Loading...
HomeMy WebLinkAbout7423-z~0~ NO. & TOWN OF $OUTHOLD BUN.BING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .B~.,I,~I...RO~. ............ Street Map No. ~ ......... Block No. ~ ...... Lot No..~...~o,~ho~.. }i.,]~, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ~ll~... 1~19..~ pursuant to which Building Permit No. ~.. dated .............. J~Y... 1 ~, 19.7.1~., 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~.~,YS.t.~.. ~.~.. ~'~]~r..d.~e~.~l~g ....................................... The certificate is issued to . .~.,l,e .MI..~,. H~l~fJI!~. & .8~:~. ~B,~I....0~..?.~/.b..~...3,.5.~.~.... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ].o.?.. $.~..]9 .~... b~..1~..,..?~].].&. ..... UNDERWRITERS CERTIFICATE No. ~..~ ~9.0.~.. ]~.o.~.. 1 ~... ~ 9.~. ................. HOUSE NUMBER.. ~ ........ Street .... ~ll&~ .Roa~ ....................... (THIS PERMIT MUST BE I(EI~/QN THE P~EMISES UNTIL FULL COMPLETION OJ:, THE WORK 'AUTHORIZED) 7423 Z Permission is hereby gt~mntmd tO: O3,em~.~.....~te4d.lma~..e...~l~tL ..~... ........ ,o ...~...~...o.~.,....~..~.~ ................................................................................... I~ORM NO. 6 TOWN OF $OUTHOLD , Building Deportment Town Clcrks 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-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings end 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 ....~..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~Q'~Od~....~..~.'.....~......~.......~. .: ............................... Owner Or Owners Of Property ...~. ....... .~>..~. ................................................... ' ................................................. Subdivision ................................................................ Lot [No ............. Block No ............. House No ............. Permit No. ~..~..~'~.;..~..... Dote Of Permit ./.?. Applicont I~0 u o~ \ c~ '1 ~ I nh,~r Dept. Approval Health Dept. Approval ..................... ~ ........................................................................... Underwriters Approval ............................ r a n ng Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate .......................................... Fee ~ubmitt~ $ ,,~,.. ............................. Construction on above described building and permit meets all appli.oable cod~es and regulations. ................. Sworn to before me this .... day of Notary Pub ic ~~.~.....~.... Co.,unty ,~ ~ ~t~ ~ ~ ¥o~, ~'~ ~'~-~--~ ~ Commission Expires Morch 30, J ..~ (stomp or seol> /~.~.- ~'~-- SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant/~/~yg~x~)~-~.5~,_ Phone ~.~ Address ~ o~ ~oy ~ ~'~ ~'~ ~o~, ~ 2. Property Location ~,1/~¢o Y~o ' /70 '~y. ~_ ~,~ Township 5. Subdiv. ~,I)AR 6. Section 7. Lot Number 8. Private Well Village ~-c~oi~- 9. Public Water 3. Public Water Co~(pany Name Distance to main 4. Lot size: Width /77 feet Length,.2~y feet 10. Sewage Disposal System: (For Health Services Dept. Use) 11. A. 900-gallon septic tank: Precast /~Equivalent Block__ B. Leaching pools: Number of pools Precas~tj Block__~pecial If private well, fill in the fol- lowing-blanks'. A. Tank~ capacity ~ gallons B. Pump G.P.M. C. TQtM well depth D. Depth to ground water E. Amount of water in well 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~JJ~s~talled on this p~ S-15 Rev. 4/1/73 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..te~lovember 13, 197h A..,ic.t~o. No.o./i,. 757778 N 193902 THIS CERTIFIES THAT only the eleC~ea.l ~e~uipment as. des_cr~bed below and introduced by the applicant named on the above application number in the premises of elu~mann ~ ~on Bldrs., Lupen Drive, & Bi/lard ~d., Cutchogue, L.I. in the following location; [] Basement [] 1st FL [] 2nd FL OUt Side $~t~o. S~o~ rot was examlned on November 11S 197h and found to be in compliance wlth the requirernents of this Board. FIXTURE RXTURES RANGES COOKING DECKS [ OVENS DISH WASHERS EXHAUST FANS OUTLETS ~ECEPTACLEE SWfTCHES NCANDESCENT FLUORESCENT ,~E~C RY DRYERs FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELl. UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS ~ 1 ~0 1 SERVICE DISCONNECT NO. OF S E R V I C E METER 1 I00 CB x 1 2 1 ~Furneces: Oll 2-1/8h~, 1-1/~hp Robert A. Ooodale, l fir #1, Box 15A, ~'!ain ~d., ~attituck, L.I. 11952 em~ M~NAOEt COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. , SOUTHOLD, N.Y. ../ ,. ,/,,~. ~,",', ,--,--" x ~ Examined 19.'?...~... £ A,oplicol~on 1'4o...~...~.....~"~. ............... ~ , ra ed ...... Di~pp~ a~ .... ~ .............. [ ........... ,2 ...... ~~_ ~ ~ ~ K .............. ................................. ........................ APPLI~TI~ ~ ~I~G PE~IT - ~ ~ ~ ~Qfe ~.~.....~.