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HomeMy WebLinkAbout6629-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. z. .77.e ..... Date .......... N~¥ .... 12 ..... , 19.~.5. THIS CERTIFIES that the building located at . .Damx Dr£,~e .............. Street Map No.C.t.e.a.y.es..P~;. Block No ........... Lot No, .(~9 . .GI'ee~pOI'.~...]}I.,X, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~,e~r .~. , 1973.. pursuant to which Building Permit No. 6(52~Z. dated ...... J..ug. e...lq' ..... , 19 ?~.., was issued, and conforms to ali of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ?r;l.¥a'~e..o~e. £a,~K[~l~.~ .dwelJ. llag ................................. The certificate is issued to .,Ioka .& IVla:r!e .llugl~s. 3'~ ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~r~.Ln.e 3.0... ~ 9~.[. BY, .~t, .V.i~[~le~... UNDERWRITERS CERTIFICATE No, N. 2~7.3 ~ 2.~.., 19.~.~ · .. ..... Se.l : .............. HOUSE NUMBER .. ~?E ...... Street . D~wz~. D~'ive ............................. /~-<~ ~]d~ng Inspect~ ]FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERJVi~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES 0NTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6629 Z Date ......................... ~':t3:13~.....1~. ............. , ] 9.73.. Permission is hereby granted to: ..,T~..&.~.,~ ~e..Ht~13e~ ............................... ........... 2~.....01 e.az~ ook...D~. ..................... ................ ~,-~ t~t,o,,~ ....... ~.,,Y~,, ...................... ~o ...~...~l;L¢..~e~...ox~e...~l;l~....~w.e.~ 1~ ........................................................................... ............. .(~a pp x'~w,~ d.. t~y.. :B cl ..A.ppea 3.a J. ........................................................................................ at premises located at ...~L.~9. ...... .([]~,.~.a~,...~..~...S~C..~;[~ ....................................................... ........................................ ~&',~ · ,0~.;!,~ .......... Gz'ee33]~o~.t,.... ~ ~ .~ ~ ................................................... pursuant to applicdtion dated ..........................~ ......... ~ .......... , 19...~.~., and approved by the Building Inspector. Fee $...~05,~ ....... Building In~F;ector~ FORM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR tnk, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use' ]. 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 New Bqilding ...~ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Subdivision ................................................................. u~ No ........................... Health ~pt. Approval ............................................ ~bor ~pt. Approval ...... ~ ............................ Unde~riters Approval .~..~.~.~.~.~.~ ................ Planning B~rd ~proval .~ ......................... Request For Tem~a~ Ce~ificate ........................................ Fin~ Ce~ificate ..~ ............................... F~ ~bmitted $ ..~ .............................. Construction on above described building and permit meets all 9pplica~ble codes and regulations. Applicant ..... . .~..~.. .................................................................... Sworn to before me th,s ~ ~x/ ~/ .......... /...~,. day of .... ~...-./-...~...,-.~-.]..,..~.... (stamp or seal) Notary Public .... .~/~... County THE NEW YORK BOARD OF FIRE UNDERWRITERS ak BUREAU OF ELECTRICITY ~ 85 JOHN STREET. NEW YORK. NEW YORK 10038 ,,,m, September 24, 1975 ~'v'""""°"?'o'°"fu'"776201 N 247355 THIS CERTIFIES THAT John Hughes, e/side Dawn Drive, app. 600' s/o Maple Road, Greenpor~ L.I. in thefotlouqngh,catlon; L~ Basoment ~] IstFI. [] 2nd Fl. outside Section Bl~wk .. .......... ,i,,odo,, September 22, 1975 andfour,dtohelncompllanceu'iththt, requlreme,~tsofthlsBoard. 43 63 32 ~M] [ AMF ] TYPE E~lljp '~2w I ~ 3Wl3~' 3wi3~ 4Wj NO O~=C~C~CONOt ~ A~W.~,~.,~ ~O O~ HI-LEG ~'o[~W'GNJ.LEG NO O~ NEUTRAU OFANEWu?RAI 1 ; 200 CB i 4/0 I 2/0 *Furnaces: Oil 1-1/8hp, 2-1/12hp I Post light Box 166 GENERAL MANAGER st. J _mes, Per g This certificate must not be aJtered in any manner; return to the office of the Board if incorrect. Inspectors may be identified b~ their credentiols. MAD or L-AND C,~ Sc~ 'l' I..,.O L r.,, SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference No. ~ ~ 'il3- ~P, APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant,~ Address ~ 2. Property location ,~, Phone:~ ?,· 5. Subdiv. ~ ..... , ~ ~ 6. Section ~ ~ , ~ 7. Lot No. .