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HomeMy WebLinkAbout6684-zFORM NO. · TO~N OF $OUTHOLD BUIT.nINO DEPART~t~IT Town Clerk's O~ice Southol4, N. Y. Certificate Of Occupancy No. Z%82% Date ....... Mar t~ 19.~... THIS CERTIFIES that the bug&in~ located at ~. ,~.~ ~.~, .~ ........... ~t Map No.q~. 9r. ~ Block No ........... ~ No. ~. .... ~..~ .... 0~P~.. ~,Y, co~o~ su~t~fl~ly ~ ~e ~n f~ B~ P~t ~e~e ,~'~ ~ce da~ ........ ~.. ~ .... , 19.~3. p~t ~ w~ B~ P~t No..~6~. da~ ............. ~...~., 19.7~., was i~u~, ~d m~o~ to ~ of ~e r~ m~ of ~e app~ble ~o~ of ~e law. ~e ~cup~ for w~ this ce~ica~ ~ ~ ~..~r~9. ?9. ~.~ .~.~ ..................................... The ce~tfica~ ~ ~u~ ~ ...~el ~. ~ ..... ~ ............................. (o~et, Xe~e ot ~t) oJ ~e ~ot~d b~di~. 8~o~ Co~tg Dep~t o~ ~e~ ~g~tov~ . .~r...~.....~...~7..q~. ~.~... ~ao~x~s c~xc,~s ao, ~. !3~J.!f., .... ~..~...!~ ............. ~OU8~ ~ .... ~ ~ .......S~eet ... ~..~rffff.~ ........................ Btttlding FO~ 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? 668 Z Date .......................... ~"t~' .......... 2~'"'" 19"?3' Permission is hereby granted to: ....... {~mt~h~cl' ....... ~i'~'¥'~' .................................... to ..... JS~f~.~..zm~..ozm...;?~i]r-.~,~ell.~ ................................................................................. at premises located at ....~.~t...2i~.....QZ~.g~O~,~..Z/~.~,~...p~.;~~ ................................................ .............................. II/~....~t..~ ....... ~i~'e~a'por~, ............................................................. i ........ pursuant to application dated ....................... ~:tx_r:~.....1.~. ............ , 19~L~...., and approved by the Building Inspector. Fee $~, ,.~.~[ ............ TOWN OF SOUTHOLD hildiq [~:tment TMM Cle~.l OMce SouthoM, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 dispcsal--(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), No~-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey aT 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 New Building XX Old or Pre-existing Building Vacant Land Location Of Property ...... .~...~..~.~..N~.~.:...~.~..~.?...~..w...n.~.~.e.~e.~.~..~.e..e...n.~..~..~.~.~: ..................................... Owner Or Owners Of Property ...... ..~..e.~e.n.....'~'.~..c..h..e.. ....................................................................................... Man of Greennort Driving Park /-- 20 Subdivision ..... ~. ................... r. ..................................... u, No ............. Block No ............. House No ............. Permit No RD.6.684Z Date Of Permit[./..2..2./..?.3. ...... Applicant aid Town Builders. [nc. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .5.:..0..0. ............................ Construction on above described building an~l. permit meets4111 al;~licable~codes~ and regulations. ............. ............... Sworn to before me ~is (stamp or seal) ~ I~ Qualified in 5uifolk f °. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY NE YORK 10038 N 139175 TNI~ ~IFIES THAT was examined on ' [] 2nd FI. 0 bl~ B ~- (~ Section Block Lot and fourtd to be in compliance with the requirements of this Board. RANGES COOKINGDECKS ~)VENS DISHWASHERS EXHAUST FANS FIXTURE FIXTURES OUTLETS SWITCHES FLUORESCENT DRYERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF F~ET OTHER APPARATUS: ()il, 1-1/2hp, E R V I C NO'OFpERCC' COND'ff OF A' W' G'CC. COND. NO'OF HI-LEG oFA' W' G'Hi. LEG NO. OF IqEUTRALS 2 1-1/12hr. l~onald F. Lnnis PC) (~ox 20J! ?Iddle Island, L.I. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No~-~ APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS Date Approval to construct said systems is requested,pertinent data herewith: i-Applicant Address. . ~ ?