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HomeMy WebLinkAbout7381-zTOWN OF SOUTHOLD BUH.BING DEPARTMENT Town Clerk'~ Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ............................ Street Map No..~,.X'~/4eT.~. 1-. Block No ........... Lot No ..... .~. .......................... conforms sub~tan~l~any to the Application for Building Permit heretofore filed in thl, office dated ..............~. x///l ¥ 19.7. t/pursuant to which Building Permit No. 7.~. ~./...Z- dated ............... ~..~J//./-?¢ 19..~y was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ..A .... O t~.~' ..... F./}. ~ J./..¥'. ..... ~{<~/:'. 4 L.t. a(~. ..................... The certificate is issued to .. ~ J~ l~d 1'~ ~...~.. ~...~..~..L....~ .0..L...~..~...~ ............ (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval . (7. .~..~?J.. t.~?. :1....N..~..o.: .~.~;/. ~' UNDERWRITERS CERTIFICATE No ....... ~9.. ].~..~.~.. ~. t~ ................... HOUSE NUMBER..~..~. 0. .... Street .. A~N .~.~.o...~......~..~. ~4 .~.- ............... ........................................... · ~ ~ .T. ~ .o..a.j~ .................... Building Inspector FORM NO. ~B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ,~M.ITHOLD, N. Y. BUILDING PERMIT ~HIS PEFJ~IT MUST BE KEPl' ON THE PEEMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) N? 7381 Date ~TIi~ '8 19 ~+ Permission is hereby granted to: ~ae~r ~o~klta~ A/CMTera~e & Ca. tel So3.g~r Orien% Building Inspector. Fe I Disapproved a/c ..~ ................. ................ ................. BUILDING DEPARTMENT ~_/ __ ~ TOWN a. ERK'S OFFICE //J-Z/Th~- ~ ~ ~- ~"'~/7"' 1'- ..~. ~u~oLD, N.Y. ~/~ o ~ .... c~........ ,9.2..~ ~ Examined ..... Application No ...... ./.....~....u., ./. ........... p.~, No....~..~. ........ ~...~ ~ ?~ ~ APPLICATION FOR BUILDING PERMIT Date ............. ~._..~..~......~......., 19..~.~..,~.~ INSTRUCTIONS ~ ~ a. This application must be completely filled in by typewriter or in ir~, and submitted in triplicate to the Building Inspector' with 3 set~ of pla~s, accurate plot Plan to scale. Fee according to schedule. ~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ ,~ areas, and giving a detailed description of layout ofproperty must. be drawn on the diagram which is part of this applicatior~ ~' 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 permit~ :b 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 Occupan,~t 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 ~uild!n.g. Zon,e O.r.dinance. of the T,o,~ o.f. Southo. ld, iSuffolk County, New York, and other appl .c. ab · Laws, Ordinances or egu~at~ons, tar me construction o~ ouildmgs, add t Ohs Or alterations, or for remova or demohtion, as herein described. The applicant agrees to comply with all appli.cable laws, ordnances, building code, housing, cade, and regulations, and to admit authorized inspectors on *premises and ~n buildings for ~ inspections. . ................. .......... (Si~ature of app icant, or name, if o co~tl~i' (Address of applicant) State whether applicant i~'b~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ................................... ................................................................................................................ Name of owner of premises~...~1~?/....'~.....~...,~. :.....~...~ ..................................... If applicant 'is a COrporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's bicense No. ~'~ ~' 7Z;> " Electrician's License No. ~--/~°°"~' Other Trode's License No ............................................... ~/ /' ,,~ ~ /7~Z Location of !and on whic~h proposed work will be done. M,ap No.: ...~~ or'No....~... ................ Street and Number "~"~'":...'~--..~',/...'..'~..-~i ................ Municipality 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 ~ i 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ........... , ......... Other Work ...................................................... ~ (Description) 4. EetimOted Cost ...~..' ................................................................................................................................................... (to be paid on filing this application) / 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If gerage, number of oars ............................................................................................................................................. 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 of entire new construction: Front ....~....~.../. ...................... Rear ...~....~...~ ................ Depth .~..../.. ................ Height .../..~...~. ........ Number of Stories ..... /. ............................................................................................................... 9. Size of lot: Front .... /...~....~.,..~..~.. ................................ Rear ../...~...,~..:....O..~. ................... Depth ../...~:...~.:..~..~.. .......... 10. Date of Purchase ........... ..