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HomeMy WebLinkAbout7426-zFORM NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~ ,.. ]b:~d ............. Street Map No.. ~;~ ........ BlOck No...:~ ..... Lot No. ~. ~.~..S~. ~)~k ..... :..' ...... conforms substantially to the Application for Building Permit heretofore fried in ~hi~ office dated ........... .J~.....~.., 1 .~.~.. pursuant to which Bufld/ng Permit No. 'i~. dated ........... J...~....~.~..., 19~..., was issued, and co~/forms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is . The certificate is issued to .. ~a],~l~;o~e. &. ~llll~l. ~ .... .~I~$F]I ........ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health ApprovalJl~,: .~....~.~. UNDERWRITERS CERTIFICATE No....il. ~.~.. ...... ..I~... HOUSE NUMBER .... ~.~.. ...... Street..K..e~'...~.8....IIA~.~. ..... f / (THIS PERMIT MUST BE~KEPY ON THE PREMISES UNTIL FULL COMPLETION CH: THE WORK AUTHORIZED) No. 7426 Z Building In.~pector. APPLICATION IS .N~ ~t~ · HEREBY MADE to the Build~l for the m~mm of a Butldin~ ~rmit porsmmt to the Buildin~ Zone Ordin,nce of the Town of ~. ~~, other al~dJ LIII. O~tneneel or j for tile ;on,tructio~ of building, ~ldlttom or iI~'ltlOn~, or tWl~ll/itlo~, M herein ~, h K ~ to ~l~ ~ MI ~l~licd~te Ilws, ordinancel, buildtr~ ~ houli~ oode, and re~uMtions, Ifld to mlmit authorizld ~ ~ ~ and in:lxdMin~l for ~ iml~ctioni, (Signature of applicant, or name, if a corporation) ~ ~.x~.~ '- .// ,,"~ ..................... ~..~,.....~..,z.......~. .......... (A~lrm~ ~f a~dicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plUmber or builder. '. .................. ~..~.z./..F.~..~ .......................................................... : ...................... :: ................................................... Name of owner of premses ...~...~..~..../~.~..~.~...~..~.: .~..//..~...~......d..~...:~/,' ' ........ ~:l,f applicant is a corporate, signature of duly authorized officer. IN,me and title of corporate officer) Builder's License No .......................................................... //7-~,--/~ ~/~ Plu,~.,~i~se,o ......... z~.~...P... ................................ Electricians License No ......... .~:'..g~.~.~. ........................... ~ ~c- _ ~> Other Trade's License No ................................................... 1. Location of land on which pr~ work will be done. Map No ..................................... ......... Lot No ........................ st~.nd Num~ ............. .,,'_.~...~,e,~,~.....,~..d. .............. /]Z..~.....~£~.,<~,, ........................................... . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: . a. Existing use and occupancy .............................................................. .....,ex.................. .................... ...................... ( 3. Nature of work (check which apl~licable): New Building .............. Addition ..................... A terat on ....... .~. ..... e Repair ....................Removal.... .......... ... ..... ... Demolition ........................ OtherWork .................................... ..... :~ (Description) 5 ......................... 4. Estimated Cost ........~:~..(2...~...~. ..................... Fee .... (to b;'l~'~i'~l on '~i'li~g'this a'p~ii'cationi ....................... · ' ! umb 5. If dwelling, number of dwelhng umts ................. N er of dwelling units on each floor ......................................... If garage, number of cars ............... ~.. ...................................................... ~...i ...................... '. ......................................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of usa ..................................... 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 ........................................ S, Dimensions of entire ne~v construction: Front .........................Rear ................... Depth ................................. ~ ,,~,+ /,.~.. ........... Number of Stones ...... .~ ................................................................................. 9. Size of lot: Front ........ /..~..,~.'...~...-~.. ......... Rear ........ /...~..q. ........................ Depth .....~...~...:/...~..~....'~.. ............... 10. Date of Purchasa ..... ~.~..7-...~-.- .................... Name of Former Owner ............................................................................ 