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HomeMy WebLinkAbout6702-zFOKM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z5.~.60 ..... Date ............ ~.~1.?..~..8 ....... , 19..~.. THIS CERTIFIES that the building located at .$/S..LesS,is ~ Ro.~d ......... Street Map No. B. aY. H.o.~.e.~. Block No ........... Lot No, ...8 .... g..u~h.o .g~...' N.:Y. ~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... June,. 2~...., 19..~.3 pursuant to which Building Permit No.. t57.02Z. dated J~ly 3 73 ....................... , 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 Px, iV&.te · one. family ~lvelltng ....................................... The certificate is issued to . g~.~lL~ell. ~.o.~z~;;r~;~[.o.n.. ¢o..rl~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval l~y...22.. ~.97.~...bY..R.: .¥.~.1.1.~ .... UNDERWRITERS CERTIFICATE No..~I] ~2.~.9[~ ..... Jlll~..~...~.~. ................ HOUSE NUMBER..~.i?0 ........ Street ..... ~Z~..i.e...Re.a.d. ........................ Building Inspector APPLtGATIOI~ ~OR ~I":~T~F~C:ATE OF ~OCCUPAhlC;Y ~st~ructi~ns A. This application must be filled in typewriter OR ink, and sdbmitted in duplicate to the Building Inspector with the following; for new buildings or new use: 1~ Final survey of property with accurate location of all bui dings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewelrage disposal--(S-9 form or equal). 3. Approval of electrical installation fram Board of Fire Un~derwriters. 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. Dote 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 New Building,.,,,,,,.,,,,,,,,,,.~" O~d or Pre-existing Building ................ , ........... ocant Land ............................ . ............................................................ ........................................ ........... Location Of Property .~..~..~. Owner Or Owners Of Property ....~...~...~....~1....~...~,-~.:....~..~..,,~,...~....~........:Z~.~..~....p. Subdivision ...~..~..~.~...~....~-,'~- ........................... Lot No...4~...;.. Brock No ............. House No ............. Permit No..~--~...~..~.,.~ ...... Date Of Permit ~...~/?.~'pplicont .~".~..~..../-~....~'.~....,~....~.~....'¢~....~.v~',~ iZ,.....,......~...~./~....~.. Health Dept. Approval ............. .~..~. :...~..~/~..~ ....... Labor Dept. ,~pproval ................... "'~r~ .1..~....,...,......~'"' Underwriters Approval .............................................. Planning Boa~d Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ............. ~ ........ Fee Submitted $ .,,..%~. ~.,,'~,. ..................... Construction on above described building a~,~it meet~,~,.plicable codes end regulations. App cant -~L~'.~ ~ .~~ ................... Sworn ,o before me THE NEW YORK BOARD OF FIRE UNDERWRITERS a[.c SUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~I~IES THAT Clausen Constr., s/side Leslie Rd., 1500' e/o Bay Avenue, Cu~cho~u~ L.I. i. thefol~win~l~ation; ~ Basement ~ ;st FI. ~ 2nd Fl. OUt side Section Bl~ Lot w~ exami~d on ~.~ 3 0~ ~ 9 ~ ~ and found to be in compllance with the requirements of th~ Board. OUTLETS RECEPTACLES SWITCHES iNCANDESCENT ,~ERCVA~RRY 22 32 2~1 I o,LFURHNPACE MGO~sTOR$,.p. [ FUT~G?~E APPUNAo~CE F~OwE~GS' · 1 3 6 SERWCE mSCONNEO I NO. O~ I $ METER 1 100 CD x1 ~Furnaces: Oil 1-1/ShpE l-1/12hp RANGES ~PECIAL REC'PT COOKING DECKS OVENS DISH WASHERS TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET I NO. OF HI-LEG OF HI-LEG EXHAUST FANS MAT, H, P. 2 F DIMMERS A~T. WATTS A W, G NO. OF NEUTRALS A- W. G. OF CC. COND. OF NEUTRAL Pat I{eaney Elec., lS2 East Montauk }[~jt, Hampton Bays, L.!. 119~6 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BI: ALTERED IN ANY MANNER. SUFFOLK COUNTY DEPARTHENT OF HEALTH APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATB SBWACE DISPOSAL SYSTEN e 4. 10. Address;f~,~O ~c'c~/~ ./~/ ~/~,'/ /~.'/. '6. Section ' 2. Property locatiOn ~'~/ ~ ~ 7. Lot No. ~ 8. Private well /~-;~ Villale ~~ Township ~,~/~ /~ 9. Public water Public ~a~er ComcaSt.name Distance to main Lot size: ~idth /~,J feet Length ~' feat (Rnt~r on center plot Sewage Disposa/~ystem: A. ~J~gallon septic tank: Precast B9uivalent Block B. Leaching pools: Number ~ Precast~Block Special below) Street If private well fill in bla~ke below: Tank capacity~'Gals. Pump ~.P.M. ~ Total well depth ~g~ Depth to C.W. ~6 Amount of water in well g/~ Test Hole Data Feet 0 lO 12 16 18 The undersigned CBRTIFIBS: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current stand- ards thereto." / Owner or Builder FOR HEALTH ~BPARTN~NT USB 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. Date ~ - ~/~ Signed ~ff/~~ S-15 Revised 4/1/72 APPLICATION FOR BUILDING PERMIT · . INSTRUCTIONS ' ~ a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this appIJcation, k-'~ c. The work covered by this application may not be commenced before issuance of Building Permit.