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HomeMy WebLinkAbout7553-zFOR~ NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6p.~.'~ ...... Date ............ gSa .... 2 ........ , 19.?.~. Tills CERTIFIES that the building located at .. Ca. tvez..Neck. & .Ilar. per..R~treet Map No.. ~ ....... Block No.. ~;~c.; ..... Lot No...Xt~... · · 8outho'td,. bi,Y, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 8aIM;. ·. ~3., 19..7.b pursuant to which Building Permit No. dated .......... Se.pt... 2be.., 19.7.~., 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 . .P.z, iva. te. one. ~'atally. rlwe~ ltr~; ...................................... The certificate is issued to .. Edward .&. laeatr.iee, ateinbuehler. .... .0~.r~e,r~. ..... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Jan. 2..t97~...by. I4,. ViS, la ........ UNDERWRITERS CERTIFICATE No...p~ndlag .................................. HOUSE NUMBER .. ~ O+0 ....... Street ... fla.lvzz. -Nzek..Rd ...................... ~ Harper Road Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERIMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7553 Z Permission is hereby granted to: ~..c.~.~..~...~.~..~..~ ~...I..~..~ ......~.../..q.. E..~...&....B..?..a..t ri~® Stetnb~eh~e~' ..................................... .~..~.~.~..,.~...~.~...~...~..z.~.,..~...~.~.. ~.~ ......... : ........................................ at premises located at ...... .(L,B.,~tt~LL.~'~.~ .................................................................................... 8outho~d ~,Y · pursuant to application dated ................................ ~p~....2~.;..., 19...~J'., and approved by the Building Inspector. Fee $.~,~.3,~.1 [ ........ Building Inspector '" / ........ 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 ink,, and submitted 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 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, Mu[t[p[e 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, qccupancy 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 af occupancy $1.00 Date J~.~,....~..I/.... I.~'. ~. ~ .~.. ............. New Building ..... ; .v~... ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Subdivision ................................................................ Lot No ............. Black NO ............. House No ............. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ~.~'t.9. l.~,g.:.: .......................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....~ .............................. Fee Submitted $ ...,.~...~..~..~ ..................... Sworn to before me,is ~ .......... ~.... day o~~~......~...~..?... ~x' Construction on above described building~,~/~.~lj~and permit meets a~/~plicable codes and regulations. SUFFOLK COUNTY DEPARTMENT OF HEALTHReference Health Department Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant~ '~I h.<, ~ Address ,,, ~ y ~.,,., ~ >~-'~ ~.~, ~ :~ ,~ ,~ , ~ ~ ~W Property Locati on ,~, ,, , ~, ~, ~ ........ ,~ .~ ~ ~ ,~ ~:: g~ Village .~ .,"~,, ,~ ,,~ Township >~w Public Water Company Name , ~q~e~T Lot size: Width ~z9 feet Length (?~, feet 10. Sewage Disposal System: A. 900-gallon septic tank: Precast .,~ Equivalent Block B. Leaching pools: Number of pools t Precast/Block Special If private well, fill following blanks: ll. A. Tank capacity in the · gallons B. Pump G.P.M. C. Total well de~h D. Depth to ground wa,}er [. Amount of/water in 5. Subdi¥. 6. Section 7. Lot Number 8. Private Well 9, Public Water Distance to main (For Health Dept. Use) The undersigned C~RTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto. This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. 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 and Water Supply can be installed on this plot. APPROVAL DATE SIGNED S-15 Rev, 4/1173 ~ami~ ~ ' ..... ~ ........ ~ ...... , ,,.~... ~ ~ : ........................ ':;c ................................. .............. : --~>.~ / : ~'~- ........................................... a lki~ Iicati~ ~ t c I~1 fill i~ · ' · ' - · ~ ~1 I ~ ...... ~ ~,~y--~ u~ ~ o;~ must N a~wn ~ tne al~m ~lCh (~ c~er~ ~ ~is a~t~ ~ n~ ~ f~eA~ ildi .,,- .,._ .. ~,.