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HomeMy WebLinkAbout7557-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6290 ...... Date .............. Jail...1.0 ..... , 19.7~. THIS CERTIFIES that the building located at .]~en~aet~; .Pond .Land ...... Street Map No.B. ann®l:.t;. Poll~lock No ........... Lot No.. 10. .... ~4~;~;l~;.qqk...~ ...~.o ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. t]op.t .. 2)+19..~1~ pursuant to which Building Permit No.. dated ........... 8ap~;...2~.., 19.7be., 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 . 4v~'l~ral;e. ona. £anai~L.y..clw~.~.;~lng ...................................... The certificate is issued to . A~;hD.~..&. ~.ran~.az. B&l.el~ila .... 0~a.~.~l~ ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...,,Xail · .~...~.97~. · .by. lto. ~/&].la... UNDERWRITERS CERTIFICATE No. ~. 202283 ..... ;Ia~..7. · .].97~. .............. HOUSE NUMBER ...... ~00. .... StreetB®nr~.tt. Polqd. I,~® ...................... ...... ........ ~ ' Building Inspector ! FO]~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPART/ViENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 7557 Z Date $111p t ~5 19.?...~... Permission is hereby granted to: /~.l&h.,~.l~. Cone'S,, (]O.Z'.~., /t/O ,Arthur & F:r, amee~ Baldwi~ .... ~a~,.,..~'~..J.~;~ .............................................. ................... ~.~...a..t..o.~ ............................................ to h~t ~...~w...~ae... f. aml~.:z .. Ct...w..~! .z....~..~ ..................................................................................... at premises located at Lot1© Be1~let;t PO~ B~nnett Pond Lane pursuant to application dated .............................. .~...~.]~..~........~....,..., 19.?.~..., and approved by the Building Inspector. Fee $..~,0.~.2.~..~ ....... Building Inspector FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CEKTIFICATE 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 ar 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, Mukipie 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 Date .......................... New Building b'/ Addition Old or Pre-existing Building ................ Vacant Land Location Of Property ..................................................................................................................................... Owner Or Owners Of Property .~../.~.~./~.,~,../,~. (,,~.. ~..~.~.'.~.C.i,.~.~ .................. Subd,v,s,o. ~..:...r...~....~......~l:..f ......... ~ .................. Lot No. /..~.. ...... Block No ............. House No ............. "" ' ~:~x ~ ~.~ ~;.~...~.:..~.x..~,~ Permit No..~.:R..~..,~'...~.TM. Date Of Permit ... pplicant ,¢ ). ................. -- .. Health Dept. Approval ....... Labor Dept. Approval ................................................ Underwriters Approval .././.2./.)..X ...................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~(' Fee Submitted $ ' Construction on above described building an~per,m~ll applicable codes and regulations. ........ /.d.. day of ..~..~ / ~ ¢ p o )~/~ l~,~; ~--~ O ,' Notary Public .......~/~....~.County (sram or se I SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services ~C,~"~-/¥/ Reference Number ~ APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM NID A WATER SUPPLY 2.' Property Loca~ttqn~ Village '~ ~:~ ,~ - Township 3. Public Water Compa,~ Nam 4. Lot size: Width~'~ feet 10. Sowage Disposal Syst~: A.F 900-gallon septic tank: ll. Length Precast Equivalent Block Be Leaching pools: Number of pools Precast Block, Special If private well, fill in the fol- lowing blanks: A. Tank capacity gallons !. B. Pump. G.P.M. ' C. Total well depth , D. D,~pth to ground water E. t~ount of water in well feet 5. Subdtv? . 6. Section 7. Lot Number , . 8. Prfvate Well 9. Public Water Distance to main (For, Health Services Dept. Use) ~e undePs~gned CERTIFIES: "Construction of authorized installations will be in accordance with the-Suffolk County Department of Health Seevices' current standards thereto." This applicat~n will be valld for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect; : z '-':~ ..~' / / "/ Signed ...... .,' ..... Date / m ======================== _ - = -: _ _=__- - ::=====-=_=__=_= ...... : .... =-= FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal Sy)tem and Water Supply can be installed on this plot. APPROVAL DATE ~-- S-15 Rev. 4/1/73 TOWN CL~K'S ~FICE , ....... ....... ,,..?Z 2 .Z ............. Approwd .................................... ...., IgZ.../. P~mit No..K......d../.....~ ........... ........................................................ : ..................... :'"'7 ......... ........................ ~:X-...~ ............ x. .. · 7' APPLICATION FOR "UILpING~FERMIT . , ~ ~ / ~~.~.