Loading...
HomeMy WebLinkAbout7631-zFO~M N~% 4 TOWN OF SOUTHOLD Btm.r~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z6.~A2 ...... Date ..............Jlme. 6 ....... ,19.7~. THIS CERTIFIES that the bu0dlng located at .. I&ttle..P. eeo~ie./0ay. Rd Street Map No. ~la s s....Pt.. Bleek No ........... Lot No. ~00 .... C~,tChog3~.. N...~, ........ conforms substantially to the Application for Building Permit heretofore fried in ~hl, office dated ..............Nov...~; 197.1t. pursuant to which Builcling Permit No.. dated ..............N.O.v...]3, 19.7.~.., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The eecupaney for which thi~ certificate is issued is . ~.rivate. one. family..d~teL~ing ...................................... Clara & The certificate is issued to ...Theodore. iE. red~icka .... Owner .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Depa~-~hent of Health Approval ...May...30..~.97~...by. ~...¥~J,~... UNDERWRITERS CERTIFICATE No. p.~d~ ................................... HOUSE NUMBER... R0~ ....... Street...LLttle. P. eeor~c. Ba~..PaE ............. Builrlt~g hmpector FOP,~M 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) N? 7631 Z Permission is hereby granted to: at premises located at pursuant to application dat~ ............ : ............ .......... , ...... ,..,...~,., .19....~..:, and approved by the Building Inspector. Fee $....~ ............. Bu ]ding [~SPector FORM NO. 6 TOWN OF SOUTHOLD , 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 disposel--(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: I. 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 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 Bt~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Health Dept. Approval Underwriters Approval .................... Planning B~rd Approval ....... ~.,:.~ .................... Request For Tempora~ Ce~ificate ........................................ Fin~ Certificate .......... '~ .................. Fee Submitted $ ........ ~.~ ............... Construction on above described building and permit meets oil applicable codes and regulations. ADolicant ..~..~...~...~ Sworn to before me da of ................ ............... Nota~ Public .......... TOWN CLERK'S OFFICE (~ /~ "~ /.~ SOUTHOLD, N. Y. am ned ...................... '7¢ Approved ...................... p...y...?.~};.., 19...>~/Permit No.../4.~;~../....~ ............ Disapproved a/c ... ............. , ...... ¢ × ........... '''':: '- ............ APPLICATION FOR BUILDING PERMIT Application No ..... ~ ...................... ~ INSTRUCTIONS o. This ~olicotion must be completely filled in by typewriter o~, in ink and submitted in triplir.~te to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. ' b. Plot plan sl~owJng location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed. descriPtion of laY°ut °fproperty must be drawn on the diagram which Js part of this application. c. The wonk 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 permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa rt 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 ~B~i_ludi_n~ Zon,e O.r.dinance. of .t. he T, .o~m ,of. South~.l.d.,. Suffolk Cou.n. ty, New .York, and other applicable Laws, Ordinances or r~ g a,OnS, tar tne consrract~on aT ou,amgs, aaa,t~ons or alterations, or for removal or demolition, as herein describecL The applicant agrees to comply with aU applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (S~gnature of applicant, or name, if a corporation) .. lattAtme~e (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .............. ~...~.fll~d~ ..... If applicant is a corporate, si~gl~.ture Of~duly agth~ized officer. (Name and title of corl~rate officer) Builder's License No ..................................................... Plumber's License No..~....~..~ .................... y So / ~'(~ Electrician's License No ..... J~NKI~III~ ...................... '-/'-oc>'' ~ Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ~ ~le~l~ O~,ll~b ~ ~ ........................................ ~:ot No ....................... Street and Number ............ I-I~.~I..~I~I~NI~I..~I~...~j~...IIIIII~III~..~[I~I~s,. ...... i.. ............................... Mu~icipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................... . ...... b. Intended use and occupancy ~1 ~1;~ ~ ~111~ 3. Nature of work (check which applicable): New Building ..~....~.. ........ Addition .................. Alteration ................. Repair ................... Removal .................. Demoht,on ................. ,~th ' ~L.Work, (Description) 4. Estimated Cost .........~..e..~.. ..................................... Fee .......................................................................................... (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 ....... :Il ................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. D mens ons 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 ................................ Dimensions of entire new construction: Front ..... ..~....'..~.. ..................... Rear ............................ Depth ..~1~ ................. Height ..~. ............. Number of Stories ...... 9. ............................................................................................................. 9. Size of lot: Front .... 1~ ............................................... Rear ....... 114'/ ............................ 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. Wilt lot be regraded~ .~1~. ..................... Will excess fill be removed from premises: ( ) Yes (- ~ll No 14. Name of Owner of premises ..~..~ .................... Address ............................... ~ Phone No ....................... Name of Architect .............................................................. Address ................................ Phc~O.~...~,...<~.../..;z_~~ ~" ~-~ Name of ~o mc or ...~ ........................................................ Address ................................ Phone No ....................... PLOT DIAGRAM, Locate clearly and distinctly all buildings, whether exi.~ting or proposed, and indicate all set-back dimensions from prope~t3~ 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 YORK, COUNTY OF ................................. ...................... .~.~....A.~..~....I~..~..~.~. ................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ................................................................................................................................................................................. (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 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 ........................ Notary Public,. ................................................... County ...~./~ ~.....C~....,_ ./...~ ........................... (Signature of applic~) SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Address '~ 2. Property Location ',,' ,,~ Phone ,~'S '" ?~ ? ,~ .... 5. Subdiv. ~* 6. Section ~? · ~? 7. Lot Number 8. Private Well · Township' ', - ~' ,' 9. Public Water Distance to main Villa'ge 3. Public Water Company Name 4. Lot size: Width feet L~ngth feet 10. 11. Sewage Disposal System: A. gallon septic tank: Pr~ast /"Equivalent Block B. Leaching pools: Number of pools Precast~'"Block ~pecial__ If private well, fill in the fol- lowing blanks: A. Tank capacity B. Pump G.P.M. gallons C. Total well depth ~-" D. Depth to ground water E. Amount of water in well (For Health Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' 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 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 System and Water Supply can be installed on this plot. APPROVAL DATE S-15 Rev. 4/1/73 _J~' cz) r--L-LT F 120 NT~. .ELEVATION I I- ...... .... P.-_E_.._A. D . ~_©USE __-L~:l. A N $ :£~EI~lbE 1::tT C. ST P t D L AJ'"q $. ~T~ ~. F-.. T A-I X b II .l~ ~ ~ CON, C, JF -t .... CF-Lt. U"A ~ FL, O0 P- ----II r r 'I