11. Zone or usa district in which premisas are situated ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .................................... ........................ 13. Wil ot be regraded ..... Z~x~..~..-... ............ Will excess ill! be removed from premise,s: [ ] Yes [/'~N.o , 14. Name of O_wner_ofpremj~es .,,~..(t../..o.x~/;-,~...~-,~.-~....~.'/~-~.-f'./-.(~P,~-.-..C~,~.?.'O.~ ........... f;~"/""~ ...... '~:-~'. ~'":"~'~" ..... ~qo.,,~ ~,,~1~'' f-H/~, ,]~'~-C.~,~O l~J 1:/,~/,,¢,~1'-:5 /v ~ I/J~_ (AddressL ,,, ~ p'non, e ~o.! -- ~ ~ ' ' ~ ~ ,,~ = ~ ,~M~' ~-/' o/~ ~..~../~'~...~1......awr .......... Name of Architect ........ ....~...~..././...-~:.. ...... -~...~ .................... .~'7...~-- .................... ~ ...... '~""°~" '~'~Phone No.) ~ ,-a (,A,~d, dress) , , / ....... Name of ............................................................. . ' (Add'r~s) / (Phone'No.} PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show strqet names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ) ............. ~/f~['~,.I;f'~...,~..~(~'~.l~..~..~.. ......................... being duly sworn, deposes and says that he is the applicant above named. (Name b/individual signing contract) ~)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 mannar set forth in the application filed therewith. 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 ali 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 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 inspect[on 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 New Building ....X. ........... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Pr~perty8/..~...~.~..g.?..9.~....~.8..~...~..8.~.~......~./..~.....~...~.~.~......[~..~.e..t...~.~...~.~.~. .................... Owner Or Owners Of Property ....S~'l~.&f, cir. e..&..A~ge'lt~.&...g.8,~'~J~ .................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No....~...8..0.... Permit No. ?..~..~...0.....~. ...... Date Of Permit ..~..-..~.8..'..~.Applicant ..~g.~'.~...~gD, II.~.I&G~.~ItI...TIXG~ ....... Health Dept. Approval .... .~'...80..-.~./~. ....................... Labor Dept. Approval ................................................ Underwriters Approval ~...20.(~6.9~ .......................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ...Z. ...................................... Fee Submitted $ ~..t..0...0. ........................... on atlons. Construction above described building o~,,~permit meets all(~plicable codes and r~ Apphcant ................. 0...~..~ ..................... Sworn to before me this 589-2050 TOMARK CONSTRUCTION, Inc. Building -- Construction 5250 SUNRIS£ HIGHWAY SAYVILLE, NEW YORK 11782 September 9, t97h' Building Department Town of Southold Southold, New York REs P~MIT ~ 7426Z S/s Kouros Road, 189' w/o Bunny Lane, New Suffolk, Town of Southold, New York Dear Mr. Terry, Please be advised that this letter is a statement to relieve the Southold B~ilding Department of any re- sponsibility regarding the foundation on above named Job for any leaks or cracks. Very truly yours, TOMAHKCONSTHU CTI ON INC. Richard Sc~leppi, Pres. SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number ~PLICATION FOR APPROVAL TO CONSTRUCT A PRI~a:~ ~EWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Applicant ~7~/~' ~ty~/--~Phone -O~J'~-~ 5. Subdiv. Address ,.,-,-,-,-,-,-,-,-~-~-'~ ~u ~ ~,'y~ ~,/ ~ ~u.'ll~.. 6. Section 2. Property Location ~/~ ~/0~ ~ ~ ~o~d 7. Lot Number ,avt~.~ ~ 8. Private Well Village /~/¢~ ~(~ ~ Township ~t-&~o ~ 9. Public Water 3. Public Water Company Name Distance to m~in 4. Lot size: Width /~ ~ feet Length ~j-~ ~ feet 10. 11. Sewa~i sposal System: A. ~_~a,l~eptic tank: Precast t~WEquival ent. Block B. Leaching pools: Nu~er of pools Precas t'~ Block Special If pri-vate well, fill in the following blanks: A. Tank capacity. ~/-~-gallons B. ~u~p G.P.M. ~' C. Total well depth. D. Depth to ground water E. Amount of water in well (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. Date ~- /~- ~/ Signed ~~ ~ 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 pl~ot. APPROVAL DATE -~/~_y~-?~7 ?_ , SIGNED S-15 Rev. 4/1/73 TOMAR ( CO,N~TRUCTION lN6; B2~0 ,SUNRISE HiGkiWAY ~AYVILLE, NEW YORK. 11782 LT 9-2030 ;DI/ L@ARA~ ,i UVI~ I RIGtlT LLEVA'rlO~ ¢~ ~,A ,. lNG .... :-~,~N,~ PIPELINE - "vHEN JOB COMFLETED ~20NSIBLE FOR DESIGN OR CON- k '~h©N ERRORS Lrr'T ~!..r..V^T ~0~ L ~ ...... ---~o.~ ........... J OJ L/~N~, Op I~Ou~OS' 5A LVA, TO,~ X- ~A,I~I 1~ I -to TI4/r TITL&' ,JUN-'= I0, 0e L~ L~ ~CA.L';~- - 4C)'. 1" ~i~ 0~- FEO~$ETY 5A LVATO r-1 ~