~ d. Upon approval of this application, the Buildi'ng Inspector will issue a Building Permit to the applicant. ~Such permit shall be kept on the premises available for inspection throughout the progress of 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 issuance of a Building Permit pursuant to the Building Zone Ordinqnce 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. (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 ...~....~.~....~....~._'~....!..~..~'l/ ..~...~..,~ If applicant is a corp~,~ignature of duly authorized officer. _~ ,~J~ame and title of corl~orate officer) 1. Location of land on Which proposed wor~wil~ be done. Map No.: .~...~.....~......~..~ ...... Lot No......~'.. ............ S~reet and Number ...~.....~....~.../.;...~......~..,~... ............................ 4~..'~....~.._.~--~..~...~.,~.:..;..: ....... ; ...... , ................ Municipolity '" 2. State existing use and occupancy'of premis, esOnd intended use and occupancy of Proposed constsuction. a. Exisiting use and occup ncy ............... ~ .................................................................................... ..4. .......... b. Intended use and occupancy .............~ ..................~ ............................ 3. Nature of work(check which applicable): New 'Building ,...~............ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ........... ~ ..... Other Work (Describe) ........................................ 4. Estimated Cost ......... ~...~....~.~....~,...-~.. .......................... Fee ..~.i.~......~ .................................................................... (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 occupancy, 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 ...... ~...'..~..~ .................... Rear ....~...~.~...-. .............. Depth ......~/..~.. ............. Height ...../...,~....--~ ...... Nu.rnb, er of Stories ....../.. ............................................... ~..~ ......................................................... 9. Size of lot: Front ..... ./~.'~'i ............. Rear ..../..~.....~'.. ...................... Depth ...."~..~...?. ................... 10. Date of Purchase/.~......~'.~... ................................ ~Name of Former Ow~n~ er ~.....~..../'./..-.~'..../....~..../~.....~/~....'~....'~..~... ....... 11. Zone or use dlstrR:t in which prem,ses are s,tuated ....z~.*. ......................... ..1 ............................................... ............ 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... ...~..~.. .............................................. 13. Name of Owner of premises..~...~.~...~..~."~..~..~..~..~..~{~lre£s~i~..~......~....~c~..~....~../..~'..~f~one No ..................... Name of Architect ...................................................... -- ------Address · .~...~.../...~..~..~"~....~.' ./..~.../../..)'.~,~hone No. ?~...~...~..~...¢~.. Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed~ and indicate all set-back dimensions from pr0pert~ lines. Give stree, t and block number or description according to deed, and show street names and indiCate whether Interior or comer lot. STATE OF NEW YORK, . COUNTY OF ...~ ................... ' ......... f~"o i...L ............ .~'~....~.~/~i~ ............... ;; ....... .,; ......... ......... being duly sworn, alL, oases and' says that he is the applicant (No~e of individual signing application) · .... above named. He ,s the ........ .~.~......~.: .............. ~....~. .............................................. .~...~... ............................................... (Contractor, ag~t, 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. Sworn to before me this ........................ day of ............................................ , 19 ........ Notary Public, . ........................................................... County (Signature of applicant) '5 uf.~v 6O F° RSV,mONS YOUNG & YOUNG M,~Y/~/.97',~ 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W, YOUNG HOWARD W. YOUNG PROFESSIONAL ENGINEER AND !.AND SURVEYOR LAND gURVEYOR. N.Y.g. L;C. NO. 12845 N.Y.C. LIC. NO. 45893 SURVEY FOR: CLA USEN CONSTHUCTtO~ , .~. ~ . ,~ SOUTHOLD ~ ~ . , /~ , , : , t ~ ,, :'. ~, ApPE~D~VED AS NOTED ~ 1 BEFORE BACKFILLING FOUNDA- .! .: ¸%.