Loading...
HomeMy WebLinkAbout7203-zTOWN OF SO~I~OLD BUu.nING DEPARTM~IT Town Clerk's O~ice $outhold, bi. Y. Certificate Of Occupancy No. Z6.~36 ...... Date .......... F. ebur&ry. · ~f..., 19.7~. THIS CERTIFIES that the building located at Glenn -&. Shepa.~d. D~ ...... Street Map No. ~est.Cr~ek. ~ck No ........... Lot No.~J~ ...... Smith,Id. I~,,¥, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .........April.. 2.~ .., 19~l~. pursuant to which Building Permit No. dated .........Apr&l. · ~..., 19.~,+., was ~ssued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which tht~ certificate is i~ued i~..p.r.~y~..op.e. ~.~. ~y..d.~e~.An~ ...................................... ~l~ne certificate is issued to. I,m~'~,. &..~a,r~&. ~bl, ....0~e.~. ............. (owner, lessee or {~-nant) of the doreiid building. Sdolk Co~mty Depart~nent o! H~dth Approval 0e~%.. ).~... l$}~i+.. ~ .R,..~ilh .... LrNDERVv-iZ~?_~S CEi%TIF~CA~ No~. 2<)~4~+ ..... ]~b. · 6.. ~ ~2.} ................ HOUSE ~ER..y~[. ......... Street .... ll~p&~ J)~, .......................... Examin~ ...~.~.~. ......... , 19~.~.. A~,ic.i~ No ...... ~~...~..~. ........ ~ .... ~prov~ ............. ~ ....... ~.~. .......... , 19.~.~.. Pem~ No ................................... .............................................................................. ......................... ~ lffLl~Tl~ ~ IUILmH~ ~IT ~Z~ a. This a~licatim m~ ~ c~pletely fill~ in ~ ~ewriter ~ in ~i~.~ In~or, w~h 3 ~ ~ p~, ~cumte p~ pl~ ~ ~ale. F~ ~co~i~ ~ ~h~ule. b , P ~p an ~ ~ I~at on of lOt and of buildings On premises, ~lationship to ~joining pr~i~ ar~, a~ givi~ a ~a,~ d~ripti~ of I~t of~e~ must be drown on the diagram which c~ ~e ~rk ~er~ ~ ~is a~lication m~ n~ be comme~ before i~uance of Buildi~ P~it. d. U~ 0~1 ~ ~is a~lication, ~e Building Insp~tor will isSue a Building Permit to the ~lica~. ~ch pe~t .. shall ~ ~ ~ the pmmi~ ~ailable ~r in~ti~ ~r~t ~ wor~ e. No ~il~ ~11 ~ ~cupi~ or u~ in whole or in paff for any pu~ose ~ever until a Ceffific~e of ~cu~ ~all h~ ~n gmnt~ ~ the Building In,tar. APPLICATI~ IS HEREBY ~DE to the Building ~ffment for ~e issuance of a Building Pe~t pu~ant Buildi~ Z~e ~i~nce of ~ To~ of ~t~ld, Su~lk Count, N~ Yo~, and o~er appli~le ~, ~i~ or Regulations, for the c~t~i~ of buildings, a~iti~s or alterations, or for mm~al or demhti~, ~ heroin d,cri~. ~e applicant agr~s to c~ly with all a~licable I~, o~ina~,, buildi~ c~, h~i~ c~, admit au~oriz~ in~o~ ~ premiss a~ in ~l~i~ ~r ~e~ i~ti~. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................. ~.~.~..~ ..................................................................................................................................................... Name of owner of premises ....,~.~.~/.,/~'~.C~r.....~'....~'.ArZL',~,~.....~i~4~..~A ~.. .................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder'~ License, No ...................... ~.'.~.' ...................... Plumber's License No .................. -~....:'. ...................... Electrician's License No ............... ~ ...................... Other Trade's License No ................... /~...,~., .................. Location of land on which proposed work will be done. Map No.: ........... ~.~ .~.~. ................ Lot No ...... .~....~. ........... Street and Number ........................ ~ ....................... .,~'~f~'.~E~.....~.~k.~'.~. .......................................................... Muni~ipality State existing use and occupancy of =remises and intended use and occupancy of proposed constructiOn: a. Exisiting use and occupancy ................ ~'~.~.~..~...~.. ............................................................................................. b. Intended use and occupancy ............ ~.~.~.........~.~Z~../~.~.. ....... ~.~.~'~.~,/.~.~. ............................................... / ~, 3. Nature of work (check which applicable): New Butlding ........ .. Addition ....~.. ....... ~'.. Alteration .. ....... .~. Repair Removal.../ ............... Demo it'on.....-=. ............. Other Work ...................... L ........... ..~. ............... . ~ ~, -- ~ ~ ~,-- (Description) -4. Estimated Cost . .~..~. ~. ~'~.~. ...... Fee ........... :.~.{~,:..