~ ~ 8. Private w~i% ~' ~ ~- 9. Public water ~ '2 Distance to main , ~ ~',,~ z feet (Enter on center p%ot beloW) tank: Precast ~quivalent Block Number yPrecast ~lock Special__ Village, , , ,, ,~ Township~ 3. Public Water Company name+' 4. Lot size: Width ', W feet Length 10. Sewage Dispos~ystem: A. / O:O/gallon septic B. k,_~ching pools: If private well fil Street in blanks below: Tank capacity Gal ~tal well depth__ Depth to G.W. Amount of water in well Test Hole Data I Feet 1 14 The undersigned ]ERTIFIES: "Construction of authorized installations wil be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Owner or ~ui}der FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, i is the opinion of the Health Department, that an adequate and satisfactory Sew Disposal System can be installed on this plot. Z/ fZ Signed S-15 Revised 4/]/72 SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference APPLICATION FOR APPROVAL TO CONSTRUUT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applica~ _ . ~ '~ ~ ~ ~.'~ Phone~ 5. Subdiv. C~'n,,~'~ Address ~' ~,,~,~-,,~r-~'~',.,~,r ~.~, ~"¥~'~>~'"~'~ -~U-r/----6. Section 2. Property location &),~,,,.,-~, U,Vf;,,'~' 7. Lot No. "~ ~ Village~¥,&.,%~,~z~/. . ~,:.3,~,~.~,,,~. 8. Private well ~>~, .. To~,~.i~. ~4~%'~ ....... 9. Public water ','/,.~ C 3. Public Water Comp~yz~name 4 Lot size: Width -- feet Length /~ ~,~'~z~'~F~ Distance to main feet (Enter on center plot below) 10. Sewage Dispos~Syste~: ~. A. /~0~ gallon septic tank: Precast.~quivalent B. (J~aching pools: Number ,~ Preca%t'~OBlock. Block Special If private well fill in blanks below: Tank capaci~y~ Gal~ a[ efl depth_ : Dtpth to G.W. Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 The undersigned CERTIFIES: "Construction of authorized installations wil be in accordance with the Suffolk County Department of Health's current stand- ards thereto." Date/~'/ Signed ~ Z'f"/~ ~ ~?'~ ~'~ ~/'~, FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, i is the opinion of the Health Department, that an adequate and satisfactory Sew Disposal System can be installed on this plot. 7.. Signe ... , Date S-15 Revised 4/1172 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL ................................................................... ,,,, ................ ........ . ..... ...........~~ ~..~....~.~.~Z~....~~, ' -~ .............. ~~ ....... ~..Z. ~ ~ e ~ for permit to ............................... t ............................... .................................................................. Street ~o~ .~..~..~ ~,o~ ...... ~.~.~.~~. ~o~ ...~ ..................................... returned herewith and d,$opproved on the foJlowing grounds ........ ~..~.....~.....~...~~ ,~..~...~...~ ....... ~..~... c~.~ .... ~..~:.~.: ......................... Building Inspector )'0 LAND SUi~¥£Yt~ 0 I~OR / 3 sets of plans, aCCurate Idot Men to scale. Fee according to schedule. b. Plot plan showing location of lot end of buildings on premises, relationship to adjoining premMs or public streets or erem, giving · detailed ducril~ion of layout of property must be drawn on dllgrem which is part of this aPPlication. c. The work (~ by this apldication may not be ¢Qmmencad before issuan~ of Building Permit. d. Upon ~ of' this Nxdiuetion, the Building. If~pector will issue e Building Permit to the applicant. Such permit .d~il be kept the premim ~ for inspection throughout the work. e. No bull~flll shaft be o~upled or used in whole or in part for any purpose whatever until a Ce.rtificate of O(~upaney theft here been granted by the Building Inspector. · APPLICATION IS HEREBY MADE to the Building Department fo~ the issuance of a Building Permit pursuant to~_t~_ Building Zone Ordinance of the Town of Suuthold, Suffolk County, New York, and other aPPlicable Laws, Ordinances or Regutctiom, fw ~ o~ building, additions or eltsretions, or for removal or demolition, as herein delcHbm:l. The applicant agree~ to COmldy wtt~ ilfallMleebkl lllw~' ordinances, building code, housing code, end regulations, end to admit authorized inspectors on premises and in buildings roi' ne~MseW inaJssctiom. State whether applicant is owner, levee, agent, architect, engineer, general contractor, electrician, Plumber or builder. Name of °W~er of premises ~ ~. If applicant is a corporate, sigf~re of d~y authorized officer. ~ (Name. and title o~)rporate__/~_ ~°ffice~ _~ Builder's L~cense No. f,,~;~....