-- ~ ~ sholl ~ K~t ~ the ~mi~ ~il~le for i~ ~t ~ ~rk. e. No ~ildi~ ~11 ~ ~cupi~ or u~ in ~ole or in ~ for ony pu~e ~ever until shall k~e ~e~ gmat~ ~ ~e Building I~or. admit authoriz* info., pmmi,, ~ in ~lldi~ ~ ~. i~,~t~,h~i~ ~' ....... i~....lt. ................ ..it~ ................................... (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. C/~ Name a~ owner of premiss .'~P.~.*...-.'~.....~.:.~::.&I~.'t.&~.,~...K.....~T.~/.~.&.V.j~,~/U~./~... ............................. If. applicant is a coq~omte, signature of duly authorized officer. ~ (Name ona~tltle of corporate officer) Builder's License No ..................................................... Plumber's License No. ................................................ Electrician's License No ............................................. Other Trode's License No ............................................... ]. Location of land onwl~gJ}pmpoeedwe~wittbedone Mop NO.: ....~:.,..~, ..... ..~ ..... L".'*Lo.I~,~ . Street .nd Number ...................................... ~......,,. .............. ~..~...j~.~...~....~..~.~ .~..~./~., ........ ~/&~O ~ ...... ~lcl~li~ State existing use =nd ~cu~ncy of promises o~ intended u~,~ncy~f ~isiting use ~ ~cupQncy ........................................................................... u~ ~ ~, ~ ~ .~ ~, .............................. Intend~ ond ~cu~ncy ....... ~......~ ..... ~ ~ ~ ~. 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... .'~....~.,.~l .0.,~. / ~-- (Description) 4. Estimated Cost ..b....~.....O... ................................. Fee ...~..~...~...~ ............................................ i ................... (to be paid on filing this application) 5. If dwelling number of dwelling units ....... ................. Number of dwelling units on each floor/....5../..~...~...~..'...~.~ If garage, number of cars ....~...'...,~.*~l~f~.~.l~D. ...................................................................................................... 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 c~f entire new construction: Front ..~.:./.....'1'. ..................... Rear ~.1...~ ................. Depth .-/?-..'~.. ............ Height ...I.~. ............ Number of Stories ....J[....~.P..~,.-~. ............................................................................................ 9. Size of lot: Front ~..~..~..~. ........................................ Rear ...].~.~ ...... De~h ,/.~.~. ~ . 1.0.i Date of Purchas~ ~; ......~...,.~:....; .................................. Name of Former Owner ............ ~-~..~..~; ........... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... .~....0.. ........................................... / 13. Will lot be regraded ........ ".~. .............. Will excess fill be removed fr~m~ pre~l~ Yes (11~N° 14. Name of Owner of premises ~..~..~...~..~....~..~.~..~..)e.?....~l.......b~ Address' ..~...~...,4J~..~.*f.~..~. ..... Phone No. ~..~.~..~.~;.~. Name of Architect '~ ~ · ~.~. .... .............................................................. Address ................................ Phone N~ .............. Name of Contractor ...F..~...~.....~....Ib....l~'...l~:.~....~'?e.e...~'~....~..."$...J.l~..~-Address ~'.e.~..~.....~..~.~) ...... Phetm No.~.'.~t~,~.~. PLOT DIAGP~M 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 :. whether interior or corner lot. , STATE OF NEW OF .... being applicant above named. -~' He is the ......... .,~**.e.~..~,.~'~.-~'m.....~l:~"l~J~..e'r,~'l~ ......................................................................................................... : ..... (Contractor, ag~t, co~orote officer, etc.) of said owner or owners, and is duly aut~rized to perform or have performed the ~id work a~ to ~ke add file this application; t~t all st~qts ~ntai~ iq,t~s, ~pJi~ion ~ to the best of his kn~ledge and belief; and that the work w II be perfor~'ih-~e'~h~ ~t'fo~h ~n t~e 6ppli~dtron filea ther~ith. Swam to--me this , - ~ ....... ................................... Public~.~.%~;~~ _ (Si~a~re of a~licant) Notary Pu?4ic, SIO~esuffo!k Coup//~ No. b2-0344963 / , SUFFOLK CGL~Ty H?JiT'-~ DFPJ~F[TM'ENT DATE JAN Chlef of .1 AND LOCAL C©DF~ A~ 4PM :OR REQ,~I :ILLIN FOUND, ~ ~'~tOVED tgOtlFY BUILDING 765-2660 9AM TO ED INSPECTIONS: 1. BEFCI~,E BACKFILLIN TION OR START 2. BEFORE COVERING 3. FINAL WHEN JOB CC NOT RESPONSIBLE 5TRUCT~ON ERRORS T