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HomeMy WebLinkAbout6481-z FOruM NO. ~ TOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. N9 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES ~JNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6481 Z Date ................. ;.,. ~t;~lt;~t~ .......... ~.~ ........ , 19..'~.3.. Permission is hereby granted to: 'pursuant to application dated ........................... ~r~.~-..-.-..1-2..,.; 19.~..~..., and approved by the Building Inspector. Btlilding Inspect~Ir FO~M ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. TEMP 0RARY Certificate Of Occupancy No. Z. ~..~ .3.2. ...... Date Oct 1 7 19.7.~.. THIS CERTIFIES that the building located at ... $15apard. ~r:l.y.e. ......... Street Est. Map No. ~.e.s.t.. 8F.e.e.k. Block No ........... Lot No. 1+6 Southold N .?. ' conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ .A.~ .r.i.l... ~ ~..., 19. dated ............ A~,r. il.. ,%3, 197.3., 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 Private one famil The certificate is issued to ~{obert o Cheryl Grattan O~,.mers (o~ner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...0.c..t.. J.7... J.9.~...b.},. !l....V..i.l.l.s... UNDERWRITERS CERTIFICATE No.. p.e.n.d...i.n.g. ..... ~. ............................ HOUSE NUMBER ...~.0. ........ Street ... S..h.e.p.~.t. ~ r..iy.e ........................ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in dupiicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildihgs, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage ~Jisposal-(S,9 form or equal). 3. Approval of e ectr ca nsta ation from Board of Fire Underw?iters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect dr Engineer responsible for the building, 5. Submit Planning Board approval of completed site plan requi[ements where applicable. For existing buildings (prior to April 1957). Non-conforming uses. or buildings and "pre-existing" land uses: 1. Accurate survey of p2*operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $i5.oO I .... Date ...~ J ........ New Building ............. Old or Pre-existing Building .... ~.~, ..... Vacant Land ............. Location of Property .. ~. ~:.~.. -~.-~q ~ ~.~. ~(. -n.c. ;d.~..: ...... ~.~.~.. ~.o~z~. ,~ House No. ' ....... Street ................. ~e't Owner or Owners of Property . .~ ©.~ .e.¥.~..~.~ .% .~..~ .e~..~..I....~..0~...cz.© ...................... County Tax Map No. 1000 Section . .~...~. .......... Block ...~ ........... Lot.. ~ ............ Subdivision ................................. Filed Map No. .......... Lot No .............. Permit No. ~'.~.~..L .7~... Date of Permit .?!('.JJ?.~...Applicant .................................. Health Dept. Approval ........................ Labor Dept. A~proval ........................ Underwriters Approval ........................ Planning Board Approval. ..................... Request for Temporary Certificate ..................... Final Qertificate ...'~.. .................. Fee Submitted $ .~.'~'.. (~.F).. ...................... Construction on above described building and permit meets all applidable codes and regulations. Applicant .~.~X,M~,I.. ~2%.(~!".. "~.;C~Z.b¥ !~O,~ ................... ~*0 0 Ora ! ! ! SUFFOLK COUNTY ~EP~RTMENT OF HEALTH H.D.Reference PPLICATION FOR APPRO~AL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS pproval to construct sai------'----~'systems is requested~perti~ent datai'herewith: Date 1-Applicant ~-*~{~,yz ~~u~ Phone~-Sub div ~-~ ~ddress_q3/ ~~~¢-Se~tio~ ~.~. ~=op~¢ ~ooa~io~~g~ -~o~ No. ~. ~'~1%~~ .... ........ 30~ To~m JO~qL~ ..... -Private well?~(~ 3-~blic ~ter supply nam~ ~ j~Dlsta ce nearest main 4-~t Size. Widt~ft. Length~'%. (.al~o enter on ( ~nter plot plan below:) 5.~olling: Single FamIl~ ;~ Two Family? ~Oellar? ~ ~lab? ~Crawl S~co? lO-Pro~sed ~%em: Sop%le %ank ~Proc~% g~Co~spoots ~ ~Shallow ~ols ll-S~ptic ta~ inside d~en~ion~, ~O~Gals.Long%K~f~. Widt~ft. Liquid depth 12-Precast sections: ~Numbo~Squaro F%. ~osspOols: Bl~ck Total blocks below inlet: PLOT PLAN The Undersigned CERTIFIES:~ "Construction of authorized ~nstallati~fffwill be in ccordancs with the 3u£folk County Health Departments' eurr~nt S%a~da~a,.~ull~ins, nd amendments ~hor~to, covering Private So~9, D~s~al.$y~tems".f~ / / ~,~ ~.dJo~ { P.O. BOX 274 OR ~ALTH DEPART~NT USE ONLY, Based on the ~nfo~ation p~esented hePewith~ it is %he pinion of the Health De~rtment, %hat an adequate and satisfa~to~ Sewa~s~sal System FOI~i~I NO. TOWN OF SOUTHOLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Disapproved a/c ............................................................................................ ..................... ...%. ....... :...]~ ......................... ~~,.....,.....,,:.. .................... ...................... (Building Insp';~:';;~'~] ................................ APPLICATION FOR BUILDING PERMIT Date . .~R~ .l....l..~,. ........................ , 19..7.~ ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and bubmltted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule, b. Pict plan showing location of lot and of buildings on premises, relationshib to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram whii:h is part of this application. c, The work covered by this application may not be commenced before issuance bf Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit,shall be kept 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 have been granted by the Building Inspector. APPLICATION iS HEREBY MADE to the Building Department for the issuande 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 removal or demolition, as herein descr bed. iThe appl cant 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 inspections. (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. ............ Name of owner of premises ....... ~lj~be~,..a~J..t~.h~J...iJ~c~l:;it~l~ ............ ~ .......................................................................... antis a cofpj:~j~,/~signat~e,o~duly authorized officer. . .... [Name and t}tle of corporate officer) Builder's License No ................ ~..~..~..~. ................................... Plumber's License No ....... .~.~.e.~ ...................................... Electrician's License No...~[~.(~..~. ..................................... i Other Trade's License No .............................................. ,, 1. Locat,on of land on wh.ch proposed work w. II be done. Map No...l..~..e.~ ..~..~.e..k...1~...~..~.~.?~..~ 6,6 ..... ......... Lot' ' ' : No ......................... Street and Number ~./.~....l~..~.P?.~.~....l~:..*~..~ ..(~,.~....~..i.~.,*...~..~...~.~.t ........................ ~.l:..h..o.,1.8. ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ac Existing use and occupancy .................. .~.~.~.~....l~ag ..................................................... b. Intended use and occupancy Oae,,~..e~...~....~..~.Jl~.~.~, ~ - ,,,: ........................................................ 3. Nature of work (check which applicable): New Building.......................Z Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 00o.oo 4. Estimated Cost ............ ~ .................................. Fee ................................................................................................. (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 occuoancy, specify nature and extent of each type of use 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 ...... 3~.~ ............. Rear ....... ~.~ ............... Depth ......... ~ .................... Height ................................................. Number of Stories ............... ~..~ .................................................................... 9. Size of lot: Front .......... iZOd. .................... Rear ........ ~Z ............... ,,..~ta~t~t~ ..................................... 10. Date of Purchase ........ ~(~ ............... Name of Former Owner ............................................................................ 1 1. Zone or use district in which premises are situated ........... ....... , ............................................. 12. Does propomd construction vi01~te any zoning law, ordinance or regulation: ..... ~ .................................................. 13. Will lot be regraded ..... ~ ........................ Will excess fill be removed from premises: [ ] Yes ~] No 14. Name of Owner of premises ... ~.~.~]. ~a~ ................... Z~ ....................... (Ad ress) ( e No.) Name of Architect ~I~ t~. ~e~ ~ay ~e., ~e~a, ~Y. (Address) (Phone No,) Name of Contractor ...... ~..~,..~f.e...~f~..~..,~..~*...~f.~t ...... .~,~ ................. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-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. STATE OF NEW YORK, ) .................................................. , ....................................................... being duly sworn, deposes and says that he is th? applicant above named. (Name of indil~idual signing contract) He is the ................................................................................................ -..~,-~-~ ......................................................................................................... (Contractor~a e~g~ 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 manner set forth in the application filed therewith. .................................... day of ..~,.52.-hl,gA~.l ......... 19 ............. m,, o,, ~,,,,- ~,d, ~0, 1~ ff -- ~c & ...... , ........................... .... ................ (Signature of applicant) F" 0 -4 0~..~ m m 0 o~