~ ...... · i~ ........... . INSTRU~IONS a. This a~licati~ must ~ complete~ fill~ in by ~writer ~ in i~ and s~mi~ in tri~ ~ ~ BuiMi~ ~ In~tor, with 3 ~ of pl~s, accurate p~ plan to ~ale. F~ acco~ing to ~h~ule. ~ b. Plot plan showing I~at~ of I~ ~ of ~ildi~s ~ premiss, relationship~to ~joining premi~ or ~lic'str~ o~ ar~s, and givi~ a detail~ d~ripti~ of I~ ofpr~ mu~ ~ drown on ~e~i~mm which is ~ ~ ~ ~l~ati~. ~ c. ~e wo~ c~er~ by' this a~lic~ion m~ n~ ~ c~me~ before i~u~e ~ Buildi~ Pe~it. ~ d. U~n approval ~ this a~ati~, ~e Buildi~ In, tot will issue a Building Permit to the ~plica~. ~h ~rmit shall ~ ~t ~ the premi~ ~ailable ~r in~t~ ~h~t ~e ~rk. e. No building shall ~ ~cupJ~ or u~ in whole or in ~ ~ for any pu~e wh~er until a Ce~ffic~ of ~c~ ~ shall have ~n gmnt~ ~ ~e Buildi~ In--or. APPLI~TION IS HEREBY ~DE to t~ Buildi~ De~ment for the i~uance of a Building Pe~lt ~t to ~e ~uild~ Z~e O~i~e of the T~n of ~ld, ~ffdk C~n~, New Yo~ and o~r ~licab~ ~, ~ or - IRegu ati~s, ~r the co~t~ti~ of buildi~s, ~it~s ~ altemti~s, or for m~al or ~litl~, ~ h~n ~n~. ~e appli~nt agr~s to comply with a a~ ic~le ~s, ordina~, buildi~ ~, h~si~ c~e, and r~l~i~, and ~ admit au~oriz~ in,tom ~ premiss ~d in buildings ~r ~es~ i~tio~. t~,lgna~Jre OT applicanT, or name, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ E~,~I{~I~"~ ............... ................................................................................................ If applicant is a corporate, signature of duly authorized officer. Builder's License No ..................................................... Plumber's License No. Electrician's License No. {~(Nlil~el..~lC~;l~i:~d~t ...... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................... : ............ Lot No...~ ................. Street and Number ....... m']~Elql~"~.~'~'"""~ ........................................................ ........ State existing use and occupancy of premises and intended u~e. and'occupar~cy 6f proposed construction: Exisiting use and occupancy ......................... ~i"~ ................................................................ Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building. ....... ~. ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolitic~ .................... Other Work ..................................................... '7 ~-' (Description) 4. Estimated Cost ...~"~.(3OO.,~)(~ .............................Fee ..L.LL.:...~ ................................................................. (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 c~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 ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... .~[.c) ...................... Rear .......... ~.c~ ............. Depth .....~.7. ............... 8 Height .....~.~..! ........ Number of Stories . ~ :~ 9. Size of lot: Front .............. .~d~L~e ................................ Rear ...... 1..?~.1; .......................... Depth .....~L! .................. 11.Zone or use district in which premises are situated ..................... ~e,~,, ...................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... bT~ ......................................... 13. Will lot be regraded ....... ~e~ ............. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..... ~e~e ..................................... Address .......................... .. .. .. Phone No ....................... Name of Architect ............... ,.~a~.e ..................................... Address ................................ Phone No ....................... Name of Contractor Sa.tree ............................................................ Address ................................ Phone No ....................... PLOT DIAGI~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 ~ow street names and indicate whether interior or corner lot. l¥8 STATE OF N~'Wr~O~,./~ lc ~ . ..................... ........... , ose ond (Nam~f individual signing contrac~ above nam~. ~ ~ ~ He is the ................................... ~ ................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or ~ners, and is dul~ authorized to perform or have performed the said work and to ~ke and file this application; that all state,s contained Jn this application are tree to the best of his knowledge and belief; and t~ t~owb~r~il~rform~ in Jhe m( / ~ anner set fodh in the application filed therewith. ~ota~P/;,~ dayof . ' ...... C~9~ ~~~ (S'~notur~ or ~pp~ic~nt) SUFFOLK COUNTY HEALTH DEPART~U~N~ facilities ~'or this ~ccnt%o: kayo b$sn inspected by %his department ~d i'ound ~ ~ Se~lces ~,W YO,t~K 'o . ~ '"' -~ .............................. ::-~-. '- ~ , - ~. ~ . 4~ ~q_~O~]~ J NOTIFY BUILDING DEPARTMENT I/4 = 'J ~ 0" "