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HomeMy WebLinkAbout7189-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~.133 ....... Date ..............80. p.~..,. 2~...., 19 ~.~. THIS CERTIFIES that the building located at . ,R.O~f,. of~ 1~ke .])~'t. VO. Street Map No.. :g~ ......... Block No...X~ ....... Lot No....X~.. ..... .~.o.u..t~..o.1.5... ~.,.~. ? ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............Ai~LI.. 1~9'/~'.. pursuant to which Building Permit No. 7.189~.. dated ........A~.r..~.... ~ .~ .... , 19.7.~.., 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 ....~.i..~...~....~...f...a~.l.~'..~..~..1.1.~. ~. ..................................... The certificate is issued to .Ja~e.#. ~05 ..... .0~:? ............................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval . .S.e~t... 2.7....~9.7.~....b2..R.*..V.l..l.l.a... UNDERWRITERS CERTIFICATE No...]1..1.~.1..~.~.. .... .~.I.~..~...1.0...1..~..~ ............ HOUSE NUMBER .... .2.1.~.? ..... /~[,~etD .x'~.v.s. ..................................... Building Inspector FORM NO. ~g TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFfiCE SOUTHOLD: N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 7189 Z Dote ........................ Permission is hereby granted to: ~ build new one family dwelline ~t pr~mi~ I~a'~l 0t ...~..12..l~.....l~.8...I,~a..~..A.li~.8..~t~t;..P. on~ .................................... ........ .~ ~..~..~...~..P.r~bl..~.r....~;~ .......... ~.o.~t....~L.;~ ................ i ..................................... pursuant to application dated .........................A~oz:L]. ....... l.~t ...... , .l~l~z...., and approved by the Building Inspector. Approved ~ ~ , 19.- Pemit No, ~.....% ........................... . ,:,c ~NSTRUCT~ONS kg a. Th~s appliea ion must be completely f[Hed h~ by typewritm or ~n ink and submitted in triplicate to the Building Inspector, b. ~lot plan showing location of lot ~nd of buildings on ~ren'd~es, relationship to adjoining pmm[se~ or ~ubt~e streets glv[ng a deta[~ed ~esodpt~on of layout of property must be drawn on d~ag[~m wh~oh ~s part of th~s m The wo[k oove~ed by this application m~y not be commenced before issuance of Building Permit. d Upon approve} of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ,shall be kepto~s the p¢emises available for inspection throughout the work. e. No buiMing shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have APPLiCATiON }S HEREBY MADE to the Building Department for the issuance of a Building Permit PUrSUant ~othe Building bui{di.gs, addii~on~ or a teretions, or for removal or demolition, as hereff~ described. The applicant agrees to c0~pl~ with all aPPlicable ordinances, buildi~ oode housing code, 8nd ~eoulatkms, and to admit authorized inspectors on premises and in buildings f~r necessary inspecti0n~; (Address of applicant) State whether applicant is owner. ~essee, agent, architect, engff~eer, general contractor, electrician, plumber or builder;; H: app/icant is a corporate, signature of duky authorized officer. : ' t~de of corporate offmer} Builder's L~cense No. : P{umber's License No. ~' ~. )d: :' *" /...: . e- E~ectdc[an's L~cense No....~.~.~......~:~ Other Trade% License No I Loeabon o, ~and 2n whmh proposed work wd~ be done. Map No ............................. ,.-.......~.LO~ No,~..-a Stree~ and Number ................................................. 6~J ................. ¢ ......................... ';',.~'~;P,-.-'-9,~ 2, St*te existing use and occupancy of premises and intended use and a. Ex st ng use a~d occupancy .............................. . ............................. ?.;; .............................. ,., .................. e 'N~ture of work (check which ap[flicable): New Building ....: .................. Addition ..................... · Alteration ............... Repair ........ Removal ............... Demolit ....................,... Other Work ........................... Descri~ion) Estimated Cost ..... ~..~a~.l...~...~..~ ............... ~ Fee ..... .~.. ........................................................... i ........................... (to be paid on filing this application) If dwe lng, number of dwelling units ....... ! ......... Number of dwelling units on each flqor ............. ;..........."-"~. ............... If naran~ number of cars ................................................................................................................ ~ ........................... If business, commercial or mixed occuoancy, specify nature and extent of each type ~0f use ......... ~.....l~.../f...~.. ............ Dimensions of existing structures, if any: Front ....... ~,~..~....... Rear ................... ,"~'. Depth ......., ........................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Denth ............. Height ........ Number of Stories ........... L ........... · ................ · Dimension~ of entire new construction: Front ..... '~....~.. .......... Rear ....... ~....; ................ Depth ......... ~ ................... . I Height .................... [..