}~Ogi~8- ........ ; ...................................................... ........................... .~.?.~...~, .~,..?.?...~..~.r ~.~?.~..~.. ,~.~..C..~.~....~.~.u...o.~ .................................... pursuant to application dated ....................... ~,e~.y ....... .~ ............... , 19~...., and approved by the Building Inspector. Fee $ .'1..0...3..,..?..0. .......... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~I{ BUREAU OF ELECTRICrTY ~ 8B JOHN STREET, NEW YORK, NEW'YORK 10038 ' THIS CE~IFIES THAT only t~ e~t~ ~u~t ~ ~c~b~ ~ ~ Lnt~ ~ t~ ~pJi~nt ~ o~ t~ a~ ~p~i~t~ nu m~r in t~ p~m~s of Antoine Skwar~ Jr., e/side Gri~oni~ Path, Southold, L.I. in the foll~ing l~atlofl; ~ B~ement ~ lst FI. ~ 2nd FL outside S~tion Bilk ~t w~examlnedon September 2~, 1973 and found to be ln complia~e with the requirements of thiz Board. fiXTURE LECERFACLESI W T I FIXTURES RANGES OUTLETS I IS CHES IINCANDESCENTt FtUG~ESCENTI ~(~ ~V.T.K.W. 3T / 55 31 3d i I lq. SERVICE DISCONNECT NO. Of S E R 1 ~00 CB x 1 3/0 *Dryers: 1-28 amps. ~/ater heater: !-~l.5kw ~leetrle heaters: 2-2.0kw, ~-!.Skw, 1-1.25kw, 1 Oara~e Door Opener COOKING DECKS OVENS DISH WASHERS AMT, K.W. I AMT. K.W. MT. K.W. I I I I TIMECLOCKS BElLIUNITHEATERSUNITHEATERS MULTI-OUTLET T, A~,~PS, TRANS. .~ SYSTEMS ~V~ NO. OF FEET V I C NO. OF HI-LEG A.W.G. NO. OF NEUTRALS ~ HI-LEG EXHAUST FANS 3 F DIMMERS OF NEUTRAL I 1/0 3-1.0kw, 1-.75kw, 3-.5k~ E.A. Lddemann, Jr., Southald ~ L.I. GINilIAL MANAGER COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. l~)R~[ 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 unusua~ 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. Swam 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 ce rtifica te of occupancy $1.00 ~.../.,,.'..r"~'/,..~_-~'/~~x..../.. Date ................... ~ New Building ....... ~,~ ......... Old or Pre-existing Building ............................ Vacant Land ............................ - ' .... ....... Location Of Property ..~....~/~,~: ....... ~...~n.,.;~.~..CI.;~S ...... ..~.,~L..~ Owner Or Owners Of Property ..~r~.r;.......~....~. ...... ~ ...................................................... Subdivision ...~.Xc]r..~..IL~..~.......J~..e.~t...~.,,~ ....... Lot No....../..")....'~.. Block No ............. House No...~..~..~.-~c~ Permit No. ~'..,.~..~.../....'~... Dote of Permit .~.Z~l.~..-~.....Applicant .... 4:....~,'~.~.~ ....................... Health Dept. Approval ....~'.....0....~...../...~....o..~... ........... Labor Dept. Approval ............... ..~...~....~.. ................... Underwriters Approval ....''..~....J..l..'~.J~...~....~ ................ Planning Board Approval ~/ · I~.- . Request For Temporary Certificate ........................................ Final Certificate ......~... ............................ Fee Submitted $ ..~ ......... Construction on above described building and~t meets all apl~li~abl~les and regulcltions. Applicant .....~....~..~...L~...~.......,// ........... Sworn to before me this "'--,~/'~1//~ ......... Z....'~day of ..~...../...~.~..?.. ........ (stamp or seal, ~-~' ~'~ r./_.~ Notary Public .................................... Coun~ SUFFOLK COUNTY DEPARTMENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM Address r~M ~0~, Qec~.~; ~.V. ~9,~-o~' 6. Section I 2. Property l~cat~on ~,~f ~o~ ~-~ 7. Lot No. ~eJ-t~',s{~ ~ 8. Private well ~il~age~,~ek~ Township ~ c~o~a 9. Public water 3. Public Water Company~ame ~e~ ~ Distance to main 4. Lot size: Width /0~ feet Length /~ feet (Enter on center plot below) 10. Sewage Disposal System: . A. 900 gallon septic tank: Precast~Equivalent Block B. Leaching pools: Number ~ Precast Block Special in bla~ks below: Tank c%acity Gals. Pump G~M. T°ta~7%l~depth Test Hole N Data Feet 0 2 4 6 8 10 12 14 16 18 The gned CERTIFIES: "Construction of authorized installations will be in ~ccordance with the Suffolk County Department of Health's current stand- Dale ~ ~_~ Signed,,', "Owner 6r~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 plo~,--~ Date ~/~-/~ ~ S igned~,6 _~ S-15 Revised 4/l/72 TOWN OF SOUTHOLD ~ ~.~,./ ~ ~ BUILDING, DEPARTMENT TOWN CLERK'S OFFICE ~ .~ ~OUTHOLD, N.Y. ,,~,~ ,~::~ 3~,.