~..O. .............................................................. ...... (to be'paid on filing this a~lication) 5. If dwelling, number of dwelling units ........... /.. .............. Number of dwelling units on each floor ......... /. ................. If garage, number of cars ..................... ~,..z~/J~ ........................................................................................................ 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 ...;7. ........... .';.~... Number of Stories ....... -~ ......................................................................................................... Dimensions of same structure with alterations or additions: Front ....................... ~ ............ Rear ..~ ............ Depth ................................ Height ................ '..'T ......... Number of Stories ......~. ......................... 8. Dimensions of entire new construction: Front ............. .~..,~....~ ........... Rear ....... .~'...~....../...~. ..... Depth Height ....... ~..~...... Number of Stories ...................................... ~ ........................................................................... 9. Size of lot: Front ../...~...~... ................................ Rear .......... ./...~...~ ..................... Depth 10. Date of Purchase ..~.~.~,/Z'..../.~..../~..~ ................. Name of Former Owner ...... ~.(',,~.~.~c".4~'~ ..................... 11. Zone or use district in which premises are situated ../~..~T.././g.~.~(..Z'//~'~..~.~/.~.~..~ .ZT~rl'~ ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... //E .............................................. '13. Will lot be regraded .........y~..~. ......... Will excess fill be removed from premises: ( ) Yes (I/~ No 14. Name of Owner of premises .,(~A4.C,~...'t.Z'w~/~£~'/~.,~/~/~ddress ~,,~-~N~t~Phone No..~..~Z.~.~?~..~.... Name of Architect ..... ~.(Z~.~.Z,~./~.....~...../~.~.~..~'/I(. ....... Address ..,~/~.E/.~,.A~.~'.~.. Phone No..:... .................. Name of Contractor .~a~.,E~;[~,~....~..,~'~.Z~/.Z~..~.A' .~£~.. Address ...D"~/~/.~.~;~'.-Phon~ No.;~,~...~../.~.~.~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-lx~ck dimensions from property lines. Give street and block number or description according to deed, and shew street hames and indicate whether interior or corner lot. STATE OF NE'W YORK, COUNTY OF .... ~.~.~..~.¢.~.~......" ... ~ ~:'" ,~/~.~/,~ZS~.~.... '~.~Z~/~.~ .......................being duly sworn, deposes and says that[ he is the applicant (Name of individual-signing contract0 · above named. 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 an( to make end file this application; that all statements contained in this application are true to the best of his knowl~ dge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to b~ore me this ..... ............ Notary Public, .....w~....~.~ ............... ,/ ......... County /'/ NOTARY PUBLIC, St=t- of New York ~/ No. 52-9366335 Qualified in Suffolk County ~znission Expires. Me, ch 30,. 19~,,~ lrOB~ NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,- Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7203 Z Permission is hereby granted to: La~ea~e..&..~e~eae....~u~bte .................... ......... ]~o:~ ..~.3.3.....~.. g,~' ..................................... ................ ~ml~t .......................................... ro ....)~.~J.~,.~W...Q~..f~u~L~...d~L~I,tZ~ ................................................................................. at premises located at .,1.0:~..I1t~ ......... ~ieJ. i;..J~ek...F~t&tell ....................................................... ....................................... G~em~..~ .. &..,Shel~,~d,..l~, ........... ~e~®14 ....................................... pursuant to application dated ..................... ~....26 ................... 19'~.~...., and approved by the Building Inspector. Fee $~..0~ ............ FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O/iice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at (~lennP, d. & .$hel~ard. D.r .... Street Map No.~.St. CZ .... Block No ........... Lot No...1~. .... $0~..th. 0.~d..' N.,~ ~ ......... conforms substantially to the Application for Building Permit heretofore filed ~ this office dated ........... AP.~$!...~, 19~ . pursuant to which B~lding Pemit No. 72.Q3Z.. dated ......... AP~.~!....~.., 19.~., was issued, ~d conforms to all of the requffe- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is PY!va~. 0~..?~.~Y. ~g. ....................................... The certificate is issued to ~n?.~ .~. ~!~ .~! ..... ~!~! ............... (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval 0~.~.. ~.]. ~. ~ ~.. ~.Y.R.*..V!!~ .... UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER ..... ~ ....... Street ...~. ~ ........................... 27~ Gle~ Road "'-"--i-g------~-B~ldn InSpeer ' TOWN OF $OUTHOLD Building Deparfm.ent 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: 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 J / New Building ......../....~... Addition ................ Old or Pre-existing Building ................ Vacant Land ........x ..... Location Of Property ...~.f-z~..~.~.....~...:~.......~....~-......~m.....~......~..~... ........ ...~.~..~...#. ..... Owner Or Owners Of Property ...~.......~....¥~.~ ....... ............. Subdivision .... ~.~'.-..~~~....Lot No...~...y... Block No ............. House No.~.~.~..~.-~ Permit No....7~,l~.~.Z~Date Of Permit ...~......~...~.?/~pplicant .~~...~.. ............................. Health Dept. Approval ....~...~.:..~...~,:.../~.~..~. ............... Labor Dept. Approval ..... /,]'fL_ Underwriters Approval .............................................. Planning Board Approval ....~...'....~.. ........................... Request For Temporary Certificate ........................................ Final Certificate .... ~ ................................ Fee Submitted $ ~' ~ Construction on above described building and permit meets all applicable codes and regulations. Applicant . .~.........-~(~-~... ~ .................................................. Sworn to before me ........ /...ff.. dayof (s,amp or seo, SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department Reference Number Village ~'~-A~b T6wnship ~-/~m~ ~. Public Water 3. Public Water Company Name Distance to main 4. Lot size: Width/vmjTa feet Length /~,~ feet APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Applicant ~',~t.;,('~.4/~,d z'fzz.,~',~/-.~ Phone ~Z?'~$~O 5. Subdiv. ~0 Address ~y~ ~ ~.~x ~G~ ~-/v~m~ ~,~/~f'~ Section~ Location j}~: ~m~:~ ~:7~:~.~ ~:~ ~ 7 Property ' ~ ' / ] Lot Number 10. Sewage. Disposal System: A. ~/-gallon septic tank: Precast C ~uivalent B. Leaching pools: Number of pools Block Precast[~Y~Block ~pecial ll. If pri,~te well, fill in the following blanks: A. Tardwcapacity ~ gallons B. Pum~ G.P.M. t/~ < C. To~al well depth D. Depth to ground water E. Am61Unt 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. 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 ~/>-:/~" SIGNED C S-15 Rev. 4/1/73 ~T ' ~ ~)~o ,.~,/, j:rO,.144 AT ,.?04J 7-z-/oz_ L.~ / \4 t The sewage disposal and water supply facilities for this ].ocat~ou have been inspected bY thi~ department and found ' C~,~ o ScrviCe~ E LF_.VATIOM 'APPRovED AS P'~-Z~ ~~, ,m- ~- IDRAWN Ely ~ ~ L- ~= ¥ ~- ~. ;p APPROVED- IBY II I~UDOLPH A. MATERN A.I.A. REGI~BTEE ED ARCHITECT 90-04 1611t STREET, J~,MAICA ~lJ, N,Y i- design number q427 Isheet no. ~T~L o? WlUDoW UbJIT 1 = ~ '~, -- ..... ~ .~. , -,.~ ,~ ~ .......... ,_ ' , . ' -- ~ '~l I II I~ - ~ ' ~(' e~'*~"~,~ ?f~ '~ : J I ~ , .i t I~7¢.~'~.., ', ~ ,:,! [ ~_1 ,I ¢ *' ' -, ,~ ~' ~ - ~ 'O~A~ / ~J_ ~x~Z~ix~ ;, , ~ =o ,~: =---r , ~ ~ ,. ~ ._.., . O L,~S ~ ,,~ 5beet " , , ,, IL~ ~ , , ,, , , ,, ~,.,,-F ~,,~ ............... _~:,,,, , ,._,.......,,,,~,,, ; ~ ,~~~~:~:-~ ,r ~, , , RuDoLPH A. MATERN A. I.A. ~~ design number t -~ L__r ' ! ~ ..... .\. /,.. -- - ' ~-~-~-~ i!,'~ ~ , z~ ~ - I F_ ~ / ~ :sheet no. HEAD SILL SILL detail 'alwintite" aluminum double hung windows in, masonry veneer wall detail 'alwmtite" aum hum double hung windows in, frame wall .dAMB 'd F2. iGNT ,:~ LIgFT $1Dl:' ELEVATIONS DRAWN BY ~.PPROVED Egy RUDOLPH A, MATERN A. h A, REGISTERED ARCHITECT sheet no. design number G 4 L --.-s4 L L (~') RUDOLPH A, MATERN A. I. A. REOISTERED ARCHITECT 90-04 161st STREET, UAMAICA 32, N.Y APPROVED BY bed cabinet closed books . ...... ~;i/ ..... , D F_TA.I LS -', ~ ~]1 clearance ~D~-- ~ I bed cabinet opened ~ ' "~gcmto~ ~ ~ e doors piano hinged at back gle door . , .~ Tronf section note- ~ wH~ ~uqo ~.~o.s .: this Is o suggosted cabinet design for the"Murph~' ~ ~.~. E~BRIO~ BAS~EHT BNT~ANCE single s~de bed. cabinet and mattress by owner.