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.