~ ~ ~ r:.iI'. ....... .......... i" .... . .... ................. . (Bui,di~ ,n~or) . ~te ~eh 7 1973 INSTRUCTIONS a. This application mast be completely filled in by typewriter or in ink and submitted in triplicate to the Building Insl~ctor, 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 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~l~Jpt on 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 he~Jl~ heellj~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building 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 necessary inspecti6ns. Pecon~e N,¥, (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician~, plumber or builder. O~ner - bu:Llder Name of owner of premises ....... .~..J~]J~&~&....I~..WJ~a ....................... ..................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder s L~cense No .......................................................... No ........ ~..~...i~ .............................. Plumber's License Electrician's License No ..................................................... Other Trade's Lice.nsc No ................................................ 1. Location of land on which proposed work will be done. Map No.....H..~l,~'.',.T.~.~.~..~[qJllllt~l. ........ Lot No...J~ ................. Strut and Numar ....... .~s..~.~..~eok.,P~a~ .............. ~ .................................................. . . tly~ ~ MunicipaliW 2. State exi~ing u~ and o~upancy of premiss and intended u~ and ~cupancy of pro~ con~mction: a. Exi~ing u~ and ~cupancy ...... ~AG~..~A ...................................................................................................... .. one f~il~ d~!l~ ..................... . b..ntendedu~and~upan~y .............................. ,'?t .',~:' j ........ -m,- ...................... ...... ~'~'~ 3. Nature of work (check which applicable): New Building ...... ~ ..... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description 4. Estimated Cost .......... ~.6..~..0..0...0.....~ ............... Fee /~.03 , ~ (to be paid on filing this application) 5. If dwellih,g, number of dwelling units ...o.g[~. ........ Number of dwelling units on each floor ................ ; ........................ If garage; number of cars .................. 2. ....................................................................................................................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of usa ..................................... 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~ ~ Rear ~.~ . D th ...~..~. ~,2 Height ................................................. Number of Stories ....... P.~. ........................................................................... 9. Size of lot: Front ................. ~ .................... Rear .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ....~......0,;[~.~; ............................................................................... 12. 'Does prop0sad construction violate any zoning law, ordinance or regulation: ...~.o. .................................................... 13. Will lot be regraded ~.~t~ ..................... Will excess fill be removed frompremisas: [ ] Yes [ ~ No Name of Owner of remiSes ~;.o..~..e..~.~a:ra & wl/'e Pecon:[c (Address) (Phone No.) ' Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor se, me (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dim.e, nsions fromi i property lines. Give street and block number or description according to deed, and show street names and indlcFt~i er interior or corner tot. >"'"-- STATE OF NEW YORK, COUNTY OF ................. ~..1~....~...O....~. ................. ......................... ,.....~...~...o...~...e.....~....~....~..?...~. ....................................... being duly sworn, deposes and says that he is the applicant above named. (Name o£ individual signing contract) Ha is the ..................................................... ~l~.e.~.....-.....~.~'ld.~l, ................................................................................................................... (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 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 manner set forth in the applical~ion filed therewitl).. T£RRI LEE ~ ~.PUBLIC, State of Ns~Drk ~ /~ ............................. ~.......day of ............................. ~.{'~..52-.6~.~82~519 ............. / / ,'~ ~ /,//~ I ~ " (Signature of applici#it) N.*>. o4 oo ~. .~fd20 175.OO PLA~ E SUFFOLK COUNTY HEALTH Chief of Ge~:ccai Engineering Services F 3-/- 75~ APPROVED AS NOTED FEE:Jeg ~ B'r ~ NOTIFY BUILDING DEPAP, TMENT 765.2660 9AM TO 4. PM FOP, P`EQUI~.