-Section property locatior 2-Detaile ~ ~ ~' ~ ~' 8-Lot No. Hamlet ~ Town ~4 9-Private well? 3-Public water supply nam · Distance to nearest main ~-Lot Si~e: Width ~ £to also enter on eentsr plot plan below:) 5-Dwelling: Single Family~Two Family? / / Cellar? ~_)~lab? / I Crawl Space? lO-Proposed system: Septic tank~Precast /~Cesspools~Shallow pools / /Other~_/ il-Septic tank inside dimensions: Volume$$o Gals.Length ft. Width ft. Liquid depth ft. 12-Precast sections: /~mber/~Square Ft. Cesspools: Block sizeL incs. D ins. H ins. Total blocks below inlet: ~1 ~2 PLOT PLAN Street Vacant ,~ate 'th Data ~eet ~ ~o ~6 Date~ ~/~/~7 Sign~''~ ~ (10/65 revis.) 8-15 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 Plot. Indd The Undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Health Departments' current Standards, Bulletins, and amendments thereto, covering Private Sewage Disposa~ Systems"~ z Date ell l?s Signed __ Owner or Buil~'r ,, ../; / '~ ,,~ ~ -//~""~..~ TOWN OF SOUTHOLD , ,N~' ,/ "~ '~- ,~ ~,, ~:z TOWN CLElUC'S OmC[ /~'.,..,,,4,~- ~.1 . "-~/,...'_ ~'~ ~ '"'~ - ~'/" . ^pplicatia" ...... ................ .... ...... , i Date ..... .~..~...~..e. 15 ~9 73 \ , , INSTRUCTIONS. , // a;- This application must be completely filled in by typewriter Or, in ink and submitted in duphcateto the BuilBing I n,%oector. I~, Plot plan showing location of lot and of buildings on premises, relationship to adjo n ng prem ses or public streets or&. areo~ and giving a deta.iled description of layout ofpraperty must be drawn on the diagram which is part of this application. ~;% c. The work cOVered by this application may not be commenced before issuance of Building Permit. r' · d. Upon approval of this application, the Building Inspector will ssue a Building Permit to the aaollCant Such oerrnlt~ snail be kept on the premises available for inspection throughout the progress of the'work. . .... r ...... 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 Departmei~t for the ssuance of a Bud ng Permit' pui~uclnt 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 described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. OLD. TOWN BUILDERS, INC. (Signature of appJicant, or r~me, if o corporation) Main Road. 8outhold. N.Y. 11971 (Address of applicant) State whether applicant is owner, lessee, ogjent, architect, engineer, general contractor, electrician, plumber or builder. BUILDm. R Name of owner of premises ......... .I~.~.~..W~.~.~'~ ......................................... If applicant is a corporate, signature of duly authorized officer. ~ (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: 369 , . 20 .................................... ~..~. LOT No ......................... Street and Number .2..0...~...~..~...8...?~..~...T.. .. G~,~I~O~,T Municipality State existing use and occupancy of premises and intended use and occupancy of proposed constructien: a. Exisiting use and occupancy .......... .V].~,~.qt.~lLo.d. ............................................ b. Intended use and occupancy ............................... .~. ........................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alter i n ..... :'. .... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ................................. :,. ..... 4. Estimated Cost ....................................................... ;....Fee .......................................................................................... (to be paid on filing this application) ,. 5. If dwelling, number of dwelling units ........ ~.;.:..~....: ...... I~umber of dwelling units on each floor ....... ~, ................... If garage, number of cars ............