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HomeMy WebLinkAbout6424-zFORM NO. 4 TOWN. OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy /7 No. ~....5'.~..~..~ Date ........ .~....~....., ~97.3 THIS CERTIFIES that the building located at..~/~..~..~..~.". (~.~..~....~.~'~.. Street ~ap ~o .... .~. ...... Block ~o .... ~ .... Lotto...'ff..*. ?...r~.o. ~.~. .... ~:~ ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~14~.(.~...~.., 19~.~. pursuant to which Building Permit No. ~ .~..~. ~ dated ...... ~.~ .('?....0:. I.., 19.~..~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .~. ~. ~?'..~.r~ .~..0..~..~... ~../~./?./.~ f .... ~.~. ~ .~ C ............... The certificate is issued to .~0.~.~.~.~...~.~.~.. ~.~ ....... ~.~.~. (owner, lessee or tenant) Of the afores~d building. Suffolk County Department of ~e~th Approv~ ..... A. ............................ UNDeRWrITErS CERTIFICATE No ................. ' ................................. ~o~s~ ~w~..~.~. 3. ~...s~.. ~.~C .~...~. ~ ~ ~ ..................... Building Inspector l~OZ~ NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6424 Z Date ..................... ,~::. ......... 2.1 ............. , 19..7..~. Permission is hereby granted to: ....... ~g.~....~..~m~..~ ............................. ............ ~ ................................................ Build new one fa~.ily dwelling at premises located at ~..N./.~.~.~..P.~..:~..~.e.~..N.~.e...k.~.~..~..~...(..~/~..Q~`~:~1~A~`~A~Z~.~. ................................... ........................................... ~.~$hold ....... ~Y~ ................................................................................. pursuant to application dated .........................~J~....~.~.~.. ....... ~. .......... , 19~i..., and approved by the Building Inspector. Fee $..~.1 .,.~..Q. ........... BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICE . ' ~UTHOLD, N.Y. ~ ~pmv~ .......................... ~ .... X ................... ¢'"'~'""'~;w:'"': ...... k ................ ~:.wz:.g ........ , ~- sw .-[~ (Building Ins~tor) ~/ ~ ~'~ Date .~a~ .......... , 19.~...,~ INSTRU~IONS Q. This Q~li¢etion must be campletely fill~ in by ~writer or in ink end subm~ ~ t~ Building Insp~tor. b. Plot plen shying I~etion of lot ond of buil~i~s ~ premises, reletionship to edjoinlng premises or pu~ic streets or~ ereQs, end giving Q de~il~ de~ription of !eyout ofpr~ must be drawn on the diQgrGm which is ~ of this applicQtion. C. ~e ~rk c~ered ~ this e~licQtion mey nat be comme~ before i~uQnce of BuildJ~ Permit. d. U~n~pp~ of t?s QpplicQtion, the Building Ins~r will issue e Building Permit to t~li~ ~h ~it shell be k~t ~ ~e ~em:ses Qveiloble ~r in~i0n th~g~ut the p~r~ of the work. e. No building shell be ~cupied or us~ in whole or in ~ for eny purple whQt~er until sh~ll hove been gronted by the Building Insp~tor. 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, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removaP or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... i ..................... ..~..~t.~.~,~.*,. ...... c..,~. ~ .'T:.~. ~ .~.~..~..e,, ..................................................... i ........ Name of owner of premises ...~.e..?...i~l.~3.....~f:?,.l~.~'.....J.M.~. .................................................................................... · If applicant is a corporate, signature of duly authorized officer. ........ ........... (Name /grid title of ~orporate officer) 1. Location of land on wh ch proposed work wi be done. Map No.: ......................... Let No ....... Street and Number /¥/,~ ~.~3~z~.~ ~JT...~..?.~,./.l~...J~. ~.../?...~.,.*~..,./~., . ~.~J~ .'T..~.?. ~ I ~ 2. ~te ~ting ~e and ~,,~ncy of prem~es a~ inten~d ~e and ~aponcy ~ p~os~ c~: a. ~isiting u~ o~ ~cuponcy ..................................... : ......................................................................................... b. Intended u~ and ~c~ .,.L...~.~.~.~....~.~t~A ................................................................... 3. Nature of work (check which applicable): New Building ..: ............... Addition .................. Alteration Repair .................. Removal .................. Demolition ............. :~.. Other Work (l:~)esErj, be) ................................. r ...... 4. Estimated Cost .............................................. ;..: .......... Fee ...... ~..~..~. .............. ~...~..~ ................................ ~ ...... ~I1t · ~l (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 /nixed occupancy, specify nature and extent of each type of ~se ............................ 7. Dimensions of existing structures, if any: Front.....i ...................... Rear ................................ DePth .................... Hmght ........ :. ............. Number .o~~ ......... ~ ................... ~'~"~'"'~1~ ....................... D n ~~ons o ~0~-s .~' -~'~ "~" imen,'o S ~~alea 'OhS or add't'o s: Front ~~R_~am ............................ Depth";: ....... ~ ........... HeJgh~...'~..~ ...................... Number of ~ .................. ...