~. ................... , ~Z~ ..... ~, Th~ion ~us~ completely filled in by ty~writer or in ink ~nd submittal in triplm~te ~ ~k~ Su,u~ I~i~Ot, with 3 sets of plans, ~ur~te plot plan t~ scale, Fee according to schedule~ b, Plot ~ ~owihg Ioc~tion of lot ~nd of buildin~ on premMs, rel~ions~ip to ~d~ining premM~ or pu~ic ~t~ or Items, ~nd~ giving ~ detailed description of I~yout of pro~rty ~ust ~ dr~wn ~n di~r~m wki~k is p~rt of this ~liM~on, c. T~ wo~ ~red by this application may not ~ commenmd ~fore issuan~ of Building Permit. d. U~n ap~oval of this application, the Building Ins~ctor will issue a Building Permit to, the appli~nt. Su~ ~r~t MI ~ kept on the premiss available for ins~ction throughout the work. ~ e. No buildi~ shall ~ occupied or u~d in whole or in part for any put,se whatever until a ~rtifi~te o~ ~ ~Mi ha~ ~n~ gran~ by t~ Building Ins~ctor. ' ~ .'~ APPLICATION IS HEREBY MADE to the Building Depart~nt for the issuanM of a Building ~rmit p~t to t~ Buildi~ Z~e Ordinan~ of t~ To~ of ~uthold, Suffolk CounW, New York, and ot~r appliMble building, ~itions or alterations, or for removal or demolition, as herein deKri~. The a~li~nt ordinance, ~ilding ~, housing ~de, and regulations, and to admit authorized ins~ctors on ~emi~s and in ~ldin~ for ~ry in--ions. · > . ........ ~5 .................................. State whether applicant is owner, lessee, agent, architect, engineer, general contract.:i:' el.e~..i:iti:n:...p.I.T..m.,_b~.:..o.i.:uilder. Name of owner of premises .~...~..~..~..~....~... .................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work, j~lll I~e done. Map No ........ .'.~..'......~.~........ ...... ._ ................... Lot No. ~'..~. ...... ....... ..... , bzree[ eno ,umber ~c-../.~. ................................................................... ~ ..... ~, Municipality ~' 2. State existing use and occupancy of p~reTi,,~ses a~d~intanded use and occupancy of proposed construction: a. Existing use and occupancy ..... .~./~.................' '~'""-. ......................................................................................................... b. Intended use and occupancy ...... ~-.~.....~...-~..~ ........................................................ 3. Nature of work (check which applicable): New Building ........... ~ Addition ..................... AIteration.~,....:...~.. Repair ............. . ............ Removal Demolition ..., .................... Other Work .................................... ......................... ~. { Description) 4. Estimated Cost ............................................... Fee ..~.,~....~.. ....................................................................... (to be Paid on filing this application) 5. If dwelling, number of dwelling units ..... 4f. ....... ,. Number of dwelling units on each floor ......................................... f garage, number, of .ca.rs. ..... -~...~.. .................................................................................................................. 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 .................... 7 ................... Number of Stories .............................. .......... / '-~'~ ~-- ..... ...'~,,.~.~.E ........ Depth ..~,~.....~.....~...~.. ..... 8. Dimensions of entire new construction: Front ............. ~. .......... Rear Height .............. ./.., .............................. Number of Stories ................................................................................ 9. Size of lot: Front ...../....~...~.. ...................... Rear ....x~......: ......................... Depth ......./....~..~.. ............................... 10. Date of Purchase ........ .~....~....~....~:... ....... 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: ..~...~. ................................................. 13. Wiil lot be regraded ~ ....... 14. Name of Owner of prem,ses .~..~..~'-~......~...-~. ................ ~ ................................ (Address) (Phone No.) Name of Architect ..... ~~ ............................................... i~ 'r[~' ..................... · ~j~.~.,, ,~., ~/~ '~ ~ ~d,~s)~ ~,~, .............. ( dd ) / '~..~..~--/~ 7~ PLOT DIAG RAM I.ooete clearly and distinctly ali 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 wheth- er interior or corner lot. ......................................................................................................... being duly sworn, deposes and says that be is the applicant above named. He is the~../.......,~.,.~,.· .~,..~..~ ............... ~...Z"~.~.r~.....~- ................................................................................................ (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 and file this application; that ell statements contained in this application are true to the best of his kpowledge and belief; and that the work will be performed in the manner set forth in the applic/~tion filed therewith~y, No ~y ~ ~ ~'a*~ *' ,' ~w ~" ~k ......... ........ Z~ - ,,> ,, AI,48 A~,OVED AS t(O~'ED I ! IT-15-C)E, TON C.OLOIqIAL. t"~,~- '612 UIqiLL' COI,4%'T'. COF4P.. 12. f t... IV l~ ~ E~ OOkK --1~-05TON%_COLQM_I_Aj... :¢~_ ~-P~-UNLLL CQklST, _CORP. 2