~..o...D:.e. ................................................... i ................................................................... , 6. tf business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ................... :;. ....... Rear ................ .-. .............. Depth .......... .'. ........ Height ............. Z. ........ Number of Stories ........... 7. .................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Hqight ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... .:~.~! ......................... Rear .....3..6..1. .................. Depth .....2..8..~. .............. Height ..,,~.~. ........... Number of Stories .......... ~, .......................................................................................................... 9. Size of lot: Front ..... .~.~. .................. Rear ........... ..~-~' ................... Depth ......... Z:!~,3.e..~.Q ....... 10. Date of Purchase ....]~...g....z~...[3...2..2. a..~.9..T..3.. ...................... Name of Former Owner ....~;[G]3RL~...O..~.~ILtL¢~ ................. 11. 7one or use district in which premises are situated ....... .L~,e~J.c[ea.t;:Lg]. ....................................................................... 12. Does'preposed construction violate any zoning law, ordinance or regulation.;) ........... ..~..o. ........................................... 13. Name of Owner of premises .....~...e..~..e.g...9~..~.e.. .......... Address ....3..[..5....2...~.d....8.~.?..~..e..e.~P..°..z'pthone No .......... .~.-.~. Name of Contractor ..O[....d....~'...°..w...TL..~..g~l,.d..~.r.~l.&.~lg.~.....Address ~..~.~:~P~t,~G1,~.T~'~. Phone No..T..6..~..-.~..~.~.0... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether Interior or comer lot. STATE OF NEW Y~:~K~-,- x~ ! c S COUNTY OF ..:....eeT~..~y~.~.~....J''~' duly sworn, deposes and says tl~at he is the applicant (Name of individual signing application) _ above named. He is the ......... ~,~~.....~..~.'~.~e~......~......4~:-(-~ ............................................... (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 end file this application; that all statements contoined in this application qre true to the best of his knowledge and belief; and that.the;work will be performed in the manner set forth in the oppli~ati_on fil.e4;L~erewith.~,, Swam to be.fo~ me this ~ -~-, ....... //~.V~..._ day of ............ .~..4.~.a'.~.. ............. , 19.a(".s.~ ~ , ~ ~,. ~_ ~g,~. ........ ~/13~'.~=~. ..................................... Notary Public,~...~.[~~...; ......... Count~ ~/ (Sign~'dure of applicant) NOTARY PUBLIC, State of New York No. 52-6168295 Qualified in Sm~ol~ County Commisij~)n Expires March 30~ 1~'1~ ZO SUFFOLK COUNTY HEALTH DEPART}lENT Tho sewage di s!:osal ~nd ~va%e~, s]~Dpj, y ~.1~3~,~..,~ o~ by this dopa~'t~uo~]t and found Ohiof of General Enfineertn~ V.( NDOW SCHEDULE ILCODE LGT VENT I CODE LGT VENT CODE LGT. VENT CODE LGT. VENT tJ~W 6.5 3.14I NY i8.6 7 9 UU 8.20 4.0 W;J I5,72 2.50 JR 75 5.64 YN 35.0 15.6 BU io,o 4,4 VV 51 92 5 26 TN 90 4.39 ZV 24.0 6.0 UG 14.1 ' 7.0 3,92 5,26 130 __S28 I ZG 46.0 9.0 UB 17.2 8,5 VW 47.64 5 26 NW 11,05 5/45 AU t2.93 WL 47--64 5.26 WN 22 I0 10.90 EL 2F:6 I0 6 N× 16 I0 790 U~/ 25-,17 850 XN 32 0 15S QW 25.17 8.50 NOTES MODEL LAMAR DESIGN - /~ /2 R H ELEVATIONS NATIONAL HOMES ODRR DATE OF I R£V I$ ION LEFT". 7Co FRONT ELEVATIOB REAR 9Lo" -RIGHT MODEL RH FLOOR PLAN ___ ;)ATE c ~SSUE PJATIOhJAL ~4OME S C~P ~-5o-gO . BR-2 NOTE 2F% ADDS ONLY A5 LIVING RO©VI 3lC, Cb P~_y 'FLUE I 8 X [0 BEAM--,., *MAI N STACK 8 L_~ G t.., FL R DRAIN 9)'- I0" , I "4 STACK ' '~ CONC. FLOOR 35-3- 7L 7 8 15L4' 30'- 7"