~ ....... ........._...e ...... Number of Stories ....................................................................................... · [O"~ t~.e. ..... De th ..'Z....7....~'.....~...~..Ij[;J~..., ......... 9. S~ze of lot: Front ...................................... Rear ...................... · p ....... 10. Date of Purchase ..................................... Name of Former Owner ...... ~ ......... ~ ....... .~)./~....~.. ,.I~....L=.... .................... 11. Zone or uSe district in which premises are situated ........... ~........t~....~.~.~g~..~.....~.~ ................................................ · I,JO 12. Docs proposed 'construction violate any zoning law, ordinance or regulation: ............................................................ 13. W ot be'regraded .~,~....~....S'.. ................ Will excess fill be removed from~remise, s: [ ] Yes_ . - · ,)~ ~ e,~, ~ ~' ~-~t. . $ P. ;......T...'T.......?.~ ......... 14. Name of Owner of premises ............... ~ ......... ~ .................. : ........... .. ...... .~ ....... .'.~. .......,~._._..- ,. tAddress) lrnone p~o.~ Name of Architect ...................................................................... i~,~i;~'~f ................................... ~i;~"~'~i ............... Name of cOntraCtor ...... .-.~...~....~-.-.-....C~....,.~- ..~IL~. ..~...-~-..,~...-....e~...~ ...... ~.~'}.t-~RJEqr/T'' ........ "~"¢~'~'"""~'~'~ ........ (Address) !Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set4 .property lines. Give street and block number or description according to deed, and show street name er interiOr or=orner lot. ,ack dimensions from and indicate whath- STATE OF NEW y~.K,~t~' ~. ) COUNTY OF ...... ~~ .................. I .............. ~ ~.... being duly sworn, deposes and says that he is lhe applicant abOve named'~ ~ He is the ................. ~ .................... ~ ....................... ; .............................................................. ......................................... [ ~t~ctor, e~t, co.fete o~cer, etc.) of said owner or owners, and is duly authol~flRE;~ or have ~rfor~d the~id work and to make and =lie this appli~tion; th~ all statements ~n~ined in this applicatio~ito~ ~,~kn~led~and ~heT; ~t f 2 0344903 SuffoLK orth in the application filed there~ ' -- rch 30. tg~ ' .............. .......... ............. .... .............. 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 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 inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: l. 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 .... ~.~.~ .8...~....~..~..?~ Owner Or Owners Of Property Subdivision ................................................................ Lot No. 3~. .......... ~J~ . Block No ............. House No ............. Permit No....?.J.~...~. ..... Date Of Permit Health Dept. Approval .... ..~....-....S..?...-.~..9.. ............... Labor Dept. Approval ......... .../~..;.....~. ........................ Underwriters Approval ....~......!..~...!..~....~..~ .................. Planning Board Approval ..... ..~...:!..~.. ........................ Temporary Certificate ........................................ Final Certificate ......... ~. ........................... Request For Fee Submitted $ ,~', Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ...... .doyof ....... Notary Public ............ ~..~,~.....~. County (stamp or seal) SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number Applicant APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY ~'~g Imk~ Fhone %~'~$-~ 5. Subdiv. Address 2. Property Location Village 3. Public Water Company ,~iame 4. Lot size: Width t~'~ feet 10. Sewage Disposal System: A. 900-gallon septic tank: 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to main ~-~ 11. Precast t~l~.quivalent B. Leaching pools: Number of pools Precast ~'Block Block Special Length in the ·gallons If private well, fill following blanks: A. Tank. capacity' B. Pu~p G.P.M. C. Total well depth D. Depth to ground water E. Amount of water in well feet (For Health Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance w~th the Suffolk County Department of Health's current standards thereto. Thi-s applicaticn will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit 'is in effect. FOR HEAL,.-, DE?ARTMEF~T ~L~. Based on the '-~ '~ ' ~.,o, mat~on presented herewith, it is the opinion of the Health Department that an adequate a~x~q-~m~.~sfactory Sewage Disoe~System and Water Supply can/bs~nst~lled on th~s ploz. ' )X? ~ ~//~/7 · ~ '"~ , / ~ (/ ,, /.// /.,~ . / / - _ ................ ~ - ~._~ :~* V~ ~ S-15 ak THE NEW YORK BOARD OF FIRE UNDERWRITERS Sep, em e,- 10. OF THIS CE~IFIES THAT in the follmvlng loca ' · t was e:~amined on FIXTURE OUTLETS 13 ~ 2nd Fl. outside S.,on elo~k ~ot 1~7 and found to be in compliance with the requirements of this Board. HXTURES It. AN~E$ OVENS ~SH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPUANCE FREe. RS TIM$ CLOCKS UNIT HEATERS MUL~I-OUTtET DIMMERS SYSTEMS NO. OF I~ET SERVICE D~SCONNECT S E R OTHER A~ARAT~: · Furnaoe: Oil 1-1/Shp, 2-1/12hp Water heater: 1-4.Skw Motor/e: 1-1/2bp 2/0 C Ronald R. Ennls, P.O.Box 204 Middle Xsland, L.I. 11953 Pe~ :F . ............ I-.- .....