~ Plumber's iLicanse No..~... x .......... - E ectr cmn s Llcanse No. ~.~ Other Trade's License No ................................................... 1. Location of land on which prouMed work will be done. Map No ........ .~....~..~.....~.. ................... Lot No....~...~... ........... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction.~. ~ 3. Nature of work (check which applicable): New Building ........ .~¢~............ Addition ..................... Alteration.....:...: ..... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost .~L..~:.~..?-.~..:..O...O. ......................... · ................................ ; ................................. ~ ..................... (to be paid on filing this application} 5. If dwelling, number of dwelling units ................. Number of dwelling units on each floor ......................................... ~ira~e;,- nun~ber of cars ....'~:'.~ ......... ~... ....................................................................................................................... 6. If budnes,, commercial or mixed occuoancv, ,pecify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..................... Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Din~emions of same structure with alterations or ~dditions: Front .......................... Rear ......................................... Depth .: ................ : .......................... Height ....................... , ................. Number of Stories ........................................ : Front ....... ~....~... ...... near ...... .~....~... ........... Depth ....~....~... .................. 8. . . ,, Height ........ ..,~..~.....: ................. Number of Stories ............... .~.....; ...................................................... ,, ......... 9, Sl~e of lot: Front ...~...~...~. ..................... Rear ........ ~.....~../~. ....... ~,, ......... Depth, ....... .,~......~..~... .................... , ..... 10. Date'of Pumhise ....:.~..l.?.....u, ............... Name of Former Owner ...~...~.~...~....~--~..~:~:... _- 11. Zone or ule district ~n which premises am situated ........................................................... , ................ ~,C....; .......... 12. Does propoled construction vl.olats eny zoning-- law, ordinance or regulation: ......... ~.. ....... ................ ..,,.~ ....... 13. W,IIIotberegreded .... ''.~',.~r.~'r......_....:.~WIII/exc~,ssfill .be_re;ovad, fmmp. re~ises:.[ ] Y_es .["j'l~o ~ 14. Name of Owner of premise~'.~/¢,~-~..~)~~.:;...~.,,~-. ~...'~.?-. ~..,'~',<,,~...;.,Z. ...... Name of Ambite?t....(~'~.~....~..~.....,.~:....~.~,.: ........... ~"'~~ ....... ~_d~:~)_.~_~.~;_~Add~.l .~' ,~No., Name of Contra~mF./,.,~.~......~ .................. ~ ........................................................... (Addre#) (Phone No.) PLOT DIAGRAM Locate clearly and. dlstln~ly all building,, whether existing or proposed, and' indicts all ~et-back dimensions from property liner. Give ~ and block number or description according to deed, and ,how street names and Indicate whath. er Interior or corner lot. ~ 14~~ O I3-L~ STATE OF NEW YORK. ) ~ ~ ' ~UN~OF.....~.~~ ~ ~ ,, ,_ ~_) '/ ............... · .......~.=~.......~.....~~...,.....~ ....... ~ng du,~ ,~r~:~,,,s[,d ,,~, ,hat ~ ,,,~. ,,,,,n,,bo~ ,~ (Name of ~di~ ~ ~ct} [ ~ J ~ ' "* ~' ~"* ...................... ~~ ............................................................... L...~......~ ................. ; ................................................... of said owner or owners, and is duly authoriz~ to m~orm~m~r~ ~ ~ and to ~ke. and file ~is apeli~tion; th~ all ~ statemen~ contain~ in this app icat on are tr~ to t~ ~st of his knowle~li~; ~d that ~e work will ~ ~r~ in ~ ~n~r ~ ~t forth in the apportion filed t~rew~th. ~ . Fq APPROVED AS NOTED 765-2660 9AM TO 4PM FO~ REQUIR, T~E. ~ oqobsZ p,e... 4 - 'f G~Lo" 0 ' 'lq: 4° 2;c~" 4Lo,' 4L ~" ?.. 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