The URL can be used to link to this page

Home My WebLink About7223-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No..~,~ ..... Date ............... J.u~.....1 .... , 19..~.? THIS CERTIFIES that the building located at ... l[,0,1~,- t~/8. Dl~ak~ter ~![eet Map No .... XX ....... Block No. 'xx ...... Lot No. ~X .... F, att:~t~lek · · .I~.o'Y~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............... 14ay - .~ 19. ~, pursuant to which Building Pemit No. dated .......... 14a)'- "~'. ., 19~., was issued, and conforms to all of the require- ments of the applicable prowsions of the law. The occupancy for which this certificate is issued is . 'Prl~te- o~ .family. ~welt -~g ...................................... The certificate is issued to . Donald. &. Jean-Coopel' ...... 9~rl~l,w .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ' gtCO' · ~ ' ' ' ~ .................. UNDERWRITERS CERTIFICATE No ...... [i~1~1.~? ..... Jui~ '10" '1~'~ .......... HOUSE NUMBER ... 1,1t,0 ...... Street...~r~k~at®~. R5 ......... Ma~*oitu~k .... FORM NO. ~ TOWN OF sOUrHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7223 Z Permission is hereby granted to: ]).9~1.~...&..(3~Zm:.... g<OC~pe~. ............................. ................... ~.t ~tuak ....................................... to b~$~.. ~e~ ..~e..~'~..ly.. <h~.~ .1.t $~g. ..................................................................................... at premises located at ....~.O.A~[.~....,~/~..~l~l~k~'~Z..~d~t~d ...................................................... ...................................... ~e~.~.t~elc ....... ~.,.¥.,. ................................................................................... pursuant to application dated ........................ -~a~: ......... .~ ............ , 19...~,f., and approved by the Building Inspector. 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, o 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 ali 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 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 ....... 6~ .:..'~....."]...°.,..!~?. ] ...... New Building. ........ ~/. ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property '-~O ~/~_~ ~ C-~ '~"~' C0 c~ f~ ~-i-~___ Subdivision ............... ..h~....j...~. .................................... Lot No ............. Block No ............. House No ............. Permit No....~...~...~'...~....~. Date Of Permit .................... ~,pp,icant ........~...~....k~.~....4~..\......~..?.'...C~...~... .................. 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 oil aPr~Cable codes and regulations. Applicant ............ ~~..%..I..~ ....... ~ .................... Swgr, l~ to before me ~'~ ..... '1~9't-4~ H~ C~ ~-~I°. ~/~/77 ~71T ....... ~_...~ ..... ~......~ .......... tstomp or se~ , 0 ~ary Public .... .~ ~~County ~ I~ -- , SUFFOLK COUNTY DEPARTMENT OF HEALTH Health DepartnM)nt Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY Township S~o~ Length~'o mw~'lb~eet 2. Property Location ~,~ Village ~ ~vc~- 3. Public Water Company Name 4. Lot size: Width i~ feet 5. Subdiv. 6. Section 7. Lot Number 8. Private Well 9. Public Water Distance to mein 10. Sewag~ Disposal System: A.(~llon septic tank: Precast ~ Equi val ent. B1 ock__ B. Leaching pools: Number of pools '~recast~Block 'Special If p~4~tate well, f~ll in the following blanks: A. T~k capacity ~'/-- gallons B. Pump G.P.M. C. ~tal well depth (~0 D. ~pth to ground water E. Amount of water in well ~0 (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 4~- ~Ol').t~i. Signed-(--~.'~-..,..~ ~_,,,~ APPROVAL DATE S~t5 Rev. 4/1/73 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 plot. ,\Y:'Z'CV:-'D AS b.'OTED ~"-"¢F L E: BY. NOIIFY BUILDING DEPA,kqMENT 765-2660 9AM 10 4PM F-M. REQUtR- tLb' INSr'~-CTiONS: 1. BEFO~~'L- EACKFILLING FZ;UNDA- ZION (.;R '.'lAKl' FRA 7_. BEFO~,] C~VLRh~G rIP.LINE J. FlixAL '¢v~EN ]06 cOMFLETED NOT RESPONSI6LE FOR DESIGN OR STRUCTION / / / ~)~r~{O# 06 191]' ,. ~. ~.~. #_.r/~-,~_/~, The sewa{e disposal and ~mtor suppl~ facilities for this location have beem imspeoted hy this department and found ate ......... a. This application must be completely f led in by typewriter o~ in ink and submitted in triplicate to the Building~ Inspector, with 3 set, of plans, ~CCUrmt~ plot plan to scale. Fee according to SChedule. b, Plot plan showing ~locatic~ of lot and of buildings on prem ses, re at onShip to adjoining premises or public streets or areas, and giving a detailed description of layout ofprpperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. shadil be klL~eatC~P~ r~Vheal_rOefmtl~i~:saaPvPalii~a, tilon; th.e Builcl.!ng !.nspec.tor wil! issue .a Bui~'diHg Permit to the applicant. Such permit ~ p aD · tar inspection mrougnout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of bu Id ngs, add tons or alterations, or for removal or demolition, as herein described Tl?e applicant agrees to cOmply with all appl cable laws, ordinances, building code, hous ng code, and ,~,,Ulations and ~ adm t authorized inspectors on premises and in bui dings for necessary inspections. ......... (Signature of ~'l~'l'i'~,~'~oor~'~;"i~"~";~'~i;~ ........ (Address of applicant) State whether applicant is owner, lessee, agent, amhitect, engineer, general c~orttractor,~e~ctrician, plumber or builder. .................... .............................. ........... ............................................ Name of owner of oremises. D..o...I~...].6 ..~. ~T.e.a~ Coooez' ~~ \ _ . ........................................... \.~.....~ ..~,~. ........... ~, ........ ~ ......................... ~ ~,~u~ ~ ....... If opp,co,t is o co orat., signat, re of du, authorized office,. · · ............................... (Name and htle of corporate officer) Bu der's L cen se No ..................................................... . P,umber's L,c..se ........................ Electrician's License No ............................ ~ ...... ~ Other Trade's License No ............................................... ]. Location of land on which proposed work will be done. Map No.: .......... ...:~,.. ........................ Lot No....,,Z~.. ................. Street and Number ...~,,,0.~T~,~...~.~..~,~.elt~,~,.t,.e.~..,,R, t3~,~, ....... ~t,.~.1;~'{;.~; ............................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of praposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ...... 9.~...~'.¢1~.:~...~.~.,~1~ ............................................................................. 3. Nature of work (check which applicable): New 'Buil'clihg .~:.~ ..... Addition .................. Alteration ............... :& Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (Description) 29 000+ 4. Estimated Cost .... ~ ....... ,,,,....~.-- ............. Fee 1!.01! ,,~.0 ............................ (to be paid on filing this application) 1 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars one ........................................................ i ...... 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 ...... ..6.5. ........................ Rear .....~ .................. Depth ..~.~.../...~.~. ..... Height .................... Number of Stories .......... ~ .......................................................................................................... 9. Size of lot: Front ....... .1.QO......~ ................................... Rear .............~. ................. Depth ..~../....~.~6 ........ 10.. Date of Purchase. .......................................................Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....?.~,!!...(;],~.8.~ .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... ~,g ............................................ 13. Will lot be regraded ..~.e.~. ................... Will excess fill be removed from premises: ( ) Yes ( 3] No 14. Name of Owner of premises ..~...o.~...~,....~.~..q....C..9.~.~.~.~'. ........ Address ...J~.~.~.;J..~.l,t,~, ....... Phone No ....................... Name of Architect .............................................................. Address ................................Pho~e No ....................... Name of Contractor ....... ..~...*..~..t.~.".......C...°.?.~. ....................... Address ........... .J~.ti~.ug.]gPhone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock di,mensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. see attached plan STATE OF NL:W_YQI~K.. ~ c S COUNTY OF ..~..~i.O....J~.. ............. ~'~' ..................... ~1~....~.~.~.~ ................................................. being duly sworn, dap?se? and says that he is the applicant (Name of individual signing controcf) 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 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 manner set forth in the application filed therewith. Swam to before me this .................. Notary Public~ ' ..?.. ;.: nty ...... .,~,/:w7......'...'~... ....... n..../~...T....~ ............................................... ~"~'"'~'~-~'UD'~'~'. ~K£N ' (SignlSture of applicant) blota~/ Pu~Jlc, State o~ New No. 52.0344963 Suffolk Commission Expires March 30, 19-7~j APPROVED AS NOTED DATE: F~E:~B¥ , ,9 , (~)-r~ ..... .~-~, ,