~..... · 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height Numbe~ of Stories · Size of lot' Front ............................ Rear ............../~.~, ....... Dept x~..,¢~.. 10. Date of P~?ese ........................................................ Name ~lEormer Owner ........................................................ 11. Zone oru§~dstrct nwhch rems arestuate · ,~ _. ~ es d ............... ;/ .................................. ;..;~7.~. ................................... 12. Does proposed construg(i~l~iolate any zoning law, o~i~ce or regulation:) ~.~./, 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Archit~ tl~lt!~l..;.{.~-~l.11~ ........................... Address ....... ~.e.~141~4~it.~ ....... Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... ~. PLOT DIAGRAM /~1~' 4~ Locate cleady and distinct~.~ll buildings, whether existing or proposed, and indicate all set-bock di~l~ensio.ns from property lines. Give street an~oc~k number or description according to deed, and show sU:eet, name~and indicate whether'interior or comer lot. F'e~ ~e Ot~l'J~ He~$ I/e~, ,.-~ STATE OF NEW S.S COUNtrY OF (Name of signing application) abovenamed~ He ~s the ., ................ ,..~ ........................................ : ................................. ~ ............................................. · I,~l~,,~/~ii~.11 t~1~'~ ,1~, ' (Contractor, agent,~6~l~?rate officer, etc.) of said owner or owners, and is duly authorized t~ Rerfgr~ ha~..e,~fo_rr13~'the said v~b~k 'and to make and file this application; that all statements contair~d, JR/~ll~j~,,pn ~ ~es.t of his knowledge pnd belief; and tha~ the work will be performed in fhe manner set-forth ih~d~e appli~:ati6n filed therewith. Sworn to before me-this ...~.,,..,... ........................... being.duly.sworn, deposes end,says that he is the appli(~ant ~ Notary Public, . .................. ~I~'i"I:EE"~D:R ....................... County (Signature of applicant) NOT.~q¥ PUBLIC,No. 52.6168295State of New York ~/ ~~ (~ualifieci m Sultoit{ County ~emmission Expires March 30, 15 ~('*/ IPOltM ~TO. 6 TOWN OF SOUTHOLD B.i!ding Department Town Clerk~ 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 .., ,Q ~'...L.. ~J. ...... 1.0.t ....I..'1.:!..~ ..... New Building ..... '...~.... ....... Old or Pre-existing Building ............................ Vacant Land ............................ Owner Or Owners Of Property ...~..q..?..r~.~.~.~.......[~l~..~...~...~..~.~.~ ......................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~....~....~....~. ..... Date Of Permit ~.~...R.....~..~.~,~Applicont .~..e...~...~l...~..~.~'..~..~...~.~.~..~..~......J..~..~...~ .......... Health Dept. Approval .J..u...L:Tr....~.~...Jl...~.2.,~ ........ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....~ ................................ Fee Submitted $ ..... ..'~.......'TS. ................... Construction on above described building ~nd/l~ermit meets all applicable codes and regulations. Applicant. ~..J..~ .~...., ......~: .................. Sworn to before me th.~/j~)x ~ ........... I0day of '"'~'/'""~'7 ........ l..~...'~...~. (stamp or seal) Notary Public ......... ~,.~. ........... ~ ........... County SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No.~ --'~--'~~-~5~J-/~/~/ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant Po v ~o~R~ ~,,~l ~w~ Phone~f-~5. Subdiv. Address i~%~ ~ ~ :~.~o 6. Section 2. Property location~f~~~.~_~ a,~ ~4~# J~ ~7. Lot NO. 8. Private well ~ Village ,~u~T~.~,~ Township$,~T~ ~) 9. Public water ~g 3. Public Water Company,name Distance to main '* 4. Lot size: Width /~i~feet Length~,~f~ feet (Enter on center plot below) 10. Sewage Dispos~ystem: A. [~0~ gallon septic tank: Precast E_quivalent /Block E. aching pools: umber f Precast lock cial If private well fill in blanks below: Tank capacity~ Gals. Pump G.P.M. ~' Total well depth Depth to G.W. Amount of water in well Test Hole Data Feet 4 6 8 10 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 ii~ :~ , .{~ ~ Signed / - <'"- Owner or Builder FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Mealth Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date '~/~ ~ Signed ..~__ ~..~ ~ S-15 Revised 4/1/72 .V G ~ · ~4 T ~ I,Ibt Z~ MINff=t264. ',A/C~DL IOLOII CL CL ~'~L~ONI'~ ' DUOWAL L 14L~' FOR REVERSAL of the house deslg., these plans are reprinted {In reverse) on the back of each sheet. To fac~litata use of the reverse plan, take dim~n$1em fromlhe front of each sheet. ~H:~ST' ~=LO01~ ~LAI,,4 ~ DETAILF:D ' ' 'ASPHALT SNINC; -I..~ BY APPROVED BY · MA~IT~ LINDI~ZLAyM~KIT / APPROVED AS NOTEO NOiiF¥ BUILDING DEPARTMENT AT 0 RUDOLPH A. MATERN 'A. LA. REGISTERED ARCHITEC:T B9 ~, dERIC:HO TpKIE,, MINEOLA~ N, Y, sheet desig~ ~ ~ G4-I ~L32KII DETAILS' ,RAWN BY BY DOLPH A. MATERN 'A. I. A, design number ~,~,' · SECOND FLOOfZ PLAN IRAWN BY ~PPROVED BY RUDOLPH A, MATERN 'A. h A. REGISTERED ARCHITECT B~ E. dERICHO TpKE., MINEOLA~ design number sheet no, ...... _ -~FIAN~L~ ~ [SATF~ I~lO,~, I I l II DRAWN BY APPROVED BY DOLPH A, MATERN 'A, L A, RE61ST~-RED ARCHITECT B9 E. dERICHO TPKE. MINEOLA~ N.Y. _3 design number sheet no.