~..~...~ .................... Name of Former Owner ........................................................ 11. Zone or use district m which premises are situated ...~-~(....~ .................................................................................. 1:2. Does proposed construction violate any zoning law, ordinance or regulation: ~ ........................................... 13. V~ill lot be regroded ....... ~,~ ~~W~ill excess fill be removed from,~ -,~premises: Yes ( ) No 14. Name of Owner of premises~.~.~...,C;...:..~....~ .............. Address ..~C;~ ............ No. Name of Architect ..........,f~ .................... ~...~.~ ............ Address ................................ Phone No ....................... Name of Contractor ..... .~....'~.....,c. ........................ Address .~,.r.~ ......... Phone No. 6~ PLOT DIAGRAM 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 YORK. -- . I c c COUNTY Of .....~.*~....,/~...,,,J~.....~o'"' ................ ..~..~.~, .~.......~..~.~.~..~...~.... ............................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract0 above named. He is the ...................... C~,~...~....A~...~.~...~.~. .................................................................................................................... (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 thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ...... o, ..... Notary Public, ..... ~,~. '~r-~ ...................... ~'"i~i~';'~;;';;'of applicant) ..................... . ., i~A~. KLOS . NOTARY PUBLIC, STATE OF NEW YORK ~52-7306925 SUFFOLK COUNIY Commi~on Expires March ~0~ ~ FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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, 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-exist'rig' 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 Dote .......... New Building ....../'~'.. ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locat on Of Pro er ~ ~--'~, ~ ~e~----¢~ ~;~2~' p ............................................. "'- ............ Owner Or Ch~'ners Of Property ~ ~ .~.,.....~....~ ,Z=/,~,L,~o ~Z~,: .~ ,-. , ,~/./ '-"2~' ............................................... ~..-~..~.. Subdivision · -'.~,..~.....~¢. ..... Lot No..1.. .... Block No ............. House No Permit No. Z~....?.../....'~.... Dote Of Permit 7.Z..~.../..~..~..,Applicant .~,..i...~....~ Health Dept. Approval ~ ...................................... Labor Dept. Approval ................................................ Underwriters Approval ~ ........................................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .................................... Construction on above described building and permit meets all applic~le codes and regulations. App,cant ........................................ Sworn to before me this day of .................... Notary Publ~r..~<..~.~-~....'. County ~ARY O. KLOS NOTARY PUBLIC, STATE OF NEW YORK ff52-7306925 SUFFOLK COUNTY ¢emmissi0n Expires March 30, 197~ (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTHReference Health Department Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant"~o~., /~. ,,. ~,, ,._,,/ /~,/<~-Phone Address (~r~,~,.~ .,,,,..-~'-'~ ~/~'~,~ ~-/r 2. Pro~l~ert.y Locat~o~f ~/~-~,~r- /~ ~jZ Village ~'~ ~-/-~,,/,.~ Township 3. Public Water Company Name /¥/~ m~ 4. Lot size: Width/~ feet Length /~ 0 feet lO. Sewage Disposal System: A. 900-gallon septic tank: Precast ~uivalent Block B. Le~C~hing pools: Nu~er of pools _.~ Precas~y~l ock Special 11. If private well, fill in the follOWing blanks: A. Tamk capacity ?~. gallons B. Pump G.P.M. _J2.. /d) C. Total well depth _~ 9 D. Depth to ground water /~-~l E. Amount of water in well Y/~'~ 5. Subdiv./~4,. 6. Section ~ 7. Lot Number ~/ 8. Private Well 9. Public Water Distance to main (For Health Dept. Use) The undersigned CERTIFIES: "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 p)ot. APPROVAL DATE ~-/- ~/ SIGNED ~--~:~~ . S-15 Rev. 4/1/73 VAd~,t~T 22.~ SUFFOLK COUNTY MEALTH DEPART~F.~ s~age disposal and ~ate~ supply eT VAUNt' 26,~ £1 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY '' . ~ 85 JOHN STREET NEW YORK NEw:YORK 10038' M.C',,b.. 25,].~7~. ~.,~.,~.~o.o.~,,. 75~'~ ':-' N 184390 THIS CE;IFIE$~HAT ~ly the e~t~ ~u~ment ~ ~sc~ N~ ~ int~ ~ t~ ~pli~nt ~m~ on t~ ~ ~pl~ numNr in t~ p~mises of Jmrame F. ~l~eg, Anchor l~ne, & in th* /ottowlng l~at~n; ~ S~ment ~ Ist Ft. ~ ~ Ft. S~ion Blah ~t cj~ ~...~do. ~p C~er 19,1974 ,~/o..d ~e m comptlance ~ith ~he requirements o/th~ B~. iqXTURE RXTURRS RANGES OVENS DISH WASHERS EXHAUST FANS OUT.TS SWITCHES FLUOq~E~CENT DRYERS FURNACE MOTORS FUTURE AFfUANCE FEEDERS TIMECLOCKS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE S V I C E NO, O~ CC, COND. A,W,G. NO. OF HI4EG A.W.G. NO, O~NEUTRALS A,W,G. t~acer hedmr: 1-4.5kv. Z4ocors z 1-Jjhp- G & $ Concrs. P.O. Box 215 6ou r~old, L. 1.11971 COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT RE ALTERED IN ANY MANNER.