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HomeMy WebLinkAbout6736-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No. 2~8~5 ...... Date .............. April .... THIS CERTIFIES that the building located at . -Itobal, t. & .Kolql .1~ ....... Street Map No.. ~i~ ........ Block No ...........,~ Lot No.x,~X.. Sou'chold .... 1~¥'~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ iluly' ' ~ ', 19. ~3 pursuant to which Building Permit No.. 67'36Z' dated ........ 'Jllly' '1 ? ....., 1973., 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 . I~ii'i~e 'on~ '£alaily' ~lYelllng ...... (exl'sting '-" r~aved-) ........... The certificate is issued to . living 'I[;' PI'ice ........ 0~rnel, ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ' Pending .......................... UNDERWRITERS CERTIFICATE No .... peri,ling ................................. HOUSE NUMBER ..~.~ ........ Street .. 'Itob~rt-i~olm RoadR°ad .......................... ~OR3~ NO. 2 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) 6736 Z Date .......................... 5.u~.y......~ ~. .......... , 19..~.~. Permission is hereby granted to: Z.x:~.,%i'-~...,!.....,P.~,ff~o e ............................................ .......... Li~'.e ~p~=.l; ........... ~.~, ........................... to ~.~.~ ~.~.~ ~,.~.~...~...~,:.~.,~,~ ~,~.L.~ ~a.. e~x£a~'~...dwa ~ ~i~g ......................................................... i~o osed lot a~ roved b B.~ .4~o~1~ ................... .~ ....... ~. ........................ r~. ................. ~. .......... ~. .......................................................... at premises located at ....~o~a~.~,..~,O~,..~..~o~..~ ................................................................ ...................................... i~.~.g.t~ s~l~l .......... 1~.~.~ ................................................................................... pursuant to application dated ........................ J~.'t~r ....... ~ ............ , 19t~..~..., and approved by the Building Inspector. Fee $.l...t....O. ........... THE NEW YORK BOARD OF FIRE:UNDERWRITERS BUREAU OF ELECTRICI~ '.~i:. ~ :. STREET NEW YORK ~ ' ' ' :t0038~' THIS CE~IFIES THAT and found to be in compliance tvi~h the requirements of ~&is Board. FIXTURE / fiXTURES , oLFrLrrs r. CEPTACLUlSWITCHES INCAHDESCENT FLUORESCENT ~ / SERVICE DISCONNECT I Ne. OF I s u 100 C~ x I K.w. R OTHER APPARATUS: *Fmrn~e/.: 0i1, 1-1/8hp L-X/4hp ~EXeetrXG ~ ~terwl2-X.5~ 5Fe~X~d/s: 1-~ 12~ COOKiN~ DKKS' OVENS ' ID,SH WASHERS IME cLocKS BILL.. ~ MUT .V I ' C E Lot EXHAUST FANS 3 Fr. DIMMERS Peter G. Burke 301 Stxth Ave. Gtmenport, L.X. 119~ S CgPY OF CER ICAT~ MUST ~ BE A ~.P-~-D~ ~i MANNER' COPY FOR BUILDING DEPARTMENT. THI TIF . : L ; COUNTY, OF SUFFOLI(' DEPARTMENT OF HEALTH SERVICES L~v. L. 15-~ce Greenpor%, Ne',;. York 11~4 RE: ~ enO? ~-~-.. - corner of-i~bart Rd. & Horn Ed.~ Southold, N; Y. Dear~ :T,~. Price: A recent check of our files indicates that this office has never issued a final approval for the above referenced jOb. Please be advised that it is illegal to occupy the building until the f~l. )?ing paperwork is submitted to this office and/or the following inspec- tion{s} are completed: Il"ell tific '' ' ' Drillers Cer ate - · : - Water Analysis - esspool Certification '-- : na Surveys . ' · ' : '" . ~ i.l~."'*'~er ~ - - 4 Should you have any questions, please feel Very truly yours, ~Le~ ~ener~ .R~8tr, eerln~ Berl'£e~ free to contact this office. " 7 " ' ' Town Building Dep~rtm'entV~. SUFFOLK COUNTY DEPARTMENT OF HEALTH H.p. Referenoe No. J O-- y APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL $YSTEH 1. Applicant~ ~ ~0~/~ Phone Address ~/~ Jr ~-~~ ~! 2. Property locat~..on Village ~ .*f-~ Township 3. Public Water Company name 6'~'-~'~~ 4--' 4. Lot size: Width~~. feet Length /&~ feet center plot below) 10. Sewage Disposal ~w~: A. 900 gallon septic tank: Precast ivalent Block B. Leaching pools: Number~.Precas~Block Special 5. Subdiv. 6. Section 7. Lot No. 8. Private well 9. Public water Distance to main (Enter on If private w~ fill in blank~ Tank capacity W/~als. Pump G.?~M~ ~/ Amou/t of water in ' Te/:~le ~' Data Feet 0 2 4 6 8 10 12 14 16 18 installations will ~ current stand- be s ards thereto." ~ Date ~/~1/~ ~ Signed FOR HEALTH DEPARTMENT is the opinion of the Health Department, that an adequate and satisfactory Disposal System can be installed on th~s plo~. Date USE ONLY. Based on the information presented herewith, it Sewage S-15 Revfied 4/]/72 ,oh Disapproved a/c ......................................................................... APPLICATION FOR BUILDING PERMIT Date ............ ................... a. This application must be completely filled in by typewriter o~, in ink and subm tted in tr p cate to the BuJ~ng Inspector, with 3 set~ 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 adjoin ng premiSes or pub ic streets areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this opplica/t~ 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 I~hit 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 Deportment 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 .~guloti.o. ns, for the construction of buildings, additions or alterations; or for removal or demo t on, as herein described. e 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' necessa inspections. ' .......... ..................... pplicant, or name, ke~ -corporation) (,~ldress of applicant) State whether applicant is owne, r~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name ofownerofpremses.~t~ ~ ...~ ..~..../'~....~¢--~ · ' ..... If applicant is a corporate, signature of duly authorized officerL (Name and title of corporate officer) .: : Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No. ~ 1. LOCation of and on wh ch aropoSed work w J>e do~e Map No · LOt.N* ...................................... ....................... Municipality :! 2. State existing use and occupancy of premises a~d in~ended use and occupancy of prOpOsed construction.. a. Exisiting use and occupancy ......~....~...~.~. ............................................................ ...... ' b ntended use and occupancy .~.~ ~c~ ¢~ F-~,,~ ~{~ ~" '~ ...... ."'' ~ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair Removal Demo it on Other Work .. ............... 4. ~timated C~t ........... ~ ......................................... Fee .................................. (to ~ paid on filing this application) 5. If dwelling, number of dwelling uni~ ............................ Number of dwelling units on each flor ............................ If garage, number of ~m ............................................................................................................................................. 6. If business, comme~ial or mix~ ~cu~ncy, speci~ nature and extent of each ~e of u~ ............................ 7. Di~nsions of ~isting structure, if any: Front ............................ R~r ................................ Depth ......L ............. Height ........................ Nu~er of Stori~ ................................................................................................... ~ ............. Dimensions of ~me stmc~m with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire n~ constru~i~: Front ....................................Rear ............................ D~th ........................ Height .................... ~umber of ~ories ......................................................... ~ .......................................................... 9. Size of lot: Fret ..~..~Z.~..~....~.~.,..~.~ ......... Rear ....... ~[..~.~7~Z./~.. __~_.. _..Depth ............................... ,0. ~,,~ o, ,,r~,,....... ...... : ........................................... ..~. o,~or~.,.~.,, ~ '~: .......... ., . ..-.~...?...j~ _~ · 11. Zone or use district in which premises are situated ... ]~ ....... ~ ........................................ 12. D~s pr~os~ construction violate any zoning law, ordinance or regulation: ..... ~..~ .......................................... 13: Will lot be regrad~ ........ ~,...~.... WiJl~exc~ fill be rem~ed from premises: ( ) Yes ( ) No 14. Name of ~ner of premises ~[~.~.~,.,.~ A~re~ ................................ ph~ No ....................... Name of Archit~t ......................................................... "7~-"'~"'"'"-'"' '~'"'~"1~' A~re~ ................................ Pho~ No ....................... .... o, ..... ......... .......... . on,.o ....................... PLOT~IAG~M ~ate clearly and distinctly all buildings, whether existing or proposed, and indicate all ~t-~ck dimensions from prope~ lines. Give street and bilk number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YOlk, J~. COUNTY Of ..... ~... ~ '"'~.,-~ .... : ........................ ~......L~......~....~..~....' ......... being duly sworn, deposes and says that he is the applicon, (Name ~'f fndivid/~al signing 'Contracf) ' o ov. He is the ................... ~ ..................................................................................... (Contra~iJ/or, agent, corporate of~Jcer, 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. Swam to before me this .................. ............. Noto. Public.. .............. C/ ......... P ............. Coun~ ............... i;~,';g ;~' ~;,